December 5, 2013 11:12 am
Updated: December 5, 2013 11:05 am

The war on bread

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Full disclosure? I love bread. As a kid nothing fixed a bad day better than a peanut butter and jelly sandwich. Well, maybe ice cream, but that is another story. I love to make bread and I love to eat it. I love the smell of it fresh baked in the mornings. I have been known to judge a restaurant by the quality of its bread basket.

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And indeed I realize that in my love of all things “baked goods” I am not alone. Poets have written about bread, religions have based certain traditions around the use of (or abstinence from) bread. Centuries of civilizations can chart their development based on their relationship with bread. It is the symbol of prosperity and peace. Bread is earned through hard work and diligence and broken with friends in good times and bad.

And, it is good for you.

Or so I thought. Over the last decade it has become increasingly obvious that someone has it out for bread. Once the subject of sonnets and celebration, bread has suddenly found itself on many a “no fly list”. Well, not so much BREAD per se, but Gluten. Yes, dear readers, the war on gluten is upon us.

Somewhere over the last few years gluten became Satan and kale became the only vegetable worth knowing.

How did it happen? How did we vilify something that has been the subject of such love?

A recent poll of Americans shows that 30 per cent are afraid of gluten. Market research shows that 18 percent of Americans buy gluten free products exclusively. It is no surprise that the gluten free industry is growing. Projected sales by the market research firm Packet Facts show that gluten free products sales will exceed $6.6 billion annually by 2017.

Many people buying gluten free are true celiac patients; many are fans of the latest “Wheat Belly” diet craze. Others are a new emerging group of consumers who find themselves to be “gluten sensitive”.

I must admit that as a physician I was skeptical of the whole gluten sensitivity issue. I wondered if it indeed was a fad or a fantasy created by Hollywood starlets and naturopaths alike to make my dinner parties a lesson in tolerance.

But then I decided to keep an open mind and let science help me make my decision.


Gluten is Latin for “glue”. It is composed of two proteins Glutenin and Gliadin and when you combine these two proteins together and with water you get something truly magical. If you’ve ever had the experience of kneading bread and watching it become smoother and springier in your hands – you know what I mean. This very act is indeed gluten in action. Mix flour and yeast with sugar and water and sure enough you activate the proteins in the granules- Gliadin and Glutenin which come together to form gluten. The yeast ferments to form carbon dioxide which aerates the dough. The dough rises and when you bake it these bubbles expand even further and stiffen. When the bread is fully baked, the bubbles stiffen and the starch solidifies. Gluten keeps these bubbles intact as air pockets in the dough. Without it they would flatten and just dissipate.

Celiac disease

As beautiful as gluten is- it has an ugly side. On the extreme side there is celiac disease. This is a disorder that has a significant genetic predisposition. Celiac is an autoimmune disorder where the immune system of the small intestine reacts to gluten. As a result the immune system indeed attacks the small intestine causing erosion of the lining over time. Symptoms of celiac include abdominal bloating, pain, and diarrhoea. Other systems can also be involved in celiac. Patients can experience skin rashes and irritations and even neurological involvement.

Patients with celiac indeed have autoantibodies towards gluten that can be measured. They also have genetic markers of celiac. These can be measured by one or more blood tests.

About one per cent of the population in North America suffers from celiac.

Celiac is a true gluten allergy.

Gluten intolerance or gluten sensitivity is indeed where the medical and scientific lines begin to blur. One of the problems with this condition is that there really is no objective test for gluten sensitivity. It is based on the idea that the body is sensitive to gluten but does not wage an all out autoimmune response against it (at least not one that can be measured).

The scientific literature has well documented cases of patients with gluten sensitivity. These are patients who lack the autoimmune component of celiac but who have significant symptoms ranging from malabsorption to abdominal pain to memory dysfunction when eating gluten. In other words- there really is no blood test for these patients. They do however report a wide variety of symptoms that respond when gluten is taken out of their diets.

I’m not disputing the existence of gluten sensitivity. I do believe it is a definite entity in the allergy spectrum. As a medical community we are seeing a shocking rise in food allergies over the last few decades.

Many colleagues ask me, why the rise in gluten sensitivity? Are we exposed too much gluten to begin with? Has our wheat been so manipulated over the years as to cause this shift in our bodies’ ability to process such an ancient grain?

I’m not sure what the answer is. The scientific literature is not without controversy on this. Indeed there are a variety of theories as to why the rise in gluten sensitivity.


As a physician my job is to listen to a patient’s concerns, rule out the big bad diseases and suggest appropriate safe modes of treatment.

When it come to gluten sensitivity (not true celiac), the treatment is withdrawal from gluten. I also make sure I check these patients for true celiac and for malabsorption of certain Vitamins.

The good news about all of it is that withdrawal from gluten seems to be the best treatment. We can live without gluten quite nicely. Sure, pizza is off the menu but no one died (at least not physically) from bread withdrawal.

Steering clear of gluten won’t kill anyone. It’s actually not that difficult. Meat, fish, chicken and seafood are all gluten free. Vegetable and fruits are all gluten free as are milk, cream anything you can make from them (cheese glorious cheese).

Benign grains such as quinoa and corn and rice are gluten free. Chickpeas, amaranth and soy are all gluten free. There’s a great deal of NATURAL gluten free products that don’t involve going to a special isle at the supermarket labeled “Gluten Free”.

What about gluten free for weight loss? Studies actually show that patients who are diagnosed with celiac often gain weight after switching to gluten free diets.

A study published in 2012 looked at weight gain in 1018 patients with documented celiac. The study showed that 30 per cent of the patients were overweight or obese (less than nonceliac patients). After switching to a gluten free diet patients gained a significant amount of weight (4 kg on average). This is thought to be due to the fact that celiac patients on gluten suffer from malabsorption and after switching to a gluten free diet, their gut heals and absorption improves.

In real life people who do not have gluten sensitivity who go off gluten have variations in their weight. This depends not so much on whether they give up gluten products but indeed what they replace them with. If you give up cookies for gluten free cookies- we have a problem. If you give up gluten for vegetables and fruit…. bingo. Weight loss.

Gluten is a hot topic in medicine and mainstream. Human beings have always sought a great deal of identity from what we put in our mouths. Our relationship with food spills over into our cultural identity and the gluten debate is no exception.

As for me? As a physician and a scientist, my brain acknowledges that gluten sensitivity is a somewhat ambiguous food sensitivity that requires more research. As a baker and a bread lover? My heart wants what my heart wants.

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