Considering we’ve been enjoying wheat since the agricultural revolution some 10, 000 years ago the sudden explosion in gluten-sensitivity may be a little confusing. Gluten-free products are everywhere; restaurateurs are modifying menus; and the wave of ‘clean eating’ cookery books, blogs and baking is showing little sign of waning.
As a naturopath, when I mention gluten to an non-receptive ear I’m often met with a yawn; protestations; and mumblings about the next gravy train that could do with running out of steam.
So what actually is gluten?
Gluten is a protein present in most grains, including wheat, barley, rye, spelt, couscous and bulgur. It has a ‘glue like’ consistency which makes it very difficult to digest. Since the agricultural revolution more than 25,000 strains of wheat have been developed and over the last 500 years the gluten content of foods containing wheat has steadily increased (1,2).
Changes in agricultural and artisan practices are a contributing factor. The end of the 19th Century saw the invention of commercial yeast. Rather than relying on a multi-strain bacteria, lactic acid and Co2 to make bread rise (the method used in making sourdough - the sole bread at that time) a single strain of yeast was developed accelerating the fermentation process and masking the beneficial effects of lactic acid. Lactic acid helped break down the gluten protein making it less ‘sticky’ and easier to digest (3,4). So less lactic acid meant the start of poorer digestion. Over the years yeast has been refined and refined again, possibly hammering our digestion further.
The 1960’s saw the start of wheat production on a mass scale to satisfy demand both here and abroad. To ensure wheat was commercial it needed to be robust enough to survive adverse weather, fertilizers, pesticides and transportation. So how did we ensure our wheat was up for the job? We engineered a crop through a process of hybridisation, which had higher gluten levels and consequently less trace minerals than traditional crops, all at the expense of our digestive system. More recently the food industry has changed the solubility of gluten so that it can be added to foods without impairing the flavour. The downside is that this Frankenstein gluten is more problematic still.
Since that time cases of coeliac disease have risen by 400%. Researchers at the Mayo Clinic (a non-profit medical practice and medical research group) compared 9,700 well-preserved healthy blood samples taken from young males living in the 1950’s with 9,700 samples taken today. The likelihood of being coeliac today was found to be 4 times greater in elderly men (contemporaries of the original sample set) and 4.5 times greater in young (5). This all adds to the debate that an environmental link exists rather than improvements in screening and detection.
The gluten confusion
The terms allergy, sensitivity, intolerance and coeliac, are often used interchangeably when discussing gluten which can lead to muddy waters. A more accurate description would be gluten-related-disorders for which there are at least four (6).
The first one under the umbrella is the classic allergy. This involves your immune system generating something called an IgE reaction when it comes into contact with gluten. The second involves a different branch of the immune system (either IgA, IgG or IgM) referred to as a non-IgE immune response. This is where non- coeliac-gluten-sensitivity sits and, right now, is creating the biggest noise. The third is coeliac disease, whereby gluten stimulates a cascade of events leading to destruction of the lining of the small intestine, inflammation and poor nutrient absorption; and the fourth is something called non-immune-malabsorption syndrome more commonly known as intolerance and is characterised by an adverse reaction to gluten which doesn’t proliferate an immune response.
A recent study found that EVERYONE had intestinal permeability when eating gluten (7), whereby undigested gluten damages the lining of the intestine. Thankfully, the cells inside our intestines regenerate every three-five days (the fastest growing cells in the body) meaning for some the damage can be repaired and gluten doesn’t pose a problem.
The prevalence of none-coeliac-gluten-sensitivity is estimated to be six-ten times higher than coeliac disease (8) and for every one person that develops a digestive complaint following gluten there are eight who are affected elsewhere in the body, including the brain, thyroid and musculoskeletal system (9, 10). However, like with most things, we all have our individual tipping points and may develop sensitivity to this protein at any time. We especially become vulnerable when we’ve been under any form of stress.
