Gluten-free diet

By Serge Kreutz
2023

fy"> Gluten, which makes up 75 to 85 percent of the protein in wheat, has been part of the human diet for a long time. Some 10,000 years ago, wheat was cultivated in Palestine, enabling mankind to establish the first city, complete with walls, at Jericho.

Agriculture was the first revolution in human history, and wheat conquered the world. In 2020/21, production reached 775.8 million metric tons. China is the world's leading wheat producer. [Sources: Worldwide production of grain in 2020/21, by type and Leading 10 wheat producers worldwide in 2020/2021]

Jericho wasn't quite as successful. The Bible says that the Israelites, led by Joshua, crumbled the walls of the Canaanite city by blowing their trumpets. Parts of the wall are still there, but the city, once Number One, is now just a minor town in the West Bank.

Wheat allergies are nothing new. Aretaeus of Cappadocia (2nd century AD) first named celiac disease: "If the stomach be irretentive of the food and if it pass through undigested and crude, and nothing ascends into the body, we call such persons celiacs."

In the Netherlands in World War II, during the famine of 1944–1945, the Dutch pediatrician Willem Dicke noticed that when there was no bread, children with celiac disease were miraculously cured. When the Allied air-dropped bread, they relapsed.

Well, Hippocrates already knew: "All disease begins in the gut."

In 1962, Willem Dicke was headed for the Nobel Prize in Medicine for discovering the ill effects of gluten, but he died before any official announcement, and Nobel Prizes are not giving posthumously (after death).

This misfortune, though, did not stop the gluten-free movement in its tracks. In a survey in 2014, the nonprofit advocacy organization Consumer Reports (established 1936) found that 63% of Americans expected a gluten-free diet to improve their health [Source: Consumer Reports Debunks Common Myths about Gluten]

Like most mainstream media, Consumer Reports had a negative opinion of gluten-free.

The modern gluten-free diet doesn't have a founder like Atkins, and not even a famous promoter, such as Loren Cordain in the case of the Paleo Diet.

The Paleo Diet is an ideology, even a dogma. It applies deductive, top-down, logic. Its overriding premise is that for millions of years prior to agriculture, human evolution was not based on agricultural food (true, but a tautology). The next premise of the Paleo Diet is that because humans are not evolutionarily adapted to agricultural food, the products of agriculture are unhealthy (an unproven premise). Then the Paleo Diet, through deductive logic, arrives at interferences, which are "certainties", like this: Only pre-agricultural food is healthy. Yogurt is not a pre-agricultural food. Thus, yogurt is not healthy.

Modern science, on the other hand, does not work like this. Since the Lord High Chancellor of England, Sir Francis Bacon, published his Novum Organum in 1620, science employs inductive, bottom-up, logic. Science observes and collects data points, then draws conclusions that are probabilities. How does yogurt affect nutrition, digestion, gut flora, oral hygiene, calcium absorption, protein status, blood pressure, heart health, cancer susceptibility? Taking a wide array of observations into account, we arrive at a probability that yogurt is healthy. We will work on that assumption until some data suggests otherwise. That is how modern science operates.

For some people, gluten-free is an ideology. They avoid all grains because they are not pre-agricultural. But for many others, gluten-free is based on observation, anecdotal evidence, and self-experimentation. This isn't as rigorous as required for a thesis, but it's still inductive reasoning.

The most likely detrimental effect of a food not being tolerated would be diarrhea. A soft, foul smelling stool is indeed a telltale sign of celiac disease, occurring mostly in children. In modern, urban adults, the condition will ring alarm bells, and they will be quick to eliminate suspected culprits from their diets.

Diarrhea is probably under-reported on social media. Having the shits after eating bread, is something most people won't document on Instagram. They may just mention that they have a gluten intolerance, without going into further details.

However, in fairness to wheat, diarrhea after eating bakery products does not necessarily mean that gluten is the offensive ingredient. While traditional bread is just flour, salt, water, and yeast, and a dough left standing for maybe an hour for the yeast to do its job, modern bakeries speed up the process by substituting good old traditional yeast with all kinds of chemical mixtures.

One of them is baking powder, in its simplest form a mixture of baking soda (sodium bicarbonate, NaHCO₃) and Cream of Tartar (potassium bitartrate, KC₄H₅O₆, a white powder, and not cream by any stretch). Cream of Tartar, apart from its capability of raising dough in quick-time, is a laxative, an old household remedy against constipation. Some people, who believe they are gluten-sensitive because of episodes of diarrhea after eating bakery products, may actually just react to Cream of Tartar and other strange chemicals used in modern bakeries to enhance efficiency and maximize profits.

Chyme (the mashed food passing from the stomach through the intestine) is full of components posing cumulative stresses to the digestive tract. Attempts of rapid expulsion (diarrhea) is a common immediate response to too many stressors. Some people may get a diarrhea when eating bread and taking a common anti-diabetic drug, metformin. However, if they eliminate either metformin or bread, they may not suffer this discomfort. It's then a game of chance whether they blame the metformin or the bread.

On the other hand, when some people have digestive issues like bloating and diarrhea after eating bread, even though they do not take any medications, and even though they bake their own loaves of just wheat, salt yeast, and water, that still is not proof they react negatively on gluten.

