The Good Gut Guide

This week is Coeliac Awareness week. It has its own week because it is underdiagnosed. Perhaps this is because it involves the whole area of gut symptoms that we Brits aren’t great at talking about (such as wind, bloating, diarrhoea – delightful things like that). These symptoms can mean so many things and it can be confusing! Here are the top liners you need to know or pass onto a friend.

Is it Coeliac Disease?

This is an autoimmune disease, not an allergy or intolerance where in genetically susceptible individuals, gluten will attack the lining of the gut causing damage that then affects your ability to absorb nutrients.

Blood tests will identify if you have IgA tTGA (IgA tissue transglutaminase antibodies) – these are produced by the immune system in response to eating gluten, which the body is interpreting as a threat.

Although it was traditionally thought to be picked up mainly in childhood, it is now frequently diagnosed in people aged 40-60. In adults blood tests should be followed by a biopsy to confirm diagnosis but the key thing is gluten has to be present in the diet for 6 weeks for these to be accurate. Just one of the many reasons I’d advise going to the GP and not the health food store as your first point of call.

Is it something else nasty?

Your GP should also screen you for inflammatory markers (and also potentially ask you for a stool sample) to flag up any indications that your actual bowel wall is damaged in some way.

Ok, it’s not Coeliac Disease but I still reckon gluten and I don’t get on.

Non-coeliac gluten sensitivity does exist and if we’re gonna get technical relates to ‘one or more of a variety of immunological, morphological or symptomatic manifestations that are precipitated by the ingestion of gluten in people whom CD has been excluded’ but we don’t know enough yet and research continues. If you’ve ruled out Coeliac Disease this could be explored but always with a professional as it gets complicated because…

It may not be gluten but I’ve still got some sort of allergy/ intolerance thing. Shall I do one of those food intolerance tests off the internet?

No! Many are based on IgG antibodies which are regarded by the scientific community as unreliable as they can result in false negatives. IgG antibodies signify exposure to things (in this case food components), not necessarily a negative reaction to something, as is characterised by other antibodies.  In fact IgG antibodies have often been shown to increase in response to successful treatment of an allergy.

So, the bottom line is because of the lack of validity or correlation they are generally not worth taking seriously (or spending a few hundred quid on) and certainly should not form the entire basis for changes to your diet. I have seen many patients who have forked out for these tests, felt no better but then gone on to achieve symptom relief following evidence based dietary advice for the management of IBS.

If you suspect you have a food intolerance there are no blood tests you can do to identify it but professional diet advice can help.

Mmmm ok – not sure I get the difference though between allergy and intolerance?

Allergies are characterised by an immune reaction – fancily known as IgE mediated. The offending substance such as a food protein (allergen) binds to a type of immune cell called a MAST cell and inflammatory markers are released causing the classic symptoms we associate with allergy – swelling, itching etc.

There are examples of allergic reactions which are not IgE mediated (a condition known as FPIES) for example but reactions are still severe and occur 2-6 hours after eating – severe diarrhoea, vomiting etc. – this one is usually identified in childhood.

So, allergies are generally associated with more immediate symptoms and are less likely to be the cause of gut issues.

Bloody hell, it’s confusing I think I’ll just google it.

Be careful what you google, it’s a minefield. 20% of people diagnosed with Coeliac Disease have previously been diagnosed with IBS. If Coeliac Disease and other inflammatory bowel disorders have been ruled out, then IBS might be your diagnosis. As far as IBS goes, diet therapy for this has improved in recent years. For example we know some components of our diets, which remain undigested by us, pass into the large bowel to become the food for our bacterial buddies. Fructans are an example of this – these are found in foods containing wheat, rye and barley for example. These foods also contain gluten which in the case of IBS is irrelevant – so you can see how things can get confusing – more in IBS – what you need to know

Ok, I won’t google it, I’ll see a registered dietitian but in the meantime shall I take one of those probiotic things? That woman on the TV seems to have a spring in her step afterwards!

Probiotics used to be red hot – with the little bottle supposedly holding so much promise. Now things are a little more luke warm and health claims surrounding them have been removed. That’s not to say they aren’t of some help but the truth is we do not yet have the ability to create a product which is as unique to your gut bacteria as it needs to be to create a real health benefit. There’s better evidence of probiotic use after a course of antibiotics, infections in hospital such as C.Diff or travellers’ diarrhoea.

Probiotics specifically for IBS are emerging with some good data behind them and IBS sufferers have been shown to have reduced numbers of the right sort of bacteria so it pays to get the numbers up. However, these tend to have a higher price tag, aren’t yet available in supermarkets and will stand the best chance of working in conjunction with diet therapy. There is a little thing called the placebo effect though, and there are many who swear by their daily dose of gut friendly goodness thrown into the trolley!