Grains are an important part of a healthy, balanced diet for most people. However, some people have conditions that require them to limit or avoid certain grain foods. Before cutting grains from the diet, people should seek a professional diagnosis and consult an Accredited Practising Dietitian to ensure the diet is providing adequate nutrition.
In people with coeliac disease the immune system reacts abnormally to gluten, a protein found in wheat, rye, barley and oats, causing small bowel damage. The tiny, finger-like projections which line the bowel (villi) become inflamed and flattened. This is referred to as villous atrophy. The surface area of the bowel available for nutrient absorption is markedly reduced which can lead to various gastrointestinal and malabsorptive symptoms. GLNC encourages individuals with suspected coeliac disease and/or gluten intolerance to seek a qualified medical practitioner to investigate the potential of coeliac disease.
A gluten free diet is the only treatment for coeliac disease. The removal of gluten from the diet of an individual with coeliac disease allows the gut to heal and symptoms to improve. Dietary sources of gluten include any core grain foods made with gluten containing grains including breads, breakfast cereals, crispbreads, pasta, as well as ‘discretionary’ grain foods or extras such as biscuits, cakes, pastry and pizza. Ingredients within packaged foods can also come from a gluten source and so becoming ingredient aware is essential for individuals with coeliac disease. GLNC recommends anyone following a gluten free diet seek the guidance and support of an Accredited Practising Dietitian who can help to ensure a nutritionally adequate gluten free diet. For more information about gluten in grains click here.
It is estimated that food allergies affect 2 in 100 adults, and an allergy to wheat is one of the least common food allergies. According to the Australia New Zealand Food Standards Code, foods containing wheat must be labelled to help people identify the allergen.
Symptoms such as headaches, bloating or mouth ulcers after eating indicate a food intolerance, rather than food allergy. Recently research has emerged that suggests the existence of a condition called non-coeliac gluten sensitivity (NCGS). However, how common NCGS is, how it can be reliably identified and what its underlying mechanisms are, is not yet well understood.
Irritable Bowel Syndrome and FODMAPS
Many of the gastro-intestinal symptoms seen in coeliac disease (such as diarrhoea, abdominal pain, bloating, wind, distension and altered bowel habit) can mimic irritable bowel syndrome (IBS), which is a disorder affecting 15% of the population. It is thought that the fructan component of grains may contribute to IBS. Fructans are one of a group of short-chain carbohydrates poorly absorbed in the small intestine which can result in increased gas production and GI symptoms in patients with IBS. This group have been termed FODMAPs, which stands for Fermentable Oligo-, Di-, and Mono-saccharides And Polyols.
A diet low in FODMAPs has become a well understood and evidence-based short term (2-6 weeks) strategy, leading to symptomatic improvement in 74% of patients with IBS. However the low FODMAP diet is a therapeutic diet to be conducted under the supervision of a specialist dietitian. It is not a long-term diet as research indicates that FODMAPs are probably essential for maintaining a healthy population of gut bacteria which has implications on long term health. For more information on the treatment of IBS with a low FODMAP diet visit the Monash University website.
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