Does baking without wheat rise to the challenge?
For most of the world, bread, pasta and couscous are dietary staples believed to be vital for survival. Yet, for some people, wheat is toxic - and research shows that many of us don 't even know it.
The best-known wheat-related problem is coeliac disease, although the most common one is wheat intolerance, and there 's also wheat allergy. Working out the difference may be a medical minefield (see box, page 2), but millions of people round the world suffer from these symptoms.
Coeliac disease is largely inherited and due to an adverse reaction to, specifically, gluten, one of the major proteins of wheat. But it 's also found in barley, rye and oats. It affects the small intestine, causing severe inflammation, thereby preventing the proper absorption of nutrients, especially iron, calcium and vitamin D. As a result, the initial symptoms tend to be deficiency-related - for example, anaemia, tiredness and mouth ulcers. Later, coeliac disease may lead to hair loss, brittle bones and gut-wall damage. Indeed, a definitive diagnosis can be made from a biopsy sample of the gut.
Wheat allergy and intolerance are completely unlike coeliac disease. True wheat allergy is a near-instantaneous reaction to wheat, which may be severe, and can cause fatal anaphylactic shock, particularly in children (Int Arch Allergy Immunol, 2004; 133: 168-73). It is a specific response by the immune system to wheat proteins in general - not just gluten.
In contrast, wheat intolerance is caused by either incomplete digestion of wheat proteins, or an increased permeability of the intestines - the 'leaky gut' syndrome. Symptoms may not appear for up to three days, making diagnosis difficult. Symptoms are also rather vague (see box, page 2). Nevertheless, it can wreck lives if it 's not recognised early enough.
As with wheat allergy, wheat intolerance is not necessarily a reaction to gluten, but may be to other components of wheat. One clue to this possibility is that intolerance to oats is not common, yet both wheat and oats contain gluten.
How to Know What You've Got
Intolerance is the most prevalent of the wheat-related disorders, affecting perhaps one in every 10 people. Wheat allergy is thought to be fairly rare, afflicting about one in every 100 persons. Textbooks consider coeliac disease 'uncommon', with a rate of about one in every 300.
Nevertheless, when Dr Harold Hin, a GP in Banbury, Oxfordshire, decided to test the first 1000 people complaining of feeling 'tired all the time', blood tests and biopsy showed a staggering 30 patients to have coeliac disease, equating to around one in 35 people. Most of them also had gastrointestinal symptoms along with the fatigue (BMJ, 1999; 318: 164-7).
US allergy specialist Dr James Braly has recently come up with data suggesting that coeliac disease may be more widespread than previously thought (Braly J, Hoggan R. Dangerous Grains. New York: Penguin-Putnam-Avery, 2002). Braly also suggests that the disease should be classified as 'gluten intolerance' or 'gluten sensitivity' (GS), a condition he believes affects as much as 2-3 per cent of the population.
Moreover, coeliac disease/GS may be clinically 'silent' until adulthood (Pediatrics, 2001; 107: 768-70). The danger is that undiagnosed disease often leads to an increased risk of autoimmune disorders such as arthritis and diabetes (Gastroenterology, 1999; 117: 303-10), liver disease, miscarriages (Lancet, 2000; 356: 399-400) and cancer.
In fact, there are substantial cancer risks with untreated coeliac disease, as chronic exposure to gluten can lead to a high-grade T-cell lymphoma of the small intestine, a rapidly fatal cancer. Cancers of the throat and oesophagus are also common in coeliac patients (Gastroenterology, 2005; 128 [4 Suppl 1]: S79-86).
More alarming, it now appears that the immune reaction to gluten can cause damage almost anywhere in the body. The evidence for this comes from the discovery that about one in 10 of us produces an antibody to a substance in gluten called 'gliadin', and yet may have no classical signs of coeliac disease (Arch Intern Med, 2003; 163: 286-92).
What harm might gliadin be causing in the rest of the body besides the gut? Dr Marios Hadjivassiliou, a neurologist at the Royal Hallamshire Hospital in Sheffield, has found some answers. On running a gliadin-antibody test on patients with 'neurological dysfunction' of no obvious cause, he found that more than half of them had such antibodies in the blood - even though most had no gut symptoms whatsoever.
