Monday , January 18 2021

"Epidemic" of gluten-free? The research tries to see more clearly



Fashion is "gluten-free", but the confusion reigns between "real" intolerant, allergic and "
hypersensitive

"There are also those who choose to stop gluten for personal reasons, self-estimating that they do not support or harm it." As a result, an extensive research program "
from the plant to the plate

"It is held in France to try to see more clearly.

"There are three distinct pathologies", says Brigitte Jolivet, president of Afdiag, an association that has campaigned since 1989 to make life easier for gluten intolerants. The "real" intolerant, for whom it is vital to exclude gluten, are victims of celiac disease. This condition destroys the lining of the small intestine and causes anemia, diarrhea, weight loss, bone pain and even malnutrition in children. There is no treatment except the gluten-free diet for life. 1% of the population would be affected (ie 670,000 people in France), of whom only 10 to 20% correctly diagnosed.

The second group concerns allergic patients, which are much less numerous (0.1 to 0.5% of the population). A third group, "hypersensitivity" could account for 0.5 to 15% of the population, which is at least "vague," notes Jolivet. Swelling, fatigue, digestive disorders are put into the account of gluten
without scientific proof

According to Ms. Jolivet.

Both celiac disease responds to a clear diagnosis based on a blood test (IgA antibody dosage) reimbursed by social security, and confirmed by endoscopy of the duodenum (small intestine), both
hypersensitive

They are difficult to define. "
We are not sure that gluten is responsible

"Says Corinne Bouteloup, a gastro-gastroenterologist at the University Hospital of Clermont-Ferrand, who will conduct a clinical study as part of the GlutN research project.

From plant to plate

To see more clearly, this extensive research program was launched with the National Institute of Agricultural Research, Inserm, and the University Hospital of Clermont-Ferrand in particular. "
Let's study things from the plant to the plate

"Explains Catherine Ravel, who coordinates the project.

INRA studies the digestibility of breads and pastas, from a collection of 16 rows of common wheat and 8 rows of durum wheat. "
The idea is to offer hypersensitive people a product they would tolerate

She said. At CHU Clermont-Ferrand, Corinne Bouteloup will submit sixty patients (excluding intolerant and allergic patients) to a double-blind diet with or without gluten, controlling their reaction.

"
The goal is to find biomarkers because, for now, doctors are very concerned about making a diagnosis, lack of tools

"Says Catherine Grand Ravel. Blood, urine and feces tests should be used to establish the famous" markers "to diagnose gluten sensitivity.

Gluten added

The clinical study, funded by the National Research Agency, will be launched in early 2019 with the first results at the end of the year. According to Corinne Bouteloup, "
in general, we do not eat more gluten today because we eat far less bread, but the quality of gluten has changed

".

The so-called "native" gluten is naturally present in certain cereals, including wheat. But the industry also massively uses "vital gluten" for its texturizing power (volume and elasticity). "
Our grandparents ate real bread and not industrial breads, pizzas, prepared dishes, cold meats … A lot of products to which gluten was added

"Recalls Corinne Bouteloup.Now"
vital gluten is highly concentrated, possibly more resistant to digestion

".

"If we can show that it is indeed a gluten quality problem and its addition, we could perhaps modify the practices
She said. Parallel to these two programs, an epidemiological survey seeks to better understand the "gluten free" Nutrinet study, which interviews users about the relationship between nutrition and health.

"
20,000 responses to a gluten questionnaire were kept

"Says Emmanuelle Kesse-Guyot, director of research.

"
People who have celiac disease have been excluded, and we are interested in whether people who exclude gluten by personal choice have particular characteristics. What they eat? Why do they decide to exclude gluten? For abdominal comfort, physical well-being or belief (is it bad for my health, for the environment)?

"

Deficiencies

"
What we do know is that people who exclude gluten also exclude other things, which can lead to deficiencies

She watches. "
We struggle with the nutritionist I work with to get patients back to the least restrictive diet possible. We see people coming into consultation who do not know what to eat because of restrictions

", Reports Corinne Bouteloup.

"
Having seen many of them, I think the vast majority of people who say they are better off removing gluten actually get better because they remove fruity ones that also contain gluten-containing grains.
. The frutanos are part of the "Fodmaps", another "suspect" that is emerging strongly. This acronym stands for certain carbohydrates.

"
Fodmaps are found naturally in many foods, in cereals are fructose, in many fruits and vegetables are fructose, polyols, sugars that are not digested and ferment in the colon

Explains Corinne Bouteloup.

Based on ten years of experience, she suspects that "
Precisely, those who remove many things are often people not sensitive to gluten, but intolerant to Fodmaps.

"It's my clinical feeling" She observes, "But I still have not had the means to launch a study on it. It takes time, little hands, money …"

Sales of "gluten-free" groceries grew 12% last year, in a large set of "healthy" foods that exceeded 6 billion euros in supermarkets in 2017, according to a study by Xerfi.


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