The Flour Advisory Bureau must have been over the moon about the coverage they got for their most recent re-hashing of the ‘number of allergic consumers hugely exaggerated’ story. ‘Millions putting health at risk by wrongly diagnosing themselves with food allergies ’ – ‘Nine in ten food allergy cases are all in the mind’ shouted the Mail; ‘Millions wrongly think they have food allergy’ intoned the Telegraph. Even the medical journals picked up on it – ‘Britons may be avoiding wheat unnecessarily’ wrote Medical News Today. But this is both old news (the various versions of Dr Venter’s studies and figures have been quoted many times before) and totally fails to address the real issue.

Thanks to medical semantics, the newspapers need for a good story and the Flour Advisory Bureau’s need to reassure consumers that their members’ product is the healthiest thing they can buy, 'allergy' has once again been hijacked and the consumer thoroughly confused.

The meaning of allergy

Allergy, as defined by Dr Venter and her colleagues is a very specific medical condition in which a protein (in this case one or several of those found in wheat) sets off an immunological reaction in the ‘allergic person’: IgE antibodies bind to mast cells thereby initiating a release of histamine. Although, because the NHS allergy services are so poor, accurate figures for the number of people who are truly allergic to food are hard to come by, it is unlikely to be more than 5% of the population at the most. Since wheat allergy is relatively rare compared to, say, milk or peanut allergy, this would mean that there were a very small number indeed of people who are genuinely ‘allergic’ to wheat.

However, to the world at large, food allergy means something much closer to the original definition of allergy –‘ an inappropriate response to a substance – ingested (such as a food), inhaled (such as pollen) or touched (such as latex) – which does not cause a reaction in the rest of the population’. In other words, if you think that eating a specific food makes you unwell, you think you may be ‘allergic’ to it even though the food may not cause you to have an ‘allergic’ reaction in the medical sense of the word.

So the ‘millions putting their health at risk by wrongly diagnosing themselves with food allergies’ are not diagnosing themselves with the food allergies that Dr Venter is talking about – they are merely making the assumption, rightly or wrongly, that it may be the wheat they are eating that is making them feel unwell.

Nutritional deprivation and missed diagnoses

Dietitians and other health professionals get very exercised about ‘quack’ doctors and celebrity fad dieters who persuade a gullible public to cut huge swathes of foods (including wheat based products) out of their diet thus depriving them of important nutrients and, in the long run, making them genuinely ill. And of course this does happen, but the number of people to whom it happens is extremely small – although those to whom it does happen are likely to end up in hospital and to be the ones that the dietitians see.

And to be fair to dietitians, their concern is very reasonable. Severe exclusion diets are very socially and personally disruptive and can be nutritionally inadequate – but because they are extremely hard to follow, very few people do…

Health professionals are also, quite rightly, concerned that by attributing their ill health to a 'wheat allergy' and just excluding wheat from their diet without taking any further medical advice, some other more serious medical condition could get overlooked. Their main concern here would be over coeliac disease as not eating wheat (by far largest source of gluten in the average diet) would undoubtedly make undiagnosed coeliacs feel better so they might not investigate the problem any further. Since there are a number of other health conditions which can be associated with coeliac disease this is certainly not desirable.

So what is it about wheat?

So why are such a large number of people hitting on wheat as the cause of their ill health? It has, after all, been a staple of the western diet since before the Romans.

Despite its centrality in our diet, there are those who maintain that our digestions  have not really yet evolved sufficiently from our original hunter/gatherer state (eating meat, fish and fruits) to be able to satisfactorily digest grains. Others maintain  that the lectin constituent of wheat (and especially wholewheat) can seriously interfere with our ability to digest and absorb nutrients. (See, for example, The awful truth about eating grains by Dr Del Thiessen.)

But while this remains a controversial area, what is not remotely controversial is that, over the last 50–60 years, the wheat that we eat, and the processing that it undergoes have changed dramatically.

At the end of WWII most people in the West still lived on some variation of a ‘meat and two veg’ diet, most of which was cooked from scratch at home. Bread may not have been the greatest in craft bakery terms but it was baked from wheat containing a moderate amount of gluten and was proved overnight to allow the yeasts to develop.

But over the last 50 years a number of things have happened:

• The development of chemical fertilisers and pesticides made way for mono-culture, intensive farming gradually leaching the nutrients from the soil and failing to replenish them through the normal cycles of rotation cropping and thereby producing less nutritious ingredients.

•  The food industry discovered the virtues of gluten as a manufacturing aid (it glues ever small amounts of ingredients into lighter and ‘more acceptable’ foodstuffs) and encouraged the breeding of higher gluten wheats.

• Industrial and social change meant more women going out to work and a greater need for convenience, ready made, ready-processed food. The food industry were delighted to oblige.

• The invention of the Chorley Wood Bread Process in the early 1960s allowed industrial bakers to use higher levels of yeasts combined with higher gluten flour and a selection of enzymes to reduce the proving time for bread from overnight to a couple of hours and produce ever lighter and brighter breads. See Andrew Whitley’s article for the detrimental effect this had on the quality of bread and, arguably, our health.

• The enthusiasm for the Mediterranean pasta/pizza-based diet in the 1990s onwards encouraged us to eat even more processed wheat-based products than we had before. As a result, many people are now eating highly-processed, high-gluten wheat in highly-processed foods for breakfast (wheat-based cereal and toast), morning coffee (wheat-based sweet biscuit), lunch (wheat-based sandwich or pizza/pasta), tea (wheat-based sweet cake/biscuits) and supper (wheat-based pizza or pasta – whichever they had not had for lunch…).

Given that it is generally accepted that humans are omnivores and need a varied diet, this is scarcely varied. Moreover, it contains very high quantities of gluten which is, by definition, a glue. Is it surprising that digestions across the country are rebelling?

So, should we rephrase what the ‘millions’ think?

Maybe the millions do not really think that they have an allergy, they just think that their diet is making them feel unwell – and they are probably right.

Research done by FAIR (the Foundation for Allergy Information and Research) to assess the viability of running basic food allergy/intolerance clinics in GP surgeries invited people within the practice who thought they might have a food intolerance problem to come in for a consultation with a food intolerance nurse. The patients who attended the clinics filled in a questionnaire about their diet, their lifestyle and their symptoms. All were then put on a ‘healthy eating’ diet (which limited their consumption of highly-processed, wheat-based foods and increased their consumption of fresh fruit and veg) for a two week period. By their next appointment, roughly 50% of those who had been suffering from what they had believed to be ‘allergy’ symptoms, felt significantly better. (The remaining 50% then went on to two weeks of excluding wheat and dairy from their diet entirely and thence to further investigations if needed.)

So, if we were to rephrase the headlines to ‘Millions believe that the over-processed, high-gluten wheat that they are eating as a major part of every meal, every day of the week, is making them feel ill’ then that might not be far off the mark. However, that would not do a lot for the sales of white sliced – now so denatured that it has to be fortified, as the Flour Advisory Bureau proudly claim, with vitamins and minerals ‘to give your family a great taste and a healthy choice’.

First published in February 2010

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