The Gluten Oats Controversy – To Eat or Not to Eat

Celiac Disease – an autoimmune condition that affects nearly 1% of our total population is somewhat unique in the sense that if has an effective treatment in the Gluten Free diet. However, this diet can be difficult to follow and a significant number of celiac do not respond well to the diet due to accidental exposure to gluten. Gluten is traditionally found in wheat, rye, triticale, barley (sometimes oats and sometimes not). Why this confusion?? What this controversy over oats is all about?? What should you do on gluten free diet- eat oats or omit them???

The inclusion of oats in a gluten-free diet has been a controversial issue with one group pointing towards research that suggests that oats contain Avenin - a protein that closely resembles wheat gluten and may cause inflammation in susceptible individuals. Hence, unsuitable on a gluten -free diet.

Whereas the other group points towards research that suggests that none of the peptides that cause reactions in people with gluten intolerance are present in oats. Hence, safe on a Gluten –Free Diet.

Some research shows that most of the celiac can well tolerate oats and the adverse reactions are only due to the cross-contamination of oats with other gluten containing grains like wheat and the conditions in which they are grown, harvested, transported, packed and stored.

In addition to all these controversies on a personal note, my experiences with a  sizeable number of celiac reveal that there are a large number of celiac who do not report of adverse reactions when they consume oats at the same time almost an equal percentage of celiac complain of bloating and other symptoms associated with gluten intolerance.

The controversy over oats has not yet been resolved and what actually triggers the reaction – avenin or gluten cross contamination is not yet clear. A large-scale study is needed to produce valid results. However, unfortunately, no such research has been conducted till date.

Until this controversy is resolved excluding oats appears to be the only risk-free option for those on a gluten-free diet. However, if you wish to try oats you can do so by adhering to the medically approved guidelines for celiac.

People who are merely gluten sensitive may be able to well tolerate oats without any adverse effects. But as the level of gluten intolerance varies you must not consider this as a specific recommendation. Some people may tolerate it well while others may have reactions to even a small amount of it. To determine your level of tolerance, consume only small amounts of oats, in the beginning, to see how your body reacts to it. If no reaction you can slowly increase its quantity.

But before consuming oats remember, unless manufactured in a dedicated facility oats can also be cross-contaminated with gluten. So always buy oats that are manufactured in a dedicated facility and are labelled gluten free.

IS VINEGAR SAFE TO USE ON A GLUTEN FREE DIET??

Often my celiac clients ask me

if it is safe for them to have vinegar or not??

I have also seen this question posted in multiple forums. So I thought why not write a blog based on my knowledge and experience to help people find an answer to their question.

Vinegar is a controversial food item within the gluten free world. Many experts believe that all vinegar including barley and malt vinegar and other kinds of vinegar made from gluten grains are safe to consume on a gluten-free diet. This is because vinegar is a highly distilled product and the distillation process removes all the gluten fragments.

At the same time, many other experts question the safety of anything that is made using gluten containing ingredients - taking into consideration the fact that the present gluten testing technology doesn’t always pick up any small fragments of the gluten left after the refining process.

Also, many people with gluten and non-gluten sensitivity have reported of adverse reactions when they consume vinegar derived from gluten grains.

So what's the truth?

As per FDA established criteria any food that contains less than 20ppm of gluten as measured using scientifically validated analytical methods can be considered and labeled gluten free. The distilled vinegar obtained from gluten grains qualifies that criteria, hence gluten free.

But people who are reacting to gluten based distilled vinegar are also not imagining their reactions. It is not clear what percentages of people react to this kind of vinegar due to the absence of any studies. But I believe it depends upon the level of your gluten sensitivity. Highly sensitive individuals are more likely to react to the traces of gluten present in the foodstuff. My advice to all the newly diagnosed celiacs is to proceed very carefully until you find for yourself whether you react or not and if possible it’s better if they can avoid it. Why take a risk when other kinds of vinegar are also available.

What risk-free choices are available...?

