Thursday , January 21 2021

"Epidemic" intolerance to gluten in France?

Gluten-free fashion, but confusion reigns between "true" intolerable, allergic and "hypersensitive", with hesitant contours. Suddenly, there is an extensive “plant to slab” research program in France to try to see it more clearly. "There are three different pathologies"says Bridget Jolive, president of Afdiag, an association that has been campaigning since 1989 to make life easier for gluten intolerance. “Real” intolerance, for which it is vital to eliminate gluten, are victims of celiac disease. This condition destroys the lining of the small intestine and causes anemia, diarrhea, weight loss, bone pain and even growth retardation in children. There is no cure other than a gluten-free diet for life. 1% of the population will be affected (670,000 people in France), of which only 10-20% are correctly diagnosed. The second group refers to patients with allergies, which are much less numerous (from 0.1 to 0.5% of the population). The third group, “hypersensitive”, may refer to 0.5–15% of the population, which, at least, "Wave", notes Ms. Jolive. Bloating, fatigue, digestive disorders are put at the expense of gluten "Without scientific evidence"according to Ms. Jolive.

"We are not sure that gluten is responsible"

Since celiac disease responds to a clear diagnosis, based on a blood test (dosage of IgA antibodies) reimbursed by social security, and confirmed by endoscopy of the duodenum (small intestine), since “hypersensitivity” is difficult to succumb. "We are not sure that gluten is responsible"Corinna Butteloup, a gastroenterologist from the University Hospital of Clermont-Ferrand, who will conduct a clinical study as part of the GlutN research project. To see more clearly, this extensive research program was launched with the National Institute for Agricultural Research, Inserm and the University Hospital of Clermont-Ferrand in particular. "We will study things from the factory to the plate"explains Catherine Ravel, who coordinates the project.

INRA is studying the digestibility of bread and pasta from a collection of 16 lines of wheat and 8 lines of durum wheat. “The idea is to offer hypersensitive people a product that they will tolerate.”– she said. At CHU Clermont-Ferrand, Corinne Bouteloup will introduce sixty patients (excluding intolerance and allergies) to a double-blind diet with or without gluten, controlling their response. “The goal is to find biomarkers, because at the moment doctors are rather worried about the diagnosis, the lack of tools”,says Catherine Grand Ravel. Tests for blood, urine and stools should allow the establishment of the famous "markers" for diagnosing the sensitivity of gluten.

"People who exclude gluten, also exclude other things that can lead to shortcomings"

A clinical study funded by the National Research Agency will be launched in early 2019, with first results at the end of the year. According to Corinna Butelup,In general, we do not eat more gluten today because we eat much less bread, but the quality of gluten has changedThe so-called “native” gluten is naturally present in some cereals, including wheat, but the industry also uses a lot of “vital gluten” for its texturing ability (volume and elasticity). "Our grandparents ate real bread, not industrial bread, pizza, cooked meals, cold cuts … Many foods, to which gluten was added“- says Corinne Boutheloup. "Vital gluten is highly concentrated, therefore, possibly more resistant to digestion", “If we can show that this is really a quality problem for gluten and its addition, we could change the methods,”– she said.

In parallel with these two programs, an epidemiological survey is trying to better understand the "gluten-free" study from Nutrinet, which asks users about the relationship between nutrition and health. “20,000 responses to the gluten questionnaire were saved”says Emmanuel Kesse-Guyot, director of research. “We exclude people suffering from celiac disease, what interests us, whether people who exclude the gluten of their choice, have special characteristics. What do they eat? Why did they decide to eliminate gluten? "For the comfort of the abdomen, physical well-being or faith (is it bad for my health, for the environment)?"

"We know that people who exclude gluten also exclude other things that can lead to shortcomings"she is watching. “We are struggling with a nutritionist I work with to bring patients back to a diet as restrictive as possible. We see that people come to the consultation, who do not know what to eat because of restrictions. ”, reports Corinna Buttelou. “To see a lot, I think most people who say they are better when they remove gluten are actually better because they remove fructans, which are also found in cereals containing gluten. "

Another “suspect” that appears: “Fodmapas”

Fructans are part of the “Fodmaps”, another “suspect” that manifests itself strongly. This abbreviation means certain carbohydrates. "Fodmaps, naturally, are found in many products, they are fructans in cereals, in many fruits and vegetables they are fructose, polyols, sugars that are not digested and are fermented into the colon" explains Corinne Boutheloup. Based on a decade of experience, she suspects that "Those who remove a lot of things are often not sensitive to gluten, but intolerant to Fodmaps." "This is my clinical feeling"she says “But I didn’t have money to start research on this issue, it takes time, small hands, money …”

According to the Xerfi study, sales of “gluten-free” products in 2017 increased by 12% in a large “food” food mix, which exceeded 6 billion euros in supermarkets in 2017.

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