Millions of people across the country struggle with particular ingredients in their diets. And the impacts can be uncomfortable, with allergies and intolerances causing havoc on the stomach and guts of so many.
Making matters worse, the coronavirus pandemic, and the increase in stress it has brought, has worsened many health issues. That includes stomach and bowel concerns which can be exacerbated by stress.
Manchester experts believe that far more than those officially diagnosed with recognised illnesses such as irritable bowel syndrome (IBS), colitis, Chron's disease, and coeliac disease. One world-leading and University of Manchester academic, Professor Peter Whorwell, has shared his knowledge from years of treating patients and research, now operating the South Manchester Functional Bowel Service.
The key is to find out what feels normal for you, says the consultant - if certain foods aren’t giving you tummy trouble, not to worry. But if there’s a particular ingredient that seems to cause problems, it could be worth investigating.
And there are plenty of common signs to watch out for if you’re suspicious that you might have a body, gut, stomach or bowel complaint, just like so many people across the UK.
Doctors once wrongly told patients that their gastrointestinal issues were psychological and that nothing could be done to make them better, says Professor Whorwell. In reality, ‘nothing could be further from the truth’.
One ingredient that repeatedly rears its head for the doctor's roster of patients is gluten. Gluten is a general name for the proteins found in wheat, barley, rye, and other grains. Gluten helps foods maintain their shape, acting as a glue that holds food together.
Gluten can be found in many types of foods, such as bread, baked goods, soups, pastas, cereals, beers and lagers, sauces and more. It can cause issues for people with coeliac disease, general gluten intolerances, and other diseases with can come with gluten sensitivities.
Coeliac disease is common and affects 1 in 100 people. However, only 36 per cent who have the condition have been diagnosed which means there are currently nearly half a million people who have coeliac disease but don’t yet know, according to Coeliac UK.
Many other conditions including non-coeliac gluten sensitivity also need a gluten free diet. It is now estimated that at least 10 per cent of UK consumers are following this diet, adds the charity for the disease. In other nations, that figure is higher. In Australia, says the Manchester consultant, about one quarter of the population follow gluten free diets.
The difference between coeliac disease, gluten sensitivities, allergies and intolerances
Coeliac disease (pronounced see-liac) is an autoimmune condition caused by a reaction to gluten, says Coeliac UK. When someone with coeliac disease eats gluten, their body attacks its own tissue, causing damage to the lining of the gut and resulting in the body not being able to properly absorb nutrients from food. Coeliac disease is not an allergy or food intolerance.
Some people with coeliac disease are also sensitive to oats due a protein similar to gluten, called avenin. Oats can sometimes be cross contaminated with gluten during harvesting or production. Gluten free oats exist where special care has been taken to avoid this cross contamination.
Because of the way that coeliac disease can affect the gut, it's frequently misdiagnosed as IBS, adds Coeliac UK. In addition, coeliac disease is known as a 'multi-system' disorder – symptoms can affect any area of the body. Symptoms differ between individuals in terms of type and severity, and you don't need to have gut symptoms to have coeliac disease.
Wheat allergy is a reaction to proteins found in wheat, triggered by the immune system and usually occurs within seconds or minutes of eating. Non-coeliac gluten sensitivity is when symptoms similar to coeliac disease are experienced, but it is not clear how the immune system might be involved because no antibodies are produced, and there does not appear to be damage to the gut lining.
Non-coeliac gluten sensitivity is a recognised condition in many countries, although there are no specific diagnostic tests for non coeliac gluten sensitivity.
Some researchers define non coeliac gluten sensitivity as an improvement in symptoms when following a gluten free diet. However, it is difficult to rule out the possibility of a placebo effect.
More generally, these are the differences between food allergies and intolerances, according to the NHS:
- An allergy is a reaction by your immune system (your body's defence against infection). Your immune system mistakenly treats proteins found in food as a threat
- It can trigger allergy symptoms, such as a rash, wheezing and itching, after eating just a small amount of the food (these symptoms usually happen quickly)
- It is often to particular foods. Common food allergies in adults include fish and shellfish and nut allergies. Common food allergies in children include milk, eggs, fish, peanuts and other nuts
- An allergy can be life-threatening
- A food intolerance does not involve your immune system – there is no allergic reaction, and it is never life-threatening
- It causes symptoms that happen gradually, often a few hours after eating the problem food
- It only results in symptoms if you eat a substantial amount of the food (unlike an allergy, where just traces can trigger a reaction)
- An intolerance can be caused by many different foods
What are the symptoms?