Any vinegar that is made from gluten free grains is a risk-free choice. Common ones include: 

• Apple Cider Vinegar
• Grape Vinegar
• Corn Vinegar
• Rice Vinegar
• Balsamic Vinegar

However, be careful if you are using the distilled variety of the above vinegars as there is always a possibility that can get cross contaminated during the distillation process. So if you are really planning to make a risk-free choice then go for the raw/undistilled vinegar. It is also easily available online and in stores.

Raw vinegars can also be used the same way as distilled vinegars, but they have a very strong smell (at least I don’t like it) and they taste slightly different too. But do not make much difference to the cooked food. However, this can also be managed if you boil the vinegar for some time before adding it to the food. Boiling removes the raw smell and improves the taste quality and they taste and smell no different than the distilled vinegar.

So it is you who has to decide which vinegar you want to use- distilled or raw, made from gluten ingredients or gluten free ingredients.

DOES GLUTEN FREE DIET HELPS IN WEIGHT LOSS??

Image source: http://i.vimeocdn.com/video/534355281_1280x720.jpg

Whole grains have always been a part of the healthy balanced diet but due to all the promotion around gluten-free foods, several believe going gluten free will facilitate weight loss. Let's have a look on what does the science say about this and decide for ourselves if it is a fad, fact, fiction or downright foolishness.

What is gluten?

Gluten is a protein composed of gliadin and glutenin and is primarily found in grains viz. wheat, rye, barley, and triticale. It is often found in hidden form in many other foods, medications, and everyday items and its presence is not limited to bread, cookies, and pasta.

Who should go gluten free?

A strict gluten free diet is only required if you have

• Celiac Disease: A serious autoimmune disorder that affects 1 out of 100 people worldwide.

• Wheat Allergy: Should not be confused with gluten intolerance or celiac disease in which a person is allergic to a specific protein ‘gluten' which is present in wheat and a few other grains. It usually affects children and is outgrown after childhood. It affects 0.1% of the population

• Non-Celiac Gluten Sensitivity: It is a condition characterized by an array of nonspecific symptoms like constipation, bloating, headache etc. after eating gluten. However, there is no hard test as on date ( unlike celiac disease and wheat allergy that can be detected by blood tests) for non-celiac gluten sensitivity and the diagnosis is subjective.

What does the science say about gluten-free diet and weight loss?

 With more and more celebrities and weight loss clinics touting the advantages of the gluten-free diet, it is very easy to assume that giving up gluten may lead to weight loss. However, despite all health claims, there is no evidence-based research to support that gluten-free diet is effective for weight loss or necessary if you do not have any gluten-related disorders, according to the Journal of the Academy of Nutrition and Dietetics.

Many other studies have also reported a gain in weight after following a gluten-free diet. In one such study on 371 adults with celiac disease who followed a gluten-free diet for 2 years, 55 of 67 (82%) initially overweight patients gained weight 1.Another study conducted on  149 children with celiac disease who followed a gluten-free diet for at least 12 months, the percentage of overweight children almost doubled (11% to 21%) 2.

Despite all these studies many still lose weight on a gluten-free diet. Why? Let's find out

4 Reasons why people lose weight when they go gluten-free

• Gluten free diet is restrictive.
• Many high-calorie junk foods like pizza, cupcakes can no longer be eaten.
• Many high carbohydrate foods like bread, pasta can no longer be eaten both as they are not easily available and are expensive.
• Many healthy foods like fruits and vegetables are low in calories and readily available.

Alas!! Shunning off pizzas, kachoris, bhaturas, gulab jamuns, hamburgers, samosas coupled with eating more fruits and vegetables – sounds like a perfect recipe for weight loss. Isn't it??

My Verdict

There is absolutely no need to go gluten free if you are not suffering from any of the allergies gluten or wheat as mentioned above.  If your goal is weight loss try to make conscious choices by selecting whole grains, fresh fruits and vegetables and avoiding junk and fried foods.  Also, try focusing on portion sizes. a half plate full of salad without dressing, a quarter plate full with protein and the remaining quarter with carbohydrate for lunch and dinner is perfect for weight loss.

