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Gluten/Wheat intolerance or Coeliac Disease?

It is all too common to hear people saying that they are "intolerant", "sensitive" or allergic to certain foods. At the top of the list are dairy, lactose, wheat, yeast, sugar, additives and gluten, but there are many others. 

The question is, why is this now so prevalent? Is it that there is actually a higher incidence of these conditions, or rather greater awareness leading to better diagnosis?

The answer is a bit of both.

Our love-hate relationship with grains

Take our relationship with grains for example. Our eating patterns have changed drastically throughout human evolution.

While primates thrive by running on carbohydrates, and have a naturally "sweet tooth", humans have learned to isolate and concentrate the sweetness from food, thereby cheating nature and putting pressure on our bodies.

One of the most common ways that we now eat carbohydrates is through grains and, more particularly, wheat. In fact, it is a staple food in the modern diet. This makes it harder to accept that it might not be good for us.

Previously, it was believed that sensitivities to gluten (a protein composite found in wheat and related cereals, including barley and rye) were relatively rare. However, recent research suggests that:

- gluten sensitivity affects as many as 1 in 10 people 
- coeliac disease (a more serious digestive disorder and auto-immune disease caused by intolerance to gluten) affects almost 1 in 100 people.

Why is this? Well, for one thing, our ancestors ate almost no gluten at all. The cultivation of grains started only about 10,000 years ago - a relatively short time in evolutionary terms. Even then, such cultivation was not widespread. In fact, gluten grains were only introduced to the American continent a few hundred years ago. The reality is, many of us have simply not yet genetically adapted to be able to tolerate grains.

Another important factor to note is that modern wheat is very different to that grown and consumed by our distant ancestors. For one thing, gluten now makes up as much as 78% of the total protein found in it. It is now well-understood that gliadin, one of the gluten proteins, is not only an intestinal irritant, but also causes allergic reactions.

Spotting a problem

Aside from the clear role of diet in the modern tendency towards these conditions, it is also true to say that there has been a steady increase in awareness of gluten intolerance and coeliac disease in recent years.

Unfortunately, both conditions can result in ambiguous symptoms which are difficult to diagnose and can be similar to one another, and those suffering with gluten sensitivity often experience no digestive symptoms at all. 

Under-diagnosis is therefore a significant problem - research suggests that around 500,000 people have not yet been diagnosed in the UK. A diagnosis can be made at any age, but the most common age range is currently between 40 and 60 years.

Encouragingly, national public awareness campaigns have led to a new focus on education in this area for doctors, nurses, dietitians and natural health practitioners. Similarly, there have been important developments in food labelling standards and the "free from" food industry.

If you suspect that you might be suffering from a gluten intolerance or coeliac disease, and/or are experiencing unpleasant symptoms when eating foods that contain gluten, it is important to speak to your doctor. If and when diagnosed, you can then take the appropriate dietary measures - including shaping your gluten-free diet.

More about gluten intolerance

A gluten intolerance results in gut symptoms similar to those of coeliac disease, but no associated antibodies are produced by the immune system. 

As already mentioned above, some people have a sensitivity to gluten but don't experience any symptoms at all. However, many do. These might include feeling tired or depressed. Other common symptoms include:

- upper respiratory tract problems (such as sinusitis)
- problems with nutrient absorption (resulting in, for instance, weight loss, anaemia and fatigue)
- digestive disorders (including diarrhoea, constipation, bloating, Crohn's disease and diverticulitis).

Research is ongoing into gluten sensitivity and new studies suggest that gluten may not be solely responsible for the symptoms produced by the condition. Instead, it seems likely that a group of short-chain carbohydrates (referred to as FODMAPs), are poorly digested and absorbed in the small intestine and could, therefore, also contribute to symptoms. Wheat, barley and rye (all gluten-containing grains) are all high in FODMAPs.

More about coeliac disease

Coeliac disease is a lifelong autoimmune disease, which is caused by the immune system reacting to gluten - it essentially attacks its own tissues through the production of antibodies, whenever exposed to the allergen.

Unlike a gluten sensitivity, coeliac disease is far more likely to result in inflammation to, and long-term damage of, the lining of the small intestine. 

