Gluten Freedom is a fascinating analysis of gluten-related disorders by Alessio Fasano, Founder and Director of the Center for Celiac Research at Massachusetts General Hospital, Harvard Medical School. It’s packed full of facts – here are some of them
For most of human evolution, we didn’t eat gluten. However, about 10,000 years ago, humans started to use agriculture instead of just hunting and gathering. Wheat was a fantastic food source that was easy to farm and to store – and our modern diet began.
Wheat is way more complex than we are. Forget any sense of superiority you may feel over plant life… the human genome has about 20,000 genes. Wheat, on the other hand, has about five times that number.
Our bodies see gluten as an invader and launch an immune attack against it. This is true for everyone. Proteins are made of chains of molecules called amino acids, strung together a bit like a pearl necklace. When they are consumed, the body’s digestive system breaks the ‘necklace’ into chunks called peptides, ready for use elsewhere in the body. All the proteins we eat can be broken down completely within about an hour – except gluten. Dr Fasano’s research indicates that these undigested gluten peptides then cause an immune response in everyone. Does this mean we shouldn’t eat gluten? Some people think so, but let’s not forget that our immune systems are under attack all the time and for most people gluten doesn’t cause a problem. But it’s perhaps not so surprising that some people can’t tolerate it.
In 1994 the US barely recognised coeliac disease. An 800-page report published in that year by the US Department of Health and Human Services and the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases didn’t even mention it. Coeliac disease was first discovered in the Europe at the end of the 1800s. Dr Fasano had worked in Europe and was used to treating cases of the disease. He went to the US in 1993 and was amazed when he barely saw a single person with it. What was special about the US? As it turns out, nothing – Dr Fasano’s analysis of a selection of blood samples showed that in fact there were at least one in 250 people with signs of the disease. Now that proportion has been increased to up to one in 133 people.
Coeliac disease is a problem worldwide. Wheat forms the basis of staple foodstuffs in much of the world and this creates the same gluten-related problems for susceptible people no matter where they are. For years it was assumed the Chinese didn’t suffer from coeliac disease. It turns out this was probably just because the traditional diet was based on rice. As the Chinese have started to eat more wheat-based foods, so the incidence of coeliac disease has increased.
As well as coeliac disease, there is also wheat allergy and gluten intolerance. Coeliac disease is an autoimmune disease that is lifelong and there is currently no cure (though for most sufferers, avoiding gluten will give a complete cessation of symptoms). Wheat allergy is sometimes outgrown. Gluten intolerance is less understood, but there are definitely people who sufferer digestive upset after eating wheat who are neither allergic nor coeliac.
Coeliac disease doesn’t just affect the gut. While sufferers of coeliac disease typically have damage to the small intestine if they eat gluten, Dr Fasano’s research suggests that the brain and nervous system can also be affected. This can include headaches, depression, tingling of the fingertips and a foggy mind.
The gluten-free market has mushroomed in recent years. Retail sales in the US stood at $4.2bn in 2012 and are estimated to exceed $6.6bn in 2017.
It’s possible that treatment for coeliac disease will become a reality in the not-too-distant future. Coeliac disease can occur at any age, but there may be a way to prevent it starting. We already know that even if there is a genetic predisposition to coeliac disease, this doesn’t necessarily mean the person will get it (as studies on identical twins show). Other studies are looking at drug treatments.
Barley and rye don’t contain gluten. Instead they contain two closely-related proteins called secalin and hordein. These proteins contain peptides that can trigger a gluten-related reaction in people who are sensitive, so for the sake of ease, barley and rye are classed as containing gluten.
• Gluten Freedom by Alessio Fasano MD is published by Wiley, ISBN 9781118423103