However, their neurological problems were serious, including ataxia (unsteady gait, clumsiness, slurred speech), peripheral neuropathy (numbness, weak muscles) and muscle degeneration. That gluten sensitivity is principally a disease of the small bowel is a historical misconception, concludes Dr Hadjivassiliou. Gluten sensitivity can be primarily and at times exclusively a neurological disease (J Neurol Neurosurg Psychiatry, 2002; 72: 560-3). More recently, Danish doctors have found coeliac disease to be associated with schizophrenia (BMJ, 2004; 328: 438-9).
Might gluten also be linked to other immune disorders? Dr Braly certainly thinks so, and claims clinical success with gluten-free diets for those with Addison 's disease, lupus, rheumatoid arthritis and ulcerative colitis.
But why should such a staple food be so potentially harmful?
The problem with wheat
Wheat offers valuable proteins, fats, carbohydrates, vitamins and minerals, with no toxins or poisons; we 've been eating it for thousands of years, so what's the problem?
Part of the answer is in the question. We've been eating it for thousands of years, but not long enough for our bodies to have learned to cope with it. In Britain, wheat was not grown before the Roman conquest 2000 years ago. In fact, the oldest evidence of wheat being grown anywhere in the world is from 12,000 years ago. But we humans and our ape-like predecessors have been around for two or three million years, eating an exclusively hunter-gatherer diet of meat, fish, plants, berries, nuts and only the occasional grass seed (the ancestor of wheat). So, in evolutionary terms, the 2000 years of wheat-eating is only yesterday.
It's therefore likely that many of us haven't evolved the necessary mechanisms for breaking down the components of wheat, particularly gluten, it 's most complex part. (Indeed, it's one of the most complicated molecules we eat.)
Furthermore, we eat wheat mostly as bread, and bread-making isn't what it used to be. Traditionally, bread takes about six hours to make, and used just wheatflour, yeast and water. But nowadays, 97 per cent of the bread eaten in the UK is made industrially.
First invented by the British Baking Research Association in the 1960s, it's called the 'Chorleywood process', and has since spread around the world. It can make bread in just two hours. But the gain in speed has led to losses that may be contributing to health problems with wheat.
First, high-speed milling breaks down the grain so as to lose nutritional quality while increasing the flour 's capacity to absorb water (most bread is almost half water). The wheatflour is then mixed with water, yeast, fat, "baking aids" and vitamin C - not for nutritional quality, but to speed up gluten release. This combined with a short proving process means that the gluten may not be digestible - which may be behind the growing problem of wheat intolerance (Lawrence F. Not on the Label: What Really Goes Into the Food on Your Plate. Penguin Books, 2004).
What's more, the only wheat that can survive the Chorleywood process is the 'hard wheats', which naturally contain much more gluten than soft wheats - used, for example, in the French baguette.
Other potential allergens are 'baking aids' such as enzymes, added to break down the wheat. As 'aids', they're not ingredients and, so, don't have to be declared on the label. But these enzymes are known to be genetically modified, and some are not completely removed in the Chorleywood process and, thus, are able to cause allergies or intolerance.
Where can we find traditionally made bread? Alas, in fewer and fewer places. Most of the old local bakeries are dying out, and the few that remain have often abandoned old methods in favour of the 'Premix' - containing most of the Chorleywood ingredients. All the baker has to do is add water, make a dough and bake it.
The effects of this wholesale industrialisation of bread on human health are not clear. As is often the case with modern processed food, we are all taking part in a vast unplanned experiment.
Food processing in general is another reason behind our increasing sensitivity to wheat, according to allergy specialist Dr John Mansfield, author of Asthma Epidemic (Thorsons, 1997).
Dr Joseph Mercola goes further. The primary reason why grains cause problems is that they disturb insulin levels, he says. He believes that only those who are metabolically carbohydrate types can eat grains without harm (Mercola J, Levy AR. The No-Grain Diet. NY: Dutton [Penguin], 2003).
Getting rid of gluten
You can extract gluten by gently kneading a handful of flour under a slowly running tap. This will eventually wash the starch away, leaving a sticky pellet of gluten behind. However, you 'll have lost the rest of the flour in the process.
Fortunately, there is a host of gluten-free cakes, biscuits and breads on the market. The trouble is that these may contain undesirable additives - not least of which is too much sugar.
So, another solution is to bake your own using gluten-free flour. However, this is not as easy as it sounds, as removing the gluten reduces stickiness, making it harder to create something that doesn 't crumble to bits.