The main function of the small intestine is the digestion and absorption of the nutrients in food. If coeliac disease goes undiagnosed, and therefore untreated, the cells lining the small intestine can become increasingly inflamed. They can also become flatter, resulting in a surface area that is significantly reduced. 

What this can ultimately mean for the individual, is less efficient nutrient absorption and therefore potentially malnutrition, deficiencies, weight loss, fatigue, digestive disorders and a strained immune system.

It is not entirely understood what causes coeliac disease, but it is now widely accepted that there are three key factors that underlie (or at least contribute to) its development:

- an environmental trigger (i.e. exposure to gluten)
- a genetic susceptibility
- an unusually permeable or 'leaky' gut.

In rare cases, stress on the body can also trigger the onset of the condition. For example, following an operation, accident, gut infection or pregnancy.

Just as is the case with gluten sensitivity, the symptoms of coeliac disease vary from person to person and can range from mild to severe. What's more, symptoms are not restricted to the digestive tract - they can present in other parts of the body.

Some of the most common symptoms include: fatigue, anaemia, diarrhoea, abdominal discomfort, weight loss, vomiting and mouth ulcers. Again, some people may show no symptoms at all.

Living with a gluten sensitivity or coeliac disease

While there is no known "cure" for these conditions, once diagnosed they are relatively easy to address by simply removing all sources of gluten from the diet. This is the primary treatment and is usually very successful.

It is important to note that, where there has been prolonged irritation of the gut and inflammation of the intestinal lining, it can take several months for the improvement of symptoms. The individual will therefore need patience and staying-power.

A gluten-free diet to address sensitivity or coeliac disease is therefore a lifelong commitment. Sticking to it can be difficult, particularly as gluten is present in a wide range of foods that are consumed on an everyday basis (and is also sometimes 'hidden' in ingredients). It therefore takes a bit of research and practice.

"Free from" diets such as these can have a tendency to become heavily restricted. While it is perfectly achievable to have a healthy, well-balanced and varied gluten-free diet, it is important to be proactive in your meal planning to ensure this.

Gluten-free supplements, such as nutrients-fortified gluten-free meal replacements, can offer excellent support on a daily basis. With high quality products, you can rest assured that you are accessing a broad spectrum of nutrients, with certainty that you will not be exposed to gluten.

GPs one symptom approach will fail allergic patients

According to new guidelines from the Royal College of GPs (RCGPS) patients are now only being allowed to discuss one symptom per 10 minute appointment despite often having to wait for up to a month to get an appointment Dr Stokes – Lampard head of the Royal College stated

“I am saddened that we have signs up in surgery saying ‘Your appointment is to consider one problem only “. Those signs sadden me because they are a sign of our flawed system and not the sign of an efficient healthcare system.”

This might be acceptable if the visit was for say a verruca or acne but for the allergenic patient it is totally unacceptable. If you have one allergy symptom there are comorbidities with other symptoms. Even twenty years ago in 1997 the Journal of Allergy and Immuniology reported asthma , rhinitis, conjunctivitis and eczema have comorbidity/ interrelated symptoms.  Since then allergy IgE and hypersensitivity non IgE have increased according to Professor Graham Devourex “Since about 1960, the prevalence of asthma and allergic disease has increased sufficiently to become a major public-health concern. Concurrently, there have been marked changes in our diet, and it has been proposed that these changes have contributed to the increase in the prevalence of asthma and allergy” .It is worth noting that this applies to both adults and sick children.

All this leaves the allergic patient who does not realise that their rhinitis and eczema may have a root cause severely compromised urgently needing to find a resolution to their distressing conditions. Allergy is an autoimmune and an inflammatory disease as are arthritis, hypothyroidism , Type 1diabetes and certain types of anaemia. In 2017 most of these conditions are increasing relentlessly.

Visiting the GP with only one symptom will probably result in different lotions for eczema and on the next visit nasal spray for a runny nose or maybe a different antihistamine . This approach has the effect of treating symptoms with a” sticking plaster”

Unfortunately for GPs and the NHS patients have access to the internet and can read the latest evidence based science covering such issues as the gut microbiome and desensitisation to peanut allergy . They can apply the research to their symptoms and rightly expect a multi symptom approach called “functional medical” to their health instead of a one symptom approach which one could think is almost reverting to the dark ages for patients . I wonder how long they will accept it ?

