Sourdough – Safe for Gluten Sensitivity?

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There’s something special about sourdough bread. Made through a slow process that begins with simple ingredients, warm water and flour, yeast and bacteria feast on the flour’s carbohydrate, producing carbon dioxide gas and bubbles that expand the dough. Each batch may tastes a little different depending on the flour and water used as well as the environment the starter is made in. My favorite sourdough bread, the kind that is made over the course of several days, has an alluring pungent, slightly sour taste. This long fermentation process leads to more complex flavors while also creating bread that is easier for those with gluten sensitivity to digest. I shared the science behind sourdough in this segment on Fox TV:

What is Gluten?

Gluten’s stretchy fibers give dough it’s rubberband-like elasticity allowing it to stretch when pizza dough is tossed in the air like a frisbee. Gluten-rich dough traps air and water during the baking process so bread rises with delicate ease, producing light and fluffy baked goods. Without wheat (and therefore gluten, which is produced when wheat flour is mixed with water), gluten free items require a blend of flours, starches and additives yet they still can’t replicate the texture of gluten-containing baked goods.

In people with celiac disease, an autoimmune digestive disease, repeated exposure to gluten damages villi, fingerlike projections in the small intestine that help us absorb nutrients from food. Over time, a decrease in nutrient absorption can lead to anemia, osteoporosis, miscarriages and other complications. The University of Chicago Celiac Disease Center website lists over 300 symptoms associated with celiac disease though anemia is the most common symptom in adults. The only available treatment is a strict gluten free diet – which helps reverse intestinal damage over time. Gluten sensitivity is not an autoimmune disease but instead a vague medical condition without a uniform definition or diagnostic test at this time. People with gluten sensitivity report various symptoms triggered by the ingestion of gluten-containing foods including abdominal pain, bloating, and constipation or diarrhea. Though gluten sensitivity is real, someone who thinks they have sensitivity may actually be reacting to something other than gluten (another protein or the starches – see below under Is it the Gluten?)

Sourdough bread

The Science behind Sourdough

Standard yeast leads to a fast fermentation process. This ramps up production speed and it is also foolproof so companies can produce batches of bread at warp speed. Sourdough bread is made slowly, over time, letting the yeast work it’s magic to deliver an array of flavors as well as bread that is easier to digest. In one study, sourdough bread made with selected sourdough lactobacilli and long-time fermentation resulted in bread with gluten levels of 12 parts per million (ppm), which qualifies for gluten-free (anything below to 20 ppm is gluten free). A long fermentation process allows bacteria and yeast adequate time to feed on proteins and starches breaking them down into more digestible parts. Yet sourdough also boasts a lower glycemic index than many other types of bread (including white bread) and therefore it doesn’t lead to a quick spike in blood sugar levels.

In 2011, a small study conducted in Italy tried giving volunteers with celiac disease a small amount of specially prepared sourdough bread. The bread was fermented until the gluten was broken down to more easily digestible parts. The subjects in the study reacted well to the sourdough, with no changes in intestinal villi and no detectable antibodies typically found when a celiac disease patient eats a gluten containing food. According to the study authors, the bread “was not toxic to patients with celiac disease.”

In another study, conducted over 60 days, baked goods made from hydrolyzed wheat flour, manufactured with sourdough lactobacilli and fungal proteases, was not toxic to patients with celiac disease. Though these studies are groundbreaking, it is far too soon for celiac disease patients to try this at home. For sourdough bread to be an option for those with celiac disease, a uniform production process would need to be established to ensure the end product is gluten-free.

For those with Gluten Sensitivity, Is it Really the Gluten?

Some people may experience bloating and flatulence in response to FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). FODMAPs are a type of carbohydrates that are not well absorbed in the small intestine and are present in bread along with a number of other foods (other grains, some vegetables and fruits). In some people the problem may be FODMAPs, not gluten. The long fermentation process reduces FODMAPs.

