Reference Number: 456
The spectrum of gluten-related disorders has widened in recent times and includes celiac disease, non-celiac gluten sensitivity, and wheat allergy. The complex of symptoms associated with these diseases, such as diarrhoea, constipation or abdominal pain may overlap for the gluten related diseases, and furthermore they can be similar to those caused by various other intestinal diseases, such as irritable bowel syndrome (IBS). The mechanisms underlying symptom generation are diverse for all these diseases. Some patients with celiac disease may remain asymptomatic or have only mild gastrointestinal symptoms and thus may qualify for the diagnosis of IBS in the general clinical practice. Similarly, the overlap of symptoms between IBS and non-celiac gluten sensitivity (NCGS) often creates a dilemma for clinicians. While the treatment of NCGS is exclusion of gluten from the diet, some, but not all, of the patients with IBS also improve on a gluten-free diet. Both IBS and NCGS are common in the general population and both can coexist with each other independently without necessarily sharing a common pathophysiological basis. Although the pathogenesis of NCGS is not well understood, it is likely to be heterogeneous with possible contributing factors such as low-grade intestinal inflammation, increased intestinal barrier function and changes in the intestinal microbiota. Innate immunity may also play a pivotal role. One possible inducer of innate immune response has recently been reported to be amylase-trypsin inhibitor, a protein present in wheat endosperm and the source of flour, along with the gluten proteins.
Significance of this study to the baker:
Bread is identified as a common trigger for IBS and there are more and more people who report sensitivities to the proteins found in bread called gliadins (aka gluten). The Chorleywood Breadmaking process came about in 1961 when bread production was ramped up in both scale and speed. This did not allow time for the fermentation step which means the structure of the bread changes. We find this structure is unfavourable for the health of our gut, and more likely leading to increased intestinal permeability (aka ‘leaky’ gut) and promotion of Irritable Bowel Syndrome (IBS) symptoms and non-celiac gluten sensitivity (NCGS). This highlights why bread made from good quality flour and baked with a lengthy fermentation time, as in the case of sourdough, supports the physical health of our gut, reducing the symptoms of IBS and non-celiac gluten sensitivity (NCGS).