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Living with Gluten Intolerance: Alex Gazzola reviews Jane Feinmann's new book

Most people can eat gluten, no problem. Around 1% of the population has coeliac disease – though only around one eighth of those are diagnosed – and for them gluten exclusion is paramount. In between these two camps sit a group of individuals who may experience varying degrees of adverse physical effects in response to gluten consumption, but for whom sensible health information and advice remains thin on the ground. While by no means excluding coeliacs, this lucid and supportive book is written largely with them in mind.

Non-coeliac gluten intolerance is controversial, but author Jane Feinmann promises – and delivers – a balanced approach to the subject, stressing her book is ‘neither for nor against gluten’.

What we know is this. Increasing numbers of people feel they are sensitive to gluten and are restricting their intake, or eliminating it altogether. Some do so as a health choice, perceiving gluten to be, well, ‘bad’. We also know that some experts believe, or are at least coming around to the idea, that non-coeliac gluten intolerance is genuine; Feinmann cites Addenbrooke’s respected Dr John Hunter as an example.

Less clear is how many could be suffering. Figures are quoted in passing – one in 15 have problems digesting gluten; one in seven or eight have gluten sensitivity – but the source of these figures is not entirely clear.

The strongest sections are on day-to-day gluten-free living – shopping, eating, dining out – and there are very useful, up-to-date resources. But I was also interested in the history of research into gluten and coeliac disease, the changes in bread-making and its possible implications on our health, the growth of the gluten-free market, and indeed the staggering rudeness of respected food commentators towards those with food sensitivities (shame on you, Jay Rayner).

Given the widespread tendency to self-diagnose, the two chapters on diagnosis are perhaps the most important. I like that Feinmann includes possible causes of symptoms other than gluten intolerance, such as IBS, a non-varied or otherwise poor diet, and compromised gut integrity. Tests for coeliac disease are explained clearly too.

My main quibbles concern the coverage of diagnostic exclusion diets. The author says that ‘If after one week [of eating gluten-free], your symptoms disappear, then you can be fairly sure that gluten is the problem’. Many would disagree. Health improvement after gluten elimination is common, often simply as a consequence of an improved diet, free of biscuits, cakes and fast food, and suddenly richer in nutritious unprocessed foods, which individuals are compelled to seek out as replacements to gluten-containing treats and ready meals.

I feel too that the author underplays the difficulties of the exclusion diet, the need for the supervision of a specialist dietitian, and the importance of the reintroduction phase, merely calling it an ‘extra check’. But it is a key stage of the diagnosis, and, strictly, if using bread as a means of gluten reintroduction, one would also need to have already excluded and safely reintroduced both yeast and (deglutenised) wheat starch, to rule out the possibility that either was causing the symptoms, rather than gluten.

But there is so much that is practical, informative and useful about this book that I hope all creases can be ironed out for a future edition, which will surely be needed as further research uncovers more truths about intolerance. Even as it is, blessed additionally with lots of input from our own editor, Michelle, it’s easily worth the cover price.

Living with Gluten Intolerance by Jane Feinmann is published by Sheldon Press @ £7.99

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