The Trouble With Bread: What I Discovered When I Tried to Get to the Bottom of My Gluten Intolerance

When I eat standard sliced American bread, I may as well be hung over. I get a stomachache, nausea and become generally exhausted, as if my body is trying to fight off the bread. But the symptoms vary in severity. Because of this, after intermittently giving up bread, I will think I have imagined it all, try to eat bread again, and get sick all over again.

It’s a delirious cycle of love and abuse, a drug I can’t give up. I often find the succulent morsels of a toasted honey wheat or raspberry jam-slathered brioche worth an evening holding my stomach, rocking on my bed.

I love bread so much, I allow myself to forget how bad I feel after eating it. But after about two blissful years of this denial, I finally decided to do something about it.

Until recently, the idea of not being able to eat wheat was preposterous. Bread has been a staple of human life for 10,000 years, since the ancient Sumerians and Egyptians discovered its ability to literally rise above other grains, thanks to this little protein called gluten.

“Gluten is the reason that wheat was able to conquer the planet,” food writer Michael Pollan, who explores the wonders of gluten in his most recent book, Cooked, told me. Gluten, which is a combination of the proteins gliadin and glutenin, gives wheat flour a certain elasticity when mixed with water that makes it easy to work with and helps hold pockets of air within the dough, allowing it to rise.

But gluten intolerance has become a significant health concern in just the past decade or so. Celiac disease, an extreme autoimmune reaction to gluten, has increased fourfold since the 1950s. And whereas wheat counts for one-fifth of the calories in the American diet, fully a third of American adults think they should stop eating it.

Which led me to the Gluten & Allergen Free Expo at a Marriott in South San Francisco. The place was circus-like, with vendors pulling acrobatic tricks with their words to draw in the expectant consumer crowd.

“This won our national Sophie award,” says one fiercely smiling woman, gripping a box of cookies and talking close to the face of a semi-interested passerby. “So for 2012, best snack food in the organic, gluten-free product line.”

Hordes of well-fed families pushed their way from booth to booth, brochures in hand and kids in tow. They shifted weight on weekend sneakers as vendors lured them with their unusual wares: Tapioca flour. Potato starch. Rice flour.

The “gluten-free” label has become one of the best ways to sell a product. The industry is worth upward of $4 billion, and is expected to exceed $6.6 billion by 2017. Many books, diets and self-proclaimed medical specialists have taken advantage of this new trend. It has become so trendy, in fact, that even gallons of milk, that contain no gluten to begin with, have started to get the “gluten-free” stamp.

If nothing else, the gluten-free industry has shown me where I am apt to find the notorious substance, which is often used as an additive or filler in otherwise wheat-less foods: salad dressings, soy sauce and other condiments, beer, some ice creams, even deodorant. But it is most common in wheat, barley and rye, and some say, oats.

But “gluten-free” doesn’t mean healthy. Cutting down on carbs can be great in general, but transitioning to these ultra-sweet, other refined flours, as wheat replacements often are, can actually be worse for you than the wheat itself (which, at least in its whole grain form, can be quite good for you).

Michael Pollan told me he doubted that everyone who claims to be gluten-intolerant is actually having trouble eating wheat. “At any given moment in American nutritional history, there is some evil nutrient that we are trying to expunge from our diet, like it’s Satanic,” he said. “Right now, poor gluten is in the spotlight. It is the evil nutrient.”

This doesn’t do much for my self-confidence, as I would like to think that my gluten intolerance really is all in my head and give in to eating bread once more. But something in my gut tells me the symptoms will always return.

Another vendor catches me skeptically eyeing her fake barbecue that is really a griddle warming up bread rolls. “Do you want some bread?” she beckons. I wearily nod and reach out for a roll, wondering how good wheat-free bread can be. She attempts a reassuring smile as I take a bite, and have to duck behind the crowd to avoid her face as I gag, spitting out the cardboard-like saccharine substance she calls “bread.”

All of it was terrible. The rice and potato flours and everything that was trying to replace wheat was just sickeningly sweet, even with the “no added sugar!” all vendors were eager to promise. After a few disappointing samples, I ended up with a stomachache. I had not found my bread.

