What's The Deal With Gluten
What is Gluten
First off an explanation of what gluten is. I don’t want to make the assumption that everyone reading this already knows. Gluten is a protein found in certain grains; most notably wheat, barley, and rye. Gluten is created when two molecules, glutenin and gliadin, come into contact and form a bond. When bakers knead dough that bond creates an elastic membrane, which is what gives bread it’s chewy texture and what allows pizza chefs to toss and twirl the dough in the air. Gluten also traps carbon dioxide, which ferments and adds volume to the loaf.
Is it bad for everyone?
Humans have been eating gluten for at least 10,000 years. However, an estimated 1% of the population has celiac disease where even the briefest exposure to gluten can trigger an immune reaction and damage the villi of the small intestine. For those folks they absolutely have to avoid gluten in all of its forms for the rest of their life. But what about the other 99%? Up until about a decade ago most of us didn’t give it much thought. Is it really a problem for everyone? An article in the New Yorker reported that approximately 1/3 of American adults say they are trying to eliminate gluten from their diets. Is this necessary? There are essentially 3 camps in response to this question. One camp believes that gluten should absolutely be avoided by everyone. Another believes that unless you have diagnosed celiac disease you should not be avoiding gluten. And the third camp, which I am a part of, believes that some people without celiac disease do still have an intolerance, or sensitivity, to gluten. And those folks should absolutely try to avoid gluten. But I don’t believe it’s inherently bad for everyone. The gluten-free market has skyrocketed with over $15 billion of sales expected this year. Gluten-free has definitely become a health food trend, which makes it difficult to discern if it’s something everyone should avoid or can it still be a healthy part of the diet.
How do you know if you have a problem with gluten?
If you are experiencing severe digestive issues, especially when coupled with anemia, chronic fatigue, and/or autoimmune issues I would first get tested for Celiac Disease. It is best to have the test done before you start removing gluten from your diet. This will provide a more accurate result. If you test negative for Celiac Disease it is still possible you have a gluten sensitivity or intolerance. It may not be severe enough to cause an acute allergic reaction, as is the case with Celiac Disease, but it may still be causing inflammation and irritation in your gut that could help to explain various digestive complaints, body aches, allergies, headaches, inflammation, etc. There are currently no recognized tests, biopsies, genetic markers, or antibodies that can confirm a diagnosis of non-celiac gluten sensitivity. The gold standard of testing is simply an elimination of gluten from your diet for at least 2 weeks, followed by a re-introduction to see what happens to your symptoms.
What about other grains?
Although gluten gets most of the attention, some would argue that all grains (even gluten-free grains) can be problematic because of their anti-nutrient compounds, phytic acid and lectin.
Phytic acid is the main storage form of phosphorous in plants and is found in the bran of grains and in the hulls of nuts and seeds. The concern is that humans don’t have the enzyme necessary (phytase) to properly break down phytic acid. Because phytic acid has a strong binding affinity to minerals in the plant, such as calcium, magnesium, iron, copper, and zinc, it lowers the nutritional quality of the food by making those minerals unavailable (or partially unavailable) for absorption. There are some remedies to this however. Sprouting the grain reduces the quantity of phytic acid and helps make the minerals more available for digestion. You can also add mineral absorption enhancers, such as garlic and onions (alliums), which improves the bio-accessibility of iron and zinc from the grain.
This concern should be balanced though by the fact that there are some health benefits to phytates, such as anti-cancer activity and improving bone density by blocking the formation of bone eating cells.
Lectin is considered another anti-nutrient. Lectin is found in grains, beans, nuts, and seeds. Lectin is also a protein, which binds specific sugars. The concern is that lectins are highly resistant to the body’s digestive enzymes and end up moving through the GI tract unchanged. Their “stickiness” allows them to attach to the intestinal wall where they can damage the villi. Repeated exposure may eventually damage the gut wall and lead to leaky gut. However, cooking legumes properly as well as soaking, sprouting, or fermenting grains will eliminate the lectin and remove the problem.
Could the problem go beyond gluten?
Okay so at this point you’re probably seeing that this discussion is so much more than just avoiding gluten or not. We need to consider our ability to digest anti-nutrients and there’s actually even more for us to consider.
How about the fact that modern “dwarf” wheat (wheat produced in the US since the 1960’s) has more gluten, more phytates, and is less nutritious. It provides greater yields in less time but definitely at a cost nutritionally. Prior to that, the invention of modern milling has taken all the nutritional components out of the grain. Stone milling simply mashed all the parts of the grain together into a flour.
Modern steel milling separates out the parts of the grain so all that’s left is the white flour. For an experiment, buy organic whole wheat berries and grind them into a flour at home with a food processor or high powered blender. You’ll see for yourself how different the flour looks. I first discovered this when I was making my own baby food at home for my children.
