As printed in Gluten Intolerance Group Magazine: Fall Quarter,Vol. 33, 2010, #4
Wheat is such an incredible food for the human race! But what a disaster for the celiac and gluten intolerant! Wheat, in its many variant forms, supplies over 20% of calorie needs and requirements of the entire human race. Wheat was discovered growing in the wild in Eastern Europe and the northern part of the Middle East over 10,000 years ago. It was gradually cultivated and selectively bred over many thousands of years so that we now have a grain that grows lushly in large fields, is easily harvested, dried and readily stored for harsh winters that follow. Wheat not only provides a large portion of complex carbohydrates for all of us, but it also supplies protein for growth of our bodies, many vitamins and minerals and, last but not least, large amounts of insoluble fiber which promotes bowel regularity. Except for the absence of a few essential amino acids and vitamins such as A, C and D, wheat is almost the perfect food. It was almost too perfect to last for everyone. Indeed, that is the case for the person with celiac disease and gluten intolerance.
GLUTEN AND CELIAC
Gluten is a protein in wheat, rye and barley grains. It has been there for a very long time, probably over hundreds of thousands of years. A protein is made up of amino acid units linked together in certain types and numbers. All protein in plant and animal foods is broken down by stomach and pancreatic enzymes into amino acids, which are then absorbed by the small intestine and used to make the body’s many different proteins in almost every tissue in the body. Gluten is simply another of the many types of proteins in the foods we eat.
But, suddenly, there was a dramatic change. In an instant, a genetic mutation occurred in a developing fetus. The mutation change was in the lining of the small bowel. This change made the lining cells of the intestine recognize the gluten protein as foreign, as an “enemy”. The body’s white blood cells quickly moved into this area and set up an inflammatory response. This inflammation, in turn, caused damage, eventually quite severe, at the surface of the small bowel. This resulted in celiac disease.
But even at that time, two things were continuing to happen. Wheat continued to be used as a vital source of nutrition and wheat farming spread across Europe, the Middle and Far East and eventually into the Americas. The second happening was the spread of populations throughout these same areas. In particular, there was breeding between population groups so that along with the spread of wheat farming, the celiac gene was spread far and wide within the same populations.
Historical records suggest that celiac was present in the ancient Greek world in the first century A.D. Physicians in the 1900’s described clinical cases which sound very much like celiac and they even prescribed various diets which were low in gluten. Then in 1944 during World War II, a curious Dutch physician, Willem Dicke, made an interesting observation. The Nazi regime had invaded Holland and created a devastating famine, shipping all the wheat grain out of the country. However, Dr. Dicke noticed that his sickly young patients did not worsen with the famine, but instead improved. Then, after the war when wheat was again available, these same children became sick again. It was soon discovered that the wheat protein, gluten, was the culprit.
In the 55 years since that time, an enormous burst of research has occurred, which gradually unveiled the secrets of this disease. The destructive damage to the intestine was identified. The abnormal blood antibodies were discovered. Eventually, the mutated genes themselves were found. The genetics of the disease is now well known. In North America, the incidence of the disease is 1 in 133 people. But if a close blood relative is a celiac, then it is 1 in 22.
THE GUT’S BACTERIA FACTORY
A tremendous number of bacteria reside in the gut, the small intestine and especially the large bowel or colon. It was just 20 years ago that we began to understand the health importance of these bacteria. Before this time, it was found that the colon was the home to many bacteria species, perhaps 300-400. The colon absorbed water from the liquid contents that entered it so that a formed bowel movement could occur. But mostly the colon was viewed as a holding container until unwanted waste material could be evacuated. Our study of these bacteria was mostly limited to the Petri dish where these bacteria bugs could be grown and studied.
Health Benefits of Prebiotics (Figure 1)
- Increased calcium absorption
- Enhanced bone density
- Increased immunity
- Improved bowel regularity
- Increased good colon bacteria
- Decreased allergies and asthma
- Triglyceride effect
- Decreased cancer/polyp factors
- Appetite and weight control
- Decreased bad colon bacteria
- Cessation of flatus smell
A astounding revolution has occurred in this entire area of gut bacteria and its relationship to the gut, to the body and yes, indeed, to the general health of persons with celiac and gluten intolerance. This has occurred because of incredible advances in studying the very genes that reside within bacteria. New genetic probes are now telling us some amazing things about these mostly friendly gut bacteria. First, there are well over 1000 species of bacteria in the gut, perhaps over 2000. Second, the total number of bacteria in the colon is over 10 trillion, 10 times the number of cells in our entire body. Third, the total number of separate genes in this thriving pool of bacteria is over 1 million, while the number of genes in a human is a paltry 25,000. But, these are, perhaps, just boring numbers. The fourth and most important finding in this new revolutionary field of gut bacteria is that most of these intestinal bugs are our friends and, if they are fed properly by the way we eat, a wide variety of health benefits occur, both for the gut and the body. The colon, in essence, is a true health organ when the large thriving pool of bacteria is of the right mix.
For the celiac person and those on a gluten free diet, a side finding of this body of research is that the small intestine, where celiac disease occurs, and the colon itself, both have an abnormal and unhealthy balance of bacteria. This leads to the next part of the 10,000 year story of wheat, gluten, celiac and gut bacteria. (1,2)
PREBIOTICS
A prebiotic is not a probiotic. Probiotics are live bacteria found in yogurt, other dairy products and pills. A prebiotic, on the other hand, is a naturally growing plant fiber, the best of which contain the two prebiotics, oligofructose and inulin. Oligofructose is not a sugar as is plain fructose. It is also known as FOS. These two prebiotics are the ones that maximally stimulate the good bacteria to thrive and dominate in the gut. These are the ones that result in so many health benefits. Research scientists insist that for a fiber to be called a prebiotic health benefits have to be documented in research labs and then confirmed by other medical centers. (3)
These two key prebiotics, oligofructose and inulin, are very widespread in many plants throughout the world. They undoubtedly were crucial for the health of herbivorous or plant eating animals over hundreds of thousands of years. Unfortunately, they are not present in large amounts in many of the plant foods that humans eat (Figure 2). For most of the population, they are present in wheat but probably in just borderline amounts.
