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Helping you make better health choices

What Doctors Don't Tell You


July 2020 (Vol. 5 Issue 5)

Gluten for punishment

About the author: 

Gluten for punishment image

It's trendy to be gluten-intolerant-but science is discovering it's much more than a fad, and it could have to do with the way the modern loaf is made


Your grandmother was right-bread really doesn't taste as good as it did in her day. Something happened to bread-making in the 1960s that made production faster and the standard loaf cheaper. That something, known in the UK as the 'Chorleywood method' after the town where it was devised, was the adding of emulsifiers, preservatives and, most significantly, enzymes to the mix.

And something started happening to our guts too. Coeliac disease, an autoimmune response to wheat, has escalated, and a new breed of problems-irritable bowel syndrome (IBS), and inflammatory bowel diseases (IBDs) such as Crohn's and ulcerative colitis-started to emerge in the 1970s.

Around the same time, people also started to complain of being gluten-sensitive or gluten-intolerant-a problem that's been given the umbrella definition of NCGS, or 'non-coeliac gluten sensitivity'.

Doctors insist it's impossible to test for gluten intolerance as, unlike coeliac disease, there are no inflammatory markers and there's no damage done to the small intestine. Blood tests exist, but the results from these are, at best, variable.

Despite the absence of obvious biological signs, around 29 per cent of people reckon they can't eat the modern loaf and claim they suffer from one or more of the symptoms, such as upset stomach, aching joints and light-headedness.

Celebrities like pop star Miley Cyrus (who helpfully Tweeted "Gluten is crapppp anyway!"), fashion icon Victoria Beckham, tennis champion Novak Djokovic and film star Gwyneth Paltrow have all proclaimed themselves gluten-intolerant. There are travel agents who plan gluten-free holidays, while wedding planners will put together a gluten-free reception. The gluten-free rage has even infected the cartoon series South Park, which in a recent episode featured the town as 'the first gluten-free in the nation'.

The movement has been supported by two best-selling books, William Davis's Wheat Belly (Rodale, 2011) and David Perlmutter's Grain Brain (Little, Brown & Co, 2013). Davis, a cardiologist, blames gluten for everything from arthritis and asthma to multiple sclerosis (MS) and schizophrenia. Perlmutter, a neurologist, goes further. Gluten sensitivity, he says, "represents one of the greatest and most under-recognized health threats to humanity".

All of this has fuelled the ire of the sceptics who dismiss the trend as faddism. One of the more entertaining voices is April Peveteaux, a coeliac who, in her book Gluten is My Bitch (Stewart, Tabori & Chang, 2015), says: "No matter what kind of sickness has taken hold of you, let's blame gluten." After all, they argue, gluten-an elastic protein found in wheat, rye, barley and some oats-has been around for centuries, so why should it be only in the past 30 years or so that we are suddenly reacting to it?

Is it the enzymes?

There's a growing body of research that suggests they could be right-up to a point, that is. People are reacting to the modern loaf, but it may have nothing to do with gluten. Instead, it could be a reaction to the enzymes added during the baking process, especially alpha-amylase, which breaks down the starch in bread into sugars (called 'hydrolysis') that are more easily taken up by the body.

Others posit that it's really the complex carbohydrates-collectively known as FODMAPs (an acronym for 'fermentable oligosaccharides, disaccharides, monosaccharides and polyols')-that are to blame.

FODMAPs carbohydrates are osmotic, which means they pull water into the intestinal tract, which can cause abdominal pain, bloating and diarrhoea. They're found in wheat and rye, but also in some fruits and vegetables.

It's an idea that's already having some success among IBS sufferers who, when put on a FODMAPs-free diet, see their symptoms improve. But then, the same improvements have been seen in people who are gluten-intolerant.

Peter Gibson, a professor of gastroenterology at Monash University in Australia, has been fascinated by the phenomenon for years. In one study involving 34 IBS sufferers, who all said their stomach problems improved or even disappeared when they stopped eating gluten, Gibson and his team put them on a strict gluten-free diet-but didn't reveal that half of them were given muffins and bread that contained gluten. Neither the scientists nor the patients knew who was eating what, yet most of those given gluten complained that their stomach pains and bloating had returned. In one stroke, Gibson demonstrated that gluten intolerance isn't 'in the head', as many sceptics still maintain.1

Buoyed by this success, Gibson turned his attention to FODMAPs. In a later study, he recruited 37 volunteers who said they were gluten-sensitive. They were put on a strict diet free of gluten and FODMAPs and, after two weeks, they all said their symptoms had improved. Gluten was then added back into the diet of some of the volunteers, yet their symptoms didn't return, suggesting their gluten intolerance was nothing of the sort.2

A lot of it about

It's hard to be sure what's going on, but something most definitely is. The rate of coeliac disease has increased fourfold in the past 20 years, although it affects only around 1 per cent of the population, according to official figures. Dr Alessio Fasano, at the University of Maryland School of Medicine, puts it much higher at around 7 per cent, and the true figure is much higher still, as it's recognized that just 24 per cent of cases are ever diagnosed.

