I’ve been having some weird health issues somehow triggered after eating. I’ve been working with a nutritionist. They recommend, among other things, trying to eliminate gluten some of the time on the idea that gluten puts stress on the digestive system and can expose other issues that the body would normally handle. This is something like a load-bearing model: the body bears the load of bad stuff coming in without issue up until it is overloaded and then you start to get weird symptoms as various systems strain to keep up with the load of bad stuff. The proposal is that gluten is one such bad stuff.
It’s hard to find anything useful on Google that might give me a good model of how gluten sensitivity would work or why gluten might matter in such a load-bearing model (or, stepping back, that such a load-bearing model is even reasonable).
On LW I only found this old post, which is useful but not enough detail.
So, does anyone have a gears-level model of gluten sensitivity? Links or explanations would be helpful as I try to evaluate what interventions might and might not be worth trying.
From my daughters journey with IBS, I’d be looking at whether it is “gluten” or other components of flour. One thing to try is whether your body tolerates sour dough bread (eliminate other sources of flour). And that is a real sour dough—fermented at least 12 hours with no post-ferment flour added. There are “cheats” way to make “sour dough”, giving it sour dough flavour without the long ferment. Why? Well Monash uni in Oz has published a lot of research around FODMAP components in diet. The ferment process alters a lot of carbohydrate components (but not gluten) making them more digestible. Might help. If it does, then consider whether issues might improved by altering gut biota.
If you look this up, you will quickly run into their low FODMAP diet. I would be extremely wary of using long term, especially if you have any family history of autoimmune disease (eg and especially rheumatoid or psoriatic arthritis).
Is it true that sourdough fermentation alters other things but not gluten? My understanding is that the acidity of sourdough degrades gluten. I know of one person who was actually a (semi-?)professional baker before developing—at least by her account of things—a gluten intolerance, who found that she could eat some sourdough things whose non-sourdough things made her feel bad. But of course I have no way of knowing whether it was really the gluten that was giving her problems.
(Who adds flour to the dough after a sourdough fermentation? Other than maybe a dusting to prevent sticking while shaping or proofing, which will add little enough that I’d have thought someone who isn’t outright coeliac should be OK with it.)
The normal sourdough recipe is to take some of the starter, mix it with more flour and water, and let it rise/ferment for only 1-2 hours before baking.
That looks like no sourdough recipe I’ve ever seen. The usual process goes like this:
If your starter isn’t being fed very frequently, take some and give it a couple of feeds at reasonably short intervals.
Now take some starter, combine with flour and water, and leave it until it’s active and bubbly—might be 4-12 hours depending on the starter:flour ratio, starter activity, ambient temperature, etc.
Combine with flour, water and salt.
Bulk ferment: Over the next 4-12 hours, depending on the starter:flour ratio, starter activity, ambient temperature, etc., strengthen the dough by some combination of kneading and gentler folding. (A typical prescription might be: (wait 30 minutes, do some folds) 6 times, then leave it alone until it’s increased sufficiently in size, which might be another ~2 hours.
Shape and transfer to a proving basket.
Prove: Leave it for maybe 1-3 hours (or substantially longer in the fridge) until it’s increased in size again, passes the “poke test”, etc.
Bake.
There are various wrinkles (e.g., you might combine just flour and water some way in advance, before combining with starter and salt; this allows a process called autolysis) but that’s the general technique. Maybe if you do it in warm enough conditions and with a very active starter you might get it down to 4 hours bulk fermentation + 1 hour proving. You absolutely cannot do it in 1-2 hours.
(You can do a distinctly not-normal thing that’s much quicker. If you keep the bits of sourdough starter discarded at feeding in a bowl or jar in the fridge, then once you have ~1kg of that you can add a bit of flour, mix it up a bit, leave it a couple of hours, and bake it in a loaf tin. You can make a rather nice loaf this way, especially if you like your sourdough breads dense and sour. But it’s not by any stretch of the imagination “the normal sourdough recipe”.)
Just in case I’d somehow been living in a weird sourdough bubble, I put “sourdough recipe” into Google and looked at the first 8 hits. First: a no-knead no-fold recipe. 8-14 hours bulk fermentation + 1 hour refrigerated proving. Second: 3 hours bulk fermentation + 4-8 hours proving. Third: 3-12 hours bulk fermentation + 1/2-1 hour proving. Fourth: 3.5-7.5 hours bulk fermentation + 3-4 hours proving. Fifth: 2.5-3 hours bulk fermentation + 2.5 hours proving. Sixth: 4.5 hours bulk fermentation + overnight proving. Seventh: 4.5 hours bulk fermentation + overnight proving. Eighth: 10-12 hours bulk fermentation + 1.5-48 hours proving.
ok, ferment does degrade gluten but very slowly. Once the levels of lactic acid build up sufficiently, then the acid hits the gluten, but that is rather longer than 12hour. If the gluten is destroyed, then so is your dough structure—it loses the ability to trap air and steam. People struggling with ordinary bread but able to eat sourdough I think is rather common. Based on Monash publications, I would say the highly fermentable fructans in wheat are converted to easier to digest forms (mannitols??). Pretty testable for an individual. If you struggle with high fructan foods (wheat, onions, garlic) but happy with high mannitol foods, (sweet potatoes, mushrooms, melon), then I would predict you will be ok with sourdough (assuming my memory of what fructans convert to during ferment is correct). Sourdoughs with lots of low fructan flours such as oat and spelt should be even better.
