Wheat triggers autoimmune diseases, chronic inflammation and irritable bowel disorders. The doctor and biochemist Detlef Schuppan has researched the effects for a long time. He consistently dispenses with the grain.
People who say they don’t eat wheat products or say they’re “gluten-free” don’t have it easy. They’re pigeonholed with everyone else who’s picky about food, whether they’re vegan, dairy-free, or whatever. In the background people like to talk about “sensitive people” or “imaginary sick people”. Wrongly?
Often wrong, yes. For too long, the discussion has been narrowed to the intolerance of gluten, a wheat component that triggers the autoimmune bowel disease celiac disease. Much more common, however, are atypical forms of wheat sensitivity, which we can now also scientifically prove. They make up a significant proportion of irritable bowel symptoms. In addition, wheat components can also increase inflammatory diseases such as rheumatism or multiple sclerosis.
Celiac disease, which affects one to two percent of Germans, is well known. How do I know that I’m affected?
This is not easy, there is a high number of unreported cases. Celiac disease is the chameleon of internal medicine and is not discovered until adulthood in more than half of the cases. The classic symptoms such as abdominal pain, diarrhea or constipation do not always occur. There are patients who are almost symptom-free, but the disease should be diagnosed because if left untreated, serious disorders can occur in the long term. And there is a large number of those who have atypical symptoms, such as chronic fatigue and weakness, female infertility, skin changes or joint problems. A third of the patients also suffer from other autoimmune diseases at the same time.
How do you track down the disease in such cases?
We often find such patients in family screening after first-degree relatives have been diagnosed with celiac disease. A clear diagnosis can be made when certain antibodies are present in the blood and the typical changes in the tissue of the upper small intestine are found in a gastrointestinal mirror. However, tissue samples must also be taken for this, it is not enough for an endoscopist to just look at the mucous membrane of the small intestine and then say it looks ok. Unfortunately, this still happens often.
“Two out of three IBS patients have food allergies”
The gastroenterologist, biochemist and immunologist Detlef Schuppan is a professor at the University Hospital Mainz and Harvard Medical School (USA). For more than two decades, he has been researching the health effects of wheat consumption, among other things, and heads the celiac disease consultation at the Mainz University Hospital. In addition to more than 600 scientific publications, Schuppan wrote the book “Daily Bread: Sick through Wheat, Gluten and ATI” (Springer Wissenschaftsverlag 2018).
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Irritable bowel syndrome is much more common than celiac disease 15 percent of Germans suffer. How many of them can’t tolerate wheat?
We assume that about two out of three patients with irritable bowel symptoms have an atypical food allergy as the cause, the majority of them to wheat. However, there have not yet been any major epidemiological studies on this, because detection via a gastrointestinal endoscopy is very time-consuming. We extrapolate this figure from our endoscopic studies for which we pre-selected the patients. The insidious thing about these allergies is that abdominal discomfort, often skin rashes, only appear many hours after the triggering food has been eaten.
Does that mean that the diagnosis is usually made without proof?
Anyone who thinks they cannot tolerate wheat should simply try to leave it out for a short time. Symptoms should then improve within a week or two. That’s what I always tell my patients.
And if that doesn’t help?
Among the food sensitivities there are the “Big Four”, besides wheat also soy, yeast and milk. One can initially follow a basal diet of rice, potatoes, olive oil, salt and water. You can keep it up for a few days. Fried potatoes dressed with olive oil are also allowed. And the ones that get better are the food sensitives. We recruited them for our studies. The largest proportion of them, 60 percent, are sensitive to wheat. In about one fifth, the result is unclear, which we then examine with a gastrointestinal endoscopy.
How exactly does this work then?
We are looking for a disruption in the barrier in the intestines that is causing too many nutrients to get into the blood. These can trigger the allergy. In order to detect the barrier disorder, we inject the patient intravenously with a fluorescent agent, as is also used for examinations of the fundus of the eye. Then we spray food in suspension or solution directly on the inner wall of the small intestine. If there is a positive reaction, we see it in seconds, it’s like night and day, the entire inner cavity of the small intestine is filled with fluorescent liquid. This then proves the sensitivity.
Can any gastroenterologist do this?