Then there are the gluten-sensitives who complain of discomfort and stomach pains after eating gluten. Again, it's hard to gauge the true extent of the problem, but it's thought to be six times greater than for coeliac disease. Nearly 20 million Americans say they are gluten-sensitive, and a Mintel report in the UK estimated that 7 per cent of Britons complain that gluten triggers stomach problems, while a further 8 per cent avoid it as part of a 'healthy lifestyle'. But whatever is happening is down to modern processes for making the standard loaf-that much seems clear.

In 1907, master baker John Kirkland calculated that the yeast quantity in the final dough that went into making a loaf was just 0.1 per cent. By 1996, this had increased to 2.38 per cent, an increase of 23 times over that used in Kirkland's sponge-and-dough bread.

Milling methods were also beginning to change when Kirkland was making his bread. Before the invention of the roller milling used today, all flour was produced by crushing the wheat between revolving stones. All parts of the wheat-the bran, germ and starchy endosperm-were included in the mix, a process that gave its name to wholemeal, or whole-wheat, flour. With the roller system, which was first used in 1870, the wheat passed between pairs of steel cylinders which stripped the layers off the grain-yet most of the vitamins and minerals are found in the outer bran layers of wheat. So even back in those days, the goodness of bread was being depleted.

We have our methods

But the radical change happened much later, in 1961, when the British Baking Industries Research Association met at its Chorleywood, Hertfordshire, headquarters to devise a faster and more cost-effective way of making the standard loaf. They came up with a method that used low-protein wheat, an assortment of additives and high-speed mixing.

Commercially the Chorleywood method was a marvel; bread with apparent volume and lightness could be produced at high volume, very quickly and at very low cost. With the preservatives, the bread had a much longer shelf life and could also be used for days afterwards in the kitchen.

It's virtually tasteless, however, and most of us have experienced that sensation when the bread seems to stick to the roof of our mouths. But it's our guts that we need to be worried about. Just four ingredients-flour, water, salt and yeast-are needed to make bread, and even yeast isn't necessary if the baker is using sourdough. Yet the Chorleywood method includes 12 separate types of ingredients-many of which don't need to be revealed on any packaging labels-which could be playing havoc with our health.

The standard Chorleywood-method loaf includes:

o Flour
o Water
o Salt
o Yeast
o Fat
o Improving (flour-treatment) agents (L-ascorbic acid, or E300)
o Bleach (chlorine dioxide gas)
o Reducing agent (L-cysteine hydrochloride, or E920)
o Soya flour
o Emulsifiers (diacetyl tartaric acid esters, sodium stearoyl-2 lactylate, glycerol monostearates, lecithins)
o Preservatives (calcium propionate)
o Enzymes (alpha-amylase, maltogenic amylase, oxidase, protease, peptidase, lipase, phospholipase, hemicellulose, xylanase, transglutaminase).

Andrew Whitley, who co-founded the Real Bread Campaign, says the enzymes are "modern baking's big secret". They don't have to be disclosed on product labels because they can be classified under the umbrella term 'processing aids', whereas all additives must be declared.

The enzymes are used to help the bread stay softer for longer; one of them, phospholipase, is derived from pig pancreas (something that many vegetarians are unaware of as they tuck into their cheese sandwiches), while alpha-amylase is a known allergen. Transglutaminase, used to make the dough stretchier, turns the wheat protein toxic to people with severe gluten intolerance.3

And there's another ingredient that even the Chorleywood creators hadn't envisaged: the weed killer glyphosate, designated a 'probable carcinogen' by the World Health Organization. The UK's Soil Association has discovered that glyphosate is in one in every three slices of bread, put there by farmers who spray directly onto wheat before harvesting.

All about gluten

Gluten, an elastic protein and one of four contained in wheat (the other three are albumin, globulin and gliadin), is produced when water is added to flour. In the body, it's broken down into chains of amino acids known as 'peptides', and it's always been assumed that these chains pass through our digestive system-unless you're a coeliac sufferer, in which case your immune system 'sees' them as invading microbes and so mounts an inflammatory response.

