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On this episode of the Daily Dollop, I've got dietitians Stephanie Leckers back to chat about gluten. We're going to be discussing what it is, where you find it in foods and who should be avoiding it for their health. It's dollop time. Hey, hey, my name's Kate.
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Super excited to have Ayla Health's lead dietitian back on the potty today. Hi, Steph. Hello. Thanks for having me back.
Always a pleasure. And I am looking forward to the next couple of episodes where I'm going to be picking your brain about gluten. So, just a little bit of background on Steph, and I might ask you a few questions about this as well, but she has been a dietitian for a really long time. I think 10 years ago.
Yeah, just over. Look at you. It's a long time, and she's got lots of experience and done extra training in gut health and loves working with people and managing food intolerances and sensitivities. What do you like most about that process, Steph?
I like being a detective. Yeah. I like being a diet detective and trying to help people sort out what's at the bottom of their symptoms. And this might sound a bit selfish, but I also like that from a medical perspective or from a healthcare perspective, the dietitian is the person that can help with that.
We don't have medications for intolerances. We don't necessarily have tests either for a lot of them. So, it's really nice to be that part of the healthcare team that actually can do the helping in this area. Yeah, absolutely.
And a dietitian is really the only person who can do it in terms of they've got the skills and the knowledge and the training to systematically go through what is going on with your guts. And it's a complicated or tracked the gut. The gut. The gut.
Very long. Because lots to it. So, let's talk about gluten. It's a contentious topic in the world of nutrition in that there's lots of sort of just broad general sweeping messages that we need to avoid gluten for good health and that it's bad for our guts and blah, blah, blah.
And we're getting to that sort of shortly. But I wanted to really start from the beginning and talk. What is gluten to start with? And where do we find it in food?
Yeah. So, gluten is a protein. I think that's the thing that shocks people the most when I talk about it. Because they've heard the word, but they don't quite understand what it is.
So, from a chemistry perspective, gluten is a protein. And that does become important as we go through this conversation today to come up again as to why being a protein is important. And it's found in barley, rye and wheat. There are main sources.
So, it's something that is found only in grains. And it's sort of found in oats as well. So, gluten being a protein is made up of multiple strands of amino acids. This is as lectury as it's going to get.
And essentially the way that it's put together for gluten looks a particular way. And the way that the proteins show up in oats, part of what gluten looks like is present in oats. So, the whole protein as a whole isn't there. But one part of it that very much looks like a bit of gluten is present in oats.
Fun. Just, you know, I feel like just our food system and nutrition as a whole, it doesn't like us to be black and white categorical. Because, you know, we can do this with so many things like, well, saturated fats mostly come from animals. Or we'll accept coconut and these things.
You know what I mean? There's always like a little exception to the rule. And this gluten is no different. Mm.
I'm blessed. Okay. So, we've got this protein that's found in grains. Why can some people not eat it?
Because there are some people in our population that shouldn't be any gluten. Yeah, that's right. Yeah. So, people with diagnosed celiac disease have an immune response to the presence of gluten.
Right. And at this point in time, as we're recording, there is no other treatment besides avoiding gluten to help with celiac disease. So, what happens in celiac disease is that the immune system has a little bit of a misfunction and goes, oh, hey, there's this thing called gluten in the digestive system. We need to start attacking the digestive system.
That's a simplified version, but I'm going to stick with it for now. So, this attacking of the gut means that the body essentially starts to eat itself. And as you can imagine, this is problematic. We're not meant to be eating ourselves.
This means that it's harder for nutrients to be absorbed. It also means that there's then this chronic inflammation if the celiac disease is left untreated. And that can lead to a whole lot of other problems, including osteoporosis and infertility and all sorts of things. So, for people that have diagnosed celiac disease, it's of utmost importance that they do not have gluten in any way, shape or form, in any amount, because it's not a dose-dependent reaction.
And that's the thing with immune responses. It's that it flicks a switch. Right. It's here.
Flick the switch on. I mean, response happens. It's not about, oh, gluten came, but it was only there for five minutes or, you know, it was only a crumb. That's not the way our system sees it in celiac disease.
It's an on-off switch. So, for those people, super important to avoid all gluten. Yeah. So, in that instance, is it kind of similar to an allergic reaction or is it a bit different?
It's a little bit different, but it's similar enough that we can treat it as, we can treat it as seriously as we would treat an allergic reaction. It is involving the immune system. In some ways, it can be seen as a type of allergy. It's just not the type of allergy that you would have to pay nuts, for example, or to even other parts of wheat.
