The G word

I must preface this post with a disclaimer. I do not pretend to know everything about, or fully understand the gluten issue, but I have read many articles and several books which discuss it, and I came to a decision to stop eating it based on what I read. I found that I experienced an improvement in my health. Stopping eating gluten hasn’t cured me, but it’s been a positive step without any doubt. I know this is a touchy subject, but this is my perspective and my experience and I think a lot of people are mystified by this question. This is my two cents'.

If you think you understand the gluten debate, and you have concluded that gluten is completely innocuous, then you are wrong. If you have decided that gluten-free is a fad or a band wagon, you are wrong. Of that I am certain. However, that it affects some people dramatically and others imperceptibly, that is also true - as true as the fact that some people can drink two bottles of wine in an evening and become merry, and others can drink two glasses and become violently ill. The person who is merry isn't invulnerable to the effects of the alcohol, they are just tolerating it better. We are all constituted differently, and tolerate things in variable ways, and much of this is to with the landscape of our gut.

I have read several books on the microbiome – the name given to our inner universe – and it is a fascinating topic for anyone, not just those with a chronic illness. I recommend I Contain Multitudes by Ed Yong; Gut byJulia Enders; and The Gut Health Protocol, by John Herron, which is full pf typos and was obviously published in a hurry, but is still very informative and well laid-out. It is one of those things that seems to so clearly be utterly essential knowledge, like environmental awareness, that I don’t understand why this stuff isn’t being taught in school. Perhaps in the not too distant future it will be. For now, it is poorly understood and generally ignored by mainstream medicine, which likes to wait fifteen years after research has been done to implement its findings, to our general detriment. I am also a fan of Chris Kresser, who is responsible for bringing awareness of gut health to a wide audience.

I will boil it down very simply as best I can, borrowing from people whose books I found helpful. Please understand that this is a schematic, simplified explanation of something infinitely complicated and not yet fully understood. (I read somewhere that medicine is still in its infancy when it comes to understanding the digestive system – this has been borne out by my experiences with doctors over the last few years).

Your digestive system is like a tube from your mouth to your anus. The food you ingest is fuel for your body, which passes through the tube. The digestive system is responsible for sifting through what you take in, absorbing what is useful and filtering out what is toxic. This is an unimaginably complicated process. The higher the quality of what you eat the healthier your microbiome, and the healthier you are, in theory. The more toxic your intake, the more taxing for your body, logically. That’s why you feel like hell after a night of drinking. Your body is showing the strain of cleaning out the mess you poured in.

A main factor in this process is the vast quantity of bacteria which populate the gut (trillions). We each have our own little colony of bacteria. No two people's are alike, so changeable are they based on what we eat from one day to the next. We are each an ecosystem. These bacteria help us to break down foods and absorb nutrients. These bacteria are your life-force. Most of your immune system is in your gut – a point well worth dwelling on. Hormones, etc. Much of it starts there.

It makes sense, if you think about it, that the quality of what you eat will make you ill or well. You are powering the bacteria that dictate your well-being, that influence many aspects of your health. You need to feed them well. If you eat too much sugar, you cultivate more sugar-loving bacteria, and you create an imbalance. You don’t want the wrong bacteria proliferating in your gut, as anybody who has had food-poisoning will know. The better bacteria start to become outnumbered and you have a cascade of unseen problems fermenting in your gut, until one day they are not unseen anymore.

You may have heard of a condition called leaky gut. It sounds not very scientific, and is sometimes called intestinal permeability, which sounds more convincing. The medical explanation is very convincing, however. I am simplifying, and this is my interpretation, but please find a better explanation here or here if you are interested.

The tube we talked about is insulated from the rest of the body by what are named tight junctions. In a healthy gut, the nutrients we need are absorbed into our body, but the harmful particles can’t permeate the lining of the intestines thanks to these tight junctions being tight. If you abuse your gut with excess refined sugar, alcohol or foods which erode the lining, it becomes more permeable. Foods you ingest can escape into your blood stream, and this can cause an immune response. This is why autoimmune disease is strongly associated with leaky gut.

So in theory if you have a strong gut you can eat what you want. It is not in our interest to eat foods which do nothing for us, and rather we ought to eat lots of the things which will help to maintain the correct balance of bacteria - protein, lots of veg, some starch and a few fruit. Maybe some nuts and seeds, and legumes - the jury is still out on exactly what is ideal.

