Being gluten free is certainly more popular than in previous decades, but is it just a trendy fad?
I would categorise patients into three groups: coeliac, gluten intolerant, and gluten vulnerable. The first group offers no controversy. Coeliac disease is an auto-immune disease where there are antibodies created to the protein component of wheat, barley, oats and rye. This causes severe damage to the small intestine and demands a lifetime of strict avoidance of all products containing gluten even if the amounts are tiny.
Gluten intolerant patients have negative tests for coeliac disease but suffer from bloating, abdominal pain and bowel disturbance (diarrhoea or constipation) when they eat gluten containing food. Because gluten is a protein which is quite dense and hard to digest, these people develop symptoms when eating variable amounts of such foods. A therapeutic trial of strict gluten avoidance will provide relief from symptoms within two weeks, and I frequently suggest such a trial since this will inform future food choices.
I am in the third group. I did not suffer from any gut symptoms when I ate gluten but over the years have become convinced that my health and longevity demands avoidance of gluten. We now know that gluten increases the amount of an intestinal cell regulator called zonulin. Zonulin increases the permeability of the lining of the gut and allows diffusion of various particles across into the gut, where there is a large collection of immune tissue. Over time these particles may look similar to part of a cell in the body, such as the thyroid cell. The immune system may then be activated to create antibodies to the particle which attacks native cells or proteins in the body. This is very new research and I find it quite convincing. For me, it is a very small compromise to avoid gluten!!