*When the anecdotal goes viral*

Claims that avoiding wheat, barley and rye can eliminate symptoms of a wide range of diseases have reached Israel in a translated Hebrew-language book from the US. Experts here advise caution.

Bread [illustrative] (photo credit: REUTERS)
Bread [illustrative]
(photo credit: REUTERS)
Bread has been around for thousands of years, serves a major role in Jewish ritual and is regarded as the staff of life – but if it and other common food products are made from wheat, barley or rye, gluten – the protein common to all three – may trigger a variety of medical problems.
If you have taken a special blood test and been diagnosed with sensitivity to gluten – the solution is not taking drugs for it but eliminating gluten-containing products, including those that have been “adulterated” with wheat, barley or rye during the manufacturing process. If you are gluten sensitive and suffer from significant gastroenterological symptoms including pain and discomfort in the digestive tract, diarrhea, chronic constipation, as well as failure to thrive (in children), weight loss, fatigue and anemia, you will likely be diagnosed with celiac disease. In this autoimmune disease, protein causes one’s bodily defense system to attack one’s own small intestine, which is unable to properly absorb nutrients from food.
Gluten sensitivity, however, is not an allergy but due to the body’s “intolerance” to the protein. Supermarkets and health food stores now abound with products marked “gluten free” to attract consumers with celiac disease or those just sensitive to the protein. Other products are marked as “liable to contain gluten” even though they are not composed of the three relevant grains, because of possible adulteration – covering manufacturers and importers from being sued for damages.
But as in most nutrition issues, books and websites have suggested that gluten sensitivity is responsible for a wide variety of ills – from Crohn’s disease and osteoporosis to thyroid problems, psoriasis, diabetes and autism (even though a 2008 systematic review in the Cochrane Library stated that a gluten-free and/or casein-free diet has not been shown to have any effect on the behavior or functioning of individuals with autism). And the authors of these popular articles claim that when the sufferers adopted a gluten-free diet, their symptoms of many years suddenly disappeared.
The latest book to do this – translated recently into Hebrew from the original English-language book published in 2007 – has been produced by health-oriented Focus Books in Ramat Gan. It was originally titled The Gluten Connection: How Gluten Sensitivity May Be Sabotaging Your Health And What You Can Do to Take Control Now, by Dr. Shari Lieberman, a US clinical dietitian, with Linda Segall. The 251-page, NIS 94 Hebrew paperback appears as Regishut L’Gluten. Sadly, according to news stories abroad in 2009, Lieberman died at the age of 51 from metastatic breast cancer.
The paperback includes over 50 pages of recipes and diet plans by a naturopath.
The book links gluten sensitivity with allergies to casein, the protein in milk, so Lieberman recommended doing away with many dairy products as well. “There appears to be a cross-reactivity to gluten and casein,” Lieberman wrote. “Casein is one of the proteins found in milk. The other protein is whey. Many people who are sensitive to gluten may also be sensitive to casein (and vice versa).”
Rodale, the US publisher of the original book, describes Lieberman as “one of the nation’s top clinical nutritionists and maintains that gluten sensitivity affects “as much as 35 percent to 50% of the US population and is a major contributing factor to an array of chronic illnesses.
Struggling with weight gain? Plagued by fatigue? Suffering from joint pain? According to preeminent clinical nutritionist Dr. Shari Lieberman, these symptoms are among the hallmarks of a little-known but surprisingly common sensitivity to gluten, a protein in certain grains.”
She earned her doctorate in clinical nutrition and exercise physiology from the Union Institute in Cincinnati and her master of science degree in nutrition, food science and dietetics from New York Univer s i t y.
She was a certified nutrition specialist, a fellow of the American College of Nutrition, president of the American Association for Health Freedom and the recipient of the National Nutritional Foods Association 2003 Clinician of the Year Award.
Lieberman was described as having studied gluten sensitivity for more than 20 years. “In her experience, eliminating gluten can alleviate many troubling symptoms for which doctors often can’t find a cause, as well as chronic conditions for which mainstream medicine offers little hope of relief, including rheumatoid arthritis, ulcerative colitis, psoriasis, fibromyalgia, lupus and irritable bowel syndrome,” the US publisher wrote. “In fact, 85% of Dr. Lieberman’s clients who follow a gluten-free diet report dramatic improvement in their health – and scientific studies support her results.”
Ancient man was originally a hunter- gatherer, picking up food he found and eating animals he could run after. Around 10,000 years ago, say historians, he learned to grow and grind grains into flour so it became digestible, and the agricultural revolution was launched. Food was heated to make it more edible and destroy toxins found naturally in some food, the best-selling author wrote.
Wheat, rye and barley grains, which were cultivated widely, have a high gluten content, which is a combination of proteins called gliadin and glutenin that give dough an elastic, soft texture desirable for bread, cake and other foods made out of grains.
This helps the dough rise and keep its shape.
However, wrote Lieberman, not all persons adapted well to gluten.
