What are the gears of gluten sensitivity?
post by Gordon Seidoh Worley (gworley) · 2021-06-08T16:42:52.189Z · LW · GW · 6 commentsThis is a question post.
Contents
Answers 11 Phil Scadden 4 Heideana None 6 comments
I've been having some weird health issues somehow triggered after eating. I've been working with a nutritionist. They recommend, among other things, trying to eliminate gluten some of the time on the idea that gluten puts stress on the digestive system and can expose other issues that the body would normally handle. This is something like a load-bearing model: the body bears the load of bad stuff coming in without issue up until it is overloaded and then you start to get weird symptoms as various systems strain to keep up with the load of bad stuff. The proposal is that gluten is one such bad stuff.
It's hard to find anything useful on Google that might give me a good model of how gluten sensitivity would work or why gluten might matter in such a load-bearing model (or, stepping back, that such a load-bearing model is even reasonable).
On LW I only found this old post [LW · GW], which is useful but not enough detail.
So, does anyone have a gears-level model of gluten sensitivity? Links or explanations would be helpful as I try to evaluate what interventions might and might not be worth trying.
Answers
From my daughters journey with IBS, I'd be looking at whether it is "gluten" or other components of flour. One thing to try is whether your body tolerates sour dough bread (eliminate other sources of flour). And that is a real sour dough - fermented at least 12 hours with no post-ferment flour added. There are "cheats" way to make "sour dough", giving it sour dough flavour without the long ferment. Why? Well Monash uni in Oz has published a lot of research around FODMAP components in diet. The ferment process alters a lot of carbohydrate components (but not gluten) making them more digestible. Might help. If it does, then consider whether issues might improved by altering gut biota.
If you look this up, you will quickly run into their low FODMAP diet. I would be extremely wary of using long term, especially if you have any family history of autoimmune disease (eg and especially rheumatoid or psoriatic arthritis).
↑ comment by gjm · 2021-06-09T14:50:00.454Z · LW(p) · GW(p)
Is it true that sourdough fermentation alters other things but not gluten? My understanding is that the acidity of sourdough degrades gluten. I know of one person who was actually a (semi-?)professional baker before developing -- at least by her account of things -- a gluten intolerance, who found that she could eat some sourdough things whose non-sourdough things made her feel bad. But of course I have no way of knowing whether it was really the gluten that was giving her problems.
(Who adds flour to the dough after a sourdough fermentation? Other than maybe a dusting to prevent sticking while shaping or proofing, which will add little enough that I'd have thought someone who isn't outright coeliac should be OK with it.)
Replies from: Ericf, phil-scadden↑ comment by Ericf · 2021-06-09T19:52:11.647Z · LW(p) · GW(p)
The normal sourdough recipe is to take some of the starter, mix it with more flour and water, and let it rise/ferment for only 1-2 hours before baking.
Replies from: gjm↑ comment by gjm · 2021-06-09T21:34:04.614Z · LW(p) · GW(p)
That looks like no sourdough recipe I've ever seen. The usual process goes like this:
- If your starter isn't being fed very frequently, take some and give it a couple of feeds at reasonably short intervals.
- Now take some starter, combine with flour and water, and leave it until it's active and bubbly -- might be 4-12 hours depending on the starter:flour ratio, starter activity, ambient temperature, etc.
- Combine with flour, water and salt.
- Bulk ferment: Over the next 4-12 hours, depending on the starter:flour ratio, starter activity, ambient temperature, etc., strengthen the dough by some combination of kneading and gentler folding. (A typical prescription might be: (wait 30 minutes, do some folds) 6 times, then leave it alone until it's increased sufficiently in size, which might be another ~2 hours.
- Shape and transfer to a proving basket.
- Prove: Leave it for maybe 1-3 hours (or substantially longer in the fridge) until it's increased in size again, passes the "poke test", etc.
- Bake.
There are various wrinkles (e.g., you might combine just flour and water some way in advance, before combining with starter and salt; this allows a process called autolysis) but that's the general technique. Maybe if you do it in warm enough conditions and with a very active starter you might get it down to 4 hours bulk fermentation + 1 hour proving. You absolutely cannot do it in 1-2 hours.
