If you suffer from
a condition such as osteoporosis, Crohn's disease, rheumatoid
arthritis or depression, you're unlikely to blame your breakfast
cereal. After all, intolerance of wheat, or celiac disease
(CD), is a an allergic reaction to a protein called gluten,
thought to affect only about one in 1,000 people.
But now two American
clinicians, James Braly and Ron Hoggan, have published a book,
Grains, claiming that what was thought to be a relatively
rare condition may be more widespread than was previously
thought. Braly and Hoggan suggest that gluten intolerance
does not just affect a few people with CD, but as much as
2-3% of the population.
They claim that
gluten sensitivity (GS) is at the root of a proportion of
cases of cancer, auto-immune disorders, neurological and psychiatric
conditions and liver disease. The implication is that the
heavily wheat-based western diet - bread, cereals, pastries,
pasta - is actually making millions of people ill.
Your doctor, if
asked about CD, would tell you that it involves damage to
the gut wall, which makes for problems absorbing certain nutrients,
such as iron, calcium and vitamin D. As a result, you are
more likely to develop conditions such as osteoporosis and
anemia, as well as a range of gastrointestinal problems.
Children who have
it are often described as "failing to thrive". The
proof that you have CD comes when gut damage shows up in a
biopsy. The treatment, which has a high rate of success, is
to remove gluten - found in rye and barley as well as wheat
- from your diet.
But if Braly and
Hoggan are right, the problem is far more widespread than
the medical profession believes. Celiac disease, they suggest,
should be renamed "gluten sensitivity" and, in an
appendix to the book, they claim that no fewer than 192 disorders,
ranging from Addison's disease and asthma to sperm abnormalities,
vasculitis, rheumatoid arthritis and hyperthyroidism, are
"heavily overrepresented among those who are GS".
contains more than a dozen case histories of people who have
recovered from a wide variety of chronic conditions - back
pain, chronic fatigue, the auto-immune disorder lupus - simply
by following a gluten-free diet. Both authors claim great
personal benefits from such a change. "After eliminating
gluten grains," writes Hoggan, "I realized how uncomfortable
and chronically ill I had been for most of my life."
If you are someone
who has visited a clinical nutritionist or a naturopath, this
will come as no great surprise. One of their most common suggestions
is temporarily to remove wheat from the diet to see if it
makes a difference. In fact, so widespread has talk of a wheat
allergy become that last November the Flour Advisory Board
felt impelled to issue a statement warning of the dangers
of this idea. Professor Tom Sanders, head of nutrition and
dietetics at King's College, London, was quoted as saying:
"Unless you suffer from celiac disease, a very rare condition,
cutting wheat out of your diet is extremely unwise."
represents the mainstream medical view, but there is good
evidence - such as the work of Dr Harold Hin, a GP from Banbury
in Oxfordshire - to suggest that it may be in need of revision.
Over the course of a year, Hin carried out a blood test on
the first 1,000 patients who came to his surgery complaining
of symptoms that might indicate CD, such as anemia or being
"tired all the time". Thirty proved positive and
a diagnosis of CD was confirmed by a biopsy.
that CD was showing up at a rate of three per 100 - 30 times
more than expected. Significantly, all but five had no gastrointestinal
symptoms. "Underdiagnosis and misdiagnosis of coeliac
disease," Hin concluded in an article for the British
Medical Journal in 1999, "are common in general practice
and often result in protracted and unnecessary morbidity."
a large research program carried out by the University of
Maryland Center for Celiac Research in Baltimore has confirmed
Hin's findings. Scientists there tested 8,199 adults and children.
Half the sample had various symptoms associated with CD and,
of those, one in 40 of the children tested positive for CD
and one in 30 of the adults.
But it wasn't just
those who seemed ill who were having problems with wheat.
Far more worrying was what the Maryland researchers found
when they tested the other half of the sample, who were healthy
volunteers, selected at random. Among kids under 16, one in
167 had CD, while the rate among the adults was even higher
- one in 111.
If those proportions
are true for the American population in general, this means
that 1.8m adults and 300,000 children have undiagnosed CD
- people who, sooner or later, are going to develop vague
symptoms of feeling generally unwell, for which they will
be offered various drugs that are unlikely to make much difference.
Ultimately, they are at higher risk of a range of chronic
There seems, therefore,
to be good evidence that CD is underdiagnosed. But Braly's
and Hoggan's proposition is more radical than that. They believe
that the immune reaction to gluten that damages the gut in
CD can also cause problems almost anywhere else in the body.
The evidence for this is a test involving a protein found
in gluten called gliadin. When the body has an immune reaction,
it makes antibodies. The test for anti-gliadin antibodies
is known as AGA and people who test positive to AGA often
have no sign of gut damage.
In fact, according
to Dr Alessio Fasano, who carried out the University of Maryland
research, "Worldwide, CD 'out of the intestine' is 15
times more frequent than CD 'in the intestine'." Braly
estimates that between 10% and 15% of the US and Canadian
populations have anti-gliadin antibodies, putting them at
risk of conditions as varied as psoriasis, multiple sclerosis,
jaundice, IBS and eczema.
The idea of gluten
causing damage to parts of the body other than the gut is
supported by another UK practitioner, Dr M Hadjivassiliou,
a neurologist at the Royal Hallamshire Hospital in Sheffield.
He ran an AGA test on patients who had "neurological
dysfunction" with no obvious cause and found that more
than half tested positive. What is more, only a third of the
positive group had any evidence of CD gut damage. In other
words, while the gluten antibodies can damage the bowels,
they can also cause problems elsewhere. In this case, it was
the cerebellum, or the peripheral nervous system.
So if a reaction
to gluten can cause problems in the brain, might it also be
linked to immune disorders? Braly and Hoggan certainly think
so, and claim considerable clinical success in treating patients
for conditions such as Addison's disease, lupus, rheumatoid
arthritis and ulcerative colitis with a gluten-free diet.
In fact, almost all the body's systems can be affected (see
below). So if you suffer from a chronic condition that doesn't
seem to respond to treatment, cutting out wheat for a while
seems worth a try.
Are you gluten
If you suffer from
any of the following, the possibility that you are GS may
be worth investigating.
- Upper respiratory
tract problems such as sinusitis, "allergies",
- Symptoms related
to malabsorption of nutrients such as anemia and fatigue
(lack of iron or folic acid), osteoporosis, insomnia (lack
- Bowel complaints:
diarrhoea, constipation, bloating and distention, spastic
colon, Crohn's disease, diverticulitis
- Autoimmune problems:
rheumatoid arthritis, bursitis, Crohn's disease
- Diseases of
the nervous system: motor neuron disease, certain forms
- Mental problems:
depression, behavioral difficulties, ME, ADD
Guardian September 17, 2002