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The rise and fall of gluten!

  • Imran Aziz (a1), Federica Branchi (a1) (a2) and David S. Sanders (a1)
Abstract

Mankind has existed for 2·5 million years but only in the last 10 000 years have we been exposed to wheat. Wheat was first cultivated in the Fertile Crescent (South Western Asia) with a farming expansion that lasted from about 9000BC to 4000BC. Thus it could be considered that wheat (and gluten) is a novel introduction to man's diet! Prior to 1939 the rationing system had already been devised. This led to an imperative to try to increase agricultural production. Thus it was agreed in 1941 that there was a need to establish a Nutrition Society. The very roots of the society were geared towards necessarily increasing the production of wheat. This goal was achieved and by the end of the 20th century, global wheat output had expanded 5-fold. Perhaps as a result the epidemiology of coeliac disease (CD) or gluten sensitive enteropathy has changed. CD is a state of heightened immunological responsiveness to ingested gluten in genetically susceptible individuals. CD now affects 1 % or more of all adults, for which the treatment is a strict lifelong gluten-free diet. However, there is a growing body of evidence to show that a far greater proportion of individuals without coeliac disease are taking a gluten-free diet of their own volition. This clinical entity has been termed non-coeliac gluten sensitivity (NCGS), although the condition is fraught with complexities due to overlap with other gluten-based constituents that can also trigger similar clinical symptoms. This review will explore the relationship between gluten, the rising prevalence of modern coeliac disease, and the new entity of NCGS along with its associated uncertainties.

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Corresponding author
* Corresponding author: Dr I. Aziz, fax +44 114 2712692, email imran.aziz@sth.nhs.uk
Footnotes
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These two authors contributed jointly to the paper.

J Waterlow Lecture presented by Professor David S Sanders at the Nutrition Society Summer Meeting 2014.

