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
