Is It Really Gluten?

Recently, I worked a table at a running expo. I had my Super-Duper Spinning Wheel, Jar full of massage balls, and like 100 nutrition questions. The idea was to get the runners,  their spouse, or their kids to spin the wheel, and I’d ask a nutrition question. If they got it right (or wrong) they received a massage ball. Most of my prepared questions were sport nutrition related, but there were a few general wellness questions – like what is a portion of cheese, or cooked pasta, how many drinks per week is considered heavy drinking for men? women? And….one of my favorite questions “What is gluten”?

After years of nutrition counseling, I have developed a very non-judgmental attitude. I am open to what people believe or feel works for them – with a little tweaking when it is not scientifically sound.

Still, in the age of “the gluten monster” I am surprised at how many people really do not know or understand what gluten is, in spite of the rise in interest to eat a Gluten Free Diet.

I am also surprised at how the data consistently shows that the number of Americans who have a medically-indicated reason to avoid eating gluten is quite small compared to the number of Americans who actually avoid eating gluten.

Over the past several years, many of my clients either follow a gluten-free diet or ask if they should follow a gluten free diet because they believe eating the protein, gluten, found in wheat, barley and rye is unhealthy. After several weeks of avoidance, they may “slip-up” and unknowingly add something breaded or a sauce thickened with flour, be desperate when traveling, or knowingly add/sneak back wheat or rye based breads or cereals. They are also often surprised when they have no side effects. Many others avoid gluten because they genuinely feel better when following a gluten-free diet – in spite of the fact that they do not have celiac disease, an autoimmune condition for which a strict gluten-free diet is the only treatment.

If you have been diagnosed with celiac disease, you understand how much better you feel better when you avoid gluten – the protein found in wheat barley and rye, or avoid products made with flours from these grains. For those who have not been diagnosed with celiac disease, I believe there may be other reasons for feeling better when avoiding gluten, and that these reasons quite possibly have nothing to do with the gluten. Based on this, I developed four explanations as to why one might feel better when they eliminate wheat, barley and rye, and products made with flours.

1. You may have irritable bowel syndrome (IBS)

Whole grain bran – found in wheat, barley, and rye – is a coarse, protective layer of fiber that coats the grain. It is a terrific source of insoluble fiber. These non-digestible fibers can help move stool through your digestive tract and keep your bowel movements regular.

Unfortunately, in people who suffer with irritable bowel syndrome, the foods that contain bran can trigger gas, bloating, cramping, diarrhea, or an urgent need to use the bathroom. This reaction has nothing to do with gluten – but people with IBS will often react badly to whole-grain foods like whole wheat or rye breads, woven wheat crackers, shredded wheat cereals, barley soup, bran cereal, flakes, or crackers because when these foods get to the colon, they provide the bacteria which live in our colon a smorgasbord! The bacteria will metabolize, produce gas, and this could cause gas, bloating and cramping.

Additionally, osmosis could take place. Osmosis is just water moving from where there is less solute to where there is more solute. When I taught Advanced Nutrition at the local university, I told my students to think of osmosis like water rushing to one area because it wants to “party with lots of particles”. If water rushes into your colon, so it can party with all the undigested whole grain fiber (aka particles), you can wind up with cramping, diarrhea, and bathroom urgency issues.

Often, my clients will confess that if they add refined flour-based foods (like white bread or crackers), they don’t experience any gastrointestinal issues. So that’s likely why that piece of hot, white loaf of bread that you snuck after your waiter put it on your table caused no reaction(s).

2. You are sensitive to fructans

FODMAPs are found in the foods we eat. FODMAPs is an acronym (abbreviation) referring to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These are complex names for a collection of carbohydrate molecules found in food, that can be poorly absorbed by some people.

Fructans are a type of Oligosaccharides found in wheat. Like the bran, humans lack enzymes to break down fructans, so they are poorly absorbed in the small intestine. Eventually, these molecules continue to the colon, where they act as a source of food to the bacteria that live there. Once the bacteria eat the fructans, the same scenario as outlined above can exist and so the person experiences gas, bloating, cramping, diarrhea, or an urgent need to use the bathroom. In some people, researchers believe the bacteria produces metabolites that interfere with the peristalsis (muscle contractions) of the colon. If this is the case, a person might wind up suffering from constipation, or a combination of both diarrhea and constipation.

