In an interview for nikaMag, doctor Ewa Jakubowska explains who should avoid gluten, what side effects it may cause, and whether gluten-free always means healthy.
The gluten-free diet is fashionable, especially in large cities. In 2012, the American weekly " Time" recognized it as one of the most popular nutrition trends. More and more people around the world are starting to avoid gluten. There are also more and more critical voices saying that "no gluten" is pure marketing. Doctors and nutritional experts often say that wheat flour should only be avoided by people diagnosed with celiac disease . It is a rare autoimmune disease that makes us gluten intolerant. Others sometimes argue that gluten is not a poison, just an ordinary vegetable protein contained in wheat and its varieties. And by the way - it is even beneficial because it makes the dough elastic and the bread soft.
We talked about whether gluten poses a threat to our health with a doctor, internal medicine specialist Ewa Jakubowska , who studies the relationship between diet and chronic and autoimmune diseases. She runs the blog poznajeczenieszkodzi.pl and is the author of e-books, among others. “Non-celiac gluten sensitivity. A disease that does not exist?", "Gastrointestinal tract and immunity", "How to follow a gluten-free diet properly".
Ewa Jakubowska: Unfortunately, the answer to this question is not as simple as we would like. Gluten certainly harms people with celiac disease, wheat allergy and non-celiac gluten sensitivity . According to available data, about 1% of people suffer from celiac disease, 0.1% from wheat allergy, and from 6 to 10% of people worldwide, depending on the source, from non-celiac gluten sensitivity. It turns out that statistically gluten may be problematic for up to one in 10 people . Professor Alessio Fasano* has shown that gluten opens tight junctions in the intestinal barrier in everyone, even in healthy people. This means that it violates its tightness. However, the duration of this disorder varies from person to person. It is the longest in people with celiac disease, the shortest in healthy people. It is not entirely known what the significance of this phenomenon is for healthy people. The problem, however, is to demonstrate which patient may benefit from a gluten-free diet. Hence, some specialists actually use a gluten-eliminating diet, of course after excluding celiac disease and wheat allergy. They want to observe what changes in patients' well-being or test results. On this basis, they assess whether gluten is the trigger of the disease and the source of inflammation.
Intolerance is any abnormal reaction regardless of the immune response. The concept of allergy is much narrower than intolerance. An allergy is an immediate hypersensitivity reaction , often involving IgE antibodies (like peanut allergy). Celiac disease is an autoimmune disease. To consider that we can safely consume wheat or other cereals containing gluten (such as rye or barley), we should exclude all three diseases - celiac disease, wheat allergy and non-celiac gluten sensitivity. The last one occurs most often.
So if you are asking about gluten intolerance, the answer should be: probably yes. I am writing probably because many cases of gluten-related diseases remain undiagnosed . In the case of celiac disease, it is even said that patients diagnosed with the disease are the tip of the iceberg. Only 1 in 8 people know about their disease . The wide spectrum of symptoms of gluten-related diseases often makes it difficult to make such a suspicion. And this is where any diagnostics begin. However, if someone suffers from any chronic ailments or diseases without an established cause, it may be worth following the trail of gluten-dependent diseases.
Unfortunately, all forms of abnormal reaction to gluten can be difficult to distinguish without specialized testing. But research sometimes does not provide a clear answer. We use serological tests. They involve demonstrating the presence of antibodies produced by the body against gluten elements (as in wheat allergy) or its own tissues (as in celiac disease) and gastroscopy with taking several samples from different places in the duodenum. The latter test is used to demonstrate changes typical of celiac disease: atrophy of intestinal villi, hypertrophy of crypts and an increase in the number of intraepithelial lymphocytes. We have the most problems with diagnosing non-celiac gluten sensitivity. There is no marker in this disease that would clearly confirm the disease. Therefore, in this case, we often use the gluten-free diet itself and its possible effects as a tool to help make the diagnosis.
Indeed, the most typical symptoms are related to the digestive tract. They often concern patients diagnosed with irritable bowel syndrome. However, doctors and researchers dealing with gluten-dependent diseases observe that gastrointestinal symptoms occur less and less often . More often, these may be symptoms of malabsorption : iron deficiency anemia, osteoporosis or growth retardation, neurological, psychiatric, skin symptoms or fertility disorders.