But new research has discovered that gluten peptides don't travel harmlessly through the digestive system; instead, they survive the digestive process and pass through the gut walls and into the bloodstream, causing potential biological harm.

It's something of a scientific first, as all previous studies have used pure gluten for their tests. But in this case, researchers at the University of Milan used actual bread and pasta bought from the local supermarket, and discovered that the digestion of gluten resulted in exorphins (molecular fragments of wheat proteins, or peptides)-which have been found in the spinal fluid of people with schizophrenia and autism, and are believed to worsen the symptoms of these neurological conditions. They are also found to have opioid-like effects on the brain, making us feel drowsy, one of the typical symptoms mentioned by people who are gluten-intolerant.4

Our inability to process gluten proteins safely could have something to do with the manufacturing process, another recent paper suggests. While pure gluten-used in all previous studies-seems to be digested properly, the wheat gluten protein in bread is "virtually undigested . . . probably because of gluten-starch complex formation during baking".5

Science seems to be edging closer to the idea that there really is something to gluten intolerance. Instead of it being all in the head, it really could be just where the sufferers have always said it is-in the gut.

The history of coeliac disease

  • AD 2
    Aretaeus of Cappadocia, a Greek physician, describes a form of diarrhoea in children caused by the malabsorption of certain foods
  • 1888
    Samuel Gee, an English paediatrician, suggests a cure through diet for children suffering from chronic indigestion
  • 1924
    Sidney Haas, an American paediatrician, identifies carbohydrates as the culprit in coeliac disease, and treats 10 children with a banana diet
  • 1930s
    William Dicke, a Dutch paediatrician, noted that children with coeliac disease improved when they stopped eating wheat
  • 1950s
    Margot Shiner, a pediatric gastroenterologist, develops a biopsy test for examining the small intestine in coeliacs
  • 1964
    The anti-gliadin antibody is discovered
  • 1980s
    Coeliac disease is linked to other autoimmune diseases, such as thyroid problems and diabetes, as well as Down's syndrome
  • 1990s
    Coeliac disease's genetic markers are identified, along with anti-glutaminase antibodies


The gluten-free market is big business. It's now the most trendy food offering around, and it's estimated that 100 million Americans-nearly a third of the entire population-will be eating some gluten-free product this year.

The gluten-free market is generating around $9 billion in sales per year in the US alone, and it's projected to rise to $14.2 billion a year by 2017. This will be double the sales revenue achieved in 2012.

The rise is fuelled by around 40 per cent of the adult population who think that a gluten-free diet benefits everyone, unlike the 44 per cent who dismiss it as a fad.

It's big business outside the US too. In Finland, 15 gluten-free snack bars were launched in 2012, but this had risen to 74 a year by 2014. Similar patterns have been seen across the UK, Germany and France.

Wheat and gluten: what's the difference?

Wheat-free and gluten-free are terms that are used interchangeably-but there is a difference. Gluten is one of four proteins found in wheat, but many people who are allergic to wheat are reacting to one of the other proteins, most likely albumin and globulin.

Gluten is also found in rye, barley and oats, although in smaller quantities than in wheat, so a gluten-free diet probably excludes those grains as well. A gluten-free product will always be wheat-free, whereas a wheat-free item isn't always gluten-free. And if you are gluten-intolerant, you should be avoiding pizza, pasta, bread, cereals, cakes, and flour and alcohol made from the grains listed above.

IBS: gluten intolerance by another name?

The vast majority of patients with irritable bowel syndrome (IBS) are also sensitive to gluten. But is there a difference between the two conditions? Researchers who tested 148 IBS patients are beginning to doubt it. They split the group into two, and gave half a proper gluten-free powder and the rest a placebo, or dummy mix. The results were overwhelming: those on the gluten-free diet saw their symptoms improve dramatically.

So using the IBS label instead of gluten-sensitive could be misleading, and could even delay proper treatment.1

The same could be said of coeliac disease, inflammatory bowel disease (IBD) and gluten sensitivity: they all share similar symptoms and are resolved by the elimination of gluten from the diet, another study concluded.2


1 Am J Gastroenterol, 2011; 106: 508-14
2 Gastroenterology, 2013; 145: 320-8.e3
3 Trends Food Sci Technol, 2005; 16: 510-2
4 Food Res Int, 2015; 72: 208-14
5 Mol Nutr Food Res, 2015; doi: 10.1002/mnfr.201500262

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