Why people susceptible to colds, asthma, and sinusitis must be careful while having ash gourd or petha

Opinion: Your Gluten Sensitivity Might Be In Your Head

Diet plays an important role in human health, but how it does so — especially among those with gastrointestinal diseases — becomes complicated by the emotional and psychological aspects of eating.

One-third of patients with irritable bowel syndrome also have disordered eating habits and perceptions about food that may cause symptoms in and of themselves.

Many people find that wheat or gluten cause them to react in some way: Some people have a wheat allergy, some have the autoimmune condition celiac disease, but the majority find they have some sort of intolerance or sensitivity to wheat and gluten.

This is challenging to diagnose because there still aren't any reliable biomarkers to confirm gluten or wheat sensitivity, and clinicians typically rely on patient self-reports.

In irritable bowel syndrome (IBS), patients experience gastrointestinal symptoms without any visible damage to the digestive tract. Many patients with IBS believe that specific foods, like gluten or wheat, trigger their symptoms, prompting them to exclude these foods from their diets without consulting a dietitian or their doctor.

Unsurprisingly, about a third of IBS patients develop disordered eating habits and perceptions about food that may cause symptoms in and of themselves, such as orthorexia, or an unhealthy preoccupation with healthy eating. This may cause a "nocebo effect," where patients experience symptoms due to their beliefs and expectations about a substance they assume is causing their issues but is actually inert — a "nocebo."

As a nutrition researcher at McMaster University's Farncombe Institute, I'm a member of a team that ran a clinical trial to find out whether wheat, gluten or a gluten-free nocebo caused symptoms in IBS. And the results were surprising: even though some patients experienced worse symptoms from gluten or wheat, they weren't very different from the nocebo, with similar proportions of patients reacting to each.

These results are similar to other published studies. Identifying the true sensitivities for patients with IBS is a controversial research area, with some studies finding gluten avoidance to be beneficial versus others finding it to have no significant effect.

Researchers from the United Kingdom and the Netherlands published an innovative study from the Lancet medical journal. Patients with reported gluten sensitivity were divided into four groups: Two groups were given gluten-free bread, but one of these groups was told it contained gluten and one was told it didn't. Two other groups were given bread that did contain gluten, with one group believing it was gluten-free and the other believing it contained gluten.

The results showed that the patients who ate gluten and were also told they were eating gluten had significantly worse symptoms than the other three groups.

Why are people concerned about gluten?

Given the controversial evidence that not only gluten, but other wheat components like fermentable carbohydrates or immune-stimulating proteins, may exacerbate IBS symptoms, it's possible for this hot topic to get blown out of proportion or taken out of context, contributing to nutrition misinformation.

All of these factors — that it is often diagnosed by excluding all other options, the significant psychological component, the division in the scientific community and clinicians who often discount patients' experiences — make treatment difficult for patients with this disorder.

As a result, patients with IBS are often left to navigate conflicting online resources and test new diets to treat their symptoms.

How patients respond to evidence

When researchers challenge patients with gluten, wheat or a nocebo, they rarely report the personalized results back to the patients and see how this information impacts patient behaviour.

At McMaster University, we wanted to see how presenting personalized nutrition information would affect our patients. After providing them with personal results about their gluten and wheat reactions, we followed up with patients after six months or more to see how this impacted their beliefs, behaviours and symptoms.

Again, we were in for a surprise! Patients largely kept similar beliefs about gluten, maintained a gluten-free diet and had consistent symptoms even after learning that most of them did not react to gluten or wheat. This begs the question: when people more generally learn new information that conflicts with an existing belief, what may help them to change accordingly?

The role of psychology in treating IBS

IBS has been long understood as a disorder of the gut-brain interaction. Psychological treatments are being increasingly investigated to minimize patient fears of foods, or nocebo effects, and to treat IBS symptoms more generally. At Harvard, a recent study found that exposure-based cognitive behavioural therapy (CBT) showed promise to improve IBS symptoms in five sessions with a nurse practitioner.

