Friday, February 28, 2014

Gluten: Wheat's the big deal?


The recent dramatic increase in the amount of foods labeled as gluten free may have caught your attention. Is this a result of more people who can’t eat gluten or is it just a fad because Miley Cyrus once claimed it helped her lose weight? Although Miley may have created a gluten-free diet fad for some, gluten sensitivity and celiac disease are serious health problems, and are becoming more prevalent.
Unfortunately for some of us, we can no longer enjoy our favorite foods because of gluten. Yes, I am one of those poor souls. “Why?!” is a question I frequently ask when I see warm fresh bread, or when my friends want to go to Oktoberfest while I can’t drink any of the beer. Gluten sensitivity is a complex problem, and relates to the way our bodies react to the proteins in food, which continue to change and evolve as a result of industrialization.


What is gluten?

Gluten may have gotten a bad rap recently, but what exactly is it? Gluten is what gives dough its elasticity and helps it keeps its shape. It is a protein composite, meaning it is made of two proteins that are conjoined. These proteins are gliadin and glutenin. When gluten is digested, it splits back apart.


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Gluten is found mainly in wheat, but also in other grains like barley and rye. Because of its elastic and thickening properties, it is often found in imitation meats, some ice cream, and condiments like ketchup, 
 and soy sauce. This often leaves us gluten-challenged people feeling discouraged in restaurants and grocery stores.

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What are celiac disease, gluten intolerance, and wheat allergy?

Gluten sensitivity is a blanket term that covers a broad range of conditions. Celiac disease is the most severe sensitivity and is more rare than gluten intolerance. Most people who have gluten sensitivity have gastrointestinal symptoms, particularly those with celiac disease. However, some people have non-digestive symptoms like fatigue, headaches, eczema, and depression. The chart below shows the range of symptoms reported from gluten-sensitive patients.

Figure taken from Nature Reviews paper

Many of these symptoms have traditionally been diagnosed as irritable bowel syndrome, thyroid issues, or other autoimmune disorders. Recently as more research has been done, doctors have realized a diet high in gluten is part of some of the medical problems that have been on the rise.

Celiac disease, gluten intolerance, and wheat allergy are characterized by two different responses to gluten. People with celiac disease have an autoimmune reaction to the gliadin protein, meaning their bodies tell the immune system to attack itself. In the case of celiac disease, it targets the lining of the small intestine (villi). This can cause unpleasant digestive systems and may even lead to malnutrition and cancer. Celiac disease is diagnosed through an intestinal biopsy that shows damage done to the villi. About 1 in 133 people have celiac disease, but many have not yet been diagnosed. Celiac disease is a permanent condition, and gluten must be strictly avoided for those who have it in order to reduce its effects.

Non-celiac gluten sensitivity, or gluten intolerance, is a relatively new diagnosis. Causes and symptoms are still being researched. It is hypothesized that gluten intolerant people have an immune response to gluten in contrast to an autoimmune response like those with celiac disease. This means that the body attacks the gluten protein (or one of the components), the way that it would attack a bacteria or virus if you had a cold or infection. The result is inflammation inside and outside of the digestive tract, which explains why people who are gluten intolerant tend to have more non-digestive symptoms (rashes, headaches, and depression). It is estimated that about 5-10% of the population has gluten intolerance and it is not known if it is permanent or not. Typically, non-celiac gluten sensitive people should not eat gluten containing products, but do not need to be as cautious about cross-contamination with gluten.

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Having an allergy to wheat is not a form of gluten sensitivity, but exhibits some of the same symptoms. It is a reaction to one of the proteins found in wheat. An allergy is a different type of immune response to a protein. The gliadin protein is not one of the common allergenic proteins, so  one of the other components in wheat generally causes an allergic response. The body identifies the protein as harmful and sends an increased amount of white blood cells into the body to fight it, which is what triggers the reaction.  Food allergies are usually more severe than sensitivities, and contact with wheat should be avoided, but other gluten containing grains are okay.



Going gluten free simply for weight-loss is not generally recommended. A gluten-free diet can leave people nutrient-deficient, especially if they only substitute gluten-free products for regular ones. More likely, people who experience weight loss on a gluten-free diet, do because they are cutting excess calories from complex carbohydrates. This article originally posted on LiveScience goes over the reasons gluten free dieting can be problematic, and ways to diagnose celiac disease and gluten intolerance.


Why wasn’t gluten a problem 100 years ago?

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As we know, the way that we grow and process food has dramatically changed over the course of several decades. New variants of wheat, however, have been produced as a product of selective breeding with a process called hybridization that has been used for hundreds of years, which is discussed in my GMO post. This has resulted a different wheat structure than 100 years ago. Farming using machines and increased use of pesticides and fertilizers may also be the cause of some adverse reactions.

In addition, people are consuming more gluten today. To increase output, the process of bread leavening has become shorter, which increases the concentration of gluten proteins in many bread products. Additionally, there has been an increase in the amount of wheat and gluten that people are consuming because of an increase in consumption of processed foods. This factor, along with a greater understanding and ability to diagnose gluten sensitivity has contributed to the increased number of cases in recent years.

If you find that you have gluten sensitivity, there are many recipes and products available for gluten free living to make the transition easier. And lucky for me, I live in a city with many gluten-free options for foods I used to love like pizza. I have even come across some pretty good gluten-free beers! I’ll cheers to that!



References:

Volta, Umberto, and Roberto De Giorgio. "New understanding of gluten sensitivity." Nature Reviews Gastroenterology and Hepatology 9.5 (2012): 295-299.