There are a lot of column inches written about gluten!
The question is, is it beneficial to cut out gluten or not? For those who really have a proven gluten allergy, the answer is yes. But for those who don’t, is it a fad or a clever move for a clean diet? Here are the answers from an expert dietician.
Those allergic to gluten have what is called coeliac disease.
They have a gluten intolerance, which is a chronic intestinal autoimmune disorder. For those people, only a gluten free diet is therapeutic. For others, it’s more of a fad which also sparks the curiosity of foodistas and celebrity chefs in a big way. When it’s necessary, it’s a great thing. When it’s not, there are grounds for wondering whether it’s justified. To make sense of it, here’s the lowdown with Sarah Marin-Maire, a dietician and co-founder of the site Make Me Healthy.
Why Sarah ?
Sarah Marin-Maire, a dietician, set up Make Me Healthy in 2016 with her friend Colette to offer the kind of ethically-sound diet adjustments that they would have liked to have found in the healthy eating maze. With a clear aim: to shed the stuffy image of the dietician. They met with great success! Make Me Healthy is staffed by a team of qualified dieticians who offer consultations by telephone and via their app (Apple Store and Google Play). Foodies from all walks of life will be happy to know that the experts offer more than 650 recipes in the app!
Is going gluten free a health and nutrition issue that you are concerned with?
I’m interested in all things nutrition, and the subject of gluten-free foods is something that I’m particularly invested in. Our role as dietician is to support consumers. And I’m making a point of using this term “consumers”, because the gluten-free product segment has grown massively over the past few years, leading to a drop in price. You can find them in organic and specialist shops and also in supermarkets, at more affordable prices than ten or so years back. This is something positive! However, fundamentally they were developed for those suffering from coeliac disease, and now they are marketed at anyone and everyone! Unfortunately, the messaging around these products leads us to believe that even in the absence of any disorder it’s best to avoid gluten for the sake of our health. So consumers need guidance, advice and support in this area.
So people find themselves tempted to cut out gluten even though they don’t need to?
Yes, which means eating a restricted diet for no reason. All the more since consumers are increasingly wondering about their diet and want answers. Unless you react badly to gluten, it’s better to steer clear of mass-produced processed products rather than those containing it!
In your view, who should go gluten free, and why?
A gluten-free diet is advised for those with a gluten intolerance. This is a disorder which must be diagnosed by a doctor. Coeliac disease is a genuine disorder which brings pain, complications and most importantly lifelong treatment with it. This chronic inflammatory autoimmune disease is caused by a food antigen (the gliadin in gluten). It is a lifelong disease, which therefore means lifelong treatment / dietary regimens for patients. The disease presents through atrophy of the villosities of the intestinal wall. This leads to hyperpermeability of the intestinal wall and causes digestive malabsorption. The symptoms of coeliac disease appear as soon as even a small amount of gluten is ingested. They include diarrhoea, tiredness, weight loss (in children, falling short of the body weight curve and rickets), anaemia and blood coagulation disorders (vitamin K deficiency). On top of this list of symptoms comes that of the disorder’s complications: osteopenia, osteomalacia, osteoporosis, deficiencies, malnutrition, lymphoma of the small intestine, stunted growth, etc. Coeliac disease sufferers don’t eat a gluten-free diet as a “lifestyle choice”. It’s essential, and they cannot under any circumstances deviate from it.
So is there a big difference between coeliac disease sufferers and those who go gluten free as a lifestyle choice? What do you advise for those who fall into each of these groups?
Yes there is, and our role is to support, advise and provide reassurance to coeliac disease patients. When the diagnosis is made, they feel bewildered because they lose all of their points of reference when it comes to their eating habits. We have to suggest an appropriate diet, tell them which foods to avoid completely, which ones are recommended and how to adjust their diet until they find that which suits them best.
For those who go gluten free as a lifestyle choice, even if we respect their choice, we remind them that this diet is for those with a genuine disorder. In addition, cutting out gluten brings a great many restrictions with it, because there is gluten in everything. This diet also impacts on social life: meals out, family dinners, meals with friends, etc. We see a great many patients who eat a gluten-free diet not as a lifestyle choice, but just because it’s a hot topic right now. Because a gluten-free diet is recommended all over at the slightest hint of an ailment, people think they are doing the right thing by embracing it.
