Chapter 1
You are likely reading this book because you or your patients, friends or loved ones have mental health or neurological symptoms. You are not alone but may be like millions of others worldwide who have such concerns. Perhaps you are exploring the relationship between your/their symptoms and wheat and gluten? While sensitivity to gluten is not always related to neurological and mental health issues, in some people it may be an important contributing factor. We hope to shed light on these associations and on when it may be a good idea to consider further testing. We will start by explaining what gluten is, why it is related to brain health and what the evidence shows. Many people are looking for a cure. A gluten-free diet may not be the whole answer for you but we are writing this book to help you or your patients understand whether or not it may make a difference. The relationship between gluten and brain health remains under-recognized. After reading the chapters relevant to your situation, we hope you will be better equipped to consider this relationship, and whom it may affect, including yourself, your family or your patients.
In this book, we will discuss both celiac disease (CD) and non-celiac gluten sensitivity (NCGS), and the scientific evidence linking these conditions to brain-related disorders, including both neurological and psychiatric symptoms and diagnoses. Note that ‘celiac’ is often spelled coeliacin many areas of the world outside of the United States (US).
Both CD and NCGS are related to gluten consumption but there are severaldifferences between the two. This chapter will provide you with an overview of both, and the next chapters will go into greater depth to give you more understanding of these conditions. However, before you learn more about CD and NCGS, it is helpful to start with an introduction to what gluten is and how it ends up in our food.
Gluten is a Latin word meaning ‘glue’ and this refers to the stickiness in wheat-based dough used to make bread and pasta.1 Gluten is a mix of several proteins found in certain grains, such as wheat, barley and rye. There are many varieties and crossbreeds of wheat, known by different names, that also contain gluten. These include triticale (a cross between wheat and rye), durum, spelt (see below), farro and semolina, amongst others, and they developed partly due to wheat’s ability to self-pollinate.
Oats are naturally gluten free, but cross-contamination with gluten-containing grains during processing can occur and trigger a gluten reaction in those with CD and NCGS.2
Grains were first cultivated in Asia around 10,000 years ago. The use of an early form of wheat called spelt is documented in history books as far back as 5000 BCE.2 Gluten was first discovered in 1728 by Jacopo Bartolomeo Beccari, a physician and chemist in Bologna, Italy.3 However, wheat cultivation and milling by grinding or crushing in mass quantities did not occur until the 1800s. As this occurred, gluten consumption began to rise and has steadily increased worldwide ever since.4 While awareness of gluten has become more common over the last two decades, it has actually existed for thousands of years.
In the US, several time periods marked surges in wheat consumption. During World War II, when dairy products and meat were rationed, less expensive food options, such as pasta and bread, we