Marlene Hochstrasser


Digestive disorders and the bloat this January!

Still suffering from digestive disorders post festive season. Trying to understand and regulate your symptoms .  Help is at hand.

Most people, especially women, recognise that uncomfortable feeling when their stomach suddenly swells up like a balloon, often accompanied by stomach pain and flatulence. This may be triggered by, for example, eating the wrong kinds of food, stress, Digestive Disorders or a number of other factors.

Stomach bloating is actually a very common condition, which affects around 1 in 5 people on a regular basis. For many sufferers, this is just an accepted part of everyday life, because they are either too embarrassed to seek help or because they have had no luck in terms of a specific diagnosis of the root cause ie digestive disorders. Some others, who have suffered for a number of years, may simply start to believe that it is ‘normal’. It is not.

Bloating can be very unpleasant, as well as unsightly. Listen to your body – everyone experiences a bit of bloating from time to time, but if you are feeling bloated on a regular basis (and perhaps suffering with excessive wind, abdominal pain, constipation or diarrhoea) your body is trying to tell you something.

There is no need to simply accept bloating as an unwanted part of your life. Get to the bottom of what is causing it and then take action!

Some common causes of bloating

The first step in stopping bloating is identifying what causes it in your specific case – everyone is different.

The actual swelling of the belly associated with bloating is most often caused by gas in the bowel. However, when we talk about the cause of bloating, we are talking about what triggers this reaction.

Some common triggers include:

– high-fat, high-sugar diets (including high levels of refined carbohydrates and/or processed foods)
– excessive intake of inflammatory (acid-forming) foods or drinks, such as alcohol, caffeine, red meat or dairy
– food allergy or intolerance
– an imbalance of the good bacteria and harmful micro-organisms in your gut (including parasites, yeast, fungi and bad bacteria)
– digestive disorders, including chronic constipation, Irritable Bowel Syndrome (IBS) and leaky gut
– and a high toxic load (particularly in the digestive tract).

Many of these triggers are also connected or inter-dependent. For example, if your gut is inflamed or your bowels are sluggish, it can create the perfect environment for bacterial overgrowth (or dysbiosis). Similarly, food allergies or intolerances can contribute to gut permeability.

Poor diet

Considering that the digestive tract is the system through which we access nutrients and eliminate waste and toxins from the foods we eat, it is hardly surprising that diet plays a key role in the health of the digestive system and, in particular, the bowels.

For example, a high intake of sugar can place a great deal of stress on the body and increase gut toxicity, by feeding bad bacteria and yeast. This can in turn increase the amount of fermentation, which can lead directly to bloating.

In fact, abdominal bloating, constipation, diarrhoea, gas (both burping and flatulence) and IBS are all symptoms of a digestive system and liver overloaded with toxins.

Poor digestion

The average person consumes more than 25 tonnes of food over their lifetime! To avoid creating internal toxins, which can lead to symptoms like bloating, digestion must be efficient. In real terms, this equates to 1 – 3 bowel movements per day, depending on the amount of food eaten.

All too often, people eat too quickly because they are in a rush or feeling stressed – this is a bad start for the complex process of digestion.

Digestive enzymes, required for the complete break-down of food, are released at different stages of the digestive process. If food is not chewed thoroughly, the enzymes do not get a proper chance to act. Similarly, stress inhibits all enzyme secretion.

Hydrochloric acid also plays a key role in the digestion of protein in the stomach. Many people with poor diets and/or digestion suffer with indigestion (heartburn) on a regular basis. As such, they start to routinely take antacids and other stomach acid blockers – these people are unlikely to be digesting protein properly and may therefore experience abdominal bloating, reflux and burping.

It is also worth noting that, as we age, our levels of hydrochloric acid and digestive enzymes decline.

Food allergy / intolerance

If digestion is poor, or there is an imbalance in gut flora, or there are nutritional deficiencies or gut inflammation, what is known as ‘leaky gut syndrome’ can develop. This means that the intestinal lining becomes more permeable than it should be, allowing toxins and partially digested food molecules to enter the bloodstream.

