Gluten and coeliac disease

Gluten is a sticky protein substance that remains when starch is washed out of flour made from wheat and is responsible for the elasticity of bread doughs. It provides the right consistency for gas bubbles to be trapped in the dough and gives the bread a light, airy texture.

The gluten content of wheat is therefore of great importance because the quality and `bakeability` of the dough is dependent upon it. Flour made from North American wheat, which has been subject to hot sun during the growing season, is high in protein; home-grown wheat contains less protein and the flour will probably require dried gluten from other wheat sources to be added to produce good bread making flour.

Approximately one person in 1000 - 1500 in the UK is intolerant to gluten and may develop a condition known as coeliac disease. At least 1 in 100 people are estimated to suffer from coeliac disease in the UK and also 1 in 100 in Europe; however, according to a recent study only 1 in 8 cases are diagnosed.

The condition is caused by the presence of gluten in the diet in those who have a hereditary tendency to develop the disease. Coeliac disease is not always easy to recognise but can be diagnosed readily by a doctor identifying a range of symptoms

Coeliac disease is a life-long autoimmune disease, which is triggered by eating gluten, a type of protein found in wheat, rye and barley. Some people also react to oats. For people with coeliac disease, eating gluten damages the lining of the gut, which prevents normal digestion and absorption of food.

It impairs the capacity of the small intestine to absorb nutrients from food and can result in diarrhoea and malnutrition. The damage to the small intestine and associated malnutrition improve on elimination of gluten from the diet. There are serious health problems associated with coeliac disease including osteoporosis, bowel cancer and increased risk of other autoimmune diseases.

People suffering from coeliac disease can obtain many basic gluten-free foods on NHS prescription in the UK. Gluten-free flours made from maize, potatoes, rice and soya are currently available, as well as flour made from specially prepared gluten-free wheat starch. Bread made from gluten free flours may not taste as good as bread made in the traditional way. However, research is continuing to find the best possible way of making bread from grains which do not contain gluten.

If a person suspects they might have coeliac disease, the first step is for them to discuss their symptoms with their GP who can take a simple blood test to check for antibodies. Antibodies are produced by the body in response to eating gluten. It is therefore essential to continue to eat a normal gluten containing diet prior to getting tested.  The next step is for the GP to refer to a hospital specialist (gastroenterologist) for a gut biopsy. This is a simple procedure performed in out-patients which looks for the damage in the gut that is typical in coeliac disease.