Episode 66 Identifying and Managing Gluten Disorders

In this episode I demystify coeliac disease and non-coeliac gluten sensitivity. From severe nutrient deficiencies to digestive symptoms; I explain some common signs and symptoms.

Managing a gluten-free diet can feel overwhelming, but it doesn't have to be. I give you some practical advice about what a gluten free diet looks like.  I explain the difference between FODMAP-related digestive problems and gluten disorders.

Learn how to navigate the hidden gluten in common foods and sauces, and discover the naturally gluten-free options that can make your dietary transition smoother. 

Learn more about booking a nutrition consultation with Fiona: https://informedhealth.com.au/

Learn more about Fiona's speaking and media services: https://fionakane.com.au/

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Credit for the music used in this podcast:

The Beat of Nature

Music by Olexy from Pixabay

Transcript

Fiona Kane: 0:31

Hello and welcome to the Wellness Connection Podcast with Fiona Kane. I'm your host, Fi ona Kane. Today I'm going to talk to you about gluten and about celiac disease and non-celiac gluten sensitivity. Gluten issues are something I see a lot of with my clients. I work with a lot of people with these issues, so I thought I'd just give you a bit of a basic rundown so you know a little bit more about it. So, for starters, gluten is a rubbery, elastic protein and it's found in certain grains. So it's found in things like wheat, which includes other forms of wheat like durum and semolina and spelt. It's also in barley and rye triticale, if that's how you say it I'm not quite sure how you say that one actually and it can be in oats as well, more because of cross-contamination as opposed to it actually being within the oat. But a lot of the same equipment is used in sort of harvesting and that kind of thing, so there's often a cross-contamination with oats. There is also actually some other. Like many grains have a similar protein to gluten, so a lot of people who react to gluten may actually react to other grains that don't contain gluten as well. So gluten it might be the main one and some people, if they just take those gluten-containing grains out of their diet, they do better, a whole lot better. But some people are reactive to some other grains, even ones that are actually gluten-free, because they've still got quite similar proteins in them. But anyway, I'll tell you a little bit about. But anyway, I'll tell you a little bit about. Um, so celiac disease is, uh, it's an autoimmune disease, and it's an autoimmune disease of the small intestine, and what it does is it's, it's a permanent immune reaction to dietary gluten, so it's not something that gets better or goes away. Uh, you have it for life. Unfortunately, unfortunately, at this point in time, they haven't come up with any way of curing celiac disease, and it causes the lining of the small intestine to become inflamed and damaged.

Fiona Kane: 2:46

Now you've got these little villi and microvilli, the little finger-like projections that are on the wall of the small intestine, and what happens? Is they, what their job is? Well, one of their jobs is to help to protect the gut wall, to help to digest food, and they are also involved in, you know, basically absorbing digesting food and nutrients. And what happens, though, with celiac disease is they can become blunted and shortened and have a flat appearance. It almost looks like someone's gone through the lawnmower and just removed those villi and microvilli, and what, of course, that means is? It means a few things. One, it means that you are likely to start to develop nutrient deficiencies, because their job is to break down the food and absorb the nutrients. The other thing, though, is you're likely to develop leaky gut syndrome and essentially have all sorts of things from your intestine go across into the bloodstream, your intestine go across into the bloodstream, so your immune system is going to be really reactive, and you sort of will get that leaky gut syndrome and generally feel unwell.

Fiona Kane: 4:05

Besides the fact that some people, like celiac disease can vary quite a lot, some people get very severe symptoms, to the point where they're hospitalized by eating some gluten, and other people it's quite mild. Now, one of the common symptoms that I see for celiac disease and also non-celiac gluten sensitivity I'll get there in a moment to explain that one but a really common one that I see is a vitamin A deficiency. But what you see with a vitamin A deficiency a sort of very visual thing you see is that kind of chicken skin. So there's those little tiny red sort of pimples almost, and it's quite common on the forearms. So you see them on the arms. That's where I got them and it's on both arms. So that's the other thing too. Another common clue that it could be gluten is that it's mirrored. So whatever you see on one side, whatever rash or whatever issue you see on one side, is often on the other, like it's on the other leg or on the other arm. So it's this mirrored rash that you see. So that's what celiac disease is.