Reason: bread is not just gluten. Bread also contains some 2 to 3 percent of fructans, a carbohydrate, for which, apart from bread, onions and garlic are the only other two major sources in human nutrition.

Fructans are hard to digest in the human small intestine, not just for a small minority of children, but for everyone, young and old. When fructans (polymers of the simple sugar fructose) reach the large intestine (the colon), they are fermented by gut bacteria and turned into short-chain fatty acids, a nutrient that can still be absorbed in the large intestine, even though absorption mostly happens in the small intestine.

Fermentation produces gas, felt as bloating and emitted as farts, and fermentation also changes the consistency of what is excreted as feces.

Thus, bread may cause diarrhea in people who have no gluten sensitivity at all.

In celiac disease, an inflammatory response by the immune system upon gluten ingestion also causes diarrhea.

Gluten is not a single protein but an aggregate of two proteins: large glutenin molecules with a molecular weight of 2-3 million hydrogen atoms ("daltons", the 12th part of a carbon atom), and the much smaller gliadin molecules with a molecular weight of 28,000 to 55,000. Depending on the condition of a person, gliadins are small enough to pass the spaces (named "tight junctions") between the epithelial (skin) cells of the intestinal wall, and then attach themselves onto or into nearby cells, or even circulate via the bloodstream throughout the body.

In genetically predisposed individuals, certain cells expressing the foreign matter gliadins (among them the enzyme Tissue Transglutaminase, tTG) are attacked by IgA (Immunoglobulin A) antibodies of the body's immune system. "Genetically predisposed" because these individuals carry variants of genes (HLA-DQA1 and HLA-DQB1) which view gliadins as antigens (antibody generators). Other variants of the same genes present in non-predisposed individuals do not understand gliadins as antigens.

The exact role of gliadins in autoimmune diseases (type 1 diabetes, rheumatic arthritis, etc), a variety of further inflammatory conditions, and a wide range of other morbidities (including migraine and back pain) has not yet been elucidated. But hypotheses abound.

Because cytokine storms (sudden excessive inflammation) are a common cause of Covid-19-related deaths, and because gluten is inflammatory for many individuals, a gluten-free diet has been suggested as a preventive measure against Covid-19 [Source: Can a gluten-free diet be partly protective for COVID-19 infection?]

Quote: "More recently, medical experts have begun to acknowledge the possible connection between gluten and non-pathologic joint pain - joint pain that is not explained by disease. A growing body of research supports this idea." [Source: How Gluten Can Cause Joint Pain]

Quote: "A gluten-free diet (GFD) ... has been investigated as a treatment option for other medical conditions, including dermatitis herpetiformis, irritable bowel syndrome, neurologic disorders, rheumatoid arthritis, diabetes mellitus, and HIV-associated enteropathy." [Source: Gluten-Free Diet in Nonceliac Disease]

Some research even blames gluten for migraine headaches. [Source: How does a piece of bread cause a migraine?]

Celiac disease is often referred to as a genetic "disease".

But when people hear "genetic diseases", they think of the likes of Down Syndrome (named after British physician John Langdon Down who first described it), childhood (insulin dependent) diabetes, or sickle cell disease.

But Down Syndrome (an extra chromosome) is just congenital (present at birth), not genetic (inherited through genes). The parents of Down Syndrome patients are genetically normal.

Childhood diabetes is neither congenital nor caused by defect genes. It is an autoimmune disease (the immune system attacking the beta cells of the pancreas' islets of Langerhans that produce insulin). Cause unknown.

On the other hand, sickle cell disease occurs if both parents have defective ß-globin genes, causing red blood cells to be sickle-shaped and thus obstruct the flow in blood vessels. The common perception that with a genetic disease, one's fate as patient is determined, applies to sickle cell disease.

But celiac disease is not caused be a gene that would be defective in any way. It is caused by a variant of a gene, or two, that codes for immune system proteins that recognize gliadin as foreign (an antibody generator).

The gene that predisposes for celiac disease, is present in some 30 % of studied populations. [Source: Although 30% of the general population carries a genetic predisposition for CD, only approximately 3% will develop this disease

Certain genes make celiac disease more likely. But eating or not eating gluten is much more relevant. And, as a matter of fact, one can find genetic factors for about every illness.

Here are some more morbidities with strong genetic roots, as defined by MedicineNet.com: "Multifactorial inheritance disorders are caused by a combination of environmental factors and mutations in multiple genes... Examples include heart disease, high blood pressure, Alzheimer's disease, arthritis, diabetes, cancer, and obesity."[Source: 7 common multifactorial genetic inheritance disorders]

The Harvard School of Public Health titled an obesity page: Genes Are Not Destiny]

Or, with Jean-Paul Sartre (the only person ever to reject a Nobel Prize - for literature in 1964): "You can always make something out of what you've been made into."

It's true: not all food items are equally fit for human consumption. You probably do not need gluten. On the other hand, if you intend to embark on a gluten-free life, you better think first about what you will eat instead. Many other food items also come with their particular risks.

Addendum:

Diarrhea is underreported on social media. People are unlikely to post photos or clips of their experience with digestive problems on Facebook or Twitter. They will, however, take drastic measures to avoid embarrassing situations, including going gluten-free when, actually, they should just stay baking powder-free.