(You can do a distinctly not-normal thing that's much quicker. If you keep the bits of sourdough starter discarded at feeding in a bowl or jar in the fridge, then once you have ~1kg of that you can add a bit of flour, mix it up a bit, leave it a couple of hours, and bake it in a loaf tin. You can make a rather nice loaf this way, especially if you like your sourdough breads dense and sour. But it's not by any stretch of the imagination "the normal sourdough recipe".)
Just in case I'd somehow been living in a weird sourdough bubble, I put "sourdough recipe" into Google and looked at the first 8 hits. First: a no-knead no-fold recipe. 8-14 hours bulk fermentation + 1 hour refrigerated proving. Second: 3 hours bulk fermentation + 4-8 hours proving. Third: 3-12 hours bulk fermentation + 1/2-1 hour proving. Fourth: 3.5-7.5 hours bulk fermentation + 3-4 hours proving. Fifth: 2.5-3 hours bulk fermentation + 2.5 hours proving. Sixth: 4.5 hours bulk fermentation + overnight proving. Seventh: 4.5 hours bulk fermentation + overnight proving. Eighth: 10-12 hours bulk fermentation + 1.5-48 hours proving.
↑ comment by Phil Scadden (phil-scadden) · 2021-06-11T01:34:33.026Z · LW(p) · GW(p)
ok, ferment does degrade gluten but very slowly. Once the levels of lactic acid build up sufficiently, then the acid hits the gluten, but that is rather longer than 12hour. If the gluten is destroyed, then so is your dough structure - it loses the ability to trap air and steam. People struggling with ordinary bread but able to eat sourdough I think is rather common. Based on Monash publications, I would say the highly fermentable fructans in wheat are converted to easier to digest forms (mannitols??). Pretty testable for an individual. If you struggle with high fructan foods (wheat, onions, garlic) but happy with high mannitol foods, (sweet potatoes, mushrooms, melon), then I would predict you will be ok with sourdough (assuming my memory of what fructans convert to during ferment is correct). Sourdoughs with lots of low fructan flours such as oat and spelt should be even better.
As to adding flour later, then I was told by a baker that what is sold as white-flour sourdough breads can be made commercially by taking starter, maybe added to flour/water and partly fermented, but then add bakers yeast and rest of flour and process from there "normally". The process is much faster, more mechanised and, importantly, predictable - ie cheaper. The ferment still gives a sourdough "tang" to the product to keep customer happy.
My son went to a bakery in a holiday town to get sourdough loaf for his IBS sister and quizzed baker on their process to ensure he was getting real thing. She offered him a job immediately (not that he wanted one).
Replies from: gjm↑ comment by gjm · 2021-06-11T02:04:03.175Z · LW(p) · GW(p)
You can lose some gluten and still have enough to maintain the structure of your dough. I think the person I mentioned thinks that's what's going on. (But it sure seems plausible to me that the actually relevant difference between sourdough bread and other bread is something else. If gluten degradation were the mechanism then you'd think you could do equally well by using weaker flour, not kneading as much, etc.)
I've made breads that are actually leavened with ordinary baker's yeast but also contain some sourdough starter (in fact I have two loaves made that way sitting cooling on a rack right now), but it would never occur to me to call them sourdough breads. They're ordinary yeasted breads with a bit of sourdough starter in to give flavour and longevity. But I guess if you're selling bread, and your customers like the idea of sourdough bread, and you aren't too scrupulous... :-)
Replies from: phil-scadden↑ comment by Phil Scadden (phil-scadden) · 2021-06-11T02:52:45.524Z · LW(p) · GW(p)
If you google "what can legally be called a sourdough bread", then I think you might see that this can be a problem.
But anyway, I think we can safely say that sourdough is probably a good way to test whether the issues are really gluten sensitivity, (because it certainly has some), or with other components of wheat.
Also, see https://en.wikipedia.org/wiki/Chorleywood_bread_process. This is surely producing a bread with a rather different chemistry to more traditional processes.
