Over the last 9 articles we have talked about the role of fibre in feeding a healthy microbiome which is so vital in supporting many important functions of our body. This stretches from our immunity (particularly relevant in the current pandemic), through to preventing or moderating obesity, diabetes, high blood pressure, heart disease, auto-immune disease, and even neuro-psychiatric conditions, such as depression, dementia, Parkinson’s disease, and autism-spectrum disorder.
This week we are going to tackle the controversy about wheat and gluten intolerance, and if this is a reason to avoid carbohydrates and adopt a ketogenic diet.
ALSO READ: Turning the Tide – how much fibre have YOU eaten today?
Some years ago (2011) Dr William Davis, a cardiologist and self-styled health crusader started a movement against wheat, and wheat products through his many books around the theme “Wheat Belly”. He has a strong following and certainly done very well for himself from the promotion of his programme and many books. But is this based on good sound science?
Another doctor, David Perlmutter, (neurologist – come functional medicine specialist), wrote the book “Grain Brain”, and has a similar following of anti-wheat, and anti-grain supporters. I must admit I have quoted some of his theories on these blogs in the past, but have problems with his strong promotion of animal products, which so much science acknowledges as the cause of much of the lifestyle diseases of the Western world.
Both of these authors suggest that gluten as found in wheat (and oats to a lesser extent from a protein called avenin) is a cause of damage to the delicate intestinal wall resulting in leaky-gut syndrome. This then allows large proteins and micro-organisms to enter the blood stream and cause havoc with the immune system and even the blood brain barrier. Much of the impetus for this theory comes from the rather rare condition called coeliac disease in which the body is intolerant of gluten.
Coeliac disease is an autoimmune disease caused by the immune system making antibodies to a substance in gluten called gliadin, which then results in damage to the lining of the gut affecting absorption of nutrients. It is most often a familial disease and associated with a number of genetic mutations. Childhood infection with rotavirus (a common cause of diarrhoea in young children), or introducing gluten to your baby’s diet before 3 months of age (best time for introducing solid foods is around 6 months), or not breast feeding when gluten foods are introduced, are all factors that may increase the risk of coeliac disease.
It can also be associated with type 1 diabetes, thyroid conditions, ulcerative colitis, epilepsy and Down’s syndrome. How common is coeliac disease – it has been diagnosed in around 1% of people, but may occur in up to 3%. Of course the treatment is to avoid all gluten-containing foods which includes bread, wheat pasta, most baked goods and pastries made from wheat flour, couscous, bulgar wheat, rye bread, semolina – and a host of other foods which your dietician will tell you about.
What about the so-called gluten sensitivity that many people talk about? Is this a real condition? Many people claim that they feel so much better when they avoid wheat-containing foods. They claim bloating and indigestion when using wheat-containing foods. It is true that refined foods such as white flour, pastries, cakes, sugar-filled beverages and junk foods are a cause of gut symptoms, and when these are removed from the diet, as part of any diet, will result in you feeling better. But does that mean that whole-food wheat or gluten-containing foods are the cause, or is it something to do with the refining process that is the cause of the problem?
An interesting Norwegian study was conducted between 2014-2016 in which 59 people who had put themselves onto a gluten-free diet and were subsequently proved not have coeliac disease were registered in a double-blind crossover challenge. They were given one of three muesli bars for a week at a time. One group were given a gluten-laced bar, another fructan-laced bar and the third a non gluten, non fructan-containing muesli bar. After a week of using the muesli bars, they were then changed over to one of the other bars. The study showed that the lowest incidence of unpleasant symptoms occurred in the gluten-containing bars, and the highest symptoms occurred after ingesting the fructan-containing bars. https://pubmed.ncbi.nlm.nih.gov/29102613/.
What does this tell us? It may well be that symptoms blamed on wheat may be coming from fructans. These are long chains of fructose which the body cannot easily break down, and are fermented by bacteria in the gut leading to bloating and flatulence. Inulin is an artificial fibre added to foods to increase fibre content and is rich in fructans. Dried fruit, grapefruit, nectarines, persimmons, peaches, watermelon, ripe bananas, rice cakes and cornflakes are also high in fructans. Sourdough bread and pickled onions have decreased fructans compared to normal bread and onions. Fructans are part of a healthy diet, but may need to be introduced gradually if your body is not used to them.
So what is the story about gluten and wheat? Here is a very readable article by Dr John McDougall, one of the founding members of the American College of Lifestyle Medicine and someone who has been advocating a whole-food plant-based, high unrefined carbohydrate diet for 40+ years. He also writes widely on various lifestyle disease, with strong peer-reviewed scientific support for his views: https://www.forksoverknives.com/wellness/the-smoke-and-mirrors-behind-wheat-belly-and-grain-brain/
Whole grains are an important part of a healthy diet, as they have been for the last few thousand years, all around the world. The longest lived people are those who rely to a large extent on whole grains and legumes as a good source of their fibre and protein source. Now, after what we have learned in the last few weeks about the microbiome, we understand the benefits better. Here is an interesting documentary on the controversy over wheat: https://www.cbc.ca/fifth/episodes/2014-2015/the-war-on-wheat
I trust that his series on the gut microbiome and dietary fibre may encourage you to eat a more whole-food diet, with all the benefits accruing to you in reversing disease and improving your health and well-being, including wheat and other whole grains like oats, barley, brown rice, maize, quinoa, sorghum, millet, etc.
Dr Dave Glass
Dr David Glass graduated from UCT in 1975. He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital.
He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world. He no longer delivers babies but is still very clinically active in gynaecology.
An old passion, preventive health care, has now replaced the obstetrics side of his work. He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle – obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.
He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing. He is active in community health outreach and deeply involved in church activities. He enjoys teaching and sharing information.
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