As to adding flour later, then I was told by a baker that what is sold as white-flour sourdough breads can be made commercially by taking starter, maybe added to flour/water and partly fermented, but then add bakers yeast and rest of flour and process from there “normally”. The process is much faster, more mechanised and, importantly, predictable—ie cheaper. The ferment still gives a sourdough “tang” to the product to keep customer happy.
My son went to a bakery in a holiday town to get sourdough loaf for his IBS sister and quizzed baker on their process to ensure he was getting real thing. She offered him a job immediately (not that he wanted one).
You can lose some gluten and still have enough to maintain the structure of your dough. I think the person I mentioned thinks that’s what’s going on. (But it sure seems plausible to me that the actually relevant difference between sourdough bread and other bread is something else. If gluten degradation were the mechanism then you’d think you could do equally well by using weaker flour, not kneading as much, etc.)
I’ve made breads that are actually leavened with ordinary baker’s yeast but also contain some sourdough starter (in fact I have two loaves made that way sitting cooling on a rack right now), but it would never occur to me to call them sourdough breads. They’re ordinary yeasted breads with a bit of sourdough starter in to give flavour and longevity. But I guess if you’re selling bread, and your customers like the idea of sourdough bread, and you aren’t too scrupulous… :-)
If you google “what can legally be called a sourdough bread”, then I think you might see that this can be a problem.
But anyway, I think we can safely say that sourdough is probably a good way to test whether the issues are really gluten sensitivity, (because it certainly has some), or with other components of wheat.
Also, see https://en.wikipedia.org/wiki/Chorleywood_bread_process. This is surely producing a bread with a rather different chemistry to more traditional processes.
If you haven’t looked at Wikipedia yet, their entry covers the etiological basics. https://en.wikipedia.org/wiki/Gluten-related_disorders
I also saw this article that might give you some more in-depth understandings of its underlying etiology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182669/
Hope those help…❄️
This is also somewhat helpful, but it leaves me with just some vague model of gluten causes the intestine to take up more stuff it normally wouldn’t and that extra stuff crossing the blood barrier somehow causes problems. Maybe there’s not more precision available in a model I can easily understand without learning a bunch of biochemistry, but I really wish I had something that would allow me to make more precise predictions about things like:
How much gluten can I eat without risk of issue? Is it none? is it 10% of what I would normally eat?
How long do we expect the effects of gluten last on the body?
What things would make the situation better/worse if eaten with gluten?
This is probably one of those dumb, obvious questions but I’ll ask anyway. Have you consulted with a Gastroenterologist yet? If not, you might want to consider consulting w/one to help interpreting the biochemistry stuff for a more precise “scientific/medical” simulacrum of the underlying pathophysiology from from the clinical standpoint. Otherwise I think you’re best bet is probably working with your Dietitian and the various Gluten Intolerance groups online for more practical advice on dealing with it in the day-to-day world. Unfortunately, from my own clinical experience, there’s a lot of the “art of medicine” involved in phenomenologically interpreting/applying medical research findings clinically.
Yep, and several other specialist. We ruled out everything else, which left me with a vague diagnosis of nonspecific, as-yet idiopathic food sensitivity.
Ugh! I’m just realizing you haven’t even been told if Gluten-intolerance is the underlying etiology which is understandable frustrating...apologies. I looked closer at some other NCBI articles and we really don’t have a good understanding of gluten intolerance other than it appears related to some underlying autoimmune disorder. That leaves you 1) experimenting with eliminating gluten, which it sounds like you‘re already working on, to see if there’s any correlation with gluten intake at all; and 2) getting tested for the various biomarkers folks have suggested below.
There is a recent discussion article I read in the NEJM on “An Allergic Basis for Abdominal Pain” discussing some recent research on Allergies and IBS you may or may not find useful. https://www.nejm.org/doi/full/10.1056/NEJMcibr2104146?rss=searchAndBrowse Let me know you want to read it but can’t access it and I’ll be happy to email you a copy of my pdf.
Another thought is if your specialists have mentioned small intestine bacterial overgrowth (SIBO)? I’ve had vague IBS issues that had worsened over the past year that we’d been working on without any resolution. A physician friend suggested I try a nutritional supplement called Atrantil which my GI doc said was worth trying since nothing else was working. Short story is it helped which led to trying a course of xifaxin/neomycin for SIBO that I’ve had good results with. Problematic is that diagnosing SIBO isn’t really good and is trial/error of trying various antibiotics.
Please excuse typos & autocorrect strangeness
Thanks for your reply!
No one mentioned the idea of SIBO, and doesn’t sound like it would really match my symptoms, but something I’ll keep in mind.
For the types of gluten problems (or wheat allergy, which often looks like a gluten problem) actually supported by science (and not just ?maybe it’s bad?) You need to go to 0 initially to let your system recover. After that, mild allergy or celiac could allow for the occasional wheat maltodextrin ingredient or “cooked in the same kitchen as active flour usage” or “ok, just one bite of that” or “I’ll just scrape the filling out of the pie.” Severe allergy or celiac requires continued zero tolerance. At no point would eating a gluten roll or sandwich be reasonable.
Regardless, the standard diagnostic method for “I seem to have GI problems” is to remove all the things from your diet that have caused other people problems (wheat, milk, etc.) And then reintroduce them one at a time and observe your reactions. Your gut bacteria are unique to you, and you might have or lack something that makes gluten or some other protein contraindicated.