Supermarket shelves are being stacked with more and more gluten-free products. For non-coeliacs, are they a healthier option or just another fad?
My housemate arrived home with takeaway food the other night. Two hours later he was doubled over in pain. It seems he wasn’t taken seriously when he told restaurant staff he suffered from coeliac disease (pronounced seel-ee-ak) and couldn’t eat gluten. That night he suffered headaches, loss of vision, bloating and diarrhoea.
Gluten can be hidden in many unsuspecting foods such as sauces, confectionery and beer, and for those with coeliac disease (CD), it’s toxic. Coeliac disease is autoimmune, which means the body produces antibodies – in response to gluten – that attack its own tissues.
If the disease isn’t treated, the small intestine can be damaged, which can lead to serious problems such as nutrient deficiencies.
People with coeliac disease do not have a problem with the whole gluten molecule; it is the prolamine fraction that causes the trouble. The prolamine fraction has different names in the different grains, so in wheat it’s gliadin, in rye it’s secalin, in barley it’s hordein and in oats it’s avenin.
ENVIRONMENTAL OR INHERITED?
The disease is estimated to affect at least 1 in 100 Australians, or nearly a quarter of a million people. Seventy-five per cent of those are not currently diagnosed. The condition has had a four-fold increase in its prevalence over the past 50 years.
Associate Professor Andrew Day from Christchurch Hospital, says proper diagnosis is crucial. “Definitive diagnosis involves a biopsy of the small intestine, showing tissue damage. To develop CD you need to have a particular combination of genes. In this way, CD can be seen as an inherited condition, but it is not congenital [which means it starts from birth].”
The influence of genes can be seen in studies of twins, with identical twins almost always both developing CD. Within a family of someone with CD, the first-degree family members have about a 10 per cent risk of also developing it.
“Unfortunately, people with CD remain sensitive to gluten throughout their life; they are never cured of the disease. The good news is, once gluten is removed from the diet, the small bowel lining steadily repairs and the absorption of nutrients from food returns to normal,” says Day.
NEW HOPE FOR COELIACS
In the most progressive research to date, scientists from the Walter and Eliza Hall Institute of Medical Research in Australia have identified the three protein fragments that make gluten, thereby opening the way for a new generation of diagnostics, treatments, prevention strategies and food tests for the millions of people worldwide with coeliac disease.
Dr Bob Anderson, head of the coeliac disease research laboratory at the Walter and Eliza Hall Institute of Medical Research, says it had been 60 years since gluten was discovered to be the environmental cause of coeliac disease. “Since then, research has focused on identifying the toxic peptide components of gluten and that’s exactly what we’ve done.”
The research, which is a joint initiative between Monash University and the University of Melbourne, was kicked off by Dr Anderson almost 12 years ago and has involved researchers in Australia and the UK. Anderson explains, “What we hope to do is design a method whereby coeliacs can enjoy a traditional menu.” They are currently trialling a drug that switches off the immune response, which, if successful, could hit the market in five to six years. “It’s the first time anyone has produced a drug to cure CD, with the objective of replacing the gluten-free diet,” he says.
Anderson explains a gluten-free diet is not ideal: “It’s low in fibre and iron, making it complicated to get the nutrients you need, and it’s relatively high in fat because fat is used as a binder instead of gluten.”
Dr Sue Shepherd has written five gluten-free cookbooks including The Gluten-free Kitchen (Penguin Australia, 2009). Founder of the Irresistible Gluten Free Show and a coeliac herself, Shepherd says gluten-free foods are not for everyone: “If you don’t have coeliac disease the diet is not recommended.”
Shepherd puts the popularity of the gluten-free food movement down to “an increased awareness of CD, irritable bowel syndrome, and also other conditions that have reported anecdotal improvement with a gluten-free diet, such as in people with attention deficit hyperactivity disorder, autism, chronic fatigue syndrome, multiple sclerosis, and other autoimmune conditions”.
Dr Robert H Loblay, director of the Allergy Unit at Royal Prince Alfred Hospital in Sydney agrees a gluten-free diet is not recommended for the general population. “If a person doesn’t have allergies or CD there is no benefit; quite the opposite actually – it limits your diet,” he explains.
Senior nutritionist Aloysa Hourigan from Nutrition Australia concurs: “A gluten-free diet can be nutritionally balanced, but it can tend to be a bit low in wholegrain fibres and B-group vitamins,” she says. Hourigan advises that “people seek help from a dietitian to ensure a nutritional balance is reached. This is especially important for growing children,” she says.