Another really big concern is that commercially grown wheat and grains are heavily sprayed with glyphosate (Round-Up). Pre-harvest application of Round-Up has been in practice since the 1980s but routine since 1990. Glyphosate toxicity is such a health problem and so widespread in our food supply that it really deserves its own blog post, which I plan to do in the future. For now, what I think is the important take-home message is that glyphosate appears to be strongly correlated with the rise in celiac disease, according to Dr. Stephanie Seneff, a senior research scientist at the Massachusetts Institute of Technology (MIT). This may help to explain why our modern wheat is making people sick.
Another issue is that the commercial market for grains no longer uses traditional preparation methods, which interferes with our ability to properly digest and absorb the nutrients in grains. In Michael Pollen’s docu-series Cooked he speaks to this as it pertains to traditionally prepared sourdough bread. In traditional cultures grains were soaked, sprouted, and fermented prior to eating. All of these steps helped prepare the grain to be digestible. In our fast-paced consumer market we don’t have time to continue these practices thus making a product that is nutritionally inferior to what our grandparents and great-grandparents ate as well as less digestible.
The diversity of our microbiome influences our ability to digest gluten and grains. A breakthrough study from Harvard’s Peter J. and Duke’s Lawrence David reveals some of the ways in which our diet shapes our microbiome — and thereby affects our ability to digest various types of food. In 2011, the researchers fed volunteers two very different diets. One group was given a high-protein diet consisting of bacon and eggs, spareribs, brisket, salami, cheese, and pork rinds. The other was fed a very high-fiber diet of fruits, vegetables, grains, and beans. Bacterial analysis of fecal samples collected before, during, and after the experiment showed that what each group ate had a huge — and almost immediate — effect on their gut bacteria. Lo and behold, each group began to develop the very type of bacteria that would most help them digest the particular types of food they had just eaten. In just 24 hours, meat eaters saw an increase in bacteria that are resistant to bile acids (bile acids are a byproduct of the breakdown of meat). If you’re a meat-eater, you need those bacteria — so the microbiome responded. The vegetarian group had far fewer bile-resistant bacteria, because, given their diet, they didn’t need them. The microbiome was responding to them, too. Even the long-term vegetarian who agreed to eat meat for this study saw a rapid microbial shift.
Researchers in Australia found that the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) along with the insoluble fiber found in grains may be more problematic than the gluten itself for some people. FODMAPs and insoluble fiber increase the osmotic pressure in the large intestine and promote bacterial fermentation, which results in gas production and abdominal bloat. A related study found that patients who improved on a low-FODMAP diet experienced no exacerbation of symptoms when gluten was reintroduced.
Steps for an Elimination
So what should you do? Well, if you are concerned that you might have a sensitivity to gluten I would suggest a 2 week elimination. Keep in mind though, as we discussed above, that the sensitivity could be bigger than just gluten. It could include FODMAPs or other common culprits like corn, soy, eggs, etc. Working with an Integrative Dietitian you can insure that your elimination includes all the likely suspects for you.
Step 1: Identify all sources of gluten currently in your diet.
Step 2: Use up what is currently in the house and fill your pantry with gluten-free items.
Step 3: Remove all gluten completely from your diet for at least 2 weeks. Although this is not enough time to completely heal from the damage of gluten if it is a problem for you, it will provide enough of a window so you can bring it back and see what happens. Be mindful of hidden sources of gluten and be extra careful when eating out.
Step 4: Monitor your symptoms. I would suggest making a chart with a list of all your symptoms and rating each on a scale from 0 to 5 as to how severe the symptom is for you. At least weekly during the elimination go back to your chart and re-scale your symptoms to monitor for any changes.
Step 5: Bring gluten back into your diet for 1-2 days. Have at least a couple of exposures each day. Then remove from diet again for 3 days. This will help you monitor for any immediate versus delayed reactions you might have from the gluten exposure.
Step 6: If you have a reaction, continue to remove from diet for at least 3 months before you try testing it again. If you don’t have a reaction, it’s okay to resume gluten but be aware that sometimes reactions are dose dependent. This means that an occasional exposure to gluten is not an issue but if you start to eat it every day then it could become a problem.
If gluten is not an issue for you, and for your sake I hope it’s not, I would encourage you to take care not to overdo eating it and to choose gluten products that are prepared with traditional methods. Avoid industrial flour made with modern wheat. Although I haven’t yet, I am still determined to try making my own sourdough bread. Once this actually happens I will certainly post about it and will love to hear about your traditional baking adventures as well.
I would also encourage you to vary your grains and to experiment with other whole grains like quinoa, wild rice, einkorn, millet, etc. If you must eat gluten-free because of sensitivity or allergy, then please do avoid it. But don’t substitute it with highly processed, nutritionally void, gluten-free substitutes. That is probably my biggest concern about people going gluten-free. Do not automatically assume that if it’s gluten-free it’s good for you. When I walk through the grocery store most of the gluten-free products I see are less healthy and more processed than the products they’re trying to replace.
Whether you’re able to eat gluten or are avoiding gluten, sticking to minimally processed real food is the key. Throughout all my Rustic Diet plans I recommend rotating through a variety of healthy, traditional foods. That way you can take advantage of the variety of nutrients and health benefits each food has to offer while also taking care not to develop a sensitivity.