One thing that annoys organic bakers is being asked if their bread contains gluten. It’s not that they are irritated by having to make special breads for customers who are unwell, but that many digestive problems with symptoms as diverse as bloating, abdominal pain and fatigue are all blamed on gluten, which is only one of the many possible causes.

For example, the problem might actually be a non-immunologic food intolerance to the  carbohydrates or fructans in the grain, or the reaction might be to amylase-trypsin inhibitors which are the natural pesticides in wheat.¹ Another possibility is that there is a susceptibility to glyphosate residue due to the widespread practice of ‘ripening’ crops with herbicides before harvest. Then there are the myriad of chemicals used to standardise flour, whiten it, improve its texture and extend its dough-forming properties to make a uniform loaf for the supermarket shelf—the triumph of the Chorleywood bread process. To add to this there are fungicides, preservatives and colours, not to mention yeast conditioners—all commonplace in the bread as well as the other factory foods which accompany it during a snack or meal.

So what is all the fuss about gluten? To begin with, the gluten in bread is made from storage proteins in wheat called prolamins which occur mostly in the endosperm of the grain as gliadins and glutenins in wheat varieties, hordein in barley, secalin in rye, and avenin in oats—they all get lumped together as gluten. These proteins are also found as refined additives in thousands of supermarket products such as sauces, processed meats, baked goods, as well as being present in pharmaceutical drugs and supplements. They also occur inadvertently as a result of the contamination of food processing equipment that is not cleaned properly between different batches.

Coeliac disease is an immune reaction to gluten in a genetically susceptible person who carries specific genes (HLA-DQ2 and HLA-DQ8  leukocyte antigen class II), and has an incidence of about 1% worldwide. The immune response is to a portion of the gluten protein that is incompletely digested by enzymes, leaving large peptides up to 33 amino acids long. These peptides pass through the intestinal wall and trigger T-helper cells, the release of inflammatory cytokines, and antibody production from B-cells (antitissue transglutaminase antibodies and anti-endomysial antibodies). Coeliac patients also have a microbial population in the gut favouring Bacteroides species and Escherichia coli.²

Coeliac disease produces a systemic immune response with intestinal and non-intestinal symptoms. Symptoms are often noticed early in childhood such as a chronic loose bowel, abdominal distention and failure to thrive. Fatigue, weight loss, anemia, dermatitis and nutrient malabsorption may persist in adults without gastrointestinal symptoms, or they may be mistaken for irritable bowel syndrome. Tests are nevertheless specific, and an examination of the bowel reveals inflammation and atrophy of the villi.

The only form of cure for coeliac disease is the avoidance of gluten although drugs are being developed to stop the cascade of events triggering the immune reaction in order to make it easier for those averse to abstinence. These include the use of enzymes, zonulin antagonists, HLA-DQ2 blockers, immune system modulators, vaccines, gluten-sequestering polymers, anti-inflammatory drugs and anti-cytokines (anti-leuken-15, anti-TNF-α).³

Non-coeliac gluten sensitivity (NCGS) has a much higher prevalence at about 7% in Australia and is a less-easily defined problem.⁴ NCGS is associated with an innate immune response that leads to an increased permeability of the gut but does not necessarily involve permanent damage to the gut wall. There are antibodies present (anti-gliadin), but only 50% per cent of patients have gene defects indicating it is a condition distinct from coeliac disease.⁵ There is also IgG activation by the immune system, possibly to gliadins, and in some cases disordered gut bacteria (dysbiosis); however, the dysbiosis and related ‘leak gut’ may predate the NCGS and be the actual cause of the reduced tolerance to foods in the diet.

