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Gluten Free: Fad or Fact?

Gluten Free: Fad or Fact?

A mindset has slowly been spreading around the world, having emerged from the self-ordained capital of the health world in southern California. This mindset is that gluten is now the latest enemy to our health. Yes, the products of the single most staple crop, wheat, is now being blamed for a number of maladies. Despite wheat and bread making appearances in our culture throughout history, from the its role in the Bible to appearances in tapestries and its endurance all the way to today’s food, only now are we beginning to doubt it.

When wet, gluten gives dough its stretchiness, allowing it to be used in many different foods.
When wet, gluten gives dough its stretchiness, allowing it to be used in many different foods.

But what are the claims that are being made about gluten? Depending on who you speak to, gluten can be responsible for a number of problems: it is toxic, it is addictive, it makes you crave junk food, it causes allergies, it leaves you bloated and it is fattening. While many people will be able to tell you what gluten supposedly does to them, not many will be able to tell you exactly what gluten is. It is a composite of two proteins, glutenin and gliadin, which when wet forms stringy strands. This characteristic gives dough its versatility, allowing it to be turned into bread, pasta, cakes and all the other wheat based products we know.

Of course, it must be remembered that our relationship with gluten is not only defined by its supposed issues regarding health. For a certain number of the population, going gluten-free is not a choice it is in fact a necessity. Around 1% of the population in developed nations suffers from Coeliac disease, an autoimmune disorder of the small intestine that occurs upon exposure to prolamins, a family of proteins that include the gliadin component of wheat gluten as well as proteins found in barley, rye and corn. Upon exposure to gliadin, and specifically to three peptides found in prolamins, the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction. That leads to a truncating of the villi lining the small intestine. This interferes with the absorption of nutrients, as this is the main function of the villi. As such, symptoms include pain and discomfort in the digestive tract, chronic constipation and diarrhoea, failure to thrive (in children), anaemia and fatigue.

A biopsy of small bowel showing coeliac disease manifested by blunting of villi and lymphocyte infiltration of crypts - a characteristic sign of autoimmune disease.
A biopsy of small bowel showing coeliac disease manifested by blunting of villi and lymphocyte infiltration of crypts – a characteristic sign of autoimmune disease.

The only known effective treatment is a lifelong gluten-free diet and given the amount of food that contains gluten, this is an incredibly difficult and sweeping lifestyle change. A large proportion of the population, however, suffer from similar symptoms to Coeliac sufferers. If only 1% of the population actually have Coeliac disease, where does this sensitivity to gluten come from? Sensitivity is the crucial word here, as it makes the problem that a lot of people have with gluten distinct from Coeliac disease. It is thought that these newly diagnosed ‘Non-Coeliac gluten sensitivities’ (NCGS) are in fact sensitivies to a large group of carbohydrates, disaccharides and monosaccharides known as ‘FODMAPs’. The difficulty in diagnosing these sensitivities is that both gluten and FODMAPs can be found in the same high-risk foods.

FODMAPs can be found in many foods. A FODMAP sensitivity doesn't require all these foods to be cut out completely, but instead reduced. How the diet is managed depends on the person.
FODMAPs can be found in many foods. A FODMAP sensitivity doesn’t require all these foods to be cut out completely, but instead reduced. How the diet is managed depends on the person.

Peter Gibson, of the Alfred Hospital and Monarsh University in Melbourne, Australia, set about showing that these NCGS conditions could in fact be sensitivities to FODMAPs and not gluten. In his trials, 3 groups on low gluten and low FODMAP diets were given either a low or high gluten diet, or a milk protein control. All three groups had the same symptoms, suggesting that gluten was not the guilty party. Gibson suggested that these FODMAPs were the cause of affected people’s problems. These are poorly absorbed in the small intestine and are hence digested by resident bacteria, which releases gas in a process that also attracts water – leading to the flatulence, bloating and diarrhoea that many confuse with gluten intolerance. Since FODMAP sensitivity is not an immune disorder, eating fewer FODMAPs rather than cutting them out completely can significantly reduce symptoms.

So, gluten may not be to blame for a lot of our maladies, but is it as unhealthy as people claim? Many sources have jumped on the anti-gluten bandwagon, claiming that all sorts of ailments stem from its consumption. One popular theory is that gluten is the cause of the obesity and diabetes crisis in the U.S, due to a spike in blood sugar that is associated with consuming the protein. It must be emphasised, however, that blood sugar spikes must be consistent over a long period of time, not just after a single meal, to have any effect that would cause such a significant disease as diabetes.

Gluten has even been named by some as the leading cause of dementia, ADHD, anxiety and depression. However, gluten is no different to other environmental factors behind the onset of these neurological diseases – it cannot be causative by itself, as genetic factors play a very large part.

If gluten doesn’t cause disease, is it fattening or addictive as many people claim? A recent Spanish study showed that those on gluten-free diets not only generated more fat than those not on the diet, they also had lower levels of fiber. Soluble fiber is thought to protect against forms of bowel cancer by adding bulk to stools and moving them through the GI tract swiftly, reducing the contact time with potential toxins in the colon, as well as discouraging the growth of harmful bacteria in the GI tract.

There is even a belief that there is not a black and white ‘safe’ amount of carbohydrates. The ability to quickly digest these carbohydrates largely depends on the number of copies of the ‘AMY1’ gene a person has. These gene codes for alpha-amylase, an enzyme involved in the breakdown of carbohydrates. Recent studies show that if you have many copies of this gene, you may be able to tolerate high-gluten diets better than those who have fewer copies.

Ultimately, the widespread adoption of gluten free diets will probably prove to be a passing fad. Though genuine autoimmune conditions, such as Coeliac Disease, are increasing in frequency they still only affect around 1% of the population. It is likely that those who do seem suffer a sensitivity to gluten, but don’t suffer from Coeliac Disease, are in fact sensitive to a group of carbohydrates called FODMAPs and the symptoms that arise can be managed by decreasing consumption of these foods, not cutting them out completely. In terms of the general claims about our health, time will tell, but it seems likely that gluten will fade away as just another fad diet. The rule when it comes to as staple a grain as wheat is that if it has endured throughout his history for this long, it’s probably fine.

‘Til next time…

Joe

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