The main symptoms of coeliac disease, listed by the Coeliac UK, are wide-ranging. So the advice is to keep an open mind until medical tests are carried out to determine whether or not you have the disease, as it can often be misconstrued for IBS or wheat intolerance.
Common symptoms are:
- severe or occasional diarrhoea, excessive wind and/or constipation
- persistent or unexplained nausea and vomiting
- recurrent stomach pain, cramping or bloating
- any combination of iron, vitamin B12 or folic acid deficiency
- anaemia
- tiredness
- sudden or unexpected weight loss (but not in all cases)
- mouth ulcers
- skin rash (dermatitis herpetiformis)
- tooth enamel problems
- liver abnormalities
- unexplained subfertility
- repeated miscarriages
- neurological (nerve) problems such as ataxia (loss of coordination, poor balance) and peripheral neuropathy (numbness and tingling in the hands and feet)
According to the NHS, in general, people who have a food intolerance tend to experience:
- tummy pain, bloating, wind and/or diarrhoea
- skin rashes and itching
These symptoms usually happen a few hours after eating the food. It can be difficult to know whether you have a food intolerance as these are general symptoms that are typical of many other conditions.
What you can to do help
Coeliac UK says if you are experiencing symptoms when eating foods that contain wheat, barley, rye or oats and think you may have a sensitivity to gluten, it’s important to first rule out coeliac disease. Trying a gluten free diet as a first option if you are experiencing symptoms could prevent a coeliac disease test giving you an accurate result, which demand you have to keep eating gluten for a clear result.
You can carry out Coeliac UK's online assessment before going to a GP for further testing.
Professor Whorwell says that, in the event of a negative Coeliac disease test, cutting out gluten may still help if you have a sensitivity or just feel better without the problem protein.
“So many patients come to me and say ‘since I’ve stopped eating gluten, I feel a lot better’. If a patient says to me that they’ve never felt better, I’d be bonkers to tell them to stop doing that," Professor Whorwell tells the M.E.N.
“We need to think a bit more laterally. If someone suspects they’ve got a gluten intolerance, they can try eating alternatives which are easy to get hold of in supermarkets.
“It’s not going to do you any harm, even if it’s just a placebo response. I don’t have a problem with people trying cutting things out of their diet, if you’re not convinced it’s helping try something else. But don’t cut more than one ingredient out at a time, otherwise you won’t know what’s worked.”
Following a gluten free diet
The market for gluten free food still growing and is currently worth an estimated £835 million per year, according to Coeliac UK. The only treatment for coeliac disease is a strict gluten free diet.
Many people who follow a gluten free diet source suitable products from the 'Free From' aisles in major supermarkets, as well as other independent stores, health food shops and online outlets. They also look to mainstream foods using allergen labelling and the ingredients list to help them make safe choices, especially when in restaurants. Some people who have been diagnosed with coeliac disease can also access some gluten free products on prescription.
Even very small amounts of gluten can be damaging to people with coeliac disease. Therefore, taking sensible steps to avoid cross contamination with gluten is important.
Many everyday foods are also naturally gluten free and these are also vital components for people following a gluten free diet. They include:
- meat
- fish
- fruit and vegetables
- rice
- potatoes
- lentils
Read more about following a gluten free diet on Coeliac UK's website here.
When to see a doctor
If your problems are persisting over time - for example, if you have acute vomiting or diarrhoea for more than a few weeks - you should seek professional help, says Professor Whorwell.
But if you have been suffering with chronic tummy trouble, there are plenty of benefits to seeking help from a doctor, including getting a tailored diet plan or medication to suit your specific needs.
Do not ignore any bleeding, get checked out by your GP, he adds. The NHS asks people to see a doctor if they have the following issues:
- lost a lot of weight for no reason
- bleeding from your bottom or bloody diarrhoea
- a hard lump or swelling in your tummy
- shortness of breath, noticeable heartbeats (palpitations) and pale skin
These could be signs of something more serious.
Know what's natural for you
“As a general rule of thumb, it’s acceptable to open your bowels three times a day before it’s diarrhoea, and three times a week before its constipation. That’s the by-the-book definition," says the Professor.
“But if someone who was opening their bowels twice a week and wasn’t uncomfortable, I wouldn’t do anything about it. If someone goes once a day but can't get to the toilet fast enough, and it comes out in a torrent, that looks like trouble.
“If your bowel function is causing you problems, you should think about doing something about it. If not, leave it be. Everybody is different.”
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