Five years ago, if you asked a stranger on the street what gluten is and you might have been met with a blank face. Ask again today and they’ll probably tell you they’re intolerant, or that they know someone who is.
According to Coeliac UK, 1.3m Brits are following a gluten-free diet. But what actually is a gluten intolerance? And how do you know if you have it?
‘Gluten is the main protein in wheat grains as well as rye and barley,’ explains Dr Megan Rossi, registered dietician and Research Associate at King’s College London. ‘It’s a mixture of hundreds of related proteins, but the two main types are gliadin and glutenin.’
The exact reason it triggers a reaction in some people is unknown – but there’s a huge amount of research underway to find out more about what’s known as non-coeliac gluten sensitivity.
According to Rossi, if you experience any of the following symptoms after eating food containing gluten, you should make an appointment with your GP to discuss them:
- Digestive issues like bloating, gas, diarrhea or constipation
- Brain fog, fatigue or excessive tiredness
- Rashes and itchy skin
‘The symptoms can differ from person to person, but it’s important to note that they overlap with many other conditions like IBS, which is much more common than gluten intolerance. In reality, only 1-6% of people are thoughts to actually have an intolerance to gluten or other proteins in wheat.’
While it’s worth visiting your GP to rule out coeliac disease – an auto-immune disease that affects around one in 100 people in the UK – there are no specific diagnostic tests for non-coeliac gluten sensitivity.
And because there’s so much cross-over with other digestive conditions like IBS and even non-digestive conditions like Generalised Anxiety Disorder, it can be hard to pinpoint what is actually causing your symptoms.
Doctors suggest making a note of what you eat and how your body responds in a food diary. But even if you do find your symptoms come on after eating gluten, it could be that they’re caused by something else altogether.
‘Gluten gets a bad rap, but in my experience, it may be FODMAPs – short-chain sugars found in wheat rye and barley – rather than gluten that are causing the problem for many people experiencing tummy symptoms when they eat foods like bread and pasta,’ says Laura Tilt, registered dietitian. ‘Our tolerance for these sugars can change according to things like genetics, age, and the balance of bacteria in our guts.’
If you’ve spoken to your GP, kept a food diary and feel confident that you have an intolerance to gluten, you can try eliminating it from your diet.
According to the Celiac Disease Foundation, foods that contain gluten include:
- Pastas like ravioli and gnocchi
- Noodles like ramen, udon, soba chow mein and egg noodles
- Grains like cous cous and tabbouleh
- Breads, pastries and baked goods like croissants, pitta, naan, bagels, flatbreads, muffins, doughnuts, cakes, cookies and rolls
- Cereal and granola like porridge oats, corn flakes and rice puffs
- Breakfast foods like pancakes, waffles, french toast, crepes and biscuits
- Condiments like mayonnaise, ketchup, soy sauce, gravy,
- Meats and bread variations like sausages, baked beans, hot dogs, breadcrumbs, croutons and stuffings
- Alcohol like vodka, beer (unless explicitly gluten-free) and any malt beverages.
If someone is testing a period of gluten exclusion, they’ll need to remove wheat, rye and barley and anything made from these cereals,’ says Tilt.
‘The first step is to replace any food that you exclude with a gluten-free alternative – so swapping breakfast cereal for oats, pasta for rice or quinoa, or potatoes. Then add in foods that are naturally gluten-free – fruits and vegetables, dairy foods, meat fish and poultry and also pulses.’
We all know the obvious gluten-culprits, like bread, pasta and biscuits. But you’d be surprised how many products gluten is lurking in.
Be wary of any creamy sauces, marinades and gravies, as they may have been thickened with flour; processed meats like sausages, meatloaf, meatballs and other ground meat often contain wheat-based fillers; and many vegetarian alternatives, like veggie burgers and sausages also contain gluten in the form of seitan. There’s even gluten in soy sauce.
‘The best way to identify the foods that gluten is hidden in is to check the label – by law, cereals containing gluten must be highlighted on the food label with a different colour or font so they’re quite easy to spot,’ adds Tilt. ‘Free-from alternatives vary from the good to the not so good. Gluten-free foods can contain high levels of sugars, salt and fat, so always check the ingredients list.’
Those with coeliac disease will have it for life, and are advised to follow a strict gluten-free diet to avoid serious health problems later in life, like osteoporosis, infertility and small bowel cancer.
But for those who have non-coeliac gluten sensitivity, it’s worth reassessing your diet over time.
With food like bread, it could be that certain types trigger a worse reaction than others. Eating a white baguette might make you gassy, while you can demolish a sourdough pizza without any trouble.
‘When it comes to a gluten sensitivity, we don’t know for sure how much is okay and whether tolerance changes over time,’ adds Rossi. ‘With most intolerances eating small amounts is likely to be okay. But only you will know how the food you eat makes you feel. But only you will know how the food you eat makes you feel.’
Not gluten intolerant but struggling with bloated belly or other symptoms? Be sure to visit a doctor and read up on symptoms of IBS, instead.