References

1. Celiac disease and obesity: need for nutritional follow-up after diagnosis. Eur J Clin Nutr. 2010 Nov;64(11):1371-2.
2. Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet. Am J Gastroenterology. 2006 Oct;101(10):2356-9.
3.  http://www.andjrnl.org/article/S2212-2672(12)00743-5/fulltext

Gluten and PCOS Connection

I am often visited by clients who have PCOS, an endocrine disorder that impacts 5-10% of women worldwide. The true cause of PCOS is not yet known but experts believe it is due to the excess production of androgens, the male sex hormones. It was first recognized in 1935 by gynecologists as a cause for menstrual irregularities. However, it is now associated with a number of health problems like reproductive issues and metabolic disturbances.

Women with PCOS are generally obese are often advised by health experts to lose weight. Studies also confirm that even a marginal drop of 10% of body weight help to subside some of the symptoms of PCOS. Like most of my fellow nutritionists, I also used to prescribe my PCOS clients a low carb. diet for losing weight. Although my diets helped all my clients lose weight but what I noticed is some of the clients were still not very happy even after losing weight. They were still feeling bloated, constipated and had other health issues associated with PCOS. So I decided to do some research on it and what I found was something I could never have imagined – the gluten connection.

Though the research on this is still scarce but I have reasons to believe that your PCOS might be due the gluten in your diet. Initially I myself was a bit skeptical while introducing gluten free diet to my patients who despite weight loss were not reporting of much improvement in their symptoms. But to my utter amazement, I found all my patients who were complaining earlier now reported a marked improvement in their symptoms after following a strict Gluten free diet for 2-3 weeks.  However, I still do not advise gluten free diet to all my PCOS clients but I do get them all tested for gluten allergy before starting with the diet. And in case the tests are negative, I start with a normal PCOS weight loss diet and only if they report of no significant improvement in symptoms despite weight loss I put them on a gluten-free diet and till date it has not failed me.

Now let’s have a look at some of the facts on how gluten is related to PCOS.

GLUTEN AND PCOS CONNECTION

Gluten-a hormone disruptor:  Gluten is a known hormone disruptor in both males and females. Hormones disruptors are substances that interfere with the working of the endocrine system. They cause our bodies to over respond or under-respond to the release of hormones.
In polycystic ovarian syndrome, the hormones are already out of whack and inclusion of gluten contributes to further imbalance.

Gluten and Insulin Resistance: Several studies 1 have suggested that a diet high in gluten leads to the development of insulin resistance. This is because gluten acts directly on the islet cells of the pancreas responsible for the production of insulin and damages them.

Studies have now also proved that PCOS is associated with insulin resistance as well as with defects in insulin secretion 2. Insulin resistance is a condition where the cells of the body become less responsive to the effect of insulin. As a result, more insulin is then required to keep the blood sugar levels under control. Here is a very good definition of insulin resistance from medicine.net. “The diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues.  It is as if insulin is "knocking" on the door of muscle. The muscle hears the knock, opens up, and lets glucose in. But with insulin resistance, the muscle cannot hear the knocking of the insulin (the muscle is "resistant"). The pancreas makes more insulin, which increases insulin levels in the blood and causes a louder "knock." Eventually, the pancreas produces far more insulin than normal and the muscles continue to be resistant to the knock”. The increasing levels of insulin in the blood results in hyperandrogenism 2 (over production of androgens) which may ultimately lead to the development of PCOS.

Gluten and Chronic Inflammation: Polycystic ovarian syndrome is an inflammatory process 3, 4. Research suggests that PCOS women have higher markers of inflammation than women without this syndrome 3. Gluten present in wheat and other related grains is a known irritant and a contributor to chronic inflammation. Eating gluten or related products only exacerbates the inflammation problem in PCOS women.

SUMMING IT UP

There is no double-blind research, as on date, to show a connection between gluten and PCOS. However, if you are suffering from PCOS and not seeing any marked improvement in your PCOS symptoms despite weight loss I suggest why not you try the gluten free diet for a month and see how you feel? I am convinced that you will feel much better. Even if you are having trouble losing weight following a weight-loss diet you can still give gluten free a try and I am very much convinced that not only you will lose weight and will see a lot of improvement in your symptoms.