Prebiotic Choices – Foods with oligofructose and inulin (Figure 2)
- Onion
- Garlic
- Yams
- Leeks
- Asparagus
- Banana
- Chicory root
- Jerusalem artichoke
- Salsify
- Burdock
- Dandelion
It has been found that these two prebiotics, oligofructose(FOS) and inulin, are fermented or used by bacteria in different parts of the colon. The more rapidly metabolized oligofructose is quickly metabolized in the right colon, producing an acid rich and very healthy environment. Inulin, however, is more slowly fermented by bacteria in the left side of the colon, bringing some of this richness and acidity to a part of the colon where it previously had not been present. Furthermore, when a formula was developed where generous portions of both oligofructose and inulin were both present, then the best health benefits of both occurred.
HEALTH BENEFITS
A wide range of health benefits have now been demonstrated with an increase ingestion of prebiotics. Some of this research has been in the laboratory, some in animals and now, increasingly, in humans. There is now a great deal of information on these health benefits in the medical literature (Figure 1). Here are some of the results:
- Calcium and minerals – There is increased absorption of these minerals through the colon wall. In one study in young teenagers, there was a 20% increase in bone density after one year.
- Immunity – 70% of our immunity is present in the intestinal wall where you might expect it to be. This immunity, as measured by rigorous immune research, is significantly enhanced when prebiotics are added to diet. Allergies and asthma in children are thereby reduced.
- Increased numbers of good bacteria – Prebiotics stimulate the growth of beneficial colon bacteria and in so doing keep the bad bacteria from dominating. These good bacteria, in turn, generate an energy and acid rich environment which promotes both intestinal and body health.
- Cancer and polyp factors – Many factors enter into the cause of these tumors, including genes, diet and probably ingested toxic substances. A generous intake of dietary prebiotics has demonstrated a reduction in some of the carcinogenic factors often present within the colon and in the bowel wall itself.
- Appetite and weight – There are certain hormones produced in the gut wall, some of which induce hunger while others give a feeling of fullness or satiety. Prebiotics in some animal models move these two hormones in the blood in desirable directions, reducing hunger and providing fullness in the abdomen.
- Leaky gut – This is known medically as a permeable bowel. At one time it was thought to be uncommon. Now, with modern scientific techniques, it is known to be present in many disorders, including obesity, diabetes, metabolic syndrome and inflammatory bowel disease. A bad bacterial mix in the colon seems to be a common factor. Prebiotics are viewed as a likely assist in making a favorable correction to this problem.
THE CELIAC DILEMMA
As noted, wheat is the most remarkable, important and widespread food source on the planet. The celiac gene and gluten intolerance arose quietly, several thousand years ago. The result of this gene mutation is that wheat is an unacceptable food source for these people. More recently, it has been discovered that the gut bacteria factory is very important to good health when it is operating maximally.
Finally, the plant prebiotics, oligofructose(FOS) and inulin, are the two key prebiotics that allow the gut bacteria to reach the full health benefits that are possible within the intestine. That brings us to the incredible, diabolical dilemma for the celiac and gluten intolerant person. It was known back in the 1990s that wheat provided 70-80% of these important prebiotics for the North American population. (4,5) This data remained unnoticed in the medical literature until just recently uncovered. (6) When wheat is withdrawn from the diet and the prebiotic stimulus is not provided from other prebiotic rich foods, then deleterious changes occur in the bacterial makeup of the colon. This has been well demonstrated in infant and adult celiacs, the gluten intolerant and even in the non-celiac who eats a gluten free diet. (1,2)
The answer to this problem, of course, is to ingest plenty of prebiotic rich foods which are gluten free. (Figure 1). A dietary prebiotic supplement might even be considered. Many celiac persons report that they still have abdominal symptoms such as abdominal discomfort or constipation, even when they are on a strict gluten free diet. Could this be because they are not providing the strong prebiotic stimulus required in the colon and because of an abnormal colon bacterial mix?
FINAL THOUGHTS
For the celiac and gluten intolerant, a gluten free diet is tough to follow but it is the only treatment available.For most people, wheat contains the major source of prebiotics for the best growth of good colon bacteria.The diet for the celiac and gluten intolerant, therefore, must not only remove gluten in all its forms, but must add those foods that are known to be gluten free and prebiotic rich. A prebiotic rich supplement should also be considered like Prebiotin.
References:
- De Palma G, Nadal I, Collado MC, et al. (2009) Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects. Br J Nutr 102, 1154-1160.
- Collado M, Calabuig M & Sanz Y (2007) Differences between the faecal microbiota of celiac infants and healthy controls. Curr Issues Intest Microbio 8, 9-14.
- Gibson GR (2008) Prebiotics as gut microflora management tools. J Clin Gastroenterol 42, Suppl. 2, S75-S79.
- Van Loos J, Coussement P, De Leenheer L, et al. (1995) On the presence of inulin and oligofructose as natural ingredients in the Western diet. Crit Rev Food Sci Nutr 35, 525-552.
- Moshfegh AJ, Friday JE, Goldman JP, et al. (1999) Presence of inulin and oligofructose in the diets of Americans. J Nutr 129, 1407S-1411S.
- Jackson FW (2010). Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects – comment by Jackson. Br J Nutr 102, 1.