Your tight junctions make sure the rubbish is flushed out. If your gut is vulnerable from poor diet, stress, sleep deprivation, no exercise and so on, you are more likely to experience immune responses – asthma, hay fever and worse. Much, much worse. Even cortisol – the stress hormone – is known to affect the gut, and this is essentially how being stressed can cause many health problems. If you are unconvinced about the connection between stress, or your brain, and the gut, think how anxiety can cause diarrhoea, or you get butterflies in your stomach when you’re nervous. The link is real, and immediate. There is a complicated back and forth between the brain and the gut. This channel is one of the ways in which gluten is extremely dangerous. In celiac disease gluten causes the immune system to attack the small intestine, whereas in MS it is thought to create an immune response which attacks the brain via a process called molecular mimicry, where the body mistakenly identifies certain brain cells as pathogens, the antibodies having been triggered by gluten proteins.

My neurologists have been very unhelpful at lifestyle change advice. Although low vitamin D is perhaps the only factor that is accepted as contributing to MS, one neuro told me she didn’t want to advise me to get more sun because of the risk of me getting skin cancer and that coming back on her. The mind boggles. However, I was told by a neuro I quite liked (not the pattern I’m afraid) that gluten is the only food that has been proven to cause brain damage. Given the reticence of doctors to discourage people from eating it, and the refrain I hear from doctors that diet has nothing to do with MS, I was astonished to hear him say this, although I knew (having read an excellent book called Gluten is my Bitch by April Peveteaux), that there is a condition called Gluten Ataxia, another instance where gluten causes the immune system to attack the brain.

This is where I will stop this pseudo-scientific ramble for fear of a) boring you and b) getting stuff wrong. But do research it if you are interested. If you suffer from autoimmune disease it merits investigation. If you don’t, a basic understanding of the microbiome and the wide-reaching implication of diet can only improve your life.

I read a book called Grain Brain by David perlmutter - a New York Times bestseller which is highly controversial and contested. It's about the effects of eating grains on our brains, as the title suggests. He talks a lot about sugar as well. All I can say is that I found it compelling. If I had any doubts left about gluten, they were laid to rest. I think it's worth a read for anyone. Then you can decide if you find it covincing. Inconvenient, but hard to ignore. It's tough when the doctors disagree. It makes you realise that you can't take the opinion of one doctor as gospel. You need to inform yourself, and use a range of sources. I hear a lot of criticism from doctors about lack of research and anecdotal evidence. Well thousands of anecdotes make up a lot of evidence in the end. The research is happening, it's just taking a while to trickle down.

Back to gluten, which is implicated in many inflammatory conditions and beyond - from arthritis to autism. Almost all illness is associated with inflammation, and the first step in trying to heal yourself is to eliminate inflammatory foods. Gluten, dairy, sugar... it's tough.

At first giving up gluten was excruciating. Even when I realised how much better I felt without it I still tried to cheat, as if I was somehow winning, or not really eating gluten if I ate a piece of cake hurriedly in the kitchen when no one was looking. All my friends and family knew I was desperate to find a way to address my intractable health problems and I think they thought this was a passing phase. At my wedding someone asked me why I wasn’t having any of the cake I had made. She was genuinely surprised when I told her. “Don’t you think… it’s all in your mind?” she asked me with a sympathetic head-tilt.

At the time I had simply read here and there that gluten causes many issues. When you have ongoing unexplained symptoms, that’s the first thing to try, followed closely by dairy. When I was told I had MS almost a year later, and quickly read up, I heaved a sigh of relief that I had not been eating gluten for a while, and had got over the difficult transition already.

Because it is difficult to cut it out, although it gets easier. Now, I barely even think about it, and I also enjoy the challenge of working around gluten in the kitchen a great deal. If it had been this year, I would have made a gluten-free wedding cake. Back then I didn’t feel confident enough to bake one successfully, or that it was right to feed everyone a GF cake. Now I would. I’ve learned how to bake fantastic cakes without wheat, and I would probably smugly feel I was doing everyone a favour. I made a chocolate cake for a kids' party that was gluten, dairy, and egg free recently. No one guessed it was free from anything and everyone said it was delicious. I'm not saying it was healthy - still full of sugar - but normal cake isn't healthy either. It is possible to make good substitutes. It doesn't have the exact same texture, but if you can't eat any gluten, dairy or eggs it's pretty amazing.

I ate my last gluten the day after my wedding, standing in my mum’s kitchen. I looked longingly at the leftovers of the wedding cake I had toiled over, and had a small slice, thinking why shouldn’t I? You know that feeling when you do something you know you shouldn’t and you think it will feel great, but it doesn’t, it feels terrible? It was like that. That was the last time, save a few accidents, that I had gluten.

Now I genuinely don’t miss it, and nor do I find it difficult. It is a pain that you can’t grab a sandwich when you’re out, but GF is more and more catered for, so it’s getting better. If they would make some GF marmite I’d be happy. And it is very sad not to eat any baguette. My mum makes the most amazing bread - a proprietary recipe that I am sad I can't use. That's pretty upsetting. I hope to get to a stage when I can allow myself an occasional slice of sourdough bread (lowest gluten content and probiotic to boot) but for now I can’t allow myself any. It’s thought that it takes months for some people to recover from one exposure to gluten, so pernicious are its potential effects. Not worth it.