Have you or your loved one, given the gluten free diet a trial and seen improvement in PCOS symptoms. I would like to hear from you if you have. Please leave me a comment below...

 References:

1. Gluten-free diet reduces adiposity, inflammation and insulin resistance associated with the induction of PPAR-alpha and PPAR-gamma expression. J Nutr Biochem. 2013 Jun;24(6):1105-11. doi: 10.1016/j.jnutbio.2012.08.009. Epub 2012 Dec 17.
2. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997 Dec;18(6):774-800.
3. Is PCOS an inflammatory process? Fertil Steril. 2012 Jan; 97(1): 7–12.
4. Inflammation in Polycystic Ovary Syndrome: Underpinning of insulin resistance and ovarian dysfunction. Steroids. 2012 Mar 10; 77(4): 300–305.
5. http://www.medicinenet.com/script/main/art.asp?articlekey=18822

GOING GLUTEN FREE-HERE’S ALL YOU NEED TO KNOW.....

Switching on to a gluten-free diet is a big change and will take some time for you and your family members to get adjusted to it. Unlike other dietary restrictions where removal of the culprit food from the diet serves the purpose, removal of gluten requires a lot more efforts. This is because gluten is not only present in wheat, rye, and barley but is also present in hidden form in many other food products. Even a food which is naturally gluten free may get contaminated with gluten during processing.

Image source: https://upload.wikimedia.org

While you are learning to adjust yourself to this major change in your diet, you also have to keep yourself prepared to deal with the added pressure of managing social situations. In Northern part of India where wheat is a staple food there a false belief that wheat contains some of the nutrients necessary for good health. So, eliminating wheat from the diet means depriving yourself of all those essential nutrients necessary for healthy living. However, this is not completely true. Wheat does contain some of the essential nutrients, but it is not the only source of these nutrients. They can also be found in other natural foods that can be taken to meet the body's requirement.

So let us have a look on what foods contain gluten.

As mentioned earlier, gluten is present in wheat, rye, and barley. This means any product made from any of these grains needs to be completely avoided on a gluten-free diet. These include but are not limited to:

• Whole wheat flour
• Refined Flour
• Semolina
• Triticale
• Durum Wheat
• Wheat Bran
• Wheat Germ
• Cracked Wheat

Common products that are made using these ingredients:

• Pasta
• Vermicelli
• Noodles
• Cakes
• Muffins
• Pastries
• Cookies
• Wafers
• Bread
• Kulcha
• Pizza Base
• Buns
• Dalia
• Pretzels
• Momos
• Spring Roll Wrappers
• Donuts
• Gujhia
• Panjeeri
• Kachori
• Samosa
• Pani Poori

Hidden sources of gluten

 As mentioned earlier gluten may also be present in many other food products where you may never expect it to be. These include:

• Soy Sauce
• Vinegar
• Dressings and Marinades
• Fried Foods like French fries, Cutlets
• Granola Bars
• Soups (Especially Cream Soups)
• Cornflakes (Contains malt)
• Some candies
• Seasoned Chips
• Malt
• Modified Starch Foods
• Beer
• Multigrain Tortilla Chips
• Seasonings
• Asafoetida Powder (Packaged one)
• Gram Flour (Besan)
• Artificial Colours

Pl. note: All products that are wheat free are not necessarily gluten free. You must always check with the manufacturer unless it is labelled as gluten free to ensure whether the product is gluten free or not.

Cross Contamination

Cross Contamination occurs when a gluten-free food comes in contact with gluten. It generally occurs via sharing the same cooking space, storing environment or by shared utensils. The following precautions must be taken to avoid any gluten contamination:

• Clean the cooking surface properly. Make sure there is no flour or bread crumbs lying around.
• Maintain a separate set of aluminum, non-stick, wooden, melmoware, plastic utensils, chopping boards for cooking or serving. This is because gluten gets into the pores and does not get removed completely even after washing.
• If using a shared stainless steel utensil make sure to scrub it again using a separate dish wash bar before using it for a gluten free food.
• Always store gluten free foods away from chapatti’s, poori's, flours and other gluten containing food items.
• Wash hands properly before handling a gluten free product.

