July 23, 2014
Jacob Schor, ND, FABNO
Lots of people are down on bread these days, but today is bread baking day at our household and while the dough rises, let’s take a moment to consider the sorry status wheat and gluten have fallen to in recent years.
Driving through Great Falls Montana earlier this summer, we stopped for lunch at an interesting franchise called Wheat Montana, a restaurant and brewery that features Montana wheat. http://www.wheatmontana.com/
While there are some in North Dakota that may argue, Montana farmers grow some of the best wheat in our country. High gluten wheat, the kind one needs to bake a good loaf of bread.
Impulse shopper that I am, we left the restaurant with a 50 pound sack of wheat berries. As a result, I’ve taken up baking bread regularly. At about fifty cents a loaf, I can rationalize that it is a cost cutting measure.
our Schnitzer flour grinder at work
Of course many of our readers will be aghast that we are eating wheat. Of late it seems that everything has become polarized. Whether we are talking politics, culture, religion, you name it, people take positions on the extremes of the spectrum. There is no middle ground. Even with the foods we eat, people want to label them as either Super Foods or poisonous. Wheat often gets classed as the later these days. There is no middle ground anymore. My baking bread is as much a personal statement in favor of moderation in beliefs as it is a way to save money.
Wheat’s shift from public favor has been a gradual process. At one point carbohydrates were considered highly nutritious and the government and other authorities encouraged us to eat mostly carbohydrates, the days when bagels and pasta were supposed to be dietary mainstays. Everyone baked bread, or at least talked about doing it. Well that has changed as we have realized that excessive carbohydrate intake creates a condition of insulin overproduction, hyperinsulinemia or what is now called metabolic syndrome. For a period the condition went by the name Syndrome X, kind of back in time with generation X.
the mixer trying to keep up
During this same period we learned that celiac disease was far more common than previously thought. When we were in school, the Merck Manual suggested that incidence was approximately one person in about 1200. Now the disease is far more common, about one person in 100. That’s a jump. This is partly due to the fact that we have more accurate screening tests. Some researchers also argue that the disease itself is becoming more common. There is some fascinating data that compares the relatively high incidence of celiac disease in Finland with the low incidence just across the way in Russia suggesting that the protection enjoyed by the Russians is due to a higher incidence of parasites  . Another argument in favor of poor hygiene. But I’m going to leave that can of worms for the moment as my bread is rising fast and I’m hoping to finish this before it does. Suffice to say, that like everything else related to heath these days blame for increasing incidence and credit for low incidence of celiac is given over to the human biome.
Let’s take a moment for some basic food science. One of the constituents of wheat is a protein complex called gluten. Gluten is made of two proteins, glutenin and gliadin. It’s the glutenin that gets all stretchy when combined with water and makes dough all stretchy and it’s absence makes gluten free baking so deficient. Other grains besides wheat contain gluten, in particular barley and rye. Oats, while they don’t naturally contain gluten, are often contaminated with small amounts as they are typically processed on the same milling machines as wheat is. So people with celiac disease also must avoid oats unless specifically milled on gluten free machinery.
In celiac disease a person’s immune system has mistakenly developed a grudge against gluten and mistakes particular proteins in the tiny villi that line the gut as being made from gluten. So the immune system attacks the gut lining, interfering with nutrient absorption and causing a host of problems.
If only one person in 100 has celiac disease, what about all those other people who are avoiding wheat and claiming to feel better? And there are a whole lot of them….
Well some people are allergic to wheat but such allergies are rare, more rare than celiac disease. Many patients tell us that gluten makes them feel ill, causing bloating, gut pain, headaches, lethargy and other symptoms, and that all these symptoms are relieved if they avoid eating gluten. This condition has a name, “non-celiac gluten sensitivity (NCGS)” and there are suggestions that as many as 20% of the population suffer from it.
Is NCGS real? There are a few small studies suggesting that there are non-celiac people who do have symptoms that get better when they avoid wheat.
Peter Gibson from Melbourne, Australia, was the first to test gluten in a randomized placebo controlled trial. He enrolled 34 non-celiac people who nevertheless had gut symptoms that improved on a gluten free diet. He put them all on a gluten free diet but supplied them with what they all thought were gluten free muffins to eat daily. Sneaky fellow this Gibson, sometimes he did sneak gluten into the muffins. Sure enough those poor suckers who unknowingly ate gluten felt sick afterwards .
Though a tiny study, this was enough to convince many doctors that NCGS was a real thing, not just in people’s heads.
Wheat is a complex food and contains more than gluten. Gibson wondered if there was some other explanation, possibly other sugars present in wheat, what are called fermentable oligosaccharides, disaccharides, monosaccharides and polyols, though no one actually writes that out, usually the phrase is just abbreviated as FODMAPs.