Fructans are not unique to wheat, and are found in other foods like onions, garlic, leeks, jicama, artichokes, and sunchokes. From an objective standpoint, fructans are good for us. They feed and nourish certain populations of gut bacteria that are associated with numerous health benefits. But as is the case with many other types of fiber that feed bacteria, the result can often be gas and bloating that is painful, diarrhea, and/or constipation. This is especially true in those who suffer with IBS. Those affected by this unfortunate side effect of fructans do not need to follow a gluten-free diet, and can enjoy other grains that contain gluten, like rye and barley, and products made with these grains.

3. You are experiencing the benefits of eating more whole, unprocessed foods

Typically, people who start a gluten-free diet will start to eat more whole foods, less processed foods, and less packaged snacks. Sandwiches, burgers, pizza, and pasta are also no longer the “Go-To” foods chosen at restaurants and instead, salads, beans, whole grain rice, and squash with lean chicken, fish, or beef are consumed. When looking for a mid-morning or mid-day snack, they might replace the pretzels, donuts, bakery buns, cakes, and cookies with high-fiber nuts, popcorn, or fruit. Desserts are often also avoided. In other words, the constraints imposed by a gluten-free diet typically reduce the amount of refined carbohydrates consumed, and as a result, blood sugar is more controlled, cravings are reduced, and diet quality is enhanced.

For many, the result of these changes in the diet results in greater energy, less hunger, less cravings, better sleep, and often weight loss. This is great, but as mentioned, these changes are not due to their following a gluten-free diet – more likely due to adding whole foods, like fresh fruits, and vegetables to the diet in place of processed foods. I will often also see that the new gluten-free diet sparks a renewed interest in cooking more meals at home, which replace low-quality, wheat-based foods, such as salty, fatty, sugar-ladened restaurant meals and fast foods.

4. You are allergic to a protein other than gluten

While less common, allergic-type reactions or food sensitivities to wheat do occur, and can be triggered by wheat-specific proteins, other than gluten. Wheat allergies, like other food allergies, happen when your body’s IgE antibodies mistake the wheat protein for an assailant. As a result, they launch a systemic inflammatory reaction that might affect the skin, respiratory system and/or gastrointestinal tract. Most children with a wheat allergy outgrow it by about age 6; only about half of a percent of American adults are affected by it.

Unlike food allergies, food sensitivities are related to mediators that are released. This can occur anytime during one’s lifetime. Think of mediators as the part of your immune system that you were born with, versus the IgE antibody/allergy response that develops as a result of being exposed to a certain food, like nuts. Non-IgE mediated hypersensitivity reactions involve a variety of immune mechanisms (IgG, IgM, C3, C4, T-cell activation, phagocytosis, etc.) and non-immune mechanisms (pharmacologic, toxic) to trigger pro-inflammatory mediator release.

Released mediators produce corresponding physiologic effects, such as smooth muscle contraction, pain receptor activation, inflammation, mucus production, etc.. Because of the complexity of non-IgE mediated food hypersensitivity a simple, yet comprehensive method of identifying food and food-chemical induced mediator release has been developed, called the Mediator Release Test® MRT® As a certified LEAP Therapist, I test for food sensitivities using the MRT® test and LEAP Protocol. You can find out more on my website: https://beyondnutritio.wpengine.com/leap-certified/

And last, a lesser-known condition called eosinophilic esophagitis, or EoE, can also be triggered by a wheat allergy or sensitivity. EoE results in an abnormal accumulation of inflammatory white blood cells, called eosinophils (aka mediators) in the esophagus that could lead to heartburn or reflux-type symptoms, along with swelling. This could ultimately result in food getting stuck in the esophagus while swallowing because the esophagus is so very swollen. The majority of EoE cases could have one or more food triggers, such as wheat, milk protein, soy, eggs, shellfish, and nuts.

What makes a wheat allergy, food sensitivity, and EoE different than celiac disease is that people with these conditions do not have to follow a strict gluten free diet – they just have to follow a strict wheat-free diet. Other gluten-containing grains such as barley and rye should not trigger symptoms, though relatives of wheat like spelt, kamut and triticale may.

To discuss your nutrition and determine wether you need to be on a gluten free or just need to be wheat free, contact me at B3yond Nutrition LLC 973.852.3335.