Other places where cross-contamination may occur:

• Toasters: used for both gluten free and regular bread.
• Flour Sifters
• Colanders
• Fried Foods: Foods fried in the oil used for frying breaded products.
• Condiments
• Besan: usually ground near or in the same mill as wheat. Always buy a gluten free besan
• Oats: Contaminated in fields when they are grown side by side with wheat. Always buy oats labelled as gluten free.
• Non-certified gluten-free food products.

Other Items that may contain gluten

• Drugs and Over the counter medications: Always check with your doctor or manufacturer before taking any medication.
• Vitamins and Supplements
• Herbal Supplements
• Play Dough: Children may unintentionally touch their mouth or eat after handling play dough.

What to eat?

Cutting out gluten from the diet seems to be a very difficult and limiting task. Fortunately, nowadays a lot of gluten free alternatives to regular products are available in the market and are equally delicious and can

be enjoyed by gluten intolerants.

Remember adopting a strict gluten-free diet is the only treatment available for people with gluten-related disorders. However, if proper care is taken in the initial stages when not much harm has occurred to the intestine there is always a possibility that you may outgrow it in future.

If you have any questions on any specific food on whether you can eat or not or any doubt on gluten free diet please leave me a comment below.

In my later blogs, I will share the list of gluten free products and the stores from where they can be purchased.

I AM GLUTEN INTOLERANT. CAN I HAVE GHEE??

source: https://upload.wikimedia.org/wikipedia/commons/4/43/Butterschmalz-2.jpg

Ghee also known as clarified butter or drawn butter is prepared by heating butter to remove the moisture and straining away the solids that collect at the bottom of the pan. These tiny particles that settle at the bottom mainly consist of milk protein casein.

In gluten intolerance, our body recognizes gluten as a foreign substance and starts producing antibodies against this protein. Casein has a structure similar to that of gluten. The same antibodies that were produced against gluten sometimes mistakenly identify casein for gluten due to the similarity in their structure and start acting against it. This is known as a cross reaction. When in spite of having a strict gluten free diet a person does not report any improvement in his symptoms he is advised to go dairy free as well just to determine if it is a case of cross-reactivity. However, these people can re-introduce dairy in their diet after sometime.

Ghee by nature is gluten free. However, it may contain some amount of casein which may cause cross-reactions in susceptible individuals. In order to be sure that your ghee is casein free as well, do not over cook it. The moment you notice the bottom residue has started turning light brown continue cooking for a minute and switch off the burner. Carefully strain the ghee into another container making sure none of the residues gets inside the container. However, this residue also contains a lot of ghee. Remember not to try to squeeze out the ghee out of this residue. By doing this you may accidentally end up adding casein to your ghee, in spite of all the precautions that you take. The ghee from the residue can be used for other members at home who are not allergic gluten or casein. The casein or the residue left behind should also not be thrown away as it contains protein and can be mixed with a little sugar and given to kids or mixed with flour to make chapattis or paratha.  

IS GLUTEN CAUSING MY HIVES??

Hives also known as Urticaria or Nettle Rash is a sudden onset of raised red or white itchy skin rash that clears away on its own within a few hours or in rare cases in a few days. It usually first develops in the covered areas like thighs, waist, trunk, but can also appear in any other part of the body.
A variety of possible causes, including allergic reactions to certain foods, have been identified as a trigger for urticaria but unfortunately, actual trigger often goes unnoticed.

CAUSES OF HIVES

source: https://upload.wikimedia.org/wikipedia/commons/6/63/EMminor2010.JPG

• Pollen
• Insect Bites
• Stress
• Exposure to Sunlight
• Certain Medications
• Food Sensitivities

HOW HIVES DEVELOP

When we are stressed or our body comes in contact with something that produces an allergic reaction an inflammatory response in triggered in the body that causes the body cells to release a compound called Histamine. This histamine causes dilation of capillaries or tiny blood vessels which are seen as a rash or swollen area on the skin.