How to Make Sourdough at Home

Sourdough starter begins with flour and water that sits for several days while being fed intermittently with both flour and water allowing bacteria (lactobacilli) and yeast to grow and multiply creating live cultures. These microorganisms are what makes the dough ferment similar to the way milk ferments to become yogurt. Check out these recipes to make your own sourdough bread: Healthy Aperture, the Perfect Loaf.

If you run into problems making sourdough check out this page for troubleshooting.

 

 

Pros and Cons of Grain Brain, Wheat Belly and the Paleo Diet

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Diet books are tempting. They tell you the reason you’re overweight, what foods are “toxic” and how to get rid of them while strolling down the yellow brick road to lasting weight loss and good health. But there’s one main issue – many of these books aren’t based on scientific evidence but instead theories that are pulled out of thin air. “But my neighbor lost 50 lbs. following Paleo!” Well your neighbor cut out potato chips, beer and fried food in the process so of course he lost weight. The Paleo diet just gave him a convincing (even if scientifically inaccurate) reason to cut these foods out.

All of these diets have some pros and cons which I expand upon in this TV segment I did for Fox 5 and below the video:

https://www.youtube.com/watch?v=KQyfQ5hf_Qc&feature=youtu.be

Gluten is a protein formed from other proteins (gliadins and glutenins; any single wheat plant may produce > 100 gliadins and > 50 glutenins) naturally found in wheat foods when wheat flour is mixed with water (the mechanical action of mixing plus the water are necessary). Other proteins that are similar to gluten are found in barley (hordiens) and rye (secalins). Gluten gives dough it’s tough elastic structure and contributes to the light and fluffy texture of baked goods. If it sounds complex, it is but here are the important points:

  • Wheat today doesn’t have more gluten (or create more gluten when mixed with water) than varieties from 70 years ago unless the manufacturer adds vital wheat gluten back to the food itself (J Plant Reg 2012;6(1)).
  • Wheat breeding is complex and focuses on creating varieties of wheat that meet what food makers and consumers are looking for – a flaky pie crust or nice soft wheat bread for instance.
  • Gluten isn’t an easy to digest protein (there are many foods we eat that are not completely broken down) but, this isn’t a problem for most people – only those with celiac disease, wheat allergy and non-celiac gluten sensitivity (which might not be due to gluten alone but instead FODMAPs).

Paleo: What You Need to Know

The Paleo diet is based on one main principle: if we eat like our hunter-gatherer ancestors who lived between 2.6 million to 10,000 years ago, before the start of the agricultural revolution, we will avoid modern diseases such as heart disease as well as infections.

This diet is based on grass-produced meats, fish/seafood, fresh fruits and vegetables, eggs, nuts and seeds and “healthful” oils. Everything else is off limits.

Paleo’s Glaring Oversights:

  • there was no one single Paleo diet – diets varied based on region and time period (check out Christina Warinner’s TED talk on this)
  • In several regions, well over 10,000 years ago and possibly even a few million years ago, people ate grains and legumes.
  • Examination of mummies tells us that all people from this time period had clogged arteries.
  • The fruits, vegetables and meats we have today look nothing like what our ancestors ate (ex: fruit were small, tough and bitter).
  • Our ancestors hunted and gathered food – in other words, their daily lives included physical activity (both strength training which builds muscle and bone and aerobic exercise).

Paleo – What’s Good:

  • The Paleo diet cuts out our top sources of calories in the US including alcohol, desserts and sugar sweetened beverages.
  • It’s loaded with protein which will keep you full for a longer period of time after eating and help you build muscle.
  • Plenty of fruits and vegetables!

