Doctors from the Royal Hallamshire Hospital, Sheffield published an article in this month’s edition of the British Medical Journal on the subject of gluten sensitivity, and whether it actually exists, in the absence of coeliac disease [1].

What is gluten?

Gluten is the molecule formed by the bonding of two proteins, glutenin and gliadin in the endosperm of cereal seeds such as wheat. The endosperm comprises the majority of the seed and is the initial source of energy the seed utilises when it germinates. Gluten is limited to grasses, although there are a wide range of similar protein composites in other plant seeds.

Man cannot live on bread alone?

Man cannot live on bread alone?

What is coeliac disease?

Coeliac disease is an autoimmune disease that affects the small intestine and is characterised by symptoms such as diarrhoea and fatigue.  The modification of the gluten proteins by the enzyme tissue transglutaminase (tTg) factors in the condition. Upon biopsy of the small intestine the defining sign is a marked change in the villi (small hairs) that line the inner surface of the gut (villous atrophy).  As these hairs vastly increase the surface area of the gut epithelium, reduction in them causes a reduction in the efficiency of uptake of nutrients from food.

Wheat Allergy

Coeliac disease is not to be confused with wheat allergy, which is a much rarer condition involving immunoglobulin E (IgE) mediated allergy to wheat seed storage proteins, including gluten, but also including albumins and globulins.

But what of those who claim to suffer from gluten-like abdominal symptoms, yet display normal tissue on biopsy? Do such individuals, as the paper’s authors suggest, belong to a “no man’s land”, with clinicians unsure how to treat them? There might well be a significant proportion of the population who fall into this category.  For example, in one study conducted in Scandinavia in 2000, of 94 adults complaining of abdominal problems after ingestion of cereals only 9% were found to have coeliac disease (as evidenced by villous atrophy). Of the remaining patients, all were negative for tTG antibodies, whereas 40% produced gliadin antibodies [2].

New evidence…

The authors cite a soon to be published study in which dietary trials on a much larger group of patients (n=920) with abdominal symptoms were conducted.  In the words of the authors:

“… a third of patients (n=276) showed clinical and statistically significant sensitivity to wheat and not placebo, with worsening abdominal pain, bloating, and stool consistency. The evidence therefore suggests that, even in the absence of coeliac disease, gluten based products can induce abdominal symptoms which may present as irritable bowel syndrome.”

As a result of this confusion, as of this year there is now a simplified nomenclature for the range of conditions [3]:

  • coeliac disease
  • wheat allergy
  • non-coeliac gluten sensitivity (this is potentially our 40% of those not displaying villous atrophy in the above study)

Gluten: a lone wolf?

Yet gluten is not the only possible culprit for these bowel issues when consuming cereals. Wheat contains a number of other molecules which are implicated in the irritation of the bowel – carbohydrates such as fermentable fructans for example, or sugars such as sorbitol and mannitol (part of a family of short-chain carbohydrates known collectively as FODMAPs).

So what should I eat…..?

If 40% of those in the Scandinavian trial suffered from non-coeliac gluten sensitivity, then it’s not an unreasonable idea to try eliminating gluten from your diet if you too suffer from similar symptoms.  This is difficult unless you are prepared to make some serious changes (giving up bread and pasta for example). However, like all things, stick with it and you might be very pleasantly surprised by how quickly your symptoms clear up.

Mine did!


[1]. Aziz I, et al.: Does gluten sensitivity in the absence of coeliac disease exist? BMJ 2012; 345:e7907

[2]. Kaukinen K et al.: Intolerance to cereals is not specific for coeliac disease. Scand J Gastroenterol. 2000 Sep;35(9):942-6.

[3]. Sapone A, et al.: Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012 Feb 10:13.


The rehabilitation of animal fat begins…

This weekend BBC Radio 4’s Food Programme discussed the facts behind the myths and distortion surrounding animal fats, but lard in particular.  Have a listen!  The website also has a feature on how to make your own if this programme sparks your interest in cooking with this fat – particularly worth doing if you like to fry (high smoke point) or fancy making perfect short-crust pastry.




“Big Food” faces court date?

As reported by the BBC News website today, the American lawyer who took on Big Tobacco and won (with an out of court settlement) is setting his sights on what he calls “Big Food”: the large processed food manufacturers such as Kraft who market products that, despite labels claiming the product to be healthy, actually contain added sugar.  A scan of any supermarket shelf, for example of reduced or fat-free dairy products, reveals the problem: typically fat is replaced by sugar (in all its synonyms).  That the companies willfully label these products as healthy, knowing the contribution they must be making to the current obesity epidemic in America, is the basis of the case.

Just as large manufacturers such as Philip Morris produce a variety of tobacco ‘brands’, distinct only in the minds of their marketing departments, so industrial giants such as Kraft produce a wide variety of processed food.  Any concessions these large manufacturers are forced to make will have a major impact upon, at the very least, labelling on processed foods. If a ‘smoking gun’ might be found, in this case internal documents that tacitly admit the culpability of the manufacturers in contributing to the obesity epidemic, then the floodgates will be well and truly open for class-action lawsuits. Fingers crossed some unredacted memos appear!

Image courtesy of Convergence Alimentaire.

Gluten-free Novak Djokovic!

I am currently watching Novak Djokovic’s amazing performance at Wimbledon.  Can I attribute it to his gluten-free diet?  Why not? After all, according to this study, (and this one)’Atkins-style’ diets raise all-cause mortality… and if you can’t see the holes in these studies, here’s a starter for ten… they involve Food Frequency Questionnaires….

New balls please!

The Men Who Made Us Fat


It’s a refreshing change to watch a prime-time, mainstream programme that actually gets to the heart of the number one health issue that the nation faces.  The Men Who Made Us Fat stands in stark contrast to the constant diet of freak shows on Channel 4 (Supersize vs Superskinny, Secret Eaters etc…) as it attempted to explain, in a thorough, yet accessible manner, the history behind our current predicament and included some prize moments, such as a beverage manufacturer’s spokeswoman claiming black is white!

It’s a rather depressing tale of outright greed, political cowardice and how just a few individuals with axes to grind shaped the nutritional guidelines of the US and Britain and got it so wrong…


…it’s definitely worth an hour of your time!

Fish Oil – Essential?

I’ve not posted anything for a while, as I’ve bitten-off a number of complex areas to research and it’s taking longer than I thought!  I am also reading a very easy-going introduction to Epigenetics by Nessa Carey, by way of introducing myself to a topic that has really emerged in the years since I read Biology.  It’s a fascinating field and her book elucidates the common mechanisms that control DNA expression, for example, the methylation of the base cytosine to 5-methylcytosine (a process which switches the expression of the DNA off) , can be replicated and passed from one generation to the next.  Thus we are not just born of our parents, but of the environmental and nutritional milieu they inhabited and how that affected their DNA.

I was also going to post something about acid-base balance, but let’s face it, the kidney’s are complex things and I’m still in the midst of Renal Acid Loads!  That post might take a little while… Read more of this post

Nose-To-Tail Eating

In my post on ketogenic adaptation, I mentioned that the Inuit were sufficiently aware of the problems of eating excessive lean meat that they even have a name for the condition that effects those who consume only lean rabbits, when other foods are scarce.  Read more of this post