If you haven’t looked at Wikipedia yet, their entry covers the etiological basics. https://en.wikipedia.org/wiki/Gluten-related_disorders
I also saw this article that might give you some more in-depth understandings of its underlying etiology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182669/
Hope those help…❄️
↑ comment by Gordon Seidoh Worley (gworley) · 2021-06-09T00:02:54.371Z · LW(p) · GW(p)
This is also somewhat helpful, but it leaves me with just some vague model of gluten causes the intestine to take up more stuff it normally wouldn't and that extra stuff crossing the blood barrier somehow causes problems. Maybe there's not more precision available in a model I can easily understand without learning a bunch of biochemistry, but I really wish I had something that would allow me to make more precise predictions about things like:
- How much gluten can I eat without risk of issue? Is it none? is it 10% of what I would normally eat?
- How long do we expect the effects of gluten last on the body?
- What things would make the situation better/worse if eaten with gluten?
↑ comment by Hopkins Stanley (Heideana) · 2021-06-09T15:32:10.443Z · LW(p) · GW(p)
This is probably one of those dumb, obvious questions but I’ll ask anyway. Have you consulted with a Gastroenterologist yet? If not, you might want to consider consulting w/one to help interpreting the biochemistry stuff for a more precise “scientific/medical” simulacrum of the underlying pathophysiology from from the clinical standpoint. Otherwise I think you’re best bet is probably working with your Dietitian and the various Gluten Intolerance groups online for more practical advice on dealing with it in the day-to-day world. Unfortunately, from my own clinical experience, there’s a lot of the “art of medicine” involved in phenomenologically interpreting/applying medical research findings clinically.
Replies from: gworley↑ comment by Gordon Seidoh Worley (gworley) · 2021-06-10T02:48:40.654Z · LW(p) · GW(p)
Yep, and several other specialist. We ruled out everything else, which left me with a vague diagnosis of nonspecific, as-yet idiopathic food sensitivity.
Replies from: Heideana↑ comment by Hopkins Stanley (Heideana) · 2021-06-10T18:20:41.322Z · LW(p) · GW(p)
Ugh! I’m just realizing you haven’t even been told if Gluten-intolerance is the underlying etiology which is understandable frustrating...apologies. I looked closer at some other NCBI articles and we really don’t have a good understanding of gluten intolerance other than it appears related to some underlying autoimmune disorder. That leaves you 1) experimenting with eliminating gluten, which it sounds like you‘re already working on, to see if there’s any correlation with gluten intake at all; and 2) getting tested for the various biomarkers folks have suggested below.
There is a recent discussion article I read in the NEJM on “An Allergic Basis for Abdominal Pain” discussing some recent research on Allergies and IBS you may or may not find useful. https://www.nejm.org/doi/full/10.1056/NEJMcibr2104146?rss=searchAndBrowse Let me know you want to read it but can’t access it and I’ll be happy to email you a copy of my pdf.
Another thought is if your specialists have mentioned small intestine bacterial overgrowth (SIBO)? I’ve had vague IBS issues that had worsened over the past year that we’d been working on without any resolution. A physician friend suggested I try a nutritional supplement called Atrantil which my GI doc said was worth trying since nothing else was working. Short story is it helped which led to trying a course of xifaxin/neomycin for SIBO that I’ve had good results with. Problematic is that diagnosing SIBO isn’t really good and is trial/error of trying various antibiotics.
Please excuse typos & autocorrect strangeness
Replies from: gworley↑ comment by Gordon Seidoh Worley (gworley) · 2021-06-11T02:19:27.277Z · LW(p) · GW(p)
Thanks for your reply!
No one mentioned the idea of SIBO, and doesn't sound like it would really match my symptoms, but something I'll keep in mind.
↑ comment by Ericf · 2021-06-09T02:09:13.639Z · LW(p) · GW(p)
For the types of gluten problems (or wheat allergy, which often looks like a gluten problem) actually supported by science (and not just ?maybe it's bad?) You need to go to 0 initially to let your system recover. After that, mild allergy or celiac could allow for the occasional wheat maltodextrin ingredient or "cooked in the same kitchen as active flour usage" or "ok, just one bite of that" or "I'll just scrape the filling out of the pie." Severe allergy or celiac requires continued zero tolerance. At no point would eating a gluten roll or sandwich be reasonable.