FOOD SENSITIVITY AND HIVES

Food sensitivity is when your body reacts abnormally to certain proteins present in food and produce inflammation anywhere in the body, giving rise to conditions such as Arthritis, Eczema, Asthma, Dermatitis, Psoriasis and Hives depending upon the site where inflammation has occurred.
Basically, two types of proteins have been identified which may be responsible the development of hives. These are:
Gluten: Present in wheat, barley, and oats.
Casein: Present in milk and other dairy items.

GLUTEN AND HIVES

Gluten is a protein found in wheat, barley, oats and is poorly tolerated in some individuals. In fact, it has been found to be one of the major causes of hives or urticaria. A number of studies published in various medical journals like the Lancet, Allergy (4), Canadian Journal of Gastroenterology (1), Paediatric Dermatology (2), etc. have suggested links between gluten sensitivity and hives. In all these studies, patients showed improvement when put on a gluten free diet. However, the exact mechanism on how gluten leads to the development of hives is not yet known and is still under study.

TREATMENT

There are two main aspects of the treatment for hives: 

• Treatment with drugs.
• Avoidance of allergen/trigger.

Treatment with drugs: Antihistamines is usually prescribed for combating the effects of hives. These drugs work by blocking the action of histamine which is involved in Hives. Antihistamine if taken as soon as rash flares up, the rash will fade away faster than it would normally. In the case of recurrent hives, people may have to take this drug o a regular basis to prevent hives from reappearing.

Avoidance of allergen/trigger: If food or any other allergen is believed to be a cause of recurrent hives, one may have to completely avoid that food source or allergen to prevent hives from recurring. In case one is unsure of the cause of hives he may have to avoid all the potential sources that may cause an allergic reaction in that person for sometime to determine if hives disappear and then reintroduce them one by one in small amounts to find out if the rash reappears.


References

• http://www.ncbi.nlm.nih.gov/pubmed/16609761
• http://www.ncbi.nlm.nih.gov/pubmed/20199432
• http://www.ncbi.nlm.nih.gov/pubmed/18447142
• http://www.ncbi.nlm.nih.gov/pubmed/10505471

GLUTEN AND CONSTIPATION

Image by Scott Bauer, U.S. Department of Agriculture via source:<a href="http://www.public-domain-image.com/free-images/food-and-drink/bread/breads" title="Breads public domain image">Breads</a>

What is Constipation

Constipation is sporadic and difficult passage of stools. Normal bowel movements vary from one person to another. Most people have a bowel movement every day while there are some who do not have it every day instead they have it every alternate day or once in two days. As far as an individual passes soft stools, three or more times per week, his bowel movements are said to be normal.

Constipation is characterized by infrequent bowel movements less than three times a week or hard and difficult passage of stools or an inability to pass stools after much straining and pushing.

Why Constipation is Bad...

Constipation is one of the most common though lesser known symptom of gluten intolerance. Constipation does not only mean gut pain, fewer bowel movements and/or related symptoms, but it also indicates serious dysfunction in the body’s ability to digest nutrients and eliminate toxins. This toxic build-up in the body eventually affects the immune system and may give rise to a host of other health problems.

How Gluten Causes Constipation

When gluten from a food enters the digestive tract of gluten sensitive or intolerant individuals, the protein fraction of gluten catalyses the defence system of such individuals to release alleviated amount of abnormal antibodies, which attack the lining of the small intestine causing it to atrophy and erode.

The lining of the small intestine contains small finger-like projections called microvilli. These microvilli densely populate the small bowel. As the food passes through the small intestine, the microvilli help to absorb the nutrients from the food into your blood stream.

In gluten sensitive or intolerant individuals the antibodies created by gluten attack these villi, as a result the villi gradually wear down and if corrective measures are not taken on time they are eventually completely destroyed.