No, not yet. But there are some clinics that carry out the examination method, and it is now even reimbursed by health insurance companies upon application.
We spoke of the atypical wheat allergy. So is there a typical one?
Yes, the instant-type allergy. Someone eats something to which they have an allergic reaction very quickly, the mucous membranes swell, they have to sneeze, their eyes water, and intestinal symptoms are also possible. These allergies can usually be detected with a skin prick test. You put the suspected allergens on your skin, and it turns red and swollen. IgE antibodies against these allergens are often also found in the blood. Immediate-type wheat allergies affect 0.2 to 0.4 percent of Germans. They are more common in children than adults and can go away again.
You said wheat can also trigger inflammatory diseases such as rheumatism or multiple sclerosis. How does this happen?
It is not the gluten that is responsible for this, but other proteins in the wheat, the so-called amylase trypsin inhibitors, or ATI for short. They activate a subset of immune cells in the gut. And these immune cells then migrate via the blood to organs that have already been damaged, such as nerve tissue or joints. There they generate increased immune activation. We have proven this in animal experiments and seen it confirmed in numerous clinical observations. The inflammatory response happens to everyone, but if you’re healthy and undamaged, it doesn’t matter.
“Spelt, rye and barley also contain a lot of ATI”
And how do those affected notice this?
It’s not like they get a boost four hours after consuming wheat. But sufferers notice it when they eat a wheat-free diet for a week or more. We have been able to observe this well in patients who, for example, have been admitted to the rheumatology inpatient department for a few weeks. These are patients who usually continue to suffer from joint problems despite medication. They improved significantly on a wheat-free diet, and the levels of inflammation in the blood also went down. Our rheumatologists were so impressed that we are now collaborating with them on studies on rheumatoid arthritis and lupus erythematosus.
Is it enough if these patients abstain from wheat? So can they eat rye bread or spelled pasta and drink beer as they please?
Unfortunately, no. Spelled, rye or barley also contain a lot of ATI, although the content can vary greatly depending on the variety and processing. It is best for these patients to only eat bread that has been baked with flour made from buckwheat or oats, for example. If “gluten-free” is written on a product, you can be sure that there are no ATI in it. But beer contains little ATI, as we have published. So drinking a beer wouldn’t be a big problem.
I looked at the “anti-inflammatory diet” guides at a major bookstore. Surprisingly, an ATI-free diet plays no part in it, whole-wheat rolls and spelled noodles are even particularly recommended. Aren’t they up to date?
You can say that, yes. Despite constant new editions, these nutrition guides usually provide knowledge that has been known for a long time. New discoveries are made very slowly. We have already published the first clinical studies in international specialist journals, proving that anyone who suffers from rheumatism, Crohn’s disease or MS and eats an ATI-free diet usually improves their condition significantly. Even if it was difficult to convince colleagues for a long time, a change in thinking is slowly taking place, because we no longer only have good data from animal experiments, but also clinical studies on real patients.
Let’s summarize: What percentage of Germans would benefit from a wheat-free diet if you add up celiac disease and irritable bowel patients as well as patients with chronic diseases such as multiple sclerosis, rheumatism or ulcerative colitis?
About 15 percent, conservatively estimated. And the problem is: Unfortunately, many of them do not realize how much a fundamental change in diet would help them, maybe even help them better than the medication in some cases. A mild form of rheumatoid arthritis, for example, which is treated according to the guidelines with so-called basic therapeutics that can impair the immune system, could also be controlled in individual cases with an appropriate diet alone. And the course of severe forms of autoimmune diseases can also be significantly alleviated.
But to make it clear again: For the rest of the German population, and that would still be 85 percent, is the consumption of wheat unproblematic?
Exactly. One should not categorically avoid wheat unless one has health problems. Whole grains in particular can be eaten anyway if you are symptom-free because it is naturally healthier. But if people have non-specific symptoms, for example joint pain from time to time or are easily exhausted, then it makes sense to try a wheat-free diet for one to two weeks.
How do you hold it yourself?
None of us know what possible predispositions to illnesses lie dormant within us. And we’re not getting any younger. Me and my family and many who know us, we eat largely wheat-free. For myself, I think it’s good for disease prevention as well. But I also like to eat a piece of rye bread.