Are rotis really bad? The truth about gluten in our diets

What are gluten-related health impacts?

In some people, undigested gluten can be problematic. It causes an autoimmune reaction (the body’s cells attacking the intestine), which can cause abdominal fullness, flatulence and diarrhoea. Such a disease is called Celiac Disease. When fully advanced, this can result in anaemia, bone thinning and weight loss. Celiac Disease tends to run in families and can be identified by the occurrence of symptoms and positivity of antibodies (Tissue Transglutaminase IgA). Overall, it affects around one per cent of the population. Avoiding gluten in the diet removes all symptoms.

In some people, gluten sensitivity can cause skin blisters (dermatitis herpetiformis). In other people, symptoms are present after gluten ingestion, but antibodies are absent. These people are termed as gluten-intolerant (non-celiac disease gluten sensitivity). A small number of patients may have gait (walk) disturbances related to gluten. Avoidance of gluten in the diets of these individuals also helps them recover.

The link between modern wheat’s higher gluten content and increased immunogenicity is not conclusive. Its direct role in rising gluten sensitivity remains debated due to other contributing factors like diet and genetics. More research is needed for definitive conclusions.

Effect of gluten-free diets in those who do not have Celiac Disease or gluten intolerance

Long-term gluten intake has not been associated with coronary heart disease risk. However, avoiding gluten may reduce whole grain consumption, which could impact cardiovascular health. Whole grain intake should be emphasised for heart health benefits. A review of large data suggests that, for most healthy people, cutting out gluten from their diet might not be a good idea as it could mean missing out on protective nutrients and potentially increasing their risk of Type 2 diabetes.

While doubts remain about the benefits of gluten-free diets, potential harms remain areas of concern. Gluten-free diets may present side effects, such as poor palatability, high costs and socio-psychological adversities. Moreover, it may induce nutritional deficiency due to a low-quality diet.

A recent trial showed that patients with Irritable Bowel Syndrome (IBS) who believed they were gluten-sensitive reacted similarly to wheat, gluten and placebo, suggesting that expectations, rather than gluten itself, may drive symptoms in most cases. Importantly, healthy volunteers in controlled studies did not develop significant symptoms after gluten exposure. A gluten-free diet can sometimes trigger or worsen IBS-like symptoms in predisposed individuals. This can happen because some gluten-free foods might still be high in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are types of carbohydrates that can cause gas and bloating in sensitive guts), or it could be due to other factors like dietary nickel or histamine intolerance.

The gluten-free food industry has grown majorly in recent times. Interestingly, some data shows that people who do not have Celiac Disease are the largest purchasers of gluten-free products. Reassuringly, most Indians have eaten gluten most of their lives without any adverse side effects, that too for centuries.

Chapatis are good sources of fibre and protein

Chapatis/rotis, the main source of gluten in Indian diets, are an integral part of meals for most Indians, especially in North India. One medium-sized roti has about 3 g fibre and 3.8 g protein. If a person eats four such rotis a day, he/she will have eaten 12 g fibre (about one-third of the total daily requirement) and 15 g protein (26 percent of the daily protein requirement).

Fibre and protein are important for Indians to decrease the risk of heart disease and avoid weakening of muscles/bones. Further, a good amount of fibre helps in lowering cholesterol and betterment of intestinal health.

(This has been extracted from Dr Anoop Misra’s latest book, Smart Calories and Common Sense)