All about gluten...

For a few years, gluten has been badly pressed and is still a “ink bottle”. But do you really know him? Why is he demonized? And is it right? Here are some answers.

1. Gluten is a protein.

It’s a protein found in certain cereals such as wheat, barley or rye.

2. Celiac disease, “true” intolerance to gluten

In celiac disease, which is a pathology of immunological origin (therefore with the participation of antibodies, here IgG and IgA types), being in contact with gluten causes inflammation of the intestine with loss of its villi. Imagine the healthy gut like a brush. This brush is therefore a set of folds (villi) of the intestinal mucosa which increases the nutrients absorption surface. The inflammation caused by contact with gluten leads to an "abrasion" of this brush and a disappearance of the villi, which leads to various signs (iron and vitamin deficiency) and symptoms (bloating, abdominal pain, diarrhea, etc.) depending on the "extent of the disease.

It is not an allergy (mediated by IgE), nor hypersensibility.

The diagnosis is made by blood test and by digestive endoscopy. It is essential not to start a gluten-free diet before these examinations because they would be then distorted.

Treatment is a complete gluten-free diet to prevent intestinal inflammation and help preserve the intestinal "brush."

3. Why do some people who eat gluten-free and have no proven celiac disease feel better in their gut?

More and more people with intestinal discomfort are starting gluten-free diets (without prior diagnosis) and say they feel better. I think it's right. I think their intestinal comfort is improving. But why? And is this a solution?

When someone excludes gluten from its diet, he excludes wheat flour, barley and rye. This excludes not only the gluten protein but also sugars called fructans present in these flours. These fructans are thought to be responsible of symptoms in people with irritable bowel syndrome. So when they stop intake of gluten-containing foods, they decrease the intake of fructans and therefore decrease the symptoms of irritable bowel.

Unfortunately, the risk of this exclusion if it is not followed medically and nutritionally is to induce certain food deficits.

In addition, the reintroduction of gluten-containing foods after a strict exclusion diet may be poorly tolerated.

In conclusion, it does not make sense to start a strict gluten-free exclusion diet without first consulting a gastroenterologist. In the absence of celiac disease, a low-fodmap-diet may be sufficient.