Regardless, the standard diagnostic method for "I seem to have GI problems" is to remove all the things from your diet that have caused other people problems (wheat, milk, etc.) And then reintroduce them one at a time and observe your reactions. Your gut bacteria are unique to you, and you might have or lack something that makes gluten or some other protein contraindicated.
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comment by gwern · 2021-06-09T02:22:27.298Z · LW(p) · GW(p)
If you are concerned about gluten sensitivity, why not directly test for the antibodies or celiac-related genetic variants (eg 23andMe)? You can do both at home via mail for like $200 total. That information sounds much more dispositive than reducing gluten and maybe observing some effect, and given the long-term harms of problems like celiac, this is not a problem one wants to cheap out on solving.
Replies from: ChristianKl, gworley, bvbvbvbvbvbvbvbvbvbvbv↑ comment by ChristianKl · 2021-06-09T12:35:15.245Z · LW(p) · GW(p)
Many people who speak about gluten sensitivity (and other allergic symptoms) think that often even when the antibody levels don't reach levels that are detectable by antibody tests there can be still gluten sensitivity and making the experiment of reducing gluten to test whether there's an effect is more sensitive then the antibody tests.
While running tests is you can rationally deal with the results can be useful, actually doing the experiment of whether reducing gluten will have a noticeable effect is worthwhile.
If you do run antigen tests, do blood tests. Skin tests don't really provide useful medical data use but are easy to bill to insurance companies.
When it comes to running the experiment sometimes heartrate or HRV are sensitive enough to detect allergy reactions that you wouldn't notice otherwise.
The real high cost action would be "Eat only rice for a week, see if symptoms disappear, then add additional foods one-by-one to see when symptoms reappear".
Replies from: gworley↑ comment by Gordon Seidoh Worley (gworley) · 2021-06-10T03:03:12.808Z · LW(p) · GW(p)
As to the high cost action, I am working on prepping to do a true elimination diet. I say true because in many ways I'm already on one, having cut out foods that seemed to clearly give me problems and only keep those I seemed fine to eat, but that scattershot approach has left me without sufficient information to suss out what the actual triggers are.
You mentioning heart rate and HRV is interesting. I've been diagnosed as having a large number of preatrial contracts (PACs). We only noticed because I've had palpitations after eating whatever the triggering foods are (not the only symptom, though; I've also had things like thirst and chest pain that made it necessary to rule out a bunch of stuff like heart conditions and diabetes). I wonder if monitoring my heart would allow me to detect issues when they are below the level of being a problem. But I lack a model of how heart rate is connected to all this for that to make sense to me.
↑ comment by Gordon Seidoh Worley (gworley) · 2021-06-10T02:56:24.181Z · LW(p) · GW(p)
I'll look into it. I was unaware until this comment that such testing existed. My 23andMe results show I don't have the markers so celiac disease, and SNPedia findings don't show anything likely to be related to gluten. I'll see if it's possible to find testing that might indicate non-allergic food sensitivities that isn't also bogus.
↑ comment by bvbvbvbvbvbvbvbvbvbvbv · 2021-06-09T13:13:04.840Z · LW(p) · GW(p)
My several cents :
It's not just about celiac disease. There are several other disorders that seem to be worsened by gluten, the first one that comes to my mind is endometriosis.
The way I see it, it seems that some people are susceptible to pro inflammatory effects of gluten, whereas most are not. So if you already have an inflammatory disorder or autoimmune condition AND have this inflammatory sensitivity then gluten will worsen it.
I don't know if this susceptibility to gluten's inflammatory effect is genetic, or genetically identified / identifiable. Whereas you can indeed identify celiac related antibodies using various tests.
Replies from: gworley↑ comment by Gordon Seidoh Worley (gworley) · 2021-06-10T02:58:15.248Z · LW(p) · GW(p)
This fits my model that gluten somehow contributes to autoimmune/inflammation "load" and that because I'm now dealing with chronically worse asthma, even with treatment it may not be getting me down to a low enough level to consume as much gluten (or something else!) as I could in the past without issue.