Strict and lifelong gluten-free diet

A strict and lifelong gluten-free diet is the subject of a robust debate amongst scientists; there is no unanimity on the issues raised. It may not be necessary.

When scientists disagree on a subject, often vehemently, it simply means they are unsure and we need to avoid making dramatic lifestyle changes. Invariably it means there are other factors at work which have not been taken into account.

There is an exact parallel with dairy products. Is butter indeed back? Should we be avoiding cheese? Is low-fat milk the solution to cholesterol? It all depends on what else you are eating.

Are there other strategies that could be followed instead of the very cumbersome lifelong avoidance of dairy and wheat products?

Gluten

Gluten is the protein in bread that gives the dough its elastic properties enabling it to balloon by trapping the gas generated by the yeast^[2]. The prevalence of an autoimmune allergic reaction to the commercial loaf called Coeliac Disease is rising in leaps and bounds; added to that, many get abdominal discomfort and bloating.

• Meaning of gluten
  

The assumption is that gluten is to blame. The simple immunoglobulin blood test has high sensitivity and specificity; it's reliable. The prevalence of Coeliac Disease has doubled in the last 25 years^[1]; 1 in every 60 children in Italy. 

The Catassi opinion

Professor Carlo Catassi is a very well respected paediatrician in Italy. He has successfully campaigned for the screening of all children for Coeliac Disease. He argues that the silent, undiagnosed allergy could lead to serious issues such as infertility, anaemia and osteoporosis; neurological problems and even cancer.

The Sanders opinion

On the other hand Professor David Sanders in the UK takes a different line. Whilst acknowledging that two-thirds of cases are undiagnosed he has a deep concern that screening of all children would "turn a healthy person into a patient." The psychological implications are simply enormous.

Says he, "If their symptoms are so minimal then perhaps they don't need to know."

Predisposition

A positive "anti-tTG IgA" simply means that one has a predisposition for Coeliac Disease. Labelling an otherwise healthy child as sick on the basis of a screening test is ludicrous. It is only if other factors combine together that a person then becomes ill.

Lack of robust evidence

There is a complete lack of evidence that placing a healthy person on a gluten-free diet would improve their wellbeing and quality of life. In fact, quite the contrary is true.

Almost one-third of Americans say they would like to reduce or avoid gluten altogether^[3]. The great concern is that most of them instead then go onto a highly ultra-refined carb diet, lacking in fibre. These food plans are also deficient in many important minerals and vitamins; and certain key phytonutrients like lignans.

• Lignans protect the prostate gland
  

Transglutaminase

Transglutaminase is a "naturally-occurring" enzyme which increases the cross linking between the gluten proteins in flour; it improves the structure of the dough. It is now routinely used by commercial bakers to increase the volume and texture of bread.

The great concern is that when food manufacturers take a "naturally-occurring" compound and transform it, everything changes; they turn it into an "ultra processed" food.

We see something similar with industrial pectin routinely added as fibre to many ultra-processed foods; it's quite different to that found "naturally" in an apple, for example.

Anti-tTG IgA test

Notice that this stands for anti-tissue "transglutaminase" immunoglobulin A.

There is a strong body of opinion that believes that it is the use of industrial transglutaminase in bread and many other foods that is making us so sensitive and allergic to gluten; and causing the number of postive tests to rise so dramatically.

The talk

My own particular concern is that all "the talk" is about gluten-avoidance, screenings and strict diets. There is not a word, for example about the fact that the sourdough method of baking bread for millennia predigests the protein in flour.

The protein in gluten is high in a unique amino acid called proline; enzymes in the gut have difficulty digesting it, leaving short unbroken chains that provoke inflammatory reactions in the gut. If absorbed through damaged "tight junctions" the body, the whole body becomes angry.

Researchers have found that most of those with severe Coeliac Disease can enjoy bread baked with a very long sourdough pre-fermentation using certain flours.

Microbiome

There is also very little in the "the talk" concerning gluten about the importance of the microbiome; that massive number of friendly bacteria, viruses and yeast cells that dwell in a healthy intestine.

There is a massive amount of research about how a depleted microbiome is a major cause of inflammation both in the gut and the body as a whole. But in relation to gluten-intolerance it is hardly mentioned.

• How to make kefir
  

Ultra-processed foods

The dramatic increase in those with a positive screening test exactly parallels the huge rise in ultra-processed foods found in grocery stores; especially baked goods.

• What are ultra-processed foods?
  

A different strategy

A completely different approach to a strict and lifelong gluten-free diet might look like this.

1. Start making and regularly consuming a probiotic in your own kitchen. Kefir is to my mind the simplest but those with severe issues should also be considering sauerkraut and others like kimchi. Supplements are not recommended as they swamp the gut with a very narrow spectrum of bacteria.
   
2. Start baking your own bread according to the sourdough method. With a home appliance it takes only five minutes every morning to prepare the ingredients with zero industrial transglutaminase. Once slice is sufficient.
3. Slowly increase the fibre in the diet, particularly that in dark-green leafy vegetables and fruit to the recommended 30 - 40 grams per day; only 5% of those on typical grocery store food are getting the required daily allowance.
   
4. Purchase a mill for true whole grain flour which is not commercially available.
   

Strict and lifelong gluten-free diet

Strict and lifelong gluten-free diet may not be necessary.

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