Gibson ran a second study with 37 gullible people suspected of having NCGS. This time they were put on a diet that was both gluten free and low in FODMAPs.
This time Gibson snuck in either tiny or large amounts of gluten or milk protein. There was no difference in response in any of these three groups. It wasn’t the gluten that was causing the problem .
People who feel better on a gluten free diet may simply be reacting to FODMAPs. So let’s explain more carefully what they are. This big name refers to a variety of sugars that aren’t absorbed well in the intestine but instead end up feeding the bacteria living in there and generating a lot of gas. These undigested sugars put osmotic pressure on the intestine; attracting water into the gut and the combination produces loads of flatus and watery stools.
Gibson and colleagues have a webpage dedicated to helping people map out a low FODMAP diet: http://www.med.monash.edu/cecs/gastro/fodmap/
If people are sensitive to FODMAPs, then their reaction will be dose dependent. The less they eat the fewer symptoms. With celiac, even microscopic doses of gluten will cause a reaction. One of the most common FODMAPs are a chemical group called fructans, a chemical particularly high in onions. If onions make you sick, this may be why.
It’s not just the people who are relieved by gluten free diets that are avoiding wheat these days. A recent poll suggests that a third of the US population says they would like to reduce or eliminate wheat from their diets .
Two best selling books share the credit for this belief. William Davis in his book “Wheat Belly” claimed that wheat is the main cause of obesity and diabetes in the United States. David Perlmutter suggests in his book “Grain Brain” that carbohydrates from grains are the leading cause of dementia, ADHD, anxiety and depression. Given that no sane person wants any part of any of these diseases, it makes sense that people want to avoid wheat. But are any of their claims true?
Linda Geddes, writing in a recent issue of New Scientist tell us that, “… the evidence for many of the claims in the books, or their interpretation of it, is questionable. Take the claim that the spike in blood sugar caused by eating wheat and other grains triggers inflammation in the brain and thus Alzheimer's disease. One piece of evidence cited by Perlmutter is a 2013 paper  reporting that even mild elevations in blood glucose in healthy individuals put them at risk of developing dementia.
Yet Paul Crane of the University of Washington in Seattle, who led that research, disagrees with Perlmutter's interpretation. "Our study says nothing about dietary sugar, dietary carbohydrates or dietary anything," Crane says. "What we studied was a five-year average of people's blood sugar levels. This is not at all the same as how much your blood sugar goes up or down after a single meal." 
Wheat certainly has a relatively high glycemic index, it releases sugar quickly in to the blood. A lifetime diet that has a low glycemic index is associated with a lower risk of developing diabetes than a diet of highly refined sugar-rich foods  .
If glycemic index was the concern, don’t just blame wheat, also blame potatoes, corn, millet and sugar, all of which have a bigger impact on blood sugar levels than wheat.
making a mess in the kitchen
The idea that wheat is addictive as Davis claims because wheat protein fragments may bind to opioid receptors in the brain and train us to want more, is kind of cool. Maybe wheat is a little bit addictive. Milk, rice, meat and spinach also break down into fragments that bind the opioid receptors. That’s perhaps why eating is pleasurable. Would we want to live on a diet of foods that had been genetically modified so they no longer trigger these receptors? We live in Colorado after all, food fragments are the least of our worries when it comes to chemicals binding to brain receptors.
Is the claim that wheat is more fattening than other carbohydrates true? Many people lose weight on a gluten free diet, probably for the simple reason that they can’t find enough other carbohydrates to replace it with. They end up eating their burgers without the bun, or as in a recent New Yorker cartoon, ordering their pizza without the dough.
The fake flours used to make gluten-free copies of standard wheat products are certainly no healthier than wheat. They often lack the fiber wheat provides, fiber that produces satiety and perhaps lowers risk of colon cancer.
The stuff we bought back from Montana turns into some pleasing loaves of bread. We grind the flour fresh and it goes immediately into the mixer.
As I’ve written about in the past I typically use the no-knead bread dough recipe popularized by Jim Lahey and Mark Bittman in the NY Times  . This is an idiot proof recipe that only requires about a ¼ teaspoon of yeast to make a loaf of bread. Today I’m using a recipe from the Denver Post instead that calls for over a tablespoon of yeast, about 15 times as much. In years past, when all human illness was blamed on Candida and yeast exposure, this might have been cause for worry. But like many other medical fads, the worry about yeast has faded. Hopefully we will be able to say the same about our inordinate fear of gluten someday soon.
6. Geddes L. Should you eat wheat? The great gluten debate. New Scieintist. 09 July 2014. Issue # 2977