NCGS resembles irritable bowel syndrome (IBS) in its symptomatology and other sources of intestinal disturbance need to be screened out such as stress, anxiety and infection before trying a wheat-free diet. There could be a simple intolerance to fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) which may be a separate cause predating the protein-related NCGS, or result from it. These FODMAPs are poorly absorbed due to a lack of enzymes and are fermented in the intestine creating gas and distension. This can be investigated by using an elimination diet which excludes lactose, fructose, sorbitol, xylitol, mannitol, onions, garlic, beans, asparagus, broccoli, cauliflower, cabbage, chocolate, pulses and fruit, as well as fructans in wheat and rye. It is important to try this first because,  a gluten-free diet helps around 24% of patients with IBS, while a low-FODMAP diet helps 68-76%.⁶

Fructose malabsorption is a subset of FODMAPs caused by the excess consumption of factory foods. These foods contain large amounts of high-fructose corn syrup which spills from the stomach into the intestine and ferments because the gut cannot absorb it fast enough. The portion that is absorbed causes obesity and fatty liver because it is preferentially stored as fat, an increasingly common childhood condition.

Some researchers have focussed on herbicide use in search of an explanation for an increase in the prevalence of food intolerances and found a disturbing association between glyphosate and coeliac disease development. They cite the alterations in gut bacteria,⁷ inhibition of important detoxification enzyme systems (P450) and glyphosate’s ability to chelate minerals such as iron, cobalt, molybdenum and copper. This chelation of minerals causes deficiencies of amino acids such as tryptophan, tyrosine and phenylalanine, as well as anemia.⁸

If an over-sensitive person wants to eat bread then it is important that they eat grains prepared in the old-fashioned way with a sourdough starter and grown with organic farming practices because drugs and vaccines will never make the body thrive on factory food nor impart vitality—they are suppressive, designed to inhibit the body’s natural defensive responses to a hostile diet. Nevertheless, if the reader is still intolerant of grains such as wheat or rye after doing all that they reasonably can to improve their provenance, then a transition to another staple such as brown rice or quinoa, or even a palaeolithic-style diet should be considered. A Paleo diet best suits blood type O which is around 53% of the global population.⁹

An IgG test will also help identify other problem foods that have not even been suspected, and when they are removed a gut repair protocol can be commenced which will result in the healing of the gut wall and improved immunological tolerance. This protocol includes a probiotic as well as vitamins A,C and D. Herbs may include slippery elm, marshmallow, aloe vera, liquorice, plantain and calendula.

At the farmer’s market where the organic, stone-ground bread is sold a lady once told me that her two children had such bad asthma that the doctor wanted to put them on steroids as well as their ventolin puffers. She decided to put them on a wheat-free, dairy-free, additive-free diet instead and they both became so well that the steroids and puffers were no longer needed. Needless to say, it may have been a number of factors in the diet that were responsible, and not necessarily gluten.

This article is an excerpt from the more detailed eBook Bread, Grain And Gluten.

Disclaimer: this article is intended for the purpose of general education only, and is not a substitute for diagnosis, treatment advice, or a prescription that is given in a consultation with a qualified physician.

References:

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2.         Lebwohl B, Ludvigsson JF, Green PHR. Celiac disease and non-celiac gluten sensitivity. BMJ 2015;351:h4347.

3.         Makharia GK. Current and emerging therapy for celiac disease. Front Med 2014;1:6.

4.         Golley S, Corsini N, Topping D, Morell M, Mohr P. Motivations for avoiding wheat consumption in Australia: results from a population survey. Public Health Nutr 2015;18:490–9.

5.         Porcelli B, Verdino V, Bossini L, Terzuoli L, Fagiolini A. Celiac and non-celiac gluten sensitivity: a review on the association with schizophrenia and mood disorders. Auto- Immun Highlights 2014;5:55–61.

6.         De Giorgio R, Volta U, Gibson PR. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction? Gut 2016;65:169–78.

7.         Shehata AA, Schrödl W, Aldin AA, Hafez HM, Krüger M. The effect of glyphosate on potential pathogens and beneficial members of poultry microbiota in vitro. Curr Microbiol 2013;66:350–8.

8.         Samsel A, Seneff S. Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance. Interdiscip Toxicol 2013;6:159–84.

9.         D’Adamo P. Live Right For Your Type. Penguin Books; 2002.