Big Diet Things: Gluten, fructose and other misunderstood villains.

This is a true story, not a word of a lie:

Not long ago I entered a health food store looking for gluten flour. I use this to 'strengthen' flour for bread baking. 'Strong' flour, i.e. flour with a high gluten content, is better for baking bread as it results in a chewy, 'bready' texture rather than a 'cakey' texture. I'm sure you know what I mean.

I couldn't find any on the shelves, so I asked a slim, pale slip of a health food shop assistant if there was any in stock, and she said, 'Yes, we have a whole range of gluten-free flours, over there.' So I said, no thank you, I am actually after GLUTEN flour. She stared at me, uncomprehending, went even paler and retreated, horrified, stammering that she had to speak to the manager. I could see her whispering to several other employees, all of whom glanced at me and then resumed their feverish whispering. And then the manager came from out the back and was briefed of this bizarre request from this strange, plump, rosy-cheeked woman who was clearly mental. The manager laughed and calmed everyone down, saying 'Relax everyone! Gluten flour is used in bread baking, very common.' Then he came over to me and said that these youngsters had never heard of such a thing as actually seeking out gluten  because everybody is avoiding gluten, so they all panicked as they thought I was deranged.

Because it turns out that gluten is quite the bad boy these days. We all know about coeliac disease which is a kind of allergy to gluten, a protein found in wheat, rye and other grains. (Rice is usually OK, as is corn, buckwheat and quinoa.) It causes intestinal symptoms, intractable anaemias and generally makes the sufferer feel foul when untreated. It has a genetic component, thus runs in families, is associated with certain antibodies in the blood (but possessing these antibodies doesn't necessarily mean you have coeliac) and the gold standard of diagnosis is through small bowel biopsy which shows clear changes in the lining of the small intestine. But it can be tricky to diagnose:

'Coeliac disease affects on average approximately 1 in 70 Australians. However, approximately 80% currently remain undiagnosed. This means that approximately 330,000 Australians have coeliac disease but don’t yet know it.

More and more people are being diagnosed with coeliac disease. This is due to both better diagnosis rates and a true increase in the incidence of coeliac disease.' (Coeliac Australia) 

[I don't know if this is true or not, it seems a little excessive to me, but I guess Coeliac Australia should know what they are talking about]

A study from New Zealand found that gluten avoidance was five times more common than medically diagnosed coeliac disease. FIVE TIMES. (Maybe there's your missing 80% of undiagnosed coeliacs? Just a thought.)

Also, about 20% of Americans avoid gluten. Why? Probably they feel better not eating wheat.

Apparently there is a growing phenomenon of 'non-coeliac gluten sensitivity' which is, to say the least, controversial. 

The trouble is that many of the symptoms are similar to Irritable Bowel Syndrome, i.e., diarrhoea, constipation, abdominal bloating and pain. And until a few years ago, IBS was considered to be, well,  in the province of psychosomatic disorders, or functional disorders, or call it what you want but since there are no tests and the symptoms are largely subjective, you were considered a bit mental. As a doctor, back in the day when I was in General Practice, I confess doing a mental eye-roll when presented with IBS. And Chronic Fatigue Syndrome (I remember when it was called 'Yuppie Flu'). Talk about 'heart-sink' patients. And Fibromyalgia, G-d help us all. Some things gain 'legitimacy' when a blood test is actually found which does provide objective evidence. Not always. IBS (and CFS and FM) still is largely a diagnosis of exclusion, i.e., make sure you're not missing something really nasty like bowel cancer or something, and then just use the descriptive term- Irritable Bowel.

And yet: These people feel better off wheat/ gluten. So is it in their heads? Maybe it's not the gluten in the wheat, it's the fructose. And now we are on to the other Big Diet Thing now; everyone is fructose intolerant. Well, maybe it is common! There's a lot of confusion.

You know what is really common? Eating too much. That's common. You know what else? Eating processed crap and drinking soda. That's common too. I just saw the stupidest Diet Coke ad I have ever seen. Apparently it's not a real ad but a pregnancy announcement which is even more stupid. All I could think was, you're pregnant and you're drinking Diet Coke? Are you nuts? Diet Coke and sodas in general are The Devil's Piss as far as I am concerned. How can we look at the surge in diagnoses of learning disorders and autism spectrum disorders and ADHD and ignore that pregnant women are drinking this crap, and that there MIGHT be a connection? (OOH no, it's vaccines, right?)

You know what else is common? Eating disorders. Unfortunately I have seen these things, and they often go like this (I will compress 10 years of decline into a few sentences): I will no longer eat meat because I have a moral objection to eating anything that had a mother/has a face. So no fish either. And eggs. They are chicken abortions. I'll eat the whites. No, I won't. And dairy. Cows suffer so much. I'm vegan.  I eat healthy! I eat heaps of green veggies! I LOVE kale! Also I don't eat wheat, or rye or barley or oats- I'm gluten sensitive. And rice either. Oh, not gluten then. Or some special sensitivity. Or allergy. I don't eat carbs, they make me feel bloated. Or nuts. No nuts. Too much fat. Or legumes. They bloat me. I don't eat this, I don't eat that, and in the end all I eat is lettuce and broccoli. And kale. Covered in salt and spices because by now my tastebuds have gone numb because I am so mineral and protein and fat and everything deficient nothing is working anyway, least of all my starved brain.

I have seen this up close, and it's extreme and terrifying, and I think it's the tip of a disordered-eating iceberg. The rest of the iceberg is: I eat Paleo. I don't eat carbs. I'm vegetarian. I'm vegan. I'm non-coeliac gluten sensitive. Etcetera. (I'm not saying that every single vegetarian or vegan is mental, but I wonder about some.)

I'm not saying there is absolutely no such thing. Just as many cases of IBS have indeed been resolved by the FODMAP diet, and it seems that fructose does in fact have some bearing on symptoms, one day we will probably find some objective test for non-coeliac gluten sensitivity, and hurrah.

Meanwhile: Don't overeat. Don't eat too much stuff out of packets. Eat fish, eat vegetables. Eat a bit of what you fancy. And DON'T drink The Devil's Piss. Have some soda water with a bit of juice in it for a bit of cold fizz!

PS: My bread works very well, thanks for asking. I bake challah most weeks, usually half wholemeal, and I don't eat much of it. Everything in moderation. (Including moderation.)