As the microvilli are reduced in the gut, the food passes through the small intestine less processed and with far less the nutrients absorbed. 

The further the food moves along the gut, the small intestine anticipates more and more food and nutrients to be processed, digested and absorbed by your body. At the point when the parts of your intestine anticipating the food to be processed to a specific degree attempts to process this food this later part of your small gut rather either pass the sustenance totally without further processing or it assimilates what little it can- usually only the water...

This leads to the formation of hard stools that are difficult to pass.

GLUTEN INTOLERANCE- SIGNS, SYMPTOMS AND ASSOCIATED CONDITIONS

Gluten Intolerance is an impending epidemic in India.  According to Dr. Wadhwa of Sir Ganga Ram Hospital, Delhi, every 3 to 5 of 100 children in India are suffering from gluten intolerance. But this disorder is not confined to children only. A lot of adults  who had been eating gluten all their lives without any ill effects are being diagnosed for gluten intolerance for various health disorders. According to a report published by TOI, about 16% of the Diabetics (298 children and 318 adults) who were screened for gluten sensitivity at NIMS, Hyderabad were tested positive for celiac sprue/ celiac disease / gluten intolerance.

One of the reasons why more and more people are being diagnosed for gluten intolerance nowadays is that  the tests for gluten allergy have been introduced in our country just a few years back. Due to the lack of specific tests in the past the problem had remained undiagnosed and treated for something else.

Even today 99% of people with gluten allergy are not aware of their condition and blame their ill health or symptoms on something else.

More than 300 symptoms of gluten intolerance have been documented. However, these symptoms and their manifestation vary from one individual to another.

Listed below are the symptoms and conditions associated with gluten intolerance/ sensitivity. If you have any of the subsequent symptoms or suffer from any the conditions mentioned below it could be a sign that you are suffering from gluten intolerance.

• Digestive issues like gas, bloating, nausea, diarrhea, constipation, vomiting, abdominal pain, heartburn, gum bleeding, lactose intolerance, steatorrhea, gastric ulcer, irritable bowel syndrome, defective tooth enamel, unexplained bleeding, cow’s dairy intolerance, Crohn’s disease, gastrointestinal occult bleeding (blood in stools not visible to naked eyes).

• Disorders of skin, hair and nails like alopecia areata (patchy hair loss), alopecia (balding), thinning of hair, eczema, dermatitis herpetiform, nails with white spots, nails with rounded and curved down ends- dark and dry, psoriasis, follicular hyperkeratosis, scleroderma, seborrhea, vitiligo, itchy skin rash.

• Disorders of glands like autoimmune hepatitis, autoimmune thyroiditis, Addison’s disease, grave’s disease, Type 1 Diabetes, non-alcoholic fatty liver disease, idiopathic hypoparathyroidism, pancreatic insufficiency.

• Disorders of muscular system like muscle weakness, muscle wasting, muscular pain and tenderness, muscle spasm and cramps,  severe potassium deficiency, tetany, polymyositis, osteomalacic myopathy.

• Disorders of Nervous System like anxiety, depression, epilepsy, tremors, dementia, chronic fatigue syndrome, ataxia, multiple sclerosis, irritability, insomnia, inability to concentrate, frequent headache, migraine.

• Reproductive issues in females like amenorrhea (loss of menstrual period), infertility, dyspareunia (painful intercourse), early menopause, pre- menstrual syndrome, late menarche (late start of menstrual periods), vaginitis, dysmenorrhea (painful periods).

• Reproductive issues in males like infertility, impotence, sperm abnormalities, hypogonadism.

• Chromosomal Disorders like Down Syndrome and Turner Syndrome.

• Child Development issues like autism, developmental delay, hyperactivity, growth retardation, delayed puberty in boys and girls, rickets, iron deficiency anemia that is unresponsive to iron therapy, glycogenic acanthosis, hypotonia, impaired penicillin V absorption.

• Disorders of kidney and urinary tract like frequent urinary tract infection, hypercalciuria, IgA nephropathy.

• Disorders of sensory system like blurred vision, loss of taste, loss of smell, cataract.