This can place the immune system under immense strain and, over time, can contribute to the development of food intolerances and/or allergies that can produce wide-ranging symptoms. These commonly include bloating, abdominal pains, water retention, IBS, weight gain, cravings and fatigue.

In the majority of cases (upwards of 95% of cases), food allergies and intolerances develop over time, so that a food that you once tolerated well now makes you unwell.

Any foods that you are allergic or intolerant to essentially act like poisons in your body. Continuing to include them in your diet can create inflammation, further weakening your immune system. If you continue to eat these foods, your body will try to dilute them to minimise their harmful effects. This can, in turn, congest the lymphatic system, leaving you feeling puffy and bloated.

Imbalance of gut flora

It’s estimated that there are more than 500 different species of bacteria present in the human gut in concentrations of between 100 billion to 1 trillion microbes per gram. This amounts to around 95% of the total number of cells in the human body.

The naturally-occurring friendly bacteria in the stomach and intestines can quite easily be disrupted, resulting in an imbalance between the beneficial bacteria on the one hand, and harmful micro-organisms on the other (dysbiosis).

Such an imbalance of gut flora makes the body more vulnerable to the overgrowth of yeast (such as Candida albicans), fungi, parasites and harmful bacteria. The toxins produced by these micro-organisms, along with poorly digested food, a high-sugar diet and medication (like antibiotics) can all alter the intestinal pH, destroy good bacteria and then lead to bloating.

Digestive disorders

As mentioned above, as well as poor digestion, actual digestive disorders can play a significant role in recurrent bloating. Some examples are discussed below:-

Irritable Bowel Syndrome: Previously known as “mucous colitis” and “spastic colitis”, IBS involves the colon being held in spasm. The four main symptoms are bloating, stomach pain, excessive wind and altered bowel habits (diarrhoea may alternate with constipation and the condition is often accompanied with the sensation that the bowel is incompletely emptied). Discomfort is usually relieved on passing stool or wind. IBS is often linked to emotional factors (such as stress) rather than allergies / intolerances (although it is thought that cow’s milk and antigens in beef can precipitate the condition), with around one-third of cases being linked to diet. Women are more susceptible than men.

Bowel disease: Bloating is one of the symptoms of an inflamed bowel, which can be caused by a wide range of conditions, including Crohn’s disease and ulcerative colitis, as well as severe food sensitivity (as seen with coeliac disease, for example – an autoimmune disorder triggered by gluten intake).

Chronic constipation: Constipation can have a number of underlying causes, but if food is only partially digested (for instance because of a lack of digestive enzymes) and that food reaches the colon, it can putrefy and ferment. The problem is compounded if there is a lack of fibre and water in the diet. The longer food sits in the bowel, the longer gas-forming bacteria have to work, leading to bloating.

Stop bloating!

So, if you suspect that any of the above could be contributing factors to your bloating, how can you beat the bloat?

Well, a diet packed with natural whole foods (such as raw fruit and vegetables, rich in enzymes); quality dietary fibre; fermented foods (rich in probiotics); low in saturated fats, additives, preservatives, salt and sugar; and with plenty of pure water, is a great start!

Combine this type of well-balanced diet with regular exercise and you have one of the best ways to keep your digestive system healthy, regular and efficient, and therefore to beat the bloat.

You can also help to ensure healthy bowel function by:

– eating slowly and chewing well (to avoid fermentation, gas formation and therefore bloating)
– eating only when calm and relaxed (to encourage the secretion of digestive enzymes)
– supplementing your diet, as required, with high-strength, multi-strain probiotics, digestive enzymes and dietary fibre.

If you suspect that years of poor diet have resulted in a sluggish bowel or ‘hidden’ constipation (where, despite daily bowel motions, waste-matter actually sits in the colon for several days before elimination), a colon cleanse or full body detox may also be of benefit.

All the long-established dietary and nutritional therapies used down the ages recognise the benefit of regularly cleansing the system, starting with the colon. This can help to rid your body of accumulated toxins and therefore reduce the likelihood of bloating.


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