Fiona Kane: 5:14

So celiac disease is an autoimmune disease and it is absolutely characterized by this actual damage to these villi and microvilli and ultimately the wall of the intestine. So that can be really nasty for people and that is very much a very visible disease which they can diagnose by basically doing a biopsy there in the small intestine. So the other thing I wanted to talk about was non-celiac gluten sensitivity, which I also see very commonly. So essentially it still is an immune response, but in most cases it's less severe. Occasionally I've seen people that are not officially celiac but have quite severe responses, but generally speaking there's no obvious damage to the small intestine and and often not as severe, but not always Unfortunately I've seen a little bit all over the place with that.

Fiona Kane: 6:24

So even if you're not diagnosed with celiac disease, you can have some pretty severe or serious symptoms in regards to gluten. Now, gluten, some of the other symptoms, and I might just get to this. I'm just checking my notes just to make sure I cover this. But some of the other symptoms you might see in regards to celiac disease or non-celiac gluten sensitivity are things like stomach cramps, gas, abdominal pain or bloating. Now for celiac disease, what is really really common is you're running to the bathroom and loose stools. That's really really common.

Fiona Kane: 7:02

For non-celiac gluten sensitivity it can actually be the opposite. So for some people it can be constipation and again, it's not hard and fast rule. But with celiac disease often it's the cramping and the urgency because they just can't make the enzymes and digest and absorb the food properly, so it just goes straight through them, whereas with that non-celiac gluten sensitivity it can be that or it can actually be constipation. So either of those you see. And then when you do have the loose stools, it's kind of those large, bulky, foul stools, so it's just like things aren't being absorbed. There's still food in there.

Fiona Kane: 7:45

You can also get fatigue, weakness, being tired, irritable because you're just not getting those nutrients in and of course your gut's also very inflamed. You also see nutrient deficiency. So a really obvious one is iron, a low iron, but, like I said, vitamin A as well. You'll see that chicken skin or maybe your vision will start to be impaired and you'll particularly see. Maybe your night vision go first. So if that's the case you might check to see if you've got celiac disease or non-celiac gluten sensitivity.

Fiona Kane: 8:19

The other thing that in some cases nausea and vomiting people can see the weight changes. It can be up or down, but with celiac disease it's often down because things are going straight through you. So you're just not building up your nutrition and getting your nutrients so you're just sort of losing all of that goodness. The other thing you might see would be things like mouth ulcers or swelling of the mouth and tongue, itchy skin, skin rashes, eczema, like I said, small pimples on upper arms, which I'm pretty sure when I had it I had it all the way, so I don't think it's just upper arms. I think I'm pretty sure I had it on my forearms, but I would think it was both, but either of those and that's the one that's often called chicken skin.

Fiona Kane: 9:12

The other thing is altered mental alertness, maybe muscle spasms. The altered mental alertness is something that is good to know about that one. That's what I get. So I don't have celiac disease but I have non-celiac gluten sensitivity and when I have gluten it makes me just very tired. I almost explain it like a computer going into sleep mode. So I kind of just get very drowsy and very tired.

Fiona Kane: 9:38

I have seen people who have severe mood changes and they will actually get to the point where they are like extreme. Again, I always have to be careful of my language on here. But extreme thoughts right. So very, very low and extreme thoughts can happen for some people. For me it's just a general, makes me feel tired and kind of just generally low and low mood, whatever. The other thing is things like joint pains. That's one thing that I get as well. So if I have gluten I'm more likely to have some joint pain. Sugar does that with me as well. So sugar and gluten will both do that. Could be things like easy bruising, could be anxiety. Both do that. Could be things like easy bruising could be anxiety, difficulty with coordination and muscle movements, palpitations, unstable blood sugar levels, so your blood sugar going up and down quite a bit, which all those symptoms I said above, like the mood and everything will be, and being tired and irritable would all be symptoms of that as well. It can certainly affect your teeth and gum health if you're not getting your nutrition.

