A Matter of Life

Are You a Gluten Nut?

Dr Ambrish Mithal is chairman and head, Endocrinology and Diabetes Division at Medanta, The Medicity, Gurgaon
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The fashionable is not necessarily the healthy option

“ARE MY BODY aches and fatigue because of gluten allergy?” the young lady sitting across the table asks me. Won’t giving up gluten improve my health and help me lose weight? Doesn’t gluten aggravate auto-immune diseases like thyroid disorders? These and so many other questions are put to me every day by patients. Is gluten an evil that we have recently begun to recognise as a cause for all our ills? Or is it just one of those fads—here today, gone tomorrow. In this column, I check the current status of scientific knowledge on gluten and try to sift the truth out from the hype for you.

What is gluten? Gluten is a family of proteins (glutenins and gliadins) found in wheat, rye and barley. In patients with a condition known as Celiac disease, ingestion of gluten excites an immune reaction, and results in inflammation of the lining of the gut. Finger-like villi that are a part of the gut lining and provide a large surface for food absorption get inflamed and wither away. This results in pain, diarrhoea and poor absorption of nutrients. Joint pain and anaemia are common consequences, as is Vitamin D deficiency. If the diagnosis of Celiac disease is missed completely, it can even be life-threatening. The worldwide prevalence of Celiac disease is 1 in every 100. Like most auto-immune diseases, it tends to run in families. Its diagnosis is done through blood tests for antibodies; and an endoscopic biopsy is often needed for confirmation.

How is Celiac disease treated? Quite simply, by excluding gluten from the diet completely. Soon after a gluten-free diet is instituted, the abdominal symptoms disappear. The inflammation recedes and normal absorption is restored.

Not long ago, medical students in India were confidently taught that Celiac disease does not exist in India. From those days, we have moved to a stage where several health conditions are now attributed to gluten sensitivity. Gluten-free products, once almost impossible to access, now stare at us from the shelves of most upmarket grocery stores. The pressures of marketing are such that one almost feels guilty in not picking up some ‘gluten-free’ product or the other. However, other than expensive products in fancy stores, gluten-free products are still a challenge to find on Indian shopshelves.

The craze for gluten-free diets extends beyond those with Celiac disease. Broadly, I come across three groups of ‘non-Celiac’ individuals who are opting to eliminate dietary gluten. First are the gluten-sensitive group. These individuals do not have definite Celiac disease, but get abdominal symptoms when they consume gluten, and feel better once they eliminate it. Some estimate that such sensitivity could be affecting 6 per cent of the population, although reliable data is hard to come by. Others could be suffering from a common condition called Irritable Bowel Syndrome (IBS), the symptoms of which could be aggravated by poorly absorbable carbs (fructans) found in wheat. Such carbs get fermented in the colon and produce bloating and gas because the IBS-afflicted gut is unable to digest them. In these patients, it is the treatment of the primary condition that is important, rather than prescribing gluten-free diets alone.

The second group comprises those who feel that ridding their diet of gluten results in weight loss. Many people report a loss of weight after going gluten-free, especially in the initial stages. That’s because if you suddenly reduce carbs and cereals in your diet, you are bound to lose some weight. It has nothing to do with gluten. Try replacing wheat with rice in your diet. You will be gluten-free, but you may actually put on weight.

There is a third group which simply believes that gluten is evil and that everyone should give it up. This, again, is untrue and not borne out by any evidence. Transitioning to commercially available gluten-free products without reason could make you miss out on some important nutrients, and the gut flora could change adversely, making you more prone to infections. Some studies by the American Heart Association in 2017 have suggested that those on low-gluten diets are actually more prone to diabetes.

Who, then, should be on gluten-free diets? Those with proven Celiac disease through blood tests and biopsy. Those with non- Celiac gluten sensitivity and some with IBS may also do better without gluten or wheat. These groups have to ensure that nutrition is not compromised. They may need probiotic support and supplements.

For the majority of people, gluten-free diets do not offer any benefit. Gluten-free does not equal healthy. Do not fall prey to aggressive marketing and propaganda that will have you believe that the magic cure for all your ills is to give up gluten.