Digestive issues: Should I avoid gluten?

Gluten has been a hot topic for several years now. It is often singled out and perceived by some as the cause of many digestive symptoms. Despite the sensationalist coverage of this topic in the media, a portion of the population genuinely suffers when consuming gluten. This condition is known as celiac disease, and only a medical screening can confirm the diagnosis. According to Cœliaque Québec, “it is estimated that approximately 360,000 Canadians have the condition, including more than 85,000 Quebecers. And, according to some studies, 9 out of 10 people with the condition are unaware of it.”[1]

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What is celiac disease?

Celiac disease is an autoimmune disorder, meaning that our immune system mistakenly attacks the healthy cells and tissues of our own body. In this condition, the body reacts to gluten, causing inflammation in the intestinal lining. This inflammation reduces the intestine’s ability to effectively absorb nutrients from the food we eat.¹ The only treatment is to follow a strict gluten-free diet for life, allowing the intestine to heal and preventing complications.

It is important to note that this inflammation caused by gluten consumption occurs only in people with celiac disease. In the absence of this condition, the link between gluten and inflammation has not been clearly established.[2]

Certain grains contain gluten, a type of protein:

• Wheat: Including varieties like spelt, farro, kamut, durum, and einkorn.
• Barley: Found in soups and malt products.
• Rye: Found in rye bread and crackers.
• Triticale: A hybrid of wheat and rye

There are other conditions caused by the consumption of foods containing gluten, including non-celiac gluten (or wheat) sensitivity, which is diagnosed by process of elimination, as well as certain manifestations associated with celiac disease, such as dermatitis herpetiformis (a skin condition) and, more rarely, gluten-induced ataxia (a neurological condition). There is also wheat allergy, the treatment for which requires only the exclusion of wheat from the diet.¹

Symptoms

The symptoms of celiac disease vary greatly from person to person in both scope and severity.[3] The most common are digestive symptoms, such as diarrhea, constipation, abdominal pain, or bloating. However, extraintestinal symptoms may also occur:  nutritional deficiencies, infertility issues, complications during pregnancy, and liver, musculoskeletal, or oral health problems.¹

Are you familiar with the nocebo effect? Unlike the placebo effect, the nocebo effect refers to the experience of negative physiological and/or psychological symptoms following the consumption of a substance that has no documented effect.[4] In other words, in some people who do not have celiac disease, simply believing that they are gluten-intolerant can trigger, for example, gastrointestinal symptoms.

Since these intestinal symptoms are not specific to any particular disease, it is crucial to undergo screening to ensure appropriate management.

The Diagnostic Process

Screening is recommended for anyone experiencing symptoms that may be related to celiac disease, as well as for individuals who have a direct relative who has been diagnosed with the condition.¹

It is important to note that screening and diagnosis must take place while the person is still consuming gluten, as this allows for the assessment of intestinal damage.¹

The first step in diagnosis is a blood test that measures the levels of certain antibodies in the blood (IgA anti-transglutaminase). Generally, doctors perform a small intestine biopsy via gastroscopy (an endoscopy through the mouth) in the second step to confirm whether the disease is present.¹

Why not eliminate gluten before seeking medical advice?

Despite the importance of screening, the wide variety of symptoms and misconceptions about gluten delay diagnosis and treatment. This leads many people experiencing multiple symptoms to eliminate gluten from their diet without medical advice.

Several negative consequences can result from this elimination without a proper diagnosis:

Unnecessary restrictions:

• Avoiding certain foods can lead to frustration and possibly binge eating (overeating sugar, fat, and salt to compensate for a feeling of deprivation)^.1
• Gluten may not be the cause of gastrointestinal symptoms: FODMAPs, fermentable sugars found in many gluten-containing foods, can trigger similar symptoms in people with irritable bowel syndrome.¹ A personalized approach with a nutritionist is therefore necessary.

Additional costs: There are an increasing number of gluten-free products on the market, but they remain more expensive than regular products.¹

Nutritional deficiencies: Gluten-containing products are rich in beneficial nutrients. For example, wheat is a good source of starch (a source of energy), fiber, B vitamins, vitamin E, and several minerals such as iron, phosphorus, potassium, selenium, and zinc.[5]

If you are experiencing digestive issues or other symptoms, we encourage you to consult a doctor and visit the Cœliaque Québec website for support and information.

If, on the other hand, you have already been diagnosed, know that you don’t have to go through this process alone. Our nutritionists are here to support you with compassion and expertise, helping you build a gluten-free diet that is nutritious, delicious, and tailored to your needs.

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• [1] Cœliaque Québec. (s.d.).Cœliaque Québec.
• [2] Schmerling, R. H. (2022). Ditch the gluten, improve your health? Harvard Health.
• [3] Health Canada (2020). Gluten – A group of proteins that people with gluten-related disorders should avoid. Government of Canada
• [4] Inserm. (2022). Effet placebo, effet nocebo, aucun effet, vraiment?.
• [5] Vézina, A. (2024).Le blé : Un ingrédient qui fait gonfler?. Nautilus Plus.

Digestive issues: Should I avoid gluten? is a post from Nautilus Plus. The Nautilus Plus blog aims to help people in their journey to fitness through articles on training, nutrition, motivation, exercise and healthy recipes.
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