Fiona Kane: 10:48

And also, once someone does have an autoimmune disease, it's not unusual for them to develop other autoimmune diseases. And also because when you have leaky gut syndrome, leaky gut syndrome seems to be a trigger for autoimmune diseases. I'm not saying cause Cause is the wrong word but certainly a trigger. So if you've kind of got this inflammation and this leaky gut syndrome, you're more likely to trigger other autoimmune diseases. If you're predisposed to those, if you're genetically predisposed to those, it's not unusual to see others.

Fiona Kane: 11:26

The other interesting fact is that people who are diagnosed with diabetes type 1 diabetes, which is also an autoimmune disease can be diagnosed with celiac disease in that first. I think it's the first five years. I'm just checking my notes here. There was a study done on this, but I think it was within the first five years of being diagnosed with type 1 diabetes, and so it's also worth kind of just being aware of that and being checked for that if you have developed type 1 diabetes, so that so unfortunately, people who've developed that can be quite at high risk of um, of getting celiac disease. So the two things, uh, here we go. I was just was looking at this um. Yeah, there was this one one year um study where they found that 218 out of 546 so that's 40 percent of subjects um within one year had um after having been diagnosed with type 1 diabetes also were diagnosed with celiac disease. Uh, it went up to 55% within two years and 79% within five years. So I don't know those studies, I can't remember the timing, but those studies were a few years ago so I'm not sure if they've done updates since then. But just have an awareness around that that the authors just concluded that in most cases celiac disease can often be diagnosed within five years of a type 1 diabetes diagnosis and often, for some reason, the symptoms they can be quite asymptomatic, so you cannot have obvious symptoms. So it is worth being screened for that if you are type 1 diabetic, especially in that first few years.

Fiona Kane: 13:24

So in regards to non-celiac gluten sensitivity, that is something where I have seen, like in my case, I don't seem to be able to tolerate it. I do better without it. Some people, if you do enough healing of someone's gut and it's best to work with a practitioner like me to do that. But sometimes when you do gut healing then you can recover and you can start eating gluten again or you can start eating some gluten again, but sometimes you just can't. It just depends on how severe it is for that person and how they feel.

Fiona Kane: 13:58

The other thing is that gluten is one of the FODMAP foods. So FODMAP foods are all of the carbohydrates that can sit in your large intestine for a long time and cause lots of symptoms and a lot of people who have issues, who have gut issues and sort of diarrhea and and flatulence and bloating and that kind of thing. They remove FODMAP foods and that helps them, and wheat is one of those FODMAP foods. So sometimes you might have an issue with the FODMAPs, which is sort of a completely different thing, but it can include wheat. So the question is do you need to go gluten and or wheat free, but just generally gluten free, or is it about your FODMAPs and that's?

Fiona Kane: 14:47

Fodmaps is not so much. Fodmaps is not an immune response, fodmaps is just some people are genetically not able to have as many of those carbohydrate foods and the more if they have too many and too many of. So it's the amount they have and like the amount of different FODMAP foods. So if you're having things like lactose and wheat and certain fruits and that kind of thing that just might be set off your system might be too much for you and if you have less you can do fine. So FODMAPs has nothing to do with your immune system and more to do with just how well your digestive system ultimately deals with having a certain level of carbohydrate in there. So it's a different category but it can look the same. So sometimes you need to work with a practitioner to clarify which one of those is going on for you.

