Gluten: allergy, intolerance or hypochondria?

Gluten free from Shutterstock
Gluten free from Shutterstock

Most health professionals are aware of the fact that there many diseases and conditions which start out as “fads and fashions”, but then achieve recognition and acceptance as serious threats to our health and well-being.

For example, a few years ago everyone was suffering from “yuppie flu” which originally was treated with scepticism by many doctors and their support staff. This debilitating condition was subsequently renamed Chronic Fatigue Syndrome and has recently been identified as another one of the growing list of diseases and conditions attributed to autoimmune reactions. In similar fashion a number of digestive conditions like Crohn’s Disease and ulcerative colitis have also been classed as autoimmune diseases.

Allergy or sensitivity

There is, however, another side to “fashionable ailments”. Nowadays every second person is convinced that they suffer from gluten allergy or "gluten sensitivity" and that they need to avoid all gluten. It is, however, important to differentiate between individuals who are genuinely gluten sensitive and those who only think they are.

In the case of "allergens" like gluten it is important to distinguish between allergy and sensitivity/intolerance. If you have a genuine gluten allergy (coeliac disease), gluten makes you really ill and you have to studiously avoid of all foods that contain gluten. Coeliac disease will show up on a blood test.

If you don't have coeliac disease but suffer from symptoms apparently related to gluten, you may have "non-coeliac gluten sensitivity". This means that you may have symptoms similar to people who cannot tolerate gluten but don't have the "same antibodies and intestinal damage as seen in coeliac disease".

According to Mayo Clinic most physical reactions to foods are caused by a food intolerance rather than a food allergy and that the two are often confused. "A true food allergy causes an immune system reaction that affects numerous organs in the body. It can cause a range of symptoms. In some cases, an allergic reaction to a food can be severe or life-threatening. In contrast, food intolerance symptoms are generally less serious and often limited to digestive problems."

If you have a food intolerance, you may be able to eat small amounts of the offending food without trouble. You may also be able to prevent a reaction. For example, if you have lactose intolerance, you may be able to drink lactose-free milk or take lactase enzyme pills (Lactaid) to aid digestion.


Clever marketing companies have jumped on the bandwagon and are producing a variety of gluten-free food products. Although I am aware that this is a marketing ploy, I am also pleased for those patients who have a true gluten allergy or coeliac disease, as they can at last buy some baked products that do not trigger their symptoms.

It is however, important that those members of the public who are not gluten sensitive, intolerant or suffering from coeliac disease, should be realistic and go back to eating a balanced and varied diet. If you suspect that you or your child may be gluten sensitive, intolerant or suffer from coeliac disease, please have yourself or your child tested to determine which of these conditions you actually have, and what degree of avoidance is necessary.

Read: Tips for managing gluten allergy 

The reason why I am not in favour of self-diagnosis of potentially serious conditions, is that by cutting out foods that contain gluten, individuals may run the risk of developing nutrient deficiencies or chronic constipation or not achieve their energy intake requirements. This is particularly important for individuals who are experiencing rapid growth, such as young children, teenagers, and pregnant and breastfeeding women.

Who needs to cut out gluten?

If you suffer from coeliac disease or gluten-sensitive enteropathy, diagnosed by a thorough medical history combined with serological screening of blood samples for markers like anti-TTG (anti-tissue transglutaminase), and if necessary, biopsy of the small intestine, then it is vital that you should avoid gluten and all foods containing gluten.

Avoiding gluten does not only entail avoiding wheat bread, rolls and cakes, but also all products that may contain wheat or derivatives of wheat (e.g. thickeners in soups, drinks, sweets, sauces, gravies, etc.) and all rye and barley. For coeliac patients life becomes a struggle, particularly in modern society where most processed foods contain some wheat, rye or barley.

Read: More on gluten sensitivity

So if you don’t suffer from this serious condition, please don’t make your food choices and life complicated by cutting out gluten, just to be fashionable. The irony is that I have seen people who have assured me that they are “avoiding gluten” tucking into a pizza with obvious enjoyment, but avoiding the rolls served with the starter!

Foods you can eat

For those patients who genuinely need to avoid gluten, there is a variety of gluten-free grains and starchy foods that you can eat, namely:

  • Maize products – this includes maize meal, one of the most popular staple foods in South Africa which can be served in many different ways - porridges of different consistencies (from “slap pap” to “putu pap”), made from finely sieved to coarse ground maize meal, white and yellow maize meal (the latter is known as polenta, popular in Europe and the Middle East), maize grits, maize kernels fresh and canned (but not canned sweetcorn if the mixture is thickened with wheat flour), and corn on the cob.
  • Buckwheat, which despite its name, does not contain any wheat or gluten, but is made from the seeds of a plant related to knotweed or sorrel.
  • The ancient grains of Africa which were our staple foods before maize was introduced, namely millet and sorghum. Ironically as mentioned in one of my previous articles, global warming may make the cultivation of wheat and even maize difficult in Africa and other parts of the world and encourage the “rediscovery” of these ancient staples which can grow under much harsher, hotter conditions and require less water than wheat and maize.
  • Quinoa, the “queen of seeds” (this is also not a grain in the true sense of the word, but is called a “pseudocereal”), which is gaining popularity as a high-protein starchy food which is free of gluten.
  • Flours made from starchy crops such as potatoes, rice, soya, chickpeas, lentils and other pulses.
  • Sago and tapioca which are popular in some parts of the world as thickeners and are not only used for desserts, but also for savoury dishes.
  • Specific gluten-free baked goods produced from some of the non-gluten seeds, flours and starches mentioned above. 

Survival rules

If you are gluten-sensitive, keep in mind that it is very important to read every food label thoroughly and when in doubt, to avoid buying the food that could contain wheat, rye, barley or some form of gluten. Even if there is no “list of allergens” on the label, you need to be on the look-out for potential sources of gluten when shopping by carefully checking the list of ingredients.

Read: Gluten allergy boosts death risk

Be aware of the fact that “gluten-free” baked goods will probably cost you a lot because they are produced for a much smaller market than standard cakes, biscuits, and breads.

When eating out, you also need to be vigilant, and if no one can enlighten you what ingredients went into the soup or other mixed dishes, be careful and rather order grilled meat or fish with baked potatoes/chips/rice/sweet potatoes/corn on the cob and fresh salad without salad dressing or sauces. Ask for olive oil and freshly squeezed lemon juice to dress your salad! And eat fresh fruit for dessert minus custard or ice cream.

Always consult a registered dietician (contact the Association for Dietetics in SA at: to find a dietician in your area) to help you with a gluten-free diet, particularly for infants and young children, teenagers, and pregnant and breast-feeding mothers, who may find it difficult to meet their nutrient needs without some assistance.

Read more:

Eat well without dairy or gluten
Price of gluten-free foods hard to swallow
Gluten-free diet may lift 'brain fog'


- Chin C (2014). Thoughts on food. Advertorial in Sunday Times Food Magazine, 2014
- Mahan LK et al (2012). Krause’s Food & the Nutrition Care Process. 13th Edition. Elsevier Inc. USA

Image: Gluten free from Shutterstock

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