Gluten has been blamed for all sorts of health problems from bloating to tiredness but does the evidence against it stack up? Dr Joan Ransley investigates.
It is a busy Saturday morning and I am having a coffee in my fabulous local cafe, Toast House, Ilkley and I overhear a familiar conversation between two young mums. “No, no I’ll pass on the toast. I am cutting out wheat at the moment. The gluten makes me - well - bloat.”
My heart sinks and I want to jump up and give a lecture on why gluten is not public enemy number one and why cutting out good quality bread from the diet is a big dietary mistake. Good quality bread is both nutritious and delicious and should only be excluded from the diet if you really need to.
If you have coeliac disease you have no choice but to cut gluten from your diet. Your immune system produces antibodies against gluten that damage the hair like villi lining of the gut. You will be ill if you continue to eat gluten present in wheat, barley and rye. About one person in 100 has coeliac disease. Far rarer is an allergic reaction to other wheat proteins where symptoms appear rapidly.
If you don’t have coeliac disease or a wheat protein allergy but have symptoms such as bloating or gut pain they may be due to something other than gluten.
Wheat not only contains gluten but a group of short chain fermentable carbohydrates known as FODMAPs (fermentable oligosaccharides, disaccharides and polyols) and so do other foods such as onions, leeks,
pulses, apples and stone fruit, which makes pinpointing the exact cause of gut symptoms a bit of a challenge.
FODMAPs cause symptoms such as bloating, pain and diarrhoea in some people with a sensitive gut because they are poorly absorbed by the small intestine and then fermented by bacteria further down the gut. Approximately one in five people in the UK have a sensitive gut.
Over the past few years, Peter Gibson, a gastroenterologist at the Alfred Hospital and Monash University, Melbourne has been investigating this conundrum. In one study, 37 recruits who suspected they were sensitive to gluten were put on a diet that was gluten free and low in FODMAPs. Then high or low amounts of gluten were added to the diet. Milk protein was used as a control. The findings showed there was no difference in symptoms between the groups suggesting gluten was not the cause of their problems after all. Gibson concluded that people who thought they were sensitive to gluten might instead be reacting to the FODMAPs contained in the diet.
Just because a person is sensitive to FODMAPs doesn’t mean they have to be cut out of the diet altogether. Getting symptoms from eating too many high FODMAP foods is not an immune disorder like coeliac disease. The answer for most people is to cut down on the amount of high FODMAP foods eaten. Many people simply avoid eating and cooking with onions.
Traditionally-fermented sourdough breads made with lower FODMAP flours such as spelt and oats contains lower levels of FODMAPs and because these types of carbohydrate are used by the yeasts during fermentation the FODMAP content is reduced further. These breads can usually be eaten in moderation by patients with a sensitive gut including those with Irritable Bowel Syndrome.
The problem with cutting out all bread from the diet is the danger of throwing the baby out with the bath water. Bread is an important source of fibre as well as containing gut healthy prebiotics that do a good job helping to prevent colorectal cancer. Now that’s something to chew on next time you, or a friend, says no to a freshly toasted slice of delicious slow fermented sourdough.
Dr Joan Ransley is an honorary lecturer in nutrition at the University of Leeds and author of www.cookingforthesensitivegut.com.
Why not try out Joan's Gluten free bread with buckwheat, rice and potato flour recipe or have a look at our Wheat Free Flours?
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