Footnotes
References
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1. Shewry, PR, Napier, JA & Tatham, AS (1995) Seed storage proteins: structures and biosynthesis. Plant Cell 7, 945956.
2. Beccari, B (1745). De frumento. In: De Bononiensi Scientiarum et Artium Instituto atque Academia Commentarii: Bononiae : ex typographia Laelii a Vulpe; 1745.
3. Field, JM, Shewry, PR & Miflin, BJ (1983) Solubilisation and characterisation of wheat gluten proteins: correlations between the amount of aggregated proteins and baking quality. J Sci Food Agric 34, 370377.
4. Shewry, PR, Halford, NG, Belton, PS et al. (2002) The structure and properties of gluten: an elastic protein from wheat grain. Philos Trans R Soc Lond B Biol Sci 357, 133142.
5. Harlan, JR & Zohary, D (1966) Distribution of wild wheats and barley. Science 153, 10741080.
6. Copping, AM (1978) The history of the nutrition society. Proc Nutr Soc 37, 105139.
7. van den Broeck, HC, de Jong, HC, Salentijn, EM et al. (2010) Presence of celiac disease epitopes in modern and old hexaploid wheat varieties: wheat breeding may have contributed to increased prevalence of celiac disease. Theor Appl Genet 121, 15271539.
8. Dubcovsky, J & Dvorak, J (2007) Genome plasticity a key factor in the success of polyploid wheat under domestication. Science 316, 18621866.
9. Kasarda, DD (2013) Can an increase in celiac disease be attributed to an increase in the gluten content of wheat as a consequence of wheat breeding? J Agric Food Chem 61, 11551159.
10. Catassi, C (2005) Where is celiac disease coming from and why? J Pediatr Gastroenterol Nutr 40, 279282.
11. Sapone, A, Bai, JC, Ciacci, C et al. (2012) Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med 10, 13.
12. Mooney, PD, Hadjivassiliou, M & Sanders, DS (2014) Coeliac disease. Br Med J 348, 1561.
13. van Berge-Henegouwen, GP & Mulder, CJ (1993) Pioneer in the gluten free diet: Willem-Karel Dicke 1905–1962, over 50 years of gluten free diet. Gut 34, 14731475.
14. Marsh, MN (1992) Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology 102, 330354.
15. Sollid, LM, Markussen, G, Ek, J et al. (1989) Evidence for a primary association of celiac disease to a particular HLA-DQ alpha/beta heterodimer. J Exp Med 169, 345350.
16. Davidson, LS & Fountain, JR (1950) Incidence of the sprue syndrome; with some observations on the natural history. Br Med J 1, 11571161.
17. Fasano, A, Berti, I, Gerarduzzi, T et al. (2003) Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 163, 286292.
18. Volta, U, Bellentani, S, Bianchi, FB et al. (2001) High prevalence of celiac disease in Italian general population. Dig Dis Sci 46, 15001505.
19. Sanders, DS, Carter, MJ, Hurlstone, DP et al. (2001) Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling ROME II criteria referred to secondary care. Lancet 358, 15041508.
20. Corazza, GR, Valentini, RA, Andreani, ML et al. (1995) Subclinical coeliac disease is a frequent cause of iron-deficiency anaemia. Scand J Gastroenterol 30, 153156.
21. Kemppainen, T, Kröger, H, Janatuinen, E et al. (1999) Osteoporosis in adult patients with celiac disease. Bone 24, 249255.
22. Hadjivassiliou, M, Gibson, A, Davies-Jones, GA et al. (1996) Does cryptic gluten sensitivity play a part in neurological illness? Lancet 347, 369371.
23. Richey, R, Howdle, P, Shaw, E et al. (2009) Recognition and assessment of coeliac disease in children and adults: summary of NICE guidance. Br Med J 338, 1684.
24. Ford, AC, Chey, WD, Talley, NJ et al. (2009) Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med 169, 651658.
25. Rubio-Tapia, A, Hill, ID, Kelly, CP et al. (2013) ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 108, 656676.
26. Lee, SK, Lo, W, Memeo, L et al. (2003) Duodenal histology in patients with celiac disease after treatment with a gluten-free diet. Gastrointest Endosc 57, 187191.
27. Lanzini, A, Lanzarotto, F, Villanacci, V et al. (2009) Complete recovery of intestinal mucosa occurs very rarely in adult coeliac patients despite adherence to gluten-free diet. Aliment Pharmacol Ther 29, 12991308.
28. Karajeh, MA, Hurlstone, DP, Patel, TM et al. (2005) Chefs' knowledge of coeliac disease (compared to the public): a questionnaire survey from the United Kingdom. Clin Nutr 24, 206210.
29. Sverker, A, Hensing, G & Hallert, C (2005) ‘Controlled by food'- lived experiences of coeliac disease. J Hum Nutr Diet 18, 171180.
30. Aziz, I, Karajeh, MA, Zilkha, J et al. (2014) Change in awareness of gluten-related disorders among chefs and the general public in the UK: a 10-year follow-up study. Eur J Gastroenterol Hepatol. 26, 12281233.
31. Aziz, I, Lewis, NR, Hadjivassiliou, M et al. (2014) A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. Eur J Gastroenterol Hepatol 26, 3339.
32. Tanpowpong, P, Ingham, TR, Lampshire, PK et al. (2012) Coeliac disease and gluten avoidance in New Zealand children. Arch Dis Child 97, 1216.
33. Cooper, BT, Holmes, GK, Ferguson, R et al. (1976) Proceedings: chronic diarrhoea and gluten sensitivity. Gut 17, 398.
34. Ellis, A & Linaker, BD (1978) Non-coeliac gluten sensitivity? Lancet 1, 13581359.
35. Catassi, C, Bai, JC, Bonaz, B et al. (2013) Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders. Nutrients 5, 38393853.
36. Biesiekierski, JR, Newnham, ED, Irving, PM et al. (2011) Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol 106, 508514.
37. Ludvigsson, JF, Bai, JC, Biagi, F et al. (2014) Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut 63, 12101228.
38. Carroccio, A, Mansueto, P, Iacono, G et al. (2012) Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol 107, 18981906.
39. Volta, U, Tovoli, F, Cicola, R et al. (2012) Serological tests in gluten sensitivity (nonceliac gluten intolerance). J Clin Gastroenterol 46, 680685.
40. Volta, U, Bardella, MT, Calabrò, A et al. (2014) An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC Med 12, 85.
41. Sapone, A, Lammers, KM, Mazzarella, G et al. (2010) Differential mucosal IL-17 expression in two gliadin-induced disorders: gluten sensitivity and the autoimmune enteropathy celiac disease. Int Arch Allergy Immunol 152, 7580.
42. Sapone, A, Lammers, KM, Casolaro, V et al. (2011) Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med 9, 23.
43. Brottveit, M, Beitnes, AC, Tollefsen, S et al. (2013) Mucosal cytokine response after short-term gluten challenge in celiac disease and non-celiac gluten sensitivity. Am J Gastroenterol 108, 842850.
44. Verdu, EF, Armstrong, D & Murray, JA (2009) Between celiac disease and irritable bowel syndrome: the “no man's land” of gluten sensitivity. Am J Gastroenterol 104, 15871594.
45. Vazquez-Roque, MI, Camilleri, M, Smyrk, T et al. (2013) A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology 144, 903911.
46. Kabbani, TA, Vanga, RR, Leffler, DA et al. (2014) Celiac disease or non-celiac gluten sensitivity? An approach to clinical differential diagnosis. Am J Gastroenterol 109, 741746.
47. Leffler, D, Schuppan, D, Pallav, K et al. (2013) Kinetics of the histological, serological and symptomatic responses to gluten challenge in adults with coeliac disease. Gut 62, 9961004.
48. Shepherd, SJ, Parker, FC, Muir, JG et al. (2008) Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 6, 765771.
49. Gibson, PR & Shepherd, SJ (2010) Evidence-based dietary management of functional gastrointestinal symptoms: the FODMAP approach. J Gastroenterol Hepatol 25, 252258.
50. Gibson, PR & Shepherd, SJ (2012) Food choice as a key management strategy for functional gastrointestinal symptoms. Am J Gastroenterol 107, 657666.
51. Murray, K, Wilkinson-Smith, V, Hoad, C et al. (2014) Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. Am J Gastroenterol 109, 110119.
52. Biesiekierski, JR, Peters, SL, Newnham, ED et al. (2013) No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 145, 320328.
53. Junker, Y, Zeissig, S, Kim, SJ et al. (2012) Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. J Exp Med 209, 23952408.
54. Haas, H, Falcone, FH, Schramm, G et al. (1999) Dietary lectins can induce in vitro release of IL-4 and IL-13 from human basophils. Eur J Immunol 29, 918927.
55. Dalla Pellegrina, C, Perbellini, O, Scupoli, MT et al. (2009) Effects of wheat germ agglutinin on human gastrointestinal epithelium: insights from an experimental model of immune/epithelial cell interaction. Toxicol Appl Pharmacol 237, 146153.
56. Carroccio, A, Rini, G & Mansueto, P (2014) Non-celiac wheat sensitivity is a more appropriate label than non-celiac gluten sensitivity. Gastroenterology 146, 320321.
57. Sanders, DS & Aziz, I (2012) Non-celiac wheat sensitivity: separating the wheat from the chat! Am J Gastroenterol 107, 19081912.
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