Food Allergies/Gluten

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Question
Hello David and happy new year.
Although none of my blood tests have shown anything, I always just 'feel better' when I go through one of my gluten free phases. I lose a little weight, have a better mental focus, and less gas and bloating.
My wife the nurse is skeptical that I am sensitive to gluten, and I do not show the major symptoms like diarhea, weight loss, etc. I have just started my third attempt and this time I am more certain than ever.
What convinced me this time is the fact that most of my general aches and pains, and especially the stiff knee resulting from a torn ACL two years ago, have markedly improved. Last week I was walking with a limp-have been for two years, and today I walked pain free to the local outdoor rink and even skated a bit. As I type this there is only a bit of stiffness and inflammation.
This, coupled with the fact that although I have not lost any weight in the few days I have been gluten free, and I have been eating the same if not more-lots of Xmas leftovers-my belt has come in a notch.
Please give me your opinion on this.Also, regarding gluten free foods, there seems to be gluten in just about everything. The major and really only change I made replacing my morning toast and lunch sandwhich (cant live without bread) with gluten free bread. There are some good ones now. Is this sufficient, or should I be even more carefull with what I eat, apart from avoiding obvious wheat/flour products.
Thanks so much!

Answer
And Happy New Year to you too.

Firstly you seem a bit confused about gluten. And about gluten-sensitive enteropathy in particular. That is an inherited condition. It is grossly more common in the far west of Europe than elsewhere. This is because the practice of agriculture spread from the middle East westwards. The longer a population has been growing wheat, the more likely it is that members of the population with this trait will die early and not breed. The west of Ireland therefore the highest incidence in the world.

Gluten is the name for the fraction of flour that makes it "glutinous" (makes good glue) and sticky and therefore suitable for making bread. Actually, it is flour from which most of the starchy carbohydrate has been removed by washing. The most significant protein in it is called gliadin. But it is poorly recognised that gliadin preparations still contain non-protein constituents and in particular long-chain polysaccharides which cannot be digested by the human small bowel. Some of these have direct biological effects unrelated to true allergy.

The symptoms of gluten-sensitive enteropathy can be very variable and many sufferers have neither diarrhea nor other "typical" symptoms of the condition such as weight loss. Antibodies to the gliadin fraction are common, but measuring these is of very dubious diagnostic value. The only certain diagnostic procedure is small bowel biopsy. If there is the slightest chance of this condition, a small bowel biopsy is mandatory. The long-term potential effects of not completely avoiding all gluten-containing foods is often lethal. Patients with the condition can develop all sorts of symptoms which are probably secondary (and that includes small-bowel cancer).

Supposed allergy or intolerance to/of wheat/gluten is probably the most common cause of various symptoms being blamed improperly on foods. In the majority of such cases it can be shown by double-blind food challenges that there is no actual physical sensitivity. i.e. One must blame false attribution for the supposed food-symptom link.

However, feeding tests on patients with Irritable Bowel Syndrome show that high doses of wheat can sometimes cause an acute exacerbation of their symptoms. This is almost certainly due to a change in the balance of "good" and "bad" bugs caused by the undigestible complex-carbohydrate load entering the large bowel. IBS is a complex issue #forgive the pun# and there are three main symptom patterns all given the same label. Only one of them is related to this issue.

The amount of gluten needed to damage the gut lining in GSE is miniscule. One communion wafer per week is quite enough! Other organically based "gluten-reactions" require very high wheat loads.

Gluten is indeed present in very many foods in western societies, particularly processed foods. I very much doubt that anyone can successfully completely avoid gluten without the supervision of a professional, trained dietician. In the UK and most of Europe such professionals have free access to databases of foods guaranteed by their manufacturers to be "Free From ....". They are extremely valuable in treating all food intolerances. But given the attitudes of US producers in protecting propriety "secrets" I doubt such databases will be available there.

A professional dieticians help is also invaluable in preventing malnutrition. Any diet avoiding one or more staple foods is likely to be nutritionally inadequate. I am not alone in publishing cases of various forms of nutritional deficiencies in people avoiding foods due to #often unnecessary# dietary restriction. You have been warned.

If you have never had a small bowel biopsy, I would most strongly advise that you have one. Anything else one might consider doing would be completely dependant on that result.  

Food Allergies

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David Pearson

Expertise

Any in the field I believe. Only experience of questions that get asked will tell.

Experience

I am a retired medical academic from the UK. I have done major research on Food Allergy and have been a government adviser in the area. 30 years experience running an allergy clinic. And undergraduate and post-graduate teaching.

Organizations
Well, apart from the FRCP, I'm no longer active in the area. I'm too busy writing books. And I no longer have the cash to go to international meetings. But was active in many.

Publications
Will 120 scientific papers help? Chapters in books. Patient advisory materials. Magazine articles. TV appearances. Live and recorded. National and international invited lectures, etc. It was my job for 40 years. Do you think I count!

Education/Credentials
MD, PhD, Postgraduate Diplomas etc. Fellow of the Royal College of Physicians. etc. But I don't want that put out on the net! Just to let you know!

Awards and Honors
irrelevant.

Past/Present Clients
Too many to count, patients of course and a large number of all sorts of corporate consultancies and considerable work as an expert witness in the Courts. I'm volunteering because your Greek expert has been so helpful, I thought I'd offer something back.

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