The most popular claims now on Australian foods advise us that an item is gluten-free or free from a particular ingredient or additive. According to one of Australia largest supermarket chains, 40% of shoppers currently seeks gluten-free foods. Should you as well?

Coeliac disease
If you have coeliac disease, the short answer is yes, you do need to be eating gluten-free foods. In coeliac disease, your own immune system reacts abnormally to the protein gluten found in wheat, rye and barley (and it is a common contaminant in oats), causing damage to your small intestine. The tiny finger-like projections known as villi that line the small intestine become inflamed and flattened, reducing the surface area of the intestine that can absorb nutrients and possibly leading to various gastrointestinal and digestive symptoms such as diarrhoea and/or constipation; large, bulky and foul stools; unwanted weight loss or poor growth in children; flatulence; abdominal bloating, distention or pain; and anaemia.

Long-term complications can be very serious and include infertility, miscarriage, depression and dental enamel defects. There is also an increased risk of developing certain types of cancer, such as lymphoma of the small bowel.

If you have a family history of coeliac disease, some or even all of these symptoms, it’s important that you don’t self-diagnose coeliac disease and commence a gluten-free diet. A diagnosis of coeliac disease can only be made after confirming typical villous atrophy on a small-intestinal biopsy. This involves a gastroscopy procedure where several tiny samples of the small bowel are taken and examined. Importantly, you must still be eating gluten regularly before the procedure or you may get a false negative result.

Coeliac disease is becoming increasingly common, affecting around one in 100 Australians. More are being diagnosed with coeliac disease due to both better diagnosis rates and a true increase in incidence for still unknown reasons.

Coeliac disease and diabetes
For reasons yet to be completely understood, people with type 1 diabetes are at much greater risk of developing coeliac disease than people without it (up to 10 times greater; or one in 10 people with type 1 diabetes). Both coeliac disease and type 1 diabetes are thought to be autoimmune diseases that are triggered in genetically susceptible people by unknown environmental factors.

Coeliac disease can make management of blood glucose levels harder than usual in people with type 1 diabetes, with increased risk of both hyper and hypoglycaemia. People with type 2 diabetes or pre-diabetes are thought to have the same level of risk as the rest of the population.

Is gluten intolerance coeliac disease?
Some people believe that they are sensitive to gluten, although small-bowel biopsy results show that they don’t have coeliac disease. When people with gluten intolerance avoid gluten, their gastrointestinal symptoms generally improve. However, a recent Australian study suggests that people with so-called gluten intolerance may not actually be sensitive to gluten, their gut symptoms may be due to other dietary factors, especially fermentable, poorly absorbed short-chain carbohydrates (i.e. FODMAPS or oligo-, di- and monosaccharides and polyols) found in a wide range of foods. Rather than avoiding gluten, these people may instead benefit from a diet low in FODMAPs.

Gluten-free foods
A gluten-free diet is currently the only known treatment for coeliac disease and unfortunately it is for life because sensitivity to gluten can never be cured as such. By removing the cause of the disease, a gluten-free diet allows the small bowel lining to heal and symptoms to resolve. As long as gluten is avoided as strictly as possible, problems arising from coeliac disease should not return.

Previously, a gluten-free diet was a culinary disaster. Thankfully, the food industry has stepped up to the proverbial plate and there is now a gluten-free alternative for most of your favourite foods. Fortunately, many gluten-free core foods such as milk, yoghurt, some starchy vegetables, legumes and most fruits also have a low GI. However, many gluten-free grain alternatives aren’t low GI, so finding gluten-free breads, pasta, breakfast cereals, etc. can still be a challenge.

Lower-GI gluten-free foods
Grains

• Buckwheat
• Cellophane noodles
• Corn tortilla*
• Some rice varieties (e.g., SunRice Low GI Brown rice or SunRice Low GI White (formerly Doongara Clever rice))
• Rice vermicelli
• Soba noodles
• Quinoa
• Wild rice

Breakfast cereals

• Buckwheat kernels
• Rice bran
• Some mueslis

Fruit

• Most fresh, frozen, dried or canned* fruits
• 100% fruit juices

Vegetables

• Butternut pumpkin
• Carisma potatoes
• Sweet corn
• Taro
• Yam

Legumes

• Dried and canned* beans, peas, lentils, chickpeas

Dairy and soy

• Low-fat ice-cream*
• Low reduced fat milk
• Low/reduced-fat soy milk*
• Low-fat pudding, pudding mix
• Yoghurt*

Snack food

• Plain popcorn
• Nuts
• Dried fruit and nut mixes*
• Sunflower and pumpkin seeds*

*May contain gluten but gluten-free brands can be found

Conclusion

If you are at risk, or have any of the symptoms, discuss coeliac disease with your doctor as soon as possible. If you are diagnosed, see your local Accredited Practising Dietitian for practical advice so that you can avoid gluten without ruining your enjoyment of food or spending too much.

Symptoms associated with so-called gluten intolerance may in fact be due to FODMAPs. If small-intestinal biopsy excludes a diagnosis of coeliac disease, but you experience gastrointestinal symptoms, see your Accredited Practising Dietitian about trialling
a low-FODMAP diet rather than avoiding gluten.

Unless you have diagnosed coeliac disease, or require a low FODMAPs diet, you probably don’t need to be avoiding gluten, and as such do not need to purchase gluten free foods.

Dr Alan Barclay BSc, GradDip, PhD is Chief Scientific Officer at the Glycemic Index Foundation

This article was originally published in Conquest Magazine published by Health Publishing Australia