Some people must be relieved to hear your diagnosis?
Yes! Imagine their relief when a dietician tells them that they can eat bread again, without risk of putting their health in jeopardy!
Is there a solution by way of a halfway house? A happy medium?
There is not really anything to be gained from eating a gluten-free diet intermittently (for example weekdays / weekends). The body doesn’t understand why it’s being deprived of gluten all of a sudden for a certain length of time, whereas at other times it gets a generous intake of bread, pizza, cakes, crêpes, etc. Lastly, we must explain that the issue is not gluten itself, but (when it’s a lifestyle choice) it is the new Gluten! Gluten is a mass of protein comprised of two groups: prolamins and glutenins. Prolamin is the component toxic to coeliac disease sufferers. It is found in wheat, barley, oats, rye and triticale (a cross between wheat and rye). Some people with gluten intolerance can tolerate oats, but tests must be run to find out for certain. The kind of gluten that poses a problem and must be avoided is manmade cereal gluten which has been developed over the past few years via genetic engineering. Agronomers have developed “better-performing” cereal crops with optimised yield and production costs to facilitate their use in mass production. Because gluten is a binder which facilitates the production of cereal-based products. Hence the selection of cereal crops which are very high in gluten and have had their structure modified. And we have to point the finger at these modifications and avoid them.
So how do you get good gluten into yout diet?
It’s best to gravitate towards (organic) old-style or unprocessed wholegrain cereal crops like einkorn, kamut, spelt, amaranth, millet, quinoa, rye and bulghur. In addition, don’t forget that they are available in flour form for crepes, cakes, waffles, pancakes, pie crust and bread. That way you avoid the excess gluten found in modified cereal crops. While the above varieties have lower yields, they offer a great many advantages: more flavour, farming without fertiliser and weedkiller, high nutritional density and low gluten content. While the gluten in these old-style varieties is weak or not very elastic, that in modern-day cereal crop varieties is strong or very elastic (more easily “workable”). And this very feature is what sparks off gluten sensitivity and unpleasant effects/reactions. Hence the role of a dietician in helping you check that you’re eating a balanced diet which enables your body to get all the nutrients and energy that it needs for good health.
Are there people for whom going “gluten free” is inadvisable, or at least unnecessary?
Foods labelled “gluten free” are unnecessary for those without an intolerance. Sometimes inadvisable, even, because if you suffer from coeliac disease it’s preferable to eat cereals that are naturally low in gluten rather than buying “gluten free” products. Quite simply because in these products the gluten (which acts as a binder, among others) is replaced with processed fats, other ingredients and additives which are not good for your health! So yes, it can be inadvisable for those without a disorder who almost only eat this type of ultra-processed “gluten free” product (bread, pasta, cakes, etc.). We also advise those with a gluten intolerance against eating these products, but since they are receiving treatment, those people are often much better informed than the average consumer.
Is it easy to eat a gluten-free diet?
At home, yes, of course! You just need to know which cereals are naturally gluten free. It’s a bit trickier when eating out or being cooked for. So in terms of cereals, you can go for wholegrain rice, red rice, black rice, sweetcorn, buckwheat, manioc, amaranth, tapioca, millet, quinoa, sorghum, sweet potato, potato and yam. You can also eat them in flour, granule or flake form (for bread, cakes, pasta, pie crust, pancakes, crêpes etc.). There is also the large pulses family: chickpeas, kidney beans, white beans, split peas, red lentils, yellow lentils, etc. It’s best for anyone to cook from scratch using organic unprocessed ingredients that are seasonal and local.
Do you have any clever tips and easy gluten-free recipes?
The magic word, BROWS! Just think of that and you’ll know which
cereals contain gluten. Barley, Rye, Oats, Wheat and Spelt (also Triticale, a cross between wheat and rye).
You’ll find Sarah’s recipes on the site MakeMeHeathy.com
We especially liked the quinoa pizza base, green vegetable curry and braised leek with coconut milk and butternut squash. And for dessert, the no-bake hazelnut brownies and banana bread.