Fiona Kane: 15:38

And ultimately, the way to manage celiac disease is absolutely definitely a lifelong gluten-free diet. For non-celiac gluten sensitivity it's certainly a gluten-free diet, at least initially maybe a lifetime or maybe for a certain amount of time Depends on how well you heal and how severe your situation is. So that's a bit different for everybody. The other thing that's not unusual is for people with celiac disease or gluten issues to also have issues with lactose or dairy. I'm not going to go into the dairy thing in detail on this particular episode because it's a whole other topic on its own, but have an awareness that that's not unusual and you may need to go dairy-free or lactose-free for a little while and there'll be another episode where I talk more about the difference between those two. But yeah, like I said, probably not in this episode, I won't have time.

Fiona Kane: 16:33

So the other thing that in regards to going gluten-free and also I was just going to say to you about diagnosis if you go on a gluten-free diet then it's hard to get diagnosed after that because specifically to see the damage for them, to see the damage in your gut, you have to have been eating gluten. So you can certainly go on a gluten-free diet without getting tested. But just be aware, for accuracy of the testing, you might need to go back on gluten for a couple of weeks before you get tested and you can certainly have a blood test to find out if you've got non-celiac gluten sensitivity and or if you have the celiac gene. And having the celiac gene doesn't mean you have celiac disease, but it sort of puts you in the category of okay, we know it can be celiac disease as opposed to it's definitely not celiac disease. So you can just go to your GP and start with some of that testing, but just have an awareness that the blood tests you will see, but ultimately an accurate diagnosis will require that you're eating gluten at the time that you're being tested. Now, in regards to a gluten free diet, I'll just tell a little bit about that now as well. Like I said, this is something I do a lot with my clients, so we can certainly help you with that. Excuse me, I'll just have a sip of water.

Fiona Kane: 18:03

With a gluten free diet, the first thing to remember is going on. So what some people do when they go on a gluten-free diet is the first thing they do is walk down the gluten-free aisle of a supermarket and they just grab all the gluten-free junk food and so they've got the cakes and the biscuits and the this and the that and whatever, and I get it. And that's fine that you want to try some of those foods and you want to feel like you're not missing out. But be aware like a junk food diet is a junk food diet, whether it's gluten-free, whether it's vegan, whether it's this, whether it's that Junk food is still junk food, right. So a gluten-free diet isn't just walking down the gluten-free aisle and just buying all the junk food in gluten-free.

Fiona Kane: 18:41

What a gluten-free diet really is is largely removing a lot of grains from your diet and essentially, the things that are in essence gluten-free are all fruits and vegetables, all meats and proteins. So whether it's fish or whether it's fish or I said fish, fish or chicken or beef or whatever just any animal product is naturally gluten-free, and so that would also include things like if you tolerate dairy, it would also include things like cheese and milk and also some. And when we're looking at grains, grains is where you've got to be careful, so you've got to look for things like rice is usually okay. Some people can't deal with the protein in rice either, but in most cases it's okay and you would be okay. Again, corn Some people go okay with corn, some people don't, but they don't contain neither rice or corn contains gluten, and things like tofu or lentils or chickpeas all of those things essentially all of those foods are gluten-free. Now what makes them not gluten-free is what's done to them.

Fiona Kane: 19:51

So the foods themselves are naturally gluten-free, but they start to contain gluten for several reasons. One is if you're doing any sauces or marinades right, so anything to do with sauces and marinades so they often contain gluten and gluten's in all of those things, because gluten sort of thickens things up right. So kind of gravies and sauces and things like that. They often use gluten-containing things in there to thicken it up right. So anything to do with a marinade or a sauce, be aware, likely contains gluten. So always check that. The other thing is any sort of coating. So if it's kind of got a beer batter, that means it's usually flour that they're using and they might be putting breadcrumbs on the thing. So if it's got any kind of batter or breadcrumbs on it, then that contains gluten, unless they've deliberately done some other crumbs like rice crumbs or they've used corn flour or whatever. But generally always assume it's gluten containing grains and check with whoever's making it.