Similarly, CBT correlated with shifts in brain networks and the gut microbiome, or gut bacteria, that were also correlated with improvements in gastrointestinal symptoms. At the University of Calgary, virtually delivered yoga was highly feasible and helped improve symptoms for patients with IBS.

However, IBS is a complex disorder which may be exacerbated due to many different causes, and psychological treatment will likely be only one component of an effective treatment plan for many patients.

Diet plays an important role in human health, but how it does so — especially among those with gastrointestinal diseases — becomes complicated by the emotional aspects of eating and the real needs for people to have nutritious, well-balanced diets without risking malnutrition. If you have concerns that certain foods, like gluten, trigger your symptoms, it's a good idea to consult your doctor or a registered dietitian.

Caroline Seiler receives funding from the Canadian Institutes of Health Research.

Why Gluten Doesn't Cause Bloating And Six Other Gut Myths

It's safe to say that in the world of wellness, gut health has been dominating the limelight lately. Thanks to tech advancements that have allowed scientists to unearth exactly what's going on down there, our guts, we have learnt, are the foundation of everything, affecting not just our digestive systems, but also the regulation of our hormones and our immune systems.

"These advances in science have made the link between the gut and other parts of the body clearer, and people are increasingly aware of how food impacts their long-term health," says  Dr Emily Leeming, a Microbiome Scientist, Registered Dietitian and author of Genius Gut: The Life-Changing Science of Eating For Your Second Brain. Maintaining a healthy gut, it now appears, is the key to maintaining a healthy life. 

Consequently, we have been inundated with advice, whether it's a must-take supplement or a gut cleanse that will supposedly rid your digestive system of any nasties. But while it's true that there are things we can do that will make a difference to good gut health, what's the advice that's worth taking – and what are the myths we need to ignore?

Drinking lemon water helps digestion   MYTH 

It's often seen as the holy grail of morning routines, but Jordan Haworth, a clinical physiologist at the Functional Gut Clinic, a private facility in Cambridge, says you're pretty much just adding a bit of vitamin C to water, and doing little to support your gut.

"People think lemon water is going to rejuvenate them, but unless you're drinking it because you like the taste, then it's not going to have significant benefits," he says. "There's a myth [that] it helps digestion through improving the acidity of your stomach, but it's unlikely to change the acidity of your stomach at all. You're not getting any fibre either as you're not eating the whole fruit."

Fibre has consistently been proven to help support gut health and digestion.

Instead of lemon juice water, Jordan recommends eating a fibre-filled kiwi. If you keep the skin on, the amount of fibre you consume will increase by 50 per cent.

Gluten free is better for your gut  MYTH, for most people  

Gluten, a protein found in several grains including wheat, has been touted as something of a gut-health demon, with many saying it causes bloating, gas and other digestive issues.

Nevertheless, says Kirsten Jackson a consultant IBS dietitian, "gluten is not bad for the gut at all unless you have coeliac disease or a gluten allergy which is very rare. There is no proven mechanism for gluten to be harming the gut."

Research published in the journal Gastroenterology in 2018 also found that it may not be gluten causing problems, but fructans instead. These are carbohydrates or sugars found in wheat, as well as other foods such as onions, garlic and grapefruit. And, says Jackson, while many people do have an issue with fructans, this tends to be an intolerance so they won't need a strict free-from diet.

If you think you're intolerant to gluten or fructans, Jackson suggests trying sourdough bread as this is fermented, which means the end product contains less gluten and fructans and is easier to tolerate.

Around one in every 100 people has the autoimmune disease coeliac disease, according to Coeliac UK. In this instance, gluten must be avoided as it could lead to problems down the line including cancer and Type 1 diabetes.

Worried? Book an appointment with your GP who can advise on further testing as well as elimination diets.

A juice cleanse detoxes your gut   MYTH 

Think a few days of juicing will rid your gut of any nasties? Think again.