• Disorders of pulmonary system like non- response to tuberculosis treatment, bronchial pneumonia, bronchiectasis.

• Disorders of immune system like IgA deficiency, chronic urticaria (hives), asthma, hay fever, sarcoidosis, Sjogren’s syndrome.

• Cognitive issues like hallucinations, delusion, disorientation, poor memory, scattered thinking, reduced learning, slow thinking, confabulation.

• Blood test abnormalities like folic acid deficiency anemia, iron deficiency anemia, vitamin B12 deficiency anemia, elevated liver enzymes, elevated homocysteine levels;  low levels of zinc, phosphorus, calcium, magnesium, copper, and potassium;  prolonged prothrombin time,  low levels of plasma proteins in the blood, elevated bone alkaline phosphatase enzyme, haemochromatosis, neutropenia.

• Skeletal symptoms like osteoporosis, psoriatic arthritis, recurrent monoarthritis, enteropathic arthritis, bone pain.

Having any of the above symptoms does not necessarily mean that you are gluten intolerant.  As mentioned above, that the manifestation of symptoms of gluten intolerance vary from one individual to another. So if your body is not responding to any of the treatment as prescribed by your doctor for any of the above symptoms or if you are experiencing multiple symptoms from the above list it could be a sign that you are gluten intolerant or gluten sensitive.

Try a gluten elimination diet (100% elimination) for at least 3 weeks and then reintroduce it.  If you feel significantly better on a gluten free diet or feel worse when it is reintroduced it is likely that gluten is the cause of your problem.

Also note, that many of the symptoms mentioned above have recently been diagnosed. Hence, many doctors still do not link gluten with the above conditions.

HOW GLUTEN AFFECTS YOUR BODY

As discussed in the earlier post, Gluten is a protein composed of gliadin and glutenin and is found in cereal grains like wheat, barley, rye and triticale. This gluten can play havoc in the intestines of individuals who lack certain enzymes (tissue transglutaminase- tTG) necessary for breaking down gluten into its constituent proteins i.e gliadin and glutenin.

As the food passes through the digestive tract, the gastrointestinal immune system of susceptible individuals identifies gliadin as a foreign substance and starts producing antibodies against it.  These antibodies not only attack gliadin but they also attack tissue transglutaminase enzyme and cause damage to the microvilli of the small intestine which eventually atrophies and erodes. 

The main function of microvilli in our body is to absorb nutrients through the intestinal wall. However, in gluten-sensitive or intolerant individuals, their this ability of absorbing nutrients is highly decreased. This results in a host of problems like malnutrition, diarrhea, constipation, etc. This flattening of microvilli is a distinctive feature of celiac disease, an autoimmune disorder.

Unfortunately, the action of these antibodies is not restricted to tTG alone, they may also attack any other organ or system in the body like head, skin, pancreas, thyroid etc. leading to a host of other autoimmune disorders. 

GLUTEN – WHAT IS IT??

Gluten is a protein that is present in the endosperm of cereal grains viz. Wheat, barley and rye and is not found in the young  grasses that sprout from its seed.

It is composed of two different proteins:  gliadin and glutenin. Gliadin is responsible for elasticity whereas glutenin gives toughness to the gluten. The two proteins (gliadin and glutenin) when combined in the presence of water along with mechanical action form a tough elastic complex known as Gluten.

 True Gluten is sometimes referred to as being specific to Wheat, gluten is often considered to be a part of other cereal grains like rye, barley, triticale (hybrid cereal obtained from a cross breed between wheat and rye).

Gluten is present in a wide variety of processed foods that we consume daily like pizza, pasta, cakes, muffins, pastry, chips etc. Gluten helps with the rising of bread and other baked products while also adding to the texture and chewiness.  The elastic nature of the gluten makes it possible for it to be easily rolled into chapatti. It can also be used as a thickener, binder, stabilizer, flavour enhancer and protein supplement.

It is often present as a hidden source in beer, soy sauce, ketchup, ice cream and many other food products.

It is also used in shampoos, cosmetics and other dermatological preparations.