Our PROOF! Panel held a 'bake-off' to test six leading brands of wheat/gluten-free flours, making them suitable for people with wheat allergy/intolerance and, except for one, for coeliac disease, too.
Each panel member baked a Victoria sponge cake, using one of the test flours, which was then submitted to a panel of tasters. Besides bakeability, texture, taste and cost, we also factored in the quality of the flour 's ingredients. Not surprisingly, our tasters, who had to eat cake every day for a week, have vowed never to look at another Victoria sponge again.
Stamp Collection Organic and Wheat-Free Plain Flour
Manufacturer: Buxton Foods (020 7637 5505)
Price: lb1.75 for 500 g
A flour inspired by actor Terence Stamp, a lifelong wheat-allergy sufferer, all of our panellists liked the cake made from it. Very nice taste; if I hadn 't known, I would have thought it was made with normal flour, best for taste, taste-tastic were typical quotes. Texture was also praised: just crumbly enough with a nice open texture - although some thought it a little flat. In truth, the cake was too flat to be cut horizontally for the jam layer.
Nevertheless, this totally organic flour is as natural as wheat-free comes, using only organic barley, rice, millet and maize flours. Note, though, that this product is not for coeliac patients as it uses barley.
All in all, and given the reasonable price tag, this was our top-ranked choice.
Gluten Free Flour Alternative
Manufacturer: Wellfoods (01226 381 712)
Price: lb5 for 1 kg
This flour scored well on bakeability and texture. The product uses guar gum (from the guar bean plant) as a sticky gluten alternative - which works well. The best of the lot in terms of appearance, it rose well and did not sink in the middle, and it held together well were typical comments. Taste was generally rated good, with just two tasters complaining of an aftertaste. Besides guar gum, the flour uses rice, maize, potato and egg powder. It did, however, lose points for including glucose and dextrose sweeteners.
Glutano Flour Mix
Manufacturer: Gluten Free Foods (020 8953 4444 )
Price: lb5.50 for 750 g
Generally liked by our panel, almost all praised its taste, and only two complained of an aftertaste. Many, however, felt the cake didn 't hold together, and tended to crumble. It also had not risen satisfactorily, suggesting the Glutano 's guar gum content wasn't quite up to the job. Other ingredients include rice, soya, whey, skimmed milk powder, a lecithin emulsifier and an undescribed 'thickener'. Again, points were lost due to those additives.
Gluten Free Plain White Flour
Manufacturer: Doves Farm Foods (01488 684 880)
Price: lb1.89 for 1 kg
Our panel was initially impressed by the cake's flavour, but many reported a lingering aftertaste, described variously as bitter, oily, funny and dry. Texture was good and fluffy, but it tended to be too crumbly. It also baked heavy with a crater in the middle, suggesting a lack of binding quality. The flour includes rice, potato, tapioca, maize and sarrasin (buckwheat), which can impart an earthy, mushroom-like flavour.
For those on low glycaemic diets, this flour would be high GI, given the potato content. For those with tight budgets, the price is right.
Dietary Specials White Cake Mix
Manufacturer: Nutrition Point (01925 258 000)
Price: 750 g (by prescription only)
A proper cake mix, this scored high for looks and texture: the best appearance of all, a good light texture, held together well. But only one taster liked the flavour, considemost, with an aftertaste. The unpleasant artificial taste may be due its raft of chemical additives, all EU-approved, but not likely to appeal to people interested in healthy foods. It also contains potato and maize starch, both described as 'modified' - a red flag to anyone wanting to avoid GM foods.
Trufree Cake Mix
Manufacturer: Nutricia (01225 711 801)
Price: lb2.99 for 500 g
Another cake mix rather than plain flour, this was universally disliked. Tasted disgusting - like uncooked shortbread mix, acid and chemically flavoured; it felt like it left a coating on the mouth, like eating uncooked semolina, the worst cake I have ever tasted say it all. The cake 's texture was terrible, it crumbled everywhere and it all fell to pieces.
The reason for this may be because, instead of guar gum, Nutricia uses methylcellulose, a food thickener/adhesive agent often used in the construction industry.
Other ingredients include sugar, maize, potato, rice, baking powder, iron powder and a small handful of B vitamins.
gluten-free flours, wheat allergy/intolerance, coeliac disease, Crohn's disease, gluten intolerance/sensitivity, Chorleywood process, bread/cakes, gliadin