"The best way to detox is to poop as you're getting rid of your waste," says Haworth. "A juice cleanse is probably going to make you more constipated. When you do a juice cleanse, you're starving your gut bacteria, because juices are basically devoid of fibre, so you're not going to be giving your gut microbes any fibre to feed on."

Aim to eat plenty of whole fruits and vegetables instead.

Wine is good for my gut   Sometimes a MYTH, sometimes a TRUTH  

If you love a glass of red with your dinner, you might be doing your gut some favours. "Some studies show that red wine drinkers have a more diverse gut microbiome, which means they've got different kinds of bacteria in the gut, and we know that's associated with health," says Jordan.

Red wine is high in polyphenols, a type of antioxidant, but this is also found in grapes, pomegranates and other foods.

"You can get the polyphenol benefits by drinking non-alcoholic red wine and you could probably drink more than one non-alcoholic drink, because there is a threshold of where too much alcohol becomes negative for the gut," says Jordan.

The NHS suggests no more than 14 units of alcohol a week, equivalent to one small glass of red wine a day.

A happy gut means solely focusing on diet   MYTH  

For a gut that thrives, focus on your overall lifestyle and try to limit your stress levels. "In the longer term, stress has been linked to negative changes in the gut microbiome," says Jackson.

In the short term, meanwhile, stress triggers our 'fight or flight' response, a natural response where our body gets ready to fight or run away from danger, which can trigger digestive symptoms such as diarrhoea, urgency, pain and even constipation as the body prioritises the organs that are involved in fighting or running away.

Given that we don't need this bodily response when we're dealing with non life-threatening day-to-day stress such as work or financial stress, it makes sense to focus on bringing our overall stress levels down as much as possible.

You need to go for a number two every day to have a healthy gut   MYTH 

Research published this year found that those who poo once or twice a day may have healthier gut bacteria than those who go more or less often – but don't fret if that's not you: according to Dr Rebecca Reynolds, a consultant gastroenterologist with a specialist interest in inflammatory bowel disease, anywhere from three times per week to three times per day is within normal range.

The Bristol Stool Chart is a useful reference point for checking the consistency of your poo, with Type 3 and 4 – smooth and formed – being the 'ideal'. "If stools are hard, lumpy, difficult to pass or there is a feeling that not all of the stool has passed, then you are probably constipated," says Reynolds.

"The most important first step is to make sure you drink plenty of water – imagine floating logs down a river; it's the same in our intestines! Sugary fizzy drinks can make things worse so avoid these. Physical activity can help to stimulate bowel movements; even a gentle walk can be beneficial."

Increasing the fibre in your diet should also help, but do this slowly to avoid potential gas and bloating. Reynolds suggests specific high-fibre foods including kiwis, pears, dragon fruit, chia seeds and psyllium husk powder.

Probiotics are the best way to support your gut  MYTH 

Probiotics, beneficial live microorganisms, such as bacteria and yeasts, help some people with digestive issues, but if you're already healthy, taking a probiotic is going to be pretty pointless, according to Jordan.

He compares the gut microbiome to a jungle. "Taking a probiotic is like trying to throw some seeds in there to see if the plants will grow. It's unlikely to happen. It's better to feed the plants that are already in there. Prebiotics over probiotics for me." Prebiotics are types of fibre that feed the good bacteria in the gut. They can be found in foods such as wholegrains, onions, artichokes, bananas and leafy greens.

"Probiotics can help a few people if you've got IBS or constipation for example, so it's best to check in with your doctor," advises Jordan.  

Fermented foods support the gut TRUTH

A 2021 study by Stanford University found that eating six servings of fermented foods a day boosted gut microbial diversity, a sign of a healthy gut microbiome, and lowered inflammation.

Dr Leeming suggests adding fermented foods like yoghurt; kefir, a type of fermented milk; sauerkraut, fermented cabbage; and kimchi, fermented vegetables, to your diet.

"These are rich in beneficial live microbes that can support gut health. Don't be put off if six servings sounds too much to you; even adding in a smaller amount is likely to help your health in the long-term," she says. "Try stirring kraut or kimchi through cooked whole grains or rice and add kefir to dressings and onto your breakfast in the morning."

