Gluten intolerance is becoming more widely accepted as people's understanding of the condition improves and, despite a variety of claims that it doesn't actually exist, gluten intolerance is very much real.
People who are gluten intolerant are unable to digest gluten; a type of protein found in wheat, barley, rye and oats.
When we eat gluten, something called tissue transglutaminase (tTG), an enzyme in the intestinal wall, breaks down the gluten into its building blocks, gliadin (a prolamin protein) and glutenin (a glutelin protein).
As the broken down gluten travels through the digestive system, the bodies of people with gluten intolerance will identify gliadin as a dangerous substance, and produce antibodies to attack it, resulting in a variety of symptoms:
- Flatulence (wind)
- Stomach cramps/pain
- Bloated stomach
- Stomach gurgling/rumbling
- Diarrhoea or constipation
- Nausea and/or vomiting
If you regularly suffer from any of these symptoms after consuming bread, pasta, breakfast cereal, biscuits, cake or any other wheat-based product, then you should contact your doctor, who will be likely to suggest you try an elimination test. This involves removing all forms of gluten from your diet for two weeks and monitoring your symptoms.
If your symptoms do disappear during the elimination test, then your doctor will perform a blood test to rule out the risk of coeliac disease; a more severe inability to digest gluten where the antibodies don't just attack the gluten; they attack the body too! There is currently no test offered by the doctor to confirm gluten intolerance; they simply rule out coeliac disease.
Before the blood test it's important that you've been consuming gluten for at least six weeks to ensure an accurate test result. So after the elimination test you will need to reintroduce gluten to your diet for the official testing.
If your blood test results return as positive for coeliac disease, then your diagnosis is over (unless the doctor requests a biopsy), but if the results are negative, then it's highly likely that you have gluten intolerance, sometimes referred to as non-coeliac gluten intolerance.
A doctor may request a biopsy with either of these results to search for any damage to the intestinal wall - damage will only be evident in the case of coeliac disease as, although gluten intolerance is incredibly uncomfortable and at times, painful, it doesn't cause any permanent damage to the internal organs.
A biopsy is carried out in hospital. This involves a gastroenterologist inserting a small, flexible tube, medically known as an endoscope, into your mouth and down to your small intestine to look for damage. The gastroenterologist will also pass a tiny biopsy tool through the endoscope to take samples of the lining of your small intestine, which will then be examined under a microscope for signs of coeliac disease. Again, if the result is negative, then gluten intolerance is the likely culprit for your digestive issues.
Many people are undiagnosed as they simply put the stomach discomfort (and other symptoms) associated with gluten intolerance down to Irritable Bowel Syndrome (IBS), but getting a diagnosis of gluten intolerance can help because, unlike IBS, you will know what foods to rule out to avoid the symptoms.
If you are diagnosed as gluten intolerant then it's important to avoid bread, pasta, breakfast cereal, pies, biscuits and cake.
Gluten is also often present in other food items such as:
Words to look out for on food labels are:
- Gluten (obviously)
- Bulgar wheat
- Durum wheat
- Emmer wheat
- Modified wheat starch
- Modified food starch
- Caramel color
Living without gluten in your diet can initially be quite daunting as you will find that you have to check the food labels on every item you eat, but after a while it will become a routine for you, and you will begin to know what you should avoid.
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