Although there is a 13-page bibliography of mostly scientific references, Lieberman manages to wow laymen readers with her anecdotal stories claiming that autistic children and people suffering from certain types of multiple sclerosis, eczema, urticaria, atax- ia, hypothyroidism and hyperthyroidism who suffered for years – even decades – and were tossed from one medical specialist to another suddenly were symptom free after eliminating gluten/casein from their diets. It seems too good to be true, but many readers are likely to be tempted to try it.
Just one example was a teenage girl who came to her office diagnosed with severe Crohn’s disease and “had already scheduled surgery the following month to have her terminal ileum removed. I put her on a gluten – and dairy-free diet – and lo and behold, all diarrheas and bleeding stopped.
And, her physician was able to wean her off her medication. She is still fine today,” the author related.
She noted that gluten may be found in a variety of breakfast cereals, frozen dinners, potato snacks, cakes, pasta, couscous, crackers, teriyaki and soy sauces, rice mixes, soups and even ice creams, even though they are not made primarily of wheat, barley and rye. Processed food that is so widely purchased in supermarkets and eaten at fast-food restaurants can offer diners a lot of surprises, she wrote.
Eating out at parties is also risky, as your hosts may not know exactly what’s in the food they made or be willing to admit that they purchased ready-made food and don’t have a clue what’s in it.
PROF. YARON Niv, head of the gastroenterology unit at the Rabin Medical Center-Beilinson campus in Petah Tikva, told The Jerusalem Post that he has not read Lieberman’s book (and does not intend to) but knows of such “exaggerated claims” from other sources and warns against them. “People tend to get confused.
There are people with sensitivity to gluten, and there are people who are born without the enzyme for digesting gluten, which eventually results in celiac disease.
That is a chronic disease. The lack of ability to produce the enzyme occurs in about one baby out of 100. The condition varies, and it can eventually lead to vision problems, rheumatoid arthritis, cancer of the esophagus, lymphoma and other conditions, depending about the extent of the problem,” said Niv. “One can die of complications resulting from celiac disease without knowing of the cause. It doesn’t start suddenly, but it can show up in children or adults. Hypersensitivity to gluten is milder and something else.”
He added “that homoeopaths and others who don’t believe in evidence-based medicine tend to blame everything on gluten.”
There are plenty of anecdotal stories, added Niv. “Everybody has an aunt who had a medical problem and stopped eating bread made with wheat, barley or rye – and all her symptoms disappeared. It’s hard to explain the real scientific story to the public.”
If an individual suffers from gastroenterological problems, first he should go to his family doctor for a series of blood tests to rule out or confirm celiac disease.
If it is positive, Niv said, a gastroscopy (in which an endoscope is introduced into the intestine) is performed and a biopsy is taken to examine the villae (folds) to see if they are abnormal. The patient is then advised how to change his diet and what other measures to take. If celiac disease is ruled out and the patient still thinks he has a problem with gluten, one can do an elimination diet to gradually stop eating one type of food at a time for three months, said the Beilinson gastroenterologist.
“But it’s dangerous to stop consuming all types of foods without pinpointing what is the cause of the symptoms,” because identifying the real problem can become much more problematic, and the person may lack nutrients he needs.
Niv bewails the fact that foods promoted by manufacturers and importers as being gluten free cost much more than conventional food products, even though what they are made from – rice or corn, for example – are just as cheap as wheat, barley or rye. “The reason is that there is special production of gluten-free products, and the companies must be very careful to keep them separate from those with gluten. But in addition, when in a separate section in the supermarket and meant for a special diet, the prices go up.
As for the Health Ministry, “it doesn’t real deal with gluten, as it has limited manpower and other priorities.”
DR. OLGA Raz, the well-known chief clinical dietitian of Tel Aviv Sourasky Medical Center and a prolific author (including of the book The Bread Diet) also criticizes exaggeration about gluten. “The percentage of Israelis who can’t eat gluten is relatively low. There has not been enough research to determine it exactly. It is true, however, that Jews generally are more worried about their health than others, so things are exaggerated and they search for quick solutions,” said the Sourasky nutritional expert.
“There is sensitivity to almost anything.
Every protein can cause an allergic reaction, and gluten, as a protein in the three grains, can do so as well. But one should not exaggerate. It’s much easier today to diagnose, as you can test blood for antibodies.
If the doctor has a suspicion of celiac disease, it has to be diagnosed and treated with diet and other means.”
Raz suggested that people who are concerned about the possibility of gluten sensitivity “calm down, don’t get angry or hysterical.”
“I can’t stand preachers who generalize about food,” she added.
Once, she noted, only a biopsy was performed, but now it’s much more simple to diagnose. “It’s worth testing for other things as well and not just gluten,” Raz said.
If you have bought Lieberman’s book but your doctor has determined that you don’t have celiac and are not gluten sensitive, one can always try the recipes at the back of the volume, even though many of them are desserts and should not be overeaten.
The breads are made from sorghum or teff (the basic Ethiopian grain available around the country). There are also recipes for cereals, pancakes, muffins, frittatas, soups, pastas, quiches, chicken with maple syrup and chili, cakes baked with tehina and even matza.