Hi, I’m Dr. Myron Brand, Clinical Professor of Medicine within the Yale Medical School and medical consultant to Goodman Gluten Free bakery. Today I want to talk about wheat and gluten in health and disease. The last 10 years have witnessed a remarkable increase in our understanding of foods, nutrients, vitamins, and minerals in health and disease. What we once thought about nutrition and digestion really had only scratched the surface of what now appears to be a far more complicated biological process for the maintenance of our health. Just 10 years ago, we did not appreciate the interplay between food and the intestinal bacteria which inhabit our digestive tract, known as our microbiome. We now know that what we eat plays an indispensable role in the health of our microbiome and subsequently in our overall health. Recent research has revealed that a dysbiotic or abnormal microbiome has been associated with inflammatory bowel diseases, heart disease, liver disease, premature senility, obesity, and even premature death.
So where do wheat and its byproducts fit into this picture? Wheat has been a food staple for over 1000 years. Indeed, wars have been fought over this grain and it has even triggered revolutions. Remember Marie Antoinette when she told the French people who had no bread, “Let them eat cake.” We have always believed that this grain was nutritious and important for our overall health. Bread and bakery products have been part of all national cultures. Just think of the French without their baguettes and pastries. Yet, little did we appreciate that wheat is a far more complicated grain than we imagined and is composed of numerous proteins and carbohydrates which can affect our digestion and nutrition. In turn, they subsequently influence our microbiome and our immune system. Indeed, most people don’t realize that our GI tract is composed of the largest immune system within our body, protecting us from foreign microorganisms within our environment. This GI immune system is a true two way street, protecting us but also capable of damaging our bodies when inappropriately activated.

Yes, wheat and its byproducts (gluten and carbohydrates) can sustain us and give us nutrition. Yet, in certain people they can cause illnesses including celiac sprue, non-celiac gluten hypersensitivity, wheat hypersensitivity, and eosinophilic gastritis and esophagitis. The mechanisms for these diseases are all dependent on our individual genetics, interacting with our microbiome and immune systems. The classic immunological injury found in celiac sprue is triggered by wheat protein gluten and treated by elimination of this food product from our diet. With this illness, failure to maintain a gluten free diet can have serious consequences for health including severe injury to the GI tract and consequent malnutrition and even death. Not all wheat associated symptoms result in severe injury to our GI Tract. In non-celiac hypersensitivity, patients may complain of gas and bloating not secondary to gluten but rather to a malabsorption of wheat carbohydrates. Many gastroenterologists believe that non-celiac hypersensitivity is common and responsible for many nonlife threatening symptoms. These symptoms are often mistaken for Irritable Bowel Syndrome.

We have much to learn about food, the immune system and the microbiome. They are intertwined in ways we still do not fully understand. For now it makes sense that those who have wheat related disorders eliminate wheat from their daily diets until newer treatments become available.