Celiac disease, also referred to as gluten intolerance, gluten sensitivity, or celiac sprue, is a chronic condition in which the immune system reacts negatively to the presence of gluten in the small intestine. As a side effect of the immune system’s inflammatory response to gluten, intestinal villi are destroyed. Villi are small, finger-like projections on the intestinal wall that help us to absorb nutrients. Due to the destruction of the villi, celiac disease sufferers (aka celiacs) gradually lose their ability to digest nutrients. Symptoms of the disease include diarrhea, intestinal cramps, bloating, fatigue, excessive weight loss, failure to thrive (in children), allergies, anemia, and general malnutrition. The only known cure is to completely eliminate gluten from the diet.
Celiac was first described in 1887. Over the succeeding decades, it has become more commonly known and better understood. Today, many people are familiar with the concept of a gluten-free diet, and many people with digestive difficulties experiment with the diet to see if it eliminates their symptoms. In fact, in recent years a whole cottage industry of gluten-free foods has emerged, catering to the needs of those who cannot tolerate gluten, a group whose numbers seem to be growing exponentially, whether due to better diagnosis of the disease, increase in incidence, or both.
Gluten is the type of protein that is contained in the grains wheat, rye, spelt, kamut and barley. Its elastic, sticky nature is what makes these grains ideal for grinding into flour and baking into bread. The strength and elasticity of gluten protein chains enables the bread to maintain its structure as yeast releases gases that cause the bread to rise. Gluten’s thickening and stabilizing properties also make it popular as a food additive, where it can be found in processed foods sometimes under the name dextrin. In addition to being present in virtually all bread products (essentially any food made with the grains named above), gluten can be found in candies, gravies, imitation meats, lunch meats, salad dresses, sauces, soups, and most processed foods in general. A celiac disease sufferer, in order to be symptom-free, must find a way to avoid all these foods while still managing to eat a balanced diet. Gluten is especially difficult to replace when it comes to foods such as bread and pasta that require its properties to maintain their structure. As such, modern medical research is currently focused on trying to genetically engineer gluten to maintain its properties while not inflaming the immune system in celiacs.
One fact that these researchers have been able to determine is that celiac disease is hereditary. That is to say, our level of sensitivity to gluten tends to be determined by our genes. Those populations with the highest sensitivity to gluten tend to be northern and western Europeans and Caucasians in general. Interestingly, these are the populations that are most closely associated with historical consumption of gluten-containing grains such as wheat and rye. Since celiac is a relatively recent disease, what must have happened to suddenly make gluten so intolerable to significant percentages of these populations? This is an area of celiac disease research that has regrettably been left under-explored. However, a look back at history of gluten consumption may shed some light. Actually, it’s best to start with an analogy to the history of maize, or corn, consumption.
Corn, along with rice, millet, amaranth, quinoa and buckwheat, among others, is one of the gluten-free grains, so it has never been linked to celiac disease. However, corn does pose its own digestive issues. The ratio of the different types of protein in corn is not ideal for our own amino acid balance. Corn can contain mycotoxins, byproducts of mold that are carcinogenic. Finally, corn contains niacin (aka vitamin B3), an essential nutrient, but in a form that is indigestible. Anyone eating a diet that depended heavily on corn to meet nutritional needs would be at risk for a variety of serious health problems, including the vitamin B3 deficiency (aka pellagra), which, like celiac, can be ultimately fatal if the diet is not changed.
In ancient Mesoamerica, where corn was first cultivated, a process called nixtamalization was developed, in which the corn was soaked and cooked in an alkaline solution made of lime (calcium hydroxide) and ash (potassium hydroxide), then hulled. This process removed the mycotoxins, eliminated the excess protein, and freed up the niacin for absorption. As a result of this natural, time-honored form of processing, the Mesoamericans could rely on corn as a staple of their diet. However, when corn was brought to Europe by Christopher Columbus and quickly adopted by many due to its high yields, the nixtamalization process was not brought with it. Instead, corn was processed and hulled in mechanical mills. As a consequence, wherever corn became the staple food crop, malnutrition struck.
Today, if any single food has become our staple, it’s wheat, and gluten is clearly even more ubiquitous than wheat. The very people who were able to tolerate it for centuries now appear to be genetically incapable of safely digesting it. Unsurprisingly, the key to the riddle has to do with the change we’ve made from the traditional processing methods of gluten to the modern, just as in the case of the abandonment of corn nixtamalization. Next week’s article will explore the history of gluten processing and describe how, with the right preparation, gluten can be safely consumed – even by celiacs.