Fiona Kane: 20:54

The other thing is if it's been sort of deep fried, put in a deep fryer. Now some places will actually have a separate deep fryer for gluten-free, but most places will use the same deep fryer. So whether they're putting in hot chips or anything that they're deep frying, essentially what is in there is all the gluten from everything else they've dipped in there, because they've dipped in lots of things that have got a flour coating. So that will end up on your chips, your fries, whatever, or on the other foods you're eating. So even if it's gluten-free before it goes in the deep fry, it's certainly not gluten-free when it comes out. And the other thing is that most sort of we call them chips in Australia, but fries, whatever most of those these days are commercially made and they are sort of beer-battered or battered in some way where they've got a flour coating on them. So that's weak. They've already got gluten on them before you put them in the fryer. But if they don't, they will certainly have it after they go in the fryer.

Fiona Kane: 21:54

And people with celiac disease actually have to be aware of cross-contamination. So someone with non-celiac gluten sensitivity might get away with having something that so cross-contamination would be, say, where you've used the same toaster with the gluten-free bread and the gluten-containing bread or you've used the same knife. So it's like if you use the same butter knife or the same knife for your peanut butter or your jam or whatever it is, but if you put that knife in and put it on one bread and then you put that knife back in and put it on a different bread, you cross-contaminate. You can put gluten on the non-gluten bread. Right, it could be the kitchen itself just by having flour in the air. It could be the bread boards that you use, the cutting boards that you use, or the plates that you use, or just where you store it, that you store it sitting right next to each other. I've been into cafes before where they've got like a gluten-free muffin and a gluten muffin and they're kind of sitting up against each other, right. So for someone with non-celiac gluten sensitivity that might be fine, but someone with celiac disease that's usually not fine at all. So with celiac disease you actually have to have an awareness of the detail of contamination. So a lot of restaurants will say things like low gluten, and when you talk to them, what that actually means is we don't put gluten in it, but we can't guarantee of not being cross-contaminated. So if you have celiac disease, you have to really have that conversation with them.

Fiona Kane: 23:21

The other thing, too, is glucose often is from wheat. So sometimes glucose is from corn, but sometimes it's from wheat. So when something has sugar in it so it could be something like a marshmallow, right, or it could just could be any pre-prepared product that's got glucose added to it. That glucose could be wheat derived. It should say so in the packaging. It'll usually have glucose in brackets wheat or glucose in brackets corn. If it's wheat, stay away from it. If it's corn, you might be fine you should be fine, because there's not actively any gluten in there. But some people still don't deal with corn because they just don't deal with the grains. So everyone's a little bit different.

Fiona Kane: 24:01

So essentially it's anything that the food's been coated with crumbs added to it, any kind of marinade, any kind of sauce. That's where your gluten comes into things. So it's pretty easy to you know. You can buy gluten-free pasta if you want to, if you want to have pasta I just generally don't have pasta, but you can certainly buy gluten-free pasta. And, like I said, vegetables, all that jazz, they're all gluten-free Meats, vegetables, eggs, all of that is all gluten-free.

Fiona Kane: 24:31

The issue is what you do to it. So it's anything that's been done to change it or to prepare it. So always sort of check with that, or baste it, or you know chickens, they'll often baste it with some sort of gluten-containing sort of sauce, or they'll put crumbs. They'll stuff it with crumbs, you know. So just things like that and, depending on if you're celiac or non-celiac, might depend on whether or not you can tolerate that.

Fiona Kane: 24:54

I think that's probably enough for today. I just wanted to give you a bit of an idea of what the difference between celiac disease and non-celiac gluten sensitivity, what it might look like, and also that's kind of the beginning strategy of how to remove gluten from your diet. There's more to it than that, but that just gives you a good idea of a starting point, what it looks like and the sort of things to look out for, so I hope you found that useful. Please remember to like, subscribe, share, tell other people about this podcast. If you're on Rumble or YouTube, you can comment and give me feedback, and other than that, though, I really appreciate you listening and looking forward to talk to you next week. Thank you, goodbye.