Paleo – What’s Bad:

  • No legumes (peas, beans, lentils and peanuts) – legumes are rich in fiber, potassium, magnesium (some), iron (some), antioxidants and more.
  • No grains. Grains provide a good bit of the fiber in the average American diet in addition to folate, other vitamins and antioxidants.
  • No dairy – our top source of bone building calcium and vitamin D. Now, I know what some self proclaimed nutrition experts will say here – people in Africa (or insert other country here) don’t consume much calcium and they don’t have as many cases of osteoporosis as we do in the U.S. Go to Africa, conduct dietary recalls (to see what they are indeed eating) and then follow a group of women around for several days. The women I met from Africa a few years ago were big and strong thanks to farm work (in their particular country the women do all the farming). They walked (far) with buckets of water on their head daily (fantastic way to build bone density in the spine!). I don’t know any females in the U.S. who get near the bone building activity these women are getting on a daily basis. So, this is far from a valid comparison. (SN: I haven’t even bothered to research the incidence of osteoporosis here vs. Africa because I’d be comparing a largely sedentary desk-sitting population to one with different genetics that also gets bone building activity for hours each day).

Diet magic? Follow anything that makes you cut calories and you’ll lose weight. Eat more protein and you’ll tend to lose more fat than muscle.

The Great Gluten Debate

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Get two passionate Italian scientists in the room and you are in for a show. If the nitty gritty details about mucosal villous atrophy sound about as exciting as reading a manual on how to fix your vacuum cleaner, at least you’ll be entertained by the Cramer Mad Money Style voice inflections, common pop culture references and overly expressive hands gestures that put a non-verbal exclamation point on every sentence!!! The Great Gluten Debate Face-off between two world renown scientists, Stefano Guandalini, MD  from the University of Chicago Celiac Disease Center and Alessio Fasano, MD from the University of Maryland Center for Celiac Research did not disappoint.

Fasano said two things must be present for you to have celiac disease, an autoimmune digestive disease: you have the gene and you consume the trigger (gluten). Celiac disease is under diagnosed – there are many people who have it yet they have no idea that they have celiac disease. Fasano said 3 million people likely have celiac disease but less than 5% have been diagnosed. Some of the symptoms he spouted off at warp speed include:

  • anemia and fatigue – by far the most common symptoms in adults
  • delayed puberty
  • dermatitis herpetiformis
  • short stature
  • dental enamel hypoplasia

A comprehensive list of Celiac disease symptoms is available here.

Initial screening tests often include a celiac panel including a test for Immunoglobulin A, which is 90-98% sensitive and 94-97% specific for celiac disease (sensitivity means this test returns an accurate result in about 90-98% of patients screened).

Gluten is in all forms of wheat including spelt, kamut, malt, couscous, bulgar, triticale, einkorn and faro while rye and barley are related grains. Think of gluten like a long beaded necklace. According to Dr. Fasano, some of the beads (gliadin) stand out and create problems. In a person with celiac disease, the gliadin “beads” are the toxic part of gluten. Celiacs can tolerate a miniscule amount of gluten in their diet, about 10 milligrams. How much is 10 milligrams? Flip over the back of a multivitamin and take a peek at how many milligrams of each vitamin and mineral are packed into that pill or tablet and you’ll see 10 milligrams is next to nothing. Though there are about 400 new gluten free products introduced into the marketplace every year, navigating the maize of avoiding gluten can be a challenge for a number of reasons including cross contamination (French fries cooked in the same oil with anything breaded for example) and food service personnel may not understand how to keep gluten free meals completely separate from regular gluten-containing dishes. Distilled vinegar is gluten free, vinegar that isn’t distilled probably isn’t. Oats are only gluten free if they are processed, handled and packaged in a gluten free facility (otherwise, each step of the way they can be contaminated with gluten). Fasano said Triumph Dining books and apps are very helpful for people who need to navigate gluten-free grocery shopping, cooking and eating out at restaurants.

So, aside from the sheer entertainment value the biggest difference in opinion between Fasano and Guandalini was about grain intake in the normal, non-celiac disease population. Fasano said “modern wheat is a chronic poison,” and “grains are not good for us.” He also mentioned that the Paleo diet is intrinsically gluten free (all Cross Fitters are slapping high fives right about now saying “I knew it!”). Guandalini believes those without celiac disease can easily enjoy their wheat and other grains without a problem. And, he takes his own advice devouring the most delicious Italian bread and gnocchi Chicago has to offer.