Bread and water: issues on the "basics" of our nutrition. Part I: GLUTEN
In the past 50 years there has been a sharp (real) increase in the number of people getting affected by what is called gluten intolerance or sensitivity (the two terms used confusingly in alternative manner), which is a difficulty, - at different grades - in digesting food containing gluten. Such definition includes a very serious problem, celiac disease, in which a person is totally unable to deal with gluten-containing food due to an auto-immune reaction to it. Auto-immune means that the own immune system starts fighting its own tissues, in this case the intestinal wall, taken by mistake as an enemy. As a result of gluten ingestion, the microvilli of the gut wall are completely destroyed and flattened down and the person is unable to absorb any nutrient. This leads to malnutrition and a list of serious complications including cancer and premature death. The only solution to this condition, which needs to be diagnosed as soon as possible, is changing the diet and completely avoiding gluten. The disease appears as soon as gluten is added to a child’s diet. Infants that develop celiac disease and are not diagnosed often have poor growth or weight loss, because intestinal damage compromises nutrient absorption.
Now, celiac disease is not so that common (about 1% of the population and appearing mainly in people of European descent – but this percentage would raise to 5% in Europe and North America). However, some of the celiac symptoms are shared with another type of gluten intolerance, which is called non-celiac gluten sensitivity (NCGS): abdominal pain, bloating, diarrhoea or constipation, along with non-gastrointestinal symptoms such as “foggy mind”, headache, fatigue, joint and muscle pain, leg or arm numbness, dermatitis, depression and anaemia. However, the symptoms in the NCGS are milder than in real celiac disease.
Such symptoms also overlap with Irritable Bowel Disease and somehow with Chron’s disease (another autoimmune problem), making the whole diagnostic process quite tricky. There is no direct test for determining if someone suffers from NCGS, thus the diagnosis is done by exclusion: no auto-antibodies against gluten = thus no celiac disease; thus , it could be a NCGS, especially if symptoms disappears on a no-gluten diet!
Celiac people have to be very strict in their food selection, especially because there is hidden gluten in many food items. Gluten is normally present in wheat and its subtypes: spelt, kamut, semolina, einkorn, bulgur and couscous; but also in rye, barley and to some extent oats. But gluten is also added to flour to increase the chewiness of bread, and to many other food types as diverse as beer and soy sauce, ice cream and ketchup, bouillon and processed foods like sausage, luncheon meat, gravies, sauces, Tv dinners, hot pies, but also to medicines and vitamins and beauty products.
So what is gluten? It is a protein, the most abundant (about 80%) among many proteins in wheat and most grains. It is made of gliadin and glutenin. Celiac disease is a reaction to the gliadin part. Gluten helps raising the bread and making it more elastic and chewier. To give you an idea of its constituency, check the origin of the name: in Latin gluten means ‘glue’.
At any rate, this increase of sensitivities towards gluten (or an increase in not well identified enteritis-type symptoms) has sprouted a real fad against gluten and gluten-containing food, which in turn gave origin to a wide new market of no-gluten products: new products are offered with no spelt, rye, barley and also oats (although with some uncertainties there - it might not be that bad, but one never knows...), as if the majority of the population could not take wheat or other grains!
A big bulk of research has developed around this subject. Why so many more people are affected nowadays? What changed? GM wheat? New wheat? Highly selected wheat? Research focused mainly on wheat, while all the other gluten-containing grains have been forgotten on the side. Some researchers do claim that wheat has now more gluten then “before”. Others state that the difference is in the fact that people eat more wheat than “before”. Others say that gluten is actually added to wheat products to make them more ‘glue-able’, more attractive to the eye and touch, more risen, more ‘soft’, so that we are ingesting way more gluten than in the past. Other scientists suggest that it is not gluten but some other proteins in wheat that cause such increase in unclear enteritis. Yet others state that it is not the amount of gluten in the wheat but the TYPE of gluten that has changed. And finally, a new theory suggests that the increase is due to augmented use of specific herbicides (Glyphosate), recently also sprayed on crops just before harvest.
Regardless the cause, many people now feel like they have to stay away from wheat and invest in alternative (often more expensive) no-gluten food. Many people self-diagnose and decide to go off gluten without any test (which would be worrisome in the case of the presence of real celiac disease) and sometimes without real need. It has in fact been properly researched and tested that many people who present similar symptoms to gluten intolerance are actually negatively affected by some types of food that contain particular sugars, as for example broccoli, onions, cabbage, chocolate (!), pulses, apples, avocados etc. Such foods would not get properly digested and would ferment in the intestine, causing the symptoms of bloating, nausea, diarrhoea etc.. Adopting a diet that avoids such “Fermentable Oligo-, Di-, Mono-saccharides And Polyols” (FODMAP) would actually relieve the ‘false’ NCGS symptoms better than avoiding gluten (eliminated for no real good reasons).
Moreover, one should be quite careful in deciding to go off gluten since a gluten-free diet often offers too much of simple carbohydrates, and too little fibers and vitamin B. "There's a misconception that it's very, very healthy and you're automatically going to lose weight on it," Melinda Dennis (coordinator of the Celiac Center at Beth Israel Deaconess Medical Center in Boston) says. "Not true. It's not necessarily healthy. It has to be done properly."
So, if symptoms appears, test yourself or your child to eliminate a possibility of celiac disease. Try both a gluten elimination diet (as difficult as it is for one needs to eliminate ALL food containing gluten) and if symptoms don’t disappear, a FODMAP elimination diet.
In general, always consume a very diverse diet, including - but not based on!- different cereals: spelt, barley, oats and the no-gluten buckwheat, amaranth, quinoa (since there might be some truth in the overbreeding process of wheat), but focus on whole-grains, the not-refined and full of fibers and minerals grains. Make your own bread with mixed whole grain flours, so that you are sure there will be no aded gluten, no added sugars, preservatives, etc. Avoid the packages presenting a bread mix, since even there you cannot be sure if there is/isn't any added gluten. Learn to like the old-style bread with full consistency and not the fluffy, springy, airy one. You do not need a bread machine, an oven is more than enough (if you need a recipe, contact me!).
At any rate, it’s a good idea to keep the grains at a low percentage in your daily plate since, being carbohydrates, they are still pro-inflammatory food (if thay are refined grains).
Bernstein C., Fried M., Krabshuis J.H., Cohen H. et al. 2009. Inflammatory Bowel Disease, a Global Perspective, World Gastroenterology Organisation Global Guidelines.
Biesiekierski JR, Newnham ED, Shepherd SJ, Muir JG, Gibson PR. “Characterization of Adults With a Self-Diagnosis of Nonceliac Gluten Sensitivity.” Nutr Clin Pract. 2014 Apr 16.
Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR. “No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates.” Gastroenterology. 2013 Aug;145(2):320-8.e1-3
Economou, M, Pappas, G 2007. New Global Map of Crohn’s Disease: Genetic, Environmental,
and Socioeconomic Correlations, Inflam Bowel Dis. DOI 10.1002/ibd.20352
Samsel, A., Senett, S 2013, Glyphosate, pathways to modern diseases II:Celiac sprue and gluten intolerance, Interdisc Toxicol, 6, (4): 159–184.