The University of Chicago Coeliac Disease Centre identified at least 300 conditions that are triggered by gluten (11); and these will differ from person to person. If you’re curious to find out if gluten is an issue for you, eliminating ALL gluten from your diet for 30 days should see an improvement in any symptoms and general well-being for most and indicate whether or not you’d benefit from going gluten-free. If you want to take the guess work out there are highly sensitive tests available, which I use in my own work, that aren’t available in general medical practice. The current tests examine a single gluten protein, when in reality there are many factors that pose a problem, meaning that people are falling through the cracks.
The real controversy
In clinical practice, for me, the real controversy is approaching the G-word. People just don’t want to give it up and will cherry pick dietary advice to suit their lifestyle. I get it. Food, especially wheat based products, is highly emotive. Undigested wheat interacts with opiate receptors in the brain which releases dopamine – so it’s no wonder people don’t want to break up this relationship. Fresh bread, buttery pastry, baked goods.
I grew up in Cornwall and was never far away from a cream tea and a pasty. I LOVE them both in equal measure so I get it – I really do. But thankfully the gluten-free market is improving and there are some more than palatable alternatives out there (just be sure to scan the ingredients list as many are highly processed containing fillers and sugars).
If giving up the grain completely is beyond the pale try replacing your normal loaf with more traditional grains such as spelt, einkorn, emmer or sprouted grains. If you do have true gluten sensitivity these won’t be tolerated but may protect against the tipping point in those that don’t. Please also consider giving your digestive system some time out by enjoying a few wheat free days a week. Be prepared to get savvy with scanning ingredient lists – the stuff is everywhere!
(1) Sapone, A., Bai, J.C., Ciacci, C., Dolinsek, J., Green, P., Hadjivassiliou, M., et al. ( 2012). Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine. 10-13, 1741-7015.
(2) Spaenij-Dekking, L., Kooy-Winkelaar, Y., van Veelen, P., (2005). Natural variation in toxicity of wheat: potential for selection of nontoxic varieties for celiac disease patients. Gastroenterology. 129(3), 797–806.
(3) Gobbetti, M., Rizzello, C.G., Di Cagno, R., De Angelis, M., (2007). Sourdough lactobacilli and celiac disease. Food Microbiololgy. 24(2), 187-196.
(4) Klingberg, T.D., Pedersen, M.H, Cencic, A., Budde, BB. (2005). Application of Measurements of Transepithelial Electrical Resistance of Intestinal Epithelial Cell Monolayers to Evaluate Probiotic Activity. Applied and Environmental Microbiology. 71(11), 7528-30.
(5) Mayo Clinic (2015). [online]. Available from http://www.mayo.edu/research/discoverys-edge/celiac-disease-rise
(6) TheDr.com (2015). [online]. Available from http://thedr.com/wp-content/uploads/2014/11/Differentiating-Gluten-Related-Disorders.pdf
(7) Hollon, J., Leonard, E., Greenwald, B., 3, Goldberg, E., Guerrerio, A., Fasano, A., (2015). Effect of Gliadin on Permeability of Intestinal Biopsy Explants from Celiac Disease Patients and Patients with Non-Celiac Gluten Sensitivity. Nutrients. 7(3), 1565-1576.
(8) Molina-Infante, J., Santolaria, S., Montoro, M., Esteve, M., Fernández-Bañares, F., (2104). Non-celiac gluten sensitivity: a critical review of current evidence. Gastroenterology Hepatology. 37(6), 362-71.
(9) van Heel, D., West, J., (2006). For every Gluten Sensitive patient with the symptoms of an enteropathy (Classic Celiac Disease), there are 8 with no GI symptoms. Recent Advances in Coeliac Disease. Gut. 55, 1037–1046.
(10) Fasano A., Catassi C., (2001). Current Approaches to Diagnosis and Treatment of Celiac Disease: An Evolving Spectrum. Gastroenterology. 120, 636-651.
(11) The University of Chicago Celiac Disease Center (2015). [online]. Available from www.cureceliacdisease.org/wp content/uploads/2011/09/CDCFactSheets10_SymptomList.pdf
Article written by Allison Sheppard - London
The current wealth of information around health, diet and self-care can be difficult to navigate. You may feel overwhelmed and confused about which foods to eat and what to avoid or whether to bother with supplements. What you accept as healthful advice may be better suited to someone else's... [read more]