When, why and how to go gluten-free

Gluten is a protein found in some grains, mainly wheat, rye and barley. “Oats don’t contain it naturally, but can be contaminated with it during processing,” says paediatrician and allergologist Dr Candice Royal*.

It’s vital to avoid gluten if you have a wheat allergy or coeliac disease – otherwise you risk serious illness, even death. But the reason most people today give for dropping gluten from their diets is ‘gluten intolerance’ or ‘gluten sensitivity’, also known as ‘non-coeliac gluten sensitivity’ – a subject of debate not only on social media, but among medical professionals.

• Wheat allergy involves your immune system, and has clear signs – if you ingest even small amounts, it can result in hives, swelling, vomiting, difficulty breathing, a drop in blood pressure and potentially fatal anaphylactic shock, reports the Allergy Foundation South Africa (https://www.allergyfoundation.co.za/).  You can be tested for allergy in a blood test or skin-prick test, says Royal. If you have a wheat allergy, you will need to strictly avoid any wheat ingredients in food. 

• Coeliac disease is an immune system disorder, possibly inherited, where ingesting gluten damages your intestines. "Your white cells see gluten as an invader and attack it and your tissues,’ says Lucille Cholerton, who runs the Coeliac Support Service. The damage caused affects your ability to absorb vitamins and other nutrients. Coeliac disease usually becomes apparent when you’re introduced to cereal as a baby. Signs signal poor intestinal absorption – slow growth, bloated tummy, wasted muscle, abnormal stools and niggly behaviour.  

Occasionally, however, coeliac disease develops in adulthood, or it’s only then that people seek help, when signs get worse, Cholerton says. These include weakness, fatigue, fluid retention, easy bruising, mouth ulcers, skin rashes, cramps, tingling in feet and legs, anaemia, nausea, constipation and general gastric complaints. If you experience these, it’s vital to get professionally tested and seek dietary guidance for a gluten-free diet for life. Without this, long-term complications can include cancers, chronic fatigue, even psychosis.

• Gluten sensitivity/intolerance (non-coeliac gluten sensitivity) is defined simply by people reporting symptoms after eating gluten, ranging from stomach pain, bloating, flatulence and diarrhoea, to headaches, eczema, fatigue, difficulty thinking clearly (‘brain fog’), bone and joint pain, weight change and depression – and then saying they feel better after cutting gluten from their diets. But it’s still not clear scientifically how gluten sensitivity works, and many health professionals suggest these people should rather be described as having ‘irritable bowel syndrome’, says Royal.

There is no reliable test for gluten sensitivity, so it’s usually diagnosed just by eliminating other possibilities. 

How to go gluten-free

A completely gluten-free diet means avoiding wheat (and wheat-based foods such as bran, spelt, durum and semolina), barley, rye, oats (unless labelled gluten-free), malt (beer) and brewer’s yeast. You also need to check for the presence of gluten in other foods, says Kerry-Ann Dolloway, a Durban dietitian with an interest in functional medicine. This means reading labels carefully and speaking to restaurant chefs. 

Gluten can lurk in baked goods, snack foods (like muesli bars, flavoured chips and pretzels), sauces, marinades and salad dressings. It’s easiest to eat unprocessed, single-ingredient foods.

But any diet that cuts out major foods can result in deficiencies, and one that’s gluten-free can be low in B vitamins, calcium, vitamin D3, iron, zinc, magnesium and fibre, Dolloway cautions. Not all gluten-free products are enriched or fortified, and they tend to be more expensive and have a higher glycaemic index. It’s possible, however, eat a well-balanced and nutritionally complete gluten-free diet with good results, she says. 

A gluten-free diet should focus on fresh foods, vegetables, fruits, protein (meat, fish and plain dairy), eggs, potatoes, rice, corn, sorghum, quinoa and gluten-free pastas, says Cholerton. "It’s an extremely healthy diet if you don’t lean towards the expensive baked goods you can buy, and if you add extra fibre with the likes of mixed seeds."

Before going gluten-free, however, it’s essential to consult a professional dietitian for advice on how to achieve a nutrition balance with appropriate supplementation.

*Dr Candice Royal is a paediatrician and allergologist at Royal Paediatrics and Allergy in Cape Town.

Also read: Everything you need to know about food intolerances

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