The spectrum of diseases accompanying or complicating gluten-dependent diseases is very wide. These may be autoimmune diseases, e.g. Hashimoto's disease, autoimmune liver diseases, type 1 diabetes or rheumatic diseases . Some of them constitute an official indication for testing for celiac disease. However, the list of publications describing the relationship between celiac disease and non-celiac gluten sensitivity with other diseases, such as allergies or hormonal disorders , is growing, although there are still no large studies on this subject. Nevertheless, it is worth taking this relationship into account, even if tests for celiac disease do not show anything. You can find a number of case reports in the database of medical publications proving the effectiveness of a gluten-free diet in some patients with autoimmune, neurological, psychiatric or skin diseases.
Certainly, a diagnosis of celiac disease requires following a strict gluten-free diet for the rest of your life . However, there is no clear answer in the case of non-celiac gluten sensitivity. Currently, it seems that this is such a heterogeneous disease that the situation of people with this problem may vary. Some of them require a strict gluten-free diet for the rest of their lives. For some people, it will be possible to reintroduce gluten into their diet in the future. Perhaps it depends on the existence of a genetic predisposition towards celiac disease and such people will have to follow a gluten-free diet permanently. It is also possible that this group of people will include some patients with undiagnosed celiac disease. For them, any trace amount of gluten in the diet will provoke a recurrence of systemic inflammation.
I think it is worth approaching the question not only in the context of the amount of gluten, but also its quality . White wheat flour, which we usually consume the most, is devoid of the fiber and vitamins present in wholemeal flour. However, it contains a lot of simple carbohydrates, which have a negative impact on the carbohydrate metabolism. Therefore, the described diet plus fiber deficiency and a sedentary lifestyle may contribute to obesity and metabolic disorders. But this problem may also occur with a gluten-free diet, if our diet is based mainly on highly processed products with a high proportion of simple sugars and trans fats. At the same time, we also eat little fresh vegetables, fruits, legumes, nuts and seeds, which are a source of fiber and microelements important for health. That's why I caution you against thinking that gluten-free means healthier.
However, if gluten does not harm us, it is worth reaching for whole-grain cereal products. But quantity also matters, precisely because of the large proportion of carbohydrates. It is also worth knowing that many highly processed, packaged products contain hidden gluten (e.g. sweets or cold meats). This causes us to eat it much more often than we are aware of. Based on Professor Fasano's discovery, we know that gluten causes a leaky intestinal barrier even in healthy people. Therefore, if we consume it almost every moment (in meals and snacks), the intestinal barrier has no chance to regenerate . This may lead to the passage of food antigens or bacterial fragments to the other side of the barrier, stimulating the immune system and chronic inflammation . Therefore, it is worth taking into account both the quality and quantity of gluten in the diet .
* Dr. Alessio Fassano is a world-famous gastroenterologist, pediatrician, visiting professor at the Harvard Medical School, founder of the Celiac Disease Research Center at Massachusetts General Hospital in Boston - the first research and treatment facility in the USA that specializes in celiac disease, grain allergy and hypersensitivity for gluten.
Napisała: Hanna Borowska
Editor, journalist, science writer, certified nutrition consultant. Motherhood made her interest in health issues change the direction of her professional path. She has completed several trainings and courses in Poland and abroad in the field of dietetics, functional medicine and aromatherapy. She is passionate about the unexplored power of the human microbiome. She graduated with honors from the Faculty of Journalism and Political Science at the University of Warsaw. For many years associated with Euroradio.fm.
Gość: Ewa Jakubowska
The nikalab capsule impresses not only with its appearance, but also with its operation. We used two innovative...
Twoja opinia może zostać wykorzystana w naszej reklamie. Przeczytaj więcej w naszym Regulaminie. Także w opiniach dbamy o transparentność. Weryfikujemy czy pochodzą od regularnych klientów (nie osób z nami współpracujących) oraz czy są zgodne z przepisami prawa mającymi na celu ochronę konsumentów.