Dairy is much more difficult to avoid. Eggs, even worse. Gluten is not, or at least should not be, a staple food. Once you understand that and apply it to your routine it’s not a problem. For me it was like quitting smoking. It took a few attempts before it took, but once it did it ceased to be an issue.

What I have realised is how uninformed people are about gluten – what it is, where it is, and what it does to you. To cut a long story short, gluten is a set of proteins which make food elastic and pleasingly bouncy. It’s also in loads of stuff that it doesn’t need to be because they don’t need to be bouncy, like soy sauce. It is found in wheat, barley, malt, and rye, and similar proteins are found in oats (a loss I have found much more difficult to bear). It is not in rice, corn or potatoes, as people often ask me. It is in loads of things you wouldn't expect though. Worcestershire Sauce, Branston pickle, whisky, beer ...

As I said, I don’t pretend to understand everything about this – especially since medical science doesn’t appear to have reached a consensus, but I have read a few books with opinions, and I know what I find the most convincing. I don’t think that gluten is dangerous to the same extent in everyone, but I try to operate on a great principle I read somewhere which I’m afraid is undeniable: whatever you consume that isn’t doing you good is doing you harm. Your body is working hard when you ingest food, to sort the useful stuff from the rubbish that needs to be filtered out. As you digest your body is mostly occupied with this job. If you feed it food which isn’t nourishing, it is simply working to clear it out of your system. If you are eating a lot of gluten-based foods, chances are you’re not eating enough other stuff. And gluten may not be harming everyone on the same way, but one thing seems clear: like sugar, gluten isn’t really bringing you anything nutritionally speaking. And given its ubiquity in our diet, that is not to say our utter dependence on it, that is quite alarming.

After everything I have read I have come to think that no one should eat gluten as frequently as I used to. Under no circumstances should we eat gluten at every meal. You shouldn’t do this with anything. It should be an occasional thing, like sugar. We try with Flora to limit it, but it’s tough. We eat rice-based pasta, which is really great, and rice noodles, and potatoes and parsnips, and rice, risotto, things like that. She still eats the occasional biscuit, and some toast, but as we are a mostly gluten free household she doesn’t have much. I try very hard to not to give her bought gluten-free products, as another thing I try to avoid her eating is soy - more about this another time.

If you are sceptical I get it. Unless you can see tangible effects that inhibit your everyday functioning as I did it’s hard to grasp the damage gluten can be doing. So just don’t eat it at every meal. Cereal and toast for breakfast, sandwich for lunch, pasta, pizza, quiche or pie for dinner, biscuits in between. And all the places you don't even know it's hiding - chocolate, alcohol. Even foods we think of as healthy - couscous, spelt, bulgar wheat. It’s a lot of one thing which we know can have devastating effects. So maybe just limit it.

However, if you decide to ditch gluten don’t do what I did and eat a mountain of gluten-free food. That’s not the way. The only thing to recommend gluten replacement foods is the fact that they don’t contain gluten. But they are not really food, usually. Notice that they are often replacements for junk food – cookies, cake, sugary cereals, ready meals. What they often do contain is a dizzying cocktail of ingredients trying to use a massive combined effort to recreate the effect of gluten. Binding and rising agents, starches and tons of salt and sugar.

So what to do? Eat real food.

But sometimes you have to have a piece of chocolate cake or a slice of toast. For these occasions, you should try to make the food at home using the many alternative ingredients available, and the plethora of recipes you can find online. When you need a quick fix be aware that not all GF foods are created equal. Some are utterly unappetizing to the point where you have to ask yourself if it’s better not to eat something at all than to eat the sorry mess trying to pass itself off as an adequate substitute. I have tried a lot of them, and the radioactivity level is worrying. Mould is not interested in your gluten-free bread. There is nothing in it to tempt even bacteria. It is often an alarming shade of grey with a plasficky texture. Avoid.

The best gluten-free food I have found is from Marks and Spencers. Despite the lamentable lack of gluten free fresh food, their dedicated range makes me feel not sorry for myself. Sometimes I want to make a dish which has breadcrumbs in it, or I just want a poached egg on toast. Somehow they have nailed it. The ingredients are still unappealing as ever, but at least the result is satisfying. Cookies, cakes – it’s all good stuff. Here are some of my favorites. I don’t buy much food in M&S anymore because they have nothing organic at all, but I make a special trip for the GF bread.

Note: Sainsbury’s GF flour is excellent. Their chocolate cookies are good too. My local branch used to stock the Vogel GF bread but then it disappeared. That one was pretty decent.