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Gluten. It’s Complicated.

A few months ago, I had a colonoscopy (don’t worry – that’s not what this post is about). Afterward, possibly because of my happily drugged state, I suggested to the gastroenterologist that I’d bet he would write me an enormous check if I could promise him that he’d never hear the word gluten again. He replied, “In a heartbeat.”

Well, I’m now rethinking my glib and snarky remarks. I was skeptical (being a relatively close-minded, Western-trained doctor) about gluten “sensitivity” in people who don’t have celiac disease. I’ve expanded my thinking. But if you’re gluten-or wheat-sensitive, I invite you to expand your thinking, too. There’s a lot of science to get through here – but if you stick with me, you’ll be rewarded with a fabulous gluten-free recipe at the end.

While food intolerance or sensitivity of some kind affects about 20% of all people, there are no tests or biologic markers (unless you have an actual allergy or celiac disease) to make a diagnosis(1). There’s so much that isn’t known – but what is known is that for many people with food intolerance and irritable bowel syndrome (IBS), there is a change in the intestine’s permeability(2) and microbiome(3), along with an immune response that may affect the entire body(4).

As for gluten sensitivity, that’s a pretty tricky subject. Gluten is as a family of proteins found in various grains. But in people who don’t have celiac disease or an actual wheat allergy, is gluten the culprit in people who are sensitive to wheat? There are many components to wheat –other proteins, starch and more. So if you feel better after you stop eating wheat, it might or not be because of eliminating gluten(4).

Regardless of cause, this food sensitivity, probably because of an auto-immune response, often causes symptoms outside the intestinal tract(5). These symptoms may include fatigue, headache, poor concentration, joint and muscle pain, as well as other symptoms that occur a few hours or days after eating the offending food or food component and resolve when that food is eliminated from the diet(6).

What is it that makes the gut “leaky” and the immune system become so unhappy? Some researchers have indicated that it’s a result of a build-up of the “wrong” bacteria in the intestine, and that’s largely associated with “Western” diet, low in fiber and high in animal fat(7). A new theory proposes that these harmful bacteria set up a cascade of chemical changes that result in increased gut permeability and inflammation both inside and outside the intestine (2). These authors recommend a Mediterranean-type diet, rich in fruits, vegetables, whole grains, nuts, and extra virgin olive oil. suggesting that “Based on the previously described literature and evaluations, it could be considered that [non-celiac gluten/wheat sensitivity] is a potentially transient and preventable condition, strongly related to diet quality and balance, rather than to the presence or absence of gluten-containing foods.”

Wow. I have no idea if these scientists are right, but after years of study, here’s what I do know about about nutrition:

  • Fruits, vegetables, and whole grains are very good for you.

  • Processed foods are not.

Lots to think about. But in the meantime, let’s eat! Today, for you dining pleasure, I recommend the great Mark Bittman’s recipe for curried carrot coconut soup. It’s divine. The only major change I made was to use extra virgin olive oil instead of butter.

(Mostly) Mark Bittman’s Curried Carrot Coconut Soup 

Ingredients

  • 2-3 Tbsp extra virgin olive oil

  • 1/2 medium onion, roughly chopped

  • ¾ pound carrots, peeled and cut into1/2-inch coins

  • 1 tsp (or more) peeled, grated fresh ginger

  • ½ tsp ground cumin

  • 1/2 tsp ground turmeric

  • 1/2 tsp ground coriander

  • Pinch of cayenne pepper

  • 2 cups chicken or vegetable stock

  • 1 cup unsweetened coconut milk

  • Juice from 1/2 lime

  • Salt and freshly ground pepper

  • Cilantro, optional

 

Preparation

  • Heat the olive oil over medium-low heat. Add the diced chopped onions and carrots, along with the spices. Stir and cook until softened, about 10 minutes.

  • Add the stock; there should be enough to cover the vegetables. Bring the pot to a boil over high heat. Reduce the heat to medium and continue cooking until the carrots are cooked through, about 10 to 15 minutes.

  •  If you have an immersion blender, purée the soup in the pot. If not, wait until the soup cools slightly, and purée in a food processor (Janice prefers a blender – it makes the soup creamier). Add enough coconut milk (and a little more stock or water if necessary) to bring the soup to the consistency you want. Add lime juice. Garnish with cilantro and serve.

References

(1)Tuck CJ et al. Food intolerances. Nutrients 2019; 11(7);pii:E1684.

(2)Leccioli V et al. A new proposal for the pathogenic mechanism of non-coeliac/non-allergic gluten/wheat sensitivity: piecing together the puzzle of recent scientific evidence. Nutrients 2019; 9 doi: 10.3390/nu911203.

(3)Caminero A, Verdu EF. Metabolism of wheat proteins by intestinal microbes: Implications for wheat related disorders. Gastroenterol Hepatol 2019; 42(7):449-57. 

(4)Algera J et al.The Dietary Management of Patients with Irritable Bowel Syndrome: A Narrative Review of the Existing and Emerging Evidence. Nutrients2019;11(9):2162. 

(5)Uhde M., Ajamian M., Caio G., De Giorgio R., Indart A., Green P.H., Verna E.C., Volta U., 

(6)LosurdoG et al. Extra-intestinal manifestations of non-celiac gluten sensitivit
y: An expanding paradigm. World J Gastroenterol 2018; 24(14): 1521-30.

(7)Volta U et al. Non-coeliac gluten/wheat sensitivity: advances in knowledge and relevant questions. Expert Rev Gastroenterol Hepatol 2017;(1):9-18.