By Joe Wright, APD


If you are avoiding breads and cereals or anything you perceive as having gluten in it because you believe gluten is bad for you; this may not be the smartest choice for you and your family. If you have not been diagnosed with coeliac disease or a gluten intolerance, there is NO reason to avoid gluten containing products! Too often I see patients who are avoiding these foods for no other reason than they believe that gluten is bad for you.





Gluten is a protein found in bread and cereal products that contain wheat, barley, rye, spelt, triticale and possibly oats (Wahlqvist, 2011). When fats/shortenings are added during the bread making process they react with the gluten matrix which serves to break it apart and allow for individual dough particles to separate (in conjunction with carbon dioxide bubble formation by yeast and sugar) and create the honeycomb structure observed in breads. Therefore, gluten free bread is found to be denser as the flour used does not contain the gluten protein – for example the dense loaves created when using rice flour (Wahlqvist, 2011). Once the gluten is consumed it enters the digestive tract and is denatured and broken down by protease enzymes and absorbed normally like any other protein would be. However, those with coeliac disease have a very different reaction when consuming gluten.



In individuals that have coeliac disease, when these proteins enter the gastrointestinal tract (GIT) they are not broken down. Instead they remain intact where they cause an autoimmune reaction with lumen (lining) of the small intestine (Coeliac Society Australia, 2017). Lining the whole of the small and large intestines are small finger-like projections called villi and even smaller projections on them called microvilli. The villus serves to increase the surface area of the GIT lumen to enable greater efficiency of absorption of macro- and micronutrients. However, in people with coeliac disease, the presence of gluten causes an immune response which flattens and inflames the villi (villous atrophy) and therefore decreases the surface area available for absorption (Coeliac Society Australia, 2017). As a result, the bulk of the consumed food remains in the GIT lumen which leads to osmotic (food bulk drawing water into the bowel) diarrhoea; bloating caused by bacteria feeding off the food and creating gas; and malabsorption. This leads to patients presenting with symptoms such as unintended weight loss, lethargy (lack of energy), nutritional deficiencies, GIT upset, diarrhoea and mouth ulcers. If untreated patients can develop conditions such as weak bones (osteoporosis), diabetes, pregnancy difficulties, anaemia (low iron), cancer, poor teeth patency and depression (Coeliac Society Australia, 2017). This is why early diagnosis and intervention is so important to stave off long-term complications as outlined above.



The Coeliac Society (www.coeliac.org.au) is the leading support and research group within Australia. They have found that people are born with a genetic predisposition to gluten intolerance and this disease can affect both men and women of all ages (Coeliac Society Australia, 2017). To be diagnosed with coeliac disease a patient is first given a genetic blood test. If they test positive for the causative genes they undergo a small intestine biopsy as well as a ‘gluten challenge’ whereby the patient is to refrain from consuming gluten containing products for approximately a month then having them try a food known to contain gluten and record the reaction. If the individual tests positive to both the challenge and the biopsy they are diagnosed as having coeliac disease (Coeliac Society Australia, 2017). Once diagnosed the only treatment option available is a life-long avoidance of gluten containing foods. This is where seeking advice from a dietitian is required so the person can increase their knowledge of foods that contain gluten and skills in label reading. It only takes a minute amount of the gluten protein to cause symptoms which is why a strict gluten free diet is the best treatment for the disease (Wahlqvist, 2011).



Here is where I get slightly frustrated with the media and uninformed individuals that are promoting a ‘gluten free revolution’ as if gluten is the cause of all your problems. Don’t get me wrong, the availability and recent increase in gluten free products is a great thing to enable people with coeliac disease to live an easier and more convenient life. However, when I hear of people avoiding gluten for reasons such as weight loss or the perception that it is an unhealthy part of breads and cereals all I see is the ignorance of the consumer and the opportunism from vendors spruiking gluten free products to make a quick buck. According to an article published by Australian Food News the gluten free market share has risen from an estimated US$1.2 billion in 2010 to US$4.3 billion in 2015. This is an increase of around 330% over five years (Eckersley, 2010). Compare this to the findings of the Coeliac Society which reports that only 1 in 30 (<1%) Australians have coeliac disease and this prevalence rate has remained relatively the same over time (Coeliac Society Australia, 2017). Moreover, the Australian Bureau of Statistics findings that 2.5% of the population reported avoiding gluten (the second most prevalent food aversion behind cow’s milk protein intolerance) (Australian Bureau of Statistics, 2014). The increase in people avoiding gluten containing products is disproportionate to the actual prevalence of the disease which means that people are avoiding breads and cereal products for unfounded reasons.



Breads and cereals is the core food group that contains gluten. The National Health and Medical Research Council (NHMRC) recommends that adult men and women between the ages of 19-50yo should be consuming 6 serves of breads and cereals per day (preferably high in wholegrain and cereal fibre varieties) with carbohydrates to make up between 45-60% of total macronutrient intake daily (NHMRC, 2015; Wahlqvist, 2011). By avoiding bread/cereal products you are potentially missing out on crucial nutrients such as protein, thiamine, niacin, iron, zinc, folate, copper, magnesium, 20% of our daily fibre and calcium and over one-quarter of our daily manganese intake (O'Connor, 2012). All of the nutrients are required for the normal healthy functioning of the body. Gluten free products in general are lower in the beforementioned nutrients and a misguided cessation of these staple breads and cereal products would be ill-advised and potentially detrimental to your health.



In closing ask yourselves this – have I had any symptoms from eating bread/cereal products? If no, then DON’T stop eating these important staples! Carbohydrates are so very important in a healthy balanced diet and are the main source of energy for the body. If you believe that you do have a gluten intolerance please seek medical advice and start the diagnosis process. This is important because the symptoms associated with coeliac disease are similar to other disorders and if they are not properly explored you are only delaying treatment of your ailment. Lastly, if you are talking to someone who is telling you all about the health benefits of a gluten free diet you now have the basic knowledge to refute this misinformed claim and start spreading the truth about gluten. Gluten is not bad! It is simply a component of the structural make-up of breads and cereal products and should only be avoided by those diagnosed with coeliac disease in conjunction with the advice given by an Accredited Practicing Dietitian (APD) or a doctor. So, with this information I say - go out and enjoy your carbohydrates safe with the knowledge that they are not harmful to the majority of the population.



References

Australian Bureau of Statistics. (2014, May 9). 4364.0.55.007 - Australian Health Survey: Nutrition First Results - Foods and Nutrients, 2011-12 . Retrieved from ABS: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007~2011-12~Main%20Features~Food%20avoidance%20due%20to%20allergy,%20intolerance%20or%20ethical%20religious%20reasons~600


Coeliac Society Australia. (2017). Coeliac Disease. Retrieved from Coeliac Australia: http://www.coeliac.org.au/coeliac-disease/


Eckersley, N. (2010, July 13). Global gluten-free market set to grow. Australian Food News. Retrieved from http://www.ausfoodnews.com.au/2010/07/13/global-gluten-free-market-set-to-grow.html


NHMRC. (2015). Healthy Eating for Adults. Canberra, ACT, Australia: NHMRC.

O'Connor, A. (2012, August 15). An overview of the role of bread in the UK diet. British Nutrition Foundation, 37(3), 193-212. doi:10.1111/j.1467-3010.2012.01975.x


Wahlqvist, M. L. (2011). Food & Nutrition - Food and Health Systems in Australia and New Zealand (3rd ed.). Crows Nest, NSW, Australia: Allen & Unwin. Retrieved 20