Yeah. And allergic to wheat without having a gluten issue. So, you're not getting your typical allergic symptoms, like hives or swelling or rashes or difficulty breathing. The inflammation is localized into the gut.
That's right. Yeah. So, those responses that you just spoke of are typical for allergic reactions and celiac disease, anything but typical. So, some of the symptoms that people might have could be gut related.
People do talk about having altered bowel function. So, they're number two is not doing what they want them to do. They also talk about bloating and pain. But some people would see the actasease, don't get those symptoms at all.
They might get headaches. They might get migraines. They might have this unexplained infertility. That's not as uncommon as we think, right?
So, yeah, just as a side note, if there's any unexplained infertility in any of our listeners, make sure you're tested for celiac disease because it's one of their easier ways to overcome that as an issue. Treatment is the gluten-free diet. But we can also have other things that pop up for people like poor gum health. That can be a sign of celiac disease.
So, there's something super left of you that's got nothing to do with gut pain or bloating. And the other thing with symptoms and celiac disease is that you don't necessarily have a response in your symptoms that matches your intake. So, what I mean by that is somebody might get a really, really awful headache from trace amounts of gluten if they've got celiac disease. And others might only start to have physical symptoms after eating, say, bread for five weeks.
Right, yeah. Or maybe not at all, right? So, we can't assume that the food we've eaten is free from gluten in celiac disease just because we don't get symptoms because symptoms aren't a great marker of damage or of the immune response kicking off. Right, yeah.
So, what's the process of receiving a diagnosis for celiac disease? Great question. It involves doctors. Yeah.
There's a couple of ways that it can come about. The gold standard is getting a biopsy via an endoscopy. So, they get a camera go down there, have a look at what's happening in your small intestine because it's the small intestine that is affected by celiac disease. And they also take a tiny little biopsy while they have a look at it under a microscope.
That's the gold standard. To get to that point, though, there's usually at least a step before that, which is getting something called a celiac serology done. So, that's a blood test. And this blood test isn't conclusive.
Mm-hmm. I'm from streaming. And to be fair, there are researchers out there looking into other things we can do to get more types of gold standard diagnoses so that we're not always having to do biopsy. But the thing with the screening, the serology test is that, well, it's a screening.
So, if it comes back positive, then that's a really big indication that a scope needs to be done, the biopsy taken, and we can go from there. The other tests that are available, some of them aren't based in sound science, and I'm not going to give them any airtime. What I will say is that there is a test that can't tell you if you do have celiac disease, but it can tell you if you don't. Okay.
Interesting. I personally love this one for people that have taken themselves off gluten for one reason or another. Yeah. And they feel that if they go back on it, they're going to be very sick.
They're going to feel very unwell, but they don't have a celiac diagnosis yet. It's super important to be eating gluten in order to be diagnosed. Yes. Okay.
So, in that case, I suggest doing a gene test. Mm-hmm. So, this gene test looks at some genetic markers that are found in celiac disease. If you don't have those genetic markers, there's virtually a zero chance that you are capable of developing celiac disease.
Okay. So, we're not backing up the wrong tree. We'll look at why this person is having those. Okay.
Cool. So, can rule it out. Yeah. It can definitely rule it out.
It can't say that you've got it though, because just because you have a gene for something, it doesn't mean that your body's expressing that gene. Yes. But what it does mean is if you do have the genetic predisposition to developing celiac disease, and you do have symptoms, and your on a gluten-free diet, so the screening test won't give you an answer, and in this instance, a scope won't give you an answer either. It does give you a really strong reason to do what we call the gluten challenge, which is where you have to eat gluten for six weeks, at least in the lead up to having one of these tests.
Mm-hmm. And so, that means that you can know that yes, you will feel awful, and speaking to a dietitian during that time to help minimize those awful symptoms, it's helpful. It might be nice, but it means that you're not doing it for nothing, because if you've already taken yourself off gluten and then you have to do this for six weeks, but it turns out you never even had the genes. Yes.
Great. You can imagine people not having a fun time with that. Yeah. Amazing.
That is so fascinating. Thank you for that. That wraps up today's episode on gluten and leading into celiac disease. In tomorrow's episode, we're going to answer the question, can you be sensitive to gluten when you don't have celiac disease?
So make sure you tune into that. We'll catch you then. Bye. The Daily Doll Podcast is proudly brought to you by Ayla Health.
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