It's better out than in TRUTH

Passing wind throughout the day is normal. In fact, Dr Leeming says that on average, a person passes wind 10 to 20 times a day.

"It's often a sign of a healthy gut, as your gut bacteria make gas as a side effect from breaking down food."

But she warns that holding it in can lead to discomfort, bloating, and abdominal pain. "It's better to release it when needed. Try going for a walk in the 30 minutes after eating."

Wheat Intolerance: The Facts

by NAOMI COLEMAN, femail.Co.Uk

An increasing number of Britons claim they are intolerant to wheat.

But far from being one condition, health problems involving wheat actually fall into three main groups.

Here is a guide to the main health conditions involving wheat in the diet, their symptoms, methods of diagnosis and treatments.

What is gluten intolerance?

Gluten intolerance - otherwise known as coeliac disease - is an inflammatory condition of the digestive tract, caused by gluten - a protein found in wheat, rye, barley and oats. It is not a contagious illness but is often genetic.

Coeliac disease affects one person in every thousand. Most people are diagnosed between the ages of 30 and 45. Classic symptoms include lethargy, weight loss, vomiting and diarrhoea.

The condition causes Gluten to damage the lining of the small intestine which greatly reduces the ability of the gut to absorb adequate nutrients from food. In the worst cases, this can lead to severe malnutrition.

Coeliac disease can be diagnosed by a gastroenterologist (stomach consultant) who will carry out an intestinal biopsy - a sample of tissue taken from the intestine.

This involves a flexible endoscope or telescope being passed through the mouth into the stomach and upper intestine so that the lining can be inspected and a biopsy taken.

The only treatment available to sufferers of Coeliac disease is a gluten-free diet.

What is a wheat allergy?

A sensitivity or allergy to wheat can produce a variety of symptoms in the body such as sneezing itching, rashes, watery eyes, runny nose, coughing, hay fever, headaches, nausea, digestive problems, swollen limbs or general aches and pains.

When someone is allergic to a certain food, their immune system reacts as if the food were an invader and produces antibodies.

Food allergies affect 1.5 per cent of the population. Wheat allergies affect less than one per cent.

Food allergies are often difficult to identify because our reactions can be delayed from anything from two hours to many days after taking the offending foods.

Common chronic illnesses and conditions such as asthma, eczema, migraines, irritable bowel syndrome and arthritis are often associated with wheat allergies.

Unlike classic allergies, if you are allergic to wheat you will usually be allergic to more than one food. On average, sufferers react to four or five different foods.

Sufferers are advised to eliminate wheat from their diet altogether and replace with rice, corn, millet, buckwheat or potatoes.

A wheat allergy can be diagnosed by skin-prick testing available at a NHS allergy clinic. This involves the allergen (wheat) being placed on the skin after it has been pricked. If the skin flares up 15 minutes later you have a wheat allergy.

A second method of diagnosis is a RAST blood test, which involves taking a blood sample and testing for the wheat allergen.

What is wheat intolerance?

Wheat intolerance does not involve an immune response. The reasons why people suffer from wheat intolerance are not entirely understood. Some experts believe it occurs when some people are short of the enzymes necessary for the proper digestion of wheat.

Symptoms of wheat intolerance can include bloating, headaches and joint pains.

However, Isabel Skypala, head of dietetics at London's Royal Brompton Hospital, believes getting a diagnosis for wheat intolerance is difficult.

'Some people find foods such as pasta and bread hard to digest. This is because pasta absorbs water, so it swells in the body and causes discomfort. Also it is fashionable to blame intolerance on wheat. People forget that other foods such as dairy which are spread on bread or sprinkled on pasta could be the offending culprit.'

The only proper diagnosis for wheat intolerance is a test called a food challenge, carried out in a hospital. The patient is blindfolded and tested for wheat under controlled conditions.

The patient is then monitored over three days to see if they develop any symptoms. Depending on which foods they react to, a food elimination programme is carried out under strict supervision.

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