Myth or reality: Is it true that gluten is harmful?
Text: Karina Sembe
Talking about gluten is new black; it would seem that everyone is already tired of them, but the topic is sore and does not give rest. Wellness bloggers with a raw food agenda are advised to exclude oatmeal from the diet, outraged skeptics blame everything on the conspiracy of marketers and pharmacists, and doctors look for words to return common sense to patients and rid them of the fear of bread.
The fact is that about five years ago, in addition to celiac disease, a genetically determined immunological intolerance to gluten, doctors suddenly began to actively diagnose congenital sensitivity to gluten, the complaints of patients that were not previously taken into account. The results of new research were immediately adopted by dashing marketers and socially active hypochondriacs who gradually turned gluten into an enemy of the people. Then began to appear and scientific work, debunking the myth about the dangers of gluten for the entire population of the earth, and in 2014, the scientist, who previously substantiated and introduced into the scientific field the phenomenon of sensitivity to gluten, published a study with opposite results.
Whatever it was, products with bright markings "gluten-free" are often more expensive and in supermarkets are located on the shelves higher. To whom and in what case stands behind them, we found out from an expert.
Alexey Paramonov
Candidate of Medical Sciences, gastroenterologist; Deputy Chief Physician for Therapy Diplomat Clinics
There is such a group of proteins - gluten. They are found in some widely consumed plants: wheat, rye, barley. Of the entire group, gluten is the most well-known and discussed in the popular science literature. It is believed that he and gluten proteins like him cause gluten enteropathy (celiac disease). The description of celiac disease as a child's "abdominal disease" is found among ancient authors, and in the 19th century suspicions about the connection of the disease with wheat began to arise. The Dutch pediatrician Willem-Karel Dicke, who noted that during World War II, a group of sick children felt much better if they received rice instead of wheat bread scientifically justified it on clinical examples.
A few words about celiac disease. She was considered a rare disease, and her chosen pediatricians knew. Epidemiological studies have shown that it affects 1-1.5% of the population, which is quite a lot. In every apartment building there is such a patient. Her classic picture is a child who slowly grows and gains weight, often goes to the toilet; he has a bloated sore belly and low hemoglobin. But this is extreme. Adult celiac disease was not so rare - it happens that for the first time this diagnosis is made to deeply adult people. On the other hand, the popular literature began to spread the idea that gluten is an absolute poison, and that a gluten-free diet is needed by everyone and that is health. Is gluten really that bad? But what about the semolina porridge, which for decades has been a symbol of health (along with the image of a ruddy baby, absorbing it with a big appetite)? Technologists determine the quality of semolina by the gluten content: the more the better.
If you are healthy, the only thing that a gluten-free diet will give you is a reduction in the quality of life or even a threat to health.
The fact is that celiac disease develops only in genetically predisposed persons. They have a peculiar picture of the genes of the major histocompatibility complex (HLA), usually positive DQ2.5 or DQ8. Patients develop an immunological intolerance to gluten, the small intestine is soaked with lymphocytes, and their aggressive struggle with the cereal protein leads to damage to the intestine: the villi atrophy, providing absorption, the intestine becomes bald. The consequence of this is a violation of the absorption of proteins, vitamins, iron. Diarrhea, anemia develops, children develop developmental delay.
Although the duodenal biopsy is still the gold standard in the diagnosis of celiac disease, high-precision blood tests have now appeared that make it more likely to suspect this disease. This is an assay for antibodies to endomysia and tissue transglutaminase. The analysis for antibodies to gliadin is less accurate. With regard to the treatment of celiac disease, the only effective method to date is the gluten-free diet. Let me remind you that they exclude not only bread, but also all industrial semi-finished products where flour or gluten is put: these are sausages and some pastries.
However, if you are a healthy person, the only thing that a gluten-free diet will give you is a reduction in the quality of life or even a threat to health. For example, a two-year-old child with a weight deficit, but of normal height and level of development, with negative tests for celiac disease was transferred to a gluten-free diet - and he began to lose weight rapidly. They returned a full-fledged diet - he began to recover.
Children are easier - pediatricians are usually wary about celiac disease. And when an adult should think about it? The main symptoms are the same: lack of weight, low blood protein, swollen belly, anemia. Often adults have a latent iron deficiency. This is when hemoglobin is normal, but relatively low, often the size of red blood cells is reduced. If you check ferritin, a protein that stores iron, indicators will be less than 100 ng / ml. In the post-Soviet countries, the norm is from 15 ng / ml. This is fundamentally wrong, must be above a hundred. One of the reasons for this deficiency can be just adult celiac disease - it is not a sin to test antibodies to endomysia and transglutaminase. In any case, a gluten-free diet may be appropriate only if celiac disease is confirmed.
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