Our diets have changed since the development of modern agriculture. Around 10,000 years ago humans began cultivating wheat and other grains. Human food choices across the globe have changed and expanded significantly in the past one hundred years with the prevalence of processed, commercially available foods. Wheat is a staple in traditional and more modern diets, but many people have decided to avoid wheat altogether, thinking that this may help their digestion and health. Certainly, gluten-free diets have achieved fad-like status in recent years, and the increased access to gluten-free products.
So how did gluten get all the blame for our digestive ills?
Gluten is a complex plant protein found in wheat (and wheat varieties like kamut and spelt), barley and rye (conventional oats also contain a small amount of gluten, but this is by contamination, not from the grain itself). Gluten helps form the matrix which makes bread rise and is high in protein. Wheat provides essential B vitamins and minerals; the fiber feeds the beneficial bacteria (commensal bacteria) living within us and helps us eliminate waste.
The fact is some people just do not tolerate wheat.
I have read many opinions and questions about why many people cannot tolerate gluten. Is our modern wheat that different from the wheat of the past? Did our ancestors have access to wider and/or wilder varieties? Could gluten and wheat intolerance be explained by the commercial processing of wheat with the addition of added gluten and dough conditioners to ensure a good rise, or could the culprit be the use of glyphosate, herbicides, or genetically modified strains of grain?
It is difficult to know.
However, intolerance does exist. There are several types of gluten-related disorders (GRDs), including celiac disease, wheat allergy, and non-celiac wheat sensitivity that could be disrupting normal digestion and elimination.
From a global perspective, how concerned should we be about gluten-related disorders? Celiac disease is an autoimmune illness affecting about 1% of the world’s population. It is necessary to have one or both genes called the HLA DQ 2 and HLA DQ8 to be at risk for developing celiac disease. Celiac disease can occur any time in the lifespan. Often there is a triggering event like food poisoning or a viral infection that turns on an autoimmune response. The small intestine becomes inflamed, and absorption is impaired. The sole effective treatment is completely removing gluten from the diet and after about a year on average, the mucosal lining of the intestine recovers. Unfortunately, that individual must avoid gluten for the rest of their life. There is no other conventional treatment currently, but studies are under way to develop a vaccine, to use medications to suppress the immune system, and use specific probiotics.
Other intolerances to wheat include wheat allergy and non-celiac wheat/gluten sensitivity. These are more prevalent and occur in about 3-6% of the population. Some researchers believe the prevalence to be more like 10-15%. There are blood tests (and skin-reactivity tests) that can help diagnose these conditions.
Theories abound about why we seem to be seeing increased food intolerances. One main theory is that modern humans have developed an unhealthier intestinal bacterial balance, in effect altering the balance of beneficial (commensal) and not so good (dysbiotic) bacteria. While it may be difficult to think about those 2-4 pounds of bacteria that exist with us, the fact remains that humans (and most animals) need these bacteria to help us digest our food. Ingesting pesticide and herbicide residues may disrupt the healthy biofilms (environments) that bacteria form in the gut. Having a case of food poisoning or a severe, long-term illness or infection can also trigger changes in the microbiome. Elevated stress can and does affect how we digest food- our guts do their best work under the “rest and digest” guidance of the parasympathetic (calming) nervous system.
Antibiotics we take as a life-saving necessity can have an impact on our beneficial bacteria. Too many antibiotics (given too freely), those given to livestock, and other medications can knock down bacterial counts, altering the balance. And we are ingesting antibiotics and other substances in our treated drinking water. Even though these are in tiny amounts, over time they could be challenging our beneficial bacteria too.
There’s another theory why modern western societies may be losing the ability to fully digest wheat; reduced natural protection starting at birth. Infants born vaginally receive a healthy inoculation of beneficial bacteria as they travel through the vaginal canal, in theory protecting them from early infection and development of allergies. The U.S. has one of the highest rates of cesarean section births in the world. Can we be creating more allergy-prone generations in this way?
Fermented foods with natural “good” bacteria have been a part of our ancestral diets too; foods like kombucha, sauerkraut, kimchi, and yogurt. These foods bring “good bacteria” which “feed and seed” the gut microbiome. For a large part of the 20th century, ancestral foods had been crowded out of the marketplace by commercial, processed foods, some of us losing the connection with these traditional foods for the sake of modern convenience and change in lifestyles. In the later part of the 20th century, and now in the 21st century, traditional foods and traditional foodways are bringing back natural fermentation - and introducing a new generation to the idea of creating better health starting in the gut.
There is no doubt that our modern civilization has changed how we eat, the foods we consume, and the environment in which we live. So how do we build resiliency in the gut? Breast feeding, exposure to the outdoors (and dirt) as young children, early exposure to allergens, and eating “close to the earth” can go a long way towards establishing a resilient microbiome in the gut, perhaps bringing forth a better balance and wider tolerance to foods like wheat.
Tammy Jett-Parmer is a certified Physician Assistant practicing medicine in Maryland. She has been a PA for over 20 years, the last thirteen or so dedicated to Integrative and Functional medicine. Many of her patients have challenging digestive issues, so over the years she has endeavored to equip herself with the latest research and guidance regarding food sensitivity, food allergy, and the health of the gut microbiome, those 2-3 pounds of beneficial (also known as “commensal”) bacteria that live in our digestive tracts. Learn more about her practice at www.tammyjettparmer.com.