Leadership Centre

Supporting leadership capacity building within Ontario.

Leadership Centre website

Enhancing leadership competencies, facilitating thoughtful discussion and examination of leadership issues for public health professionals.

Visit site

Community Food Advisor

Promoting safe and nutritious food selection, preparation and storage practices.

Community Food Advisor website

Community Food Advisors work in their community to improve and promote safe and healthy food selection, preparation, and storage practices.

Visit site

Public Health and You

Your questions about public health answered...all in one place.

Public Health and You website

Learn about why public health plays a vital role in ensuring the health of communities across Ontario!

Visit site

Ontario Public Health Association

Committed to improving the health of Ontarians.

OPHA website

Since 1949, OPHA has served as a catalyst for development in the Public Health sector.

Visit site

Nutrition Resource Centre

Credible public health nutrition at your fingertips.

Nutrition Resource Centre website

Strengthening the capacity of health professionals across all care settings and in all communities across Ontario.

Visit site

Gluten: Bad Guy or Easy Target

Gluten: Bad Guy or Easy Target
Our next #30in30 #nutritionmonth blog post is from Zsofia Zambo, M.Sc, Country Coordinator, Canada, EPODE International Network. Thank you for submitting!
 
Everywhere you go, restaurants and grocery stores are falling over themselves to offer gluten-free options. The more than 7 million Canadians1 who perceive gluten-free as a healthier choice can now enjoy cakes, pastas and pizza like the rest of us. Gluten-free has arrived.
 
Gluten is a protein found in wheat as well as other grains. Individuals with celiac disease are allergic to gluten and its ingestion can cause injury to the small intestine2, but only 1% of the population actually have celiac disease1. What about all these people with non-celiac gluten (NCGS) sensitivity? In other words, those without celiac disease but who’s gastrointestinal symptoms improve on a gluten-free diet3.  What is causing their bloating and cramps? To quote an old science cliché, “more studies are needed”.
 
So what’s with all the belly aching? It’s possible that many people with NCGS aren’t reacting to gluten, or at least, gluten alone. FODMAPs (fermentable oligio-di-monosaccharides and Polyols)4 are sugars and sugar alcohols that are poorly absorbed by the intestinal tract, potentially causing bloating, abdominal pain, gas, constipation and diarrhea5 . They are commonly found in a variety of foods including apples, honey, cow’s milk, cabbage, chickpeas and sweeteners ending in ‘-ol’ (eg. Sorbitol, xylitol)6 . As it happens, wheat, the most common source of gluten, is a high FODMAP food source.
 
Lactose is a FODMAP, and in the specific case of lactose intolerance, individuals either lack or don’t have enough of the enzyme lactase. This enzyme is needed to break down the milk sugar lactose into its smaller components, galactose and glucose, which are then absorbed into the blood by the small intestine. Without this enzyme, however, lactose passes through to the large intestine where it exerts an osmolaric effect, drawing water into the intestinal tract. Furthermore, undigested sugars may be digested by bacteria in our gut, the by-products of which may be responsible for some of the bloating and cramping experienced.
 
So is it sugars? Or is it the gluten proteins?
 
This was investigated by researchers Biesiekierski et al. (2013) who did a double-blind cross over trial with 37 subjects who had either NCGS or irritable bowel syndrome (IBS). In this study, participants were placed on a reduced FODMAP diet, and were then placed into 1 of 3 groups and fed either high gluten, moderate gluten and whey, or just whey protein. They found that in all groups gastrointestinal symptoms consistently and significantly improved with reduction of FODMAP intake.  In addition, researchers found no evidence of a specific or dose-dependent effect of gluten on intestinal symptoms. These findings suggest that in people suffering from NCGS or IBS gluten may not be the causative agent of gastrointestinal problems.
 
What about the people who report that they feel better when they follow a gluten-free diet? Well, a follow-up study8 by the same team of researchers found that short-term exposure to gluten-induced feelings of depression, perhaps explaining why people feel better when they go gluten-free. This could also in part explain the sheer number of people enjoying a gluten-free diet, and why the trend has exploded in the past decade.
 
Mystery solved?
Both of these studies were small and require follow-up. It might be some time before this hotly debated topic is settled. However, these studies are interesting and lend credence to the idea that if you suspect a certain food is making you feel bad (bad as defined by you), then it’s OK to cut it out of your diet for a while to see if your symptoms improve. Just be careful and consult a dietician to ensure you are still eating well.
 
 
References:
  1. Anderson, R. P., D. A. van Heel, et al. (2006). "Antagonists and non-toxic variants of the dominant wheat gliadin T cell epitope in coeliac disease." Gut 55(4): 485-491.
  2. Biesiekierski, J. R., S. L. Peters, et al. (2013). "No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates." Gastroenterology 145(2): 320-328 e321-323.
  3. Canada, G. o. (2014). "Gluten Free" Claims in the Marketplace. A. a. A.-F. Canada.
  4. Gibson, P. R. and S. J. Shepherd (2005). "Personal view: food for thought--western lifestyle and susceptibility to Crohn's disease. The FODMAP hypothesis." Aliment Pharmacol Ther 21(12): 1399-1409.
  5. Gibson, P. R. and S. J. Shepherd (2010). "Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach." J Gastroenterol Hepatol 25(2): 252-258.
  6. Gibson, P. R. and S. J. Shepherd (2012). "Food choice as a key management strategy for functional gastrointestinal symptoms." Am J Gastroenterol 107(5): 657-666; quiz 667.
  7. Peters, S. L., J. R. Biesiekierski, et al. (2014). "Randomised clinical trial: gluten may cause depression in subjects with non-coeliac gluten sensitivity - an exploratory clinical study." Aliment Pharmacol Ther 39(10): 1104-1112.
  8. Sapone, A., J. C. Bai, et al. (2012). "Spectrum of gluten-related disorders: consensus on new nomenclature and classification." BMC Med 10: 13.

Comments

comments powered by Disqus