THERE is currently a buzz surrounding gluten and gluten-free diets. In fact, we may have even heard that some of our relatives and friends are on a gluten-free diet.

Gluten is a mixture of two plant proteins that are present in wheat and other cereal grains, and it is responsible for the elastic nature of dough and therefore the chewiness of baked products.

We should note, however, that not all grains contain gluten, and such gluten-free grains include brown rice, wild rice, corn, and pure oats.

Over time, some people may become sensitive to gluten (either gluten-sensitive or gluten-intolerant), which means that when breaking down gluten during the process of digestion, their bodies react abnormally and produce an immune system response (a reaction by the body’s ‘protection’ system).

Doctors typically recommend a gluten-free diet for such persons, whereby they would avoid eating any foods that contain gluten, such as bread, French fries, pasta, salad dressing, soy sauce and beers.

REACTIONS TO GLUTEN

Gluten-free diets have become increasingly popular in recent years, and are currently the most popular diets in the United States of America with more than 100 million Americans consuming gluten-free products over the past year.

The decision to go gluten-free may be mandated by health care practitioners, particularly if people begin to experience severe reactions.

The worst form of an auto-immune response to gluten is called celiac disease, which occurs in about one per cent of the population and in which the immune response damages their intestines and prevents them from absorbing vital nutrients in the gut.

The chronic gastro-intestinal disorder called irritable bowel syndrome is another condition that may be affected by gluten. However, unlike celiac disease, it is not caused by an auto-immune response.

Gluten grains are very high in starches and sugars that are easily fermented by intestinal bacteria, and in irritable bowel syndrome this may result in bloating, cramping, and diarrhoea. This condition may affect seven to 20 per cent of adults.

Non-celiac gluten sensitivity has been defined as a clinical entity induced by the ingestion of gluten and leading to intestinal and/or extra-intestinal symptoms that resolve once gluten is eliminated.

SOME BENEFITS

Some people may elect to adopt a gluten-free diet in the hope that it will improve their digestion and boost their immune system, whilst also enabling enhanced performance and weight loss.

In fact, the appeal of a gluten-free diet has become big business, and many testimonials by celebrities and athletes have been attributing their success and well-being to their adherence to the diet. However, there are barriers to going gluten-free, including cost as well as long-term safety of gluten-free foods and the potential for gluten cross-contamination of products.

Some people who avoid gluten may do so because of complaints of gastro-intestinal symptoms such as abdominal pain, gastro-oesophageal reflux, ‘gas’ or bloating, nausea, diarrhoea, or constipation.

Non-gastrointestinal symptoms have also been reported, including headache, fatigue, anxiety, depression, a ‘foggy mind’, muscle aches, and skin rashes.

Importantly, a series of studies that investigated the response to gluten in patients with irritable bowel syndrome noted an improvement in patient-reported outcomes following the institution of a gluten-free diet, including a decrease in the frequency of bowel movements in patients with diarrhoea-associated irritable bowel syndrome.

GLUTEN-FREE FOODS CAN CAUSE WEIGHT GAIN

Whilst the food restrictions associated with a gluten-free lifestyle can promote weight loss, consumption of too much ‘healthier’ gluten-free food can cause weight gain as some food manufacturers often include additional fat or sugar to render gluten-free products more tasty.

This causes an increase in the product’s calorie count and could possibly deceive those who are using such products to control their waistline.

People who go gluten-free may also suffer nutrient deficiencies since many whole grains are rich in vitamins and minerals, such as vitamins B and D, iron, and fibre. Some research studies also suggest that a gluten-free diet may affect cognitive (mental) function, since gluten and carbohydrates go hand-in-hand, and so going gluten-free may also cause a cutting back on carbohydrate intake.

Some studies suggest that high carbohydrate intake is not only linked to elevated blood glucose levels but also inflammation as well, and one much-discussed study has suggested that elevated blood sugar levels may even negatively impact brain structure and has been linked to cognitive decline and the development of Alzheimer’s disease.

So, cutting gluten and carbohydrates from your personal diet may support better cognition (mental function) as you age. However, more research on the matter is needed to fully understand the impact of gluten on the brain.

Nevertheless, going gluten-free may improve digestion, reduce bloating and diarrhoea among other symptoms, and the improved digestion associated with a gluten-free lifestyle may relieve symptoms associated with other intestinal disorders such as lactose intolerance.

As both risks and benefits accompany all our indulgences, however, we should continue to be vigilant in all matters related to our long-term health.

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the ethicist at the Caribbean Public Health Agency – CARPHA. (The views expressed here are not written on behalf of CARPHA)