This article was submitted to Wellness Adelaide by Danielle Elliott of Tummy Rescue. Tummy Rescue can help rescue you from those embarrassing and uncomfortable tummy issues, using food, supplements, lifestyle and testing to free you. Gluten-Free Adelaide
So you think it could be gluten?
So you have been experiencing symptoms, they may be related to digestion like diarrhoea, constipation, bloating or pain. Or you could just be really tired, feeling run down and having recurring mouth ulcers. Maybe someone you know suggested you should avoid gluten and see how you go. Either way there are some important steps you should follow, if you suspect gluten might be responsible for your symptoms.
You might think that getting rid of all your gluten containing food and researching all the new things you can eat would be your first step. STOP. KEEP EATING GLUTEN PRODUCTS. (Coeliac Australia) Hang on, wait a minute… this is weird advice, especially coming from a naturopath like myself. “Aren’t we meant to hate gluten and put everyone on a gluten free, dairy free and sugar free diet?” Well let me explain why you shouldn’t abruptly stop eating gluten when you strongly suspect it might be causing your health issues.
If gluten was the cause and your doctor or health care practitioner suspect you have Coeliac disease (CD), the first thing they will want to do is send you off for some simple blood tests. CD is an autoimmune condition, which means your body attacks self, in other words your body turns against itself and damages or destroys your cells. This is because in autoimmune conditions there “is a switch that is flicked” and the body sees its own cells as an enemy. The blood tests you are sent for, will be detecting if there are any antibodies (proteins found in the body that tag cells, viruses and bacteria that need to be destroyed) for gluten or for the cells found in the small intestine. This is what the body sees as an enemy in CD. If you are eating gluten and you have CD then your body will be making plenty of antibodies to gluten and to the cells in the small intestine (which end up being attacked and damaged, this is called villous atrophy- see picture).
Villi (small finger like projections) line the inside of the small intestine and increase the surface area for absorption and digestion to take place.
Healthy villi Damaged villi as they can appear in Coeliac disease
Picture 1- Illustration of what healthy villi look like as compared to damaged villi in CD. As you can see they are much smaller and inflamed. This damage hugely affects the small intestines ability to do its job of absorbing food due to the decreased surface area.
When you go on a gluten free diet, you will stop making antibodies, the ones present will be broken down and healing will take place. Even if you just decrease gluten in your diet, the antibodies may drop below detectable levels. So you could have CD, be tested while on a gluten free diet and have a negative test result to the antibodies (as they are not being produced) and you would be told you do not have CD. So this is a case of having a false negative result. You can see how this would be quite dangerous. You get told you do not have CD, so you possibly go back to including gluten, all the while causing more damage to your gut, leading to swelling and inflammation, which can then lead to other complications and/or any of the related conditions.
The other danger I see in just going on a gluten free diet, is that it can delay people being diagnosed for another reason. I have spoken to many people who go on a gluten free diet and feel better, and then of course as their symptoms improve, they don’t want to reintroduce it in the amounts needed for correct testing. They believe (I am not sure why) that they don’t have CD they just have Non- Coeliac Gluten Sensitivity and have said things like…. “that’s fine I’m happy to stay on a gluten free diet”. So they stay on a gluten free diet (mostly), because they don’t think they have CD, they think the occasional beer or cupcake won’t hurt. In CD eating gluten causes damage that can take a year to completely heal, in Non-Coeliac Gluten Sensitivity there is no damage to the cells. If you believe (possibly falsely) that you don’t have CD you just have a sensitivity, then you could spend years doing damage to your gut and ultimately the health of your entire body. Because if you don’t think you have to be 100% gluten free for ever, then you probably won’t be.
The amount of gluten you must consume to have reliable blood test results, equates to eating 4 slices of bread for adults and 2 slices for children for at least 6 weeks. (Coeliac Australia) This could also include things like crackers, pasta or baked goods.
If you were to have a positive result to either the gluten antibodies or to the small intestine cells, then your doctor would refer you to a Gastroenterologist (doctor who specialises in digestive conditions) to have a small bowel biopsy. This is a procedure that verifies without a doubt the presence of CD. It involves being sedated and having a camera and tube inserted down the oesophagus, through the stomach and into the small intestine (see picture 2). Here very small samples are taken to verify under a microscope if there is damage done to the cells that is consistent with CD. If these tests come back negative, then at least there can be further investigations done to rule out other medical conditions, that could need treatment.
Picture 2-Our food moves from our mouth to our stomach and then makes its way to the small intestine which is where gluten reacts with the immune system in CD and where the damage to the lining takes place. This is where the small samples will be taken from.
When I see many patients in clinic that have suspected gluten could be causing their problems, I always think about ruling out CD first, or ask if they have already had this done & were they eating enough gluten at the time. When the figures are showing that 4 out of 5 people that have CD do not know (Coeliac Australia), it’s a great place to start. Especially since CD does not have clear cut symptoms, some do not have any digestive symptoms and some people do not have any symptoms at all. It is not a disease that you want to leave undiagnosed for years, especially when you consider some of the complications possible are thyroid disease, Type 1 diabetes and even bowel cancer. (Coeliac Australia)
Some patients report they have been on a gluten free diet and it didn’t seem to help. In these cases I sit down and check if their gluten free diet was 100% complaint or was it just heavily gluten reduced. This is extremely important, as the only treatment for CD is a 100% gluten free diet.
As CD has such a variety of symptoms, they do cross over with other conditions. This is why correct diagnosis can be difficult and also why it is super important. I highly recommend that you seek the advice of a health professional who has extensive knowledge in digestive conditions and who can refer you for testing and guide you through the steps to correct diagnosis.