There was one good thing I took away from the expo: I heard some first-hand accounts of people with celiac disease, the genetic disorder that can be diagnosed with a blood test and confirmed with an intestinal biopsy. In celiac patients, gluten causes the finger-like villi in the intestine that take in nutrients to flatten, and in doing so, blocks nutrients from being absorbed into the body. It can cause permanent intestinal damage and malnutrition and even lead to other autoimmune disorders.

So I decided to get tested for celiac. If I had it, the answer would be clear: avoid gluten in its entirety, and you won’t feel sick. But you won’t be able to eat wheat ever again.

Praise the bread lords -- I didn’t have it. Which means I probably fall into the hazy category of gluten intolerance that nobody understands, or can even really quantify. It can’t be diagnosed with a simple blood test, so many people self-diagnose. What scientists do know is that it’s real, though not for everyone who claims to have it, and that symptoms are similar to those with celiac.

Some have estimated that six percent of Americans are gluten-intolerant, but I’ve seen much higher numbers. Clearly, more research needs to be done.

I’ll admit, I didn’t much care who else had it. I just wanted to figure out what I could do about it, apart from giving up my precious bread altogether.

The Farm

A friend suggested that I look into a burgeoning trend in planting ancient, or heritage wheats in the Sacramento Valley. The older wheat varieties are known to have less gluten, and I wondered if that meant I could more easily tolerate them. Modern varieties are bred to be high yield, per acre and per stalk. The more gluten, the easier it is to make bread, so varieties like modern hard red winter wheat are favored.

I decided to take a trip out to the Rominger Brothers Farm in Winters, Calif., where brothers Rick and Bruce Rominger had once grown heritage wheats, but gave it up. I wanted to find out why.

It was October, planting season, so tractors were busy driving the rows, dropping kernels of hard red winter wheat into the freshly turned soil. A delicious petrichor lingered in the air, that scent from rain and freshly watered ground.

It was refreshing to be out in the fields after months in the city, even if it was in the midst of a downpour and my rental car was having trouble clearing the brush in the middle of the narrow dirt roads. I wasn't super hopeful about this trip, because every "heritage wheat" bread I'd seen in the grocery store -- like emmer, spelt and einkorn -- was quite expensive, not something I could afford every day. I asked Rick Rominger about this.

“A lot of these heritage varieties are old. They don’t yield very much,” he told me. Like growing organic food, farmers had to get their heritage wheats specially certified, so there were a lot of rules.

"Every time you'd go to a different variety, you'd have to clean your harvester, you'd have to clean your drill," Rominger said. "You can't mix the different varieties. It's just obviously more complicated." Nowadays, Rominger chooses to plant hard red winter wheat. He categorized heritage wheats as "speciality products" whose stalks were taller and weaker than the modern wheat, and so were often lost to bad weather. "[Heritage wheats] are like a $100 bottle of wine," he told me.

A $100 bottle of wine was not something I could afford on a regular basis. Now I understood why heritage wheat breads were so expensive. Besides, because heritage wheats had less gluten, they were usually mixed with modern wheat to make a decent bread.

The concept that higher-gluten wheat was causing and exacerbating gluten intolerance is controversial, anyway. Some experts think that maybe it’s not the plant itself, but the way we process it that’s changed. I decided to check this out.

The Mill

Ken Albala is milling grain by hand, with a small hand quern, using its handle to rotate two stone slabs and grind the grain between them, just like they did thousands of years ago. “Except I have a little plastic knob on mine,” says Albala.

A do-it-yourself foodie, Albala bakes his own bread, cures his own meat and makes his own wine. For Albala, a history professor at the University of the Pacific in Stockton, food and history are inseparable. Once, while working on a dissertation about indigestion in the 16th century, he found himself unable to eat cucumbers, peaches or lunch -- typical of the food fads of that time period.

“All sorts of weird things that they warned you not to do, I just internalized those. And for a couple of years, I could tell you exactly what was going on in someone’s body in the 16th century,” Albala said. With his rounded belly and white goatee, he looks like someone from the 16th century. He still doesn’t eat lunch.

What Albala can’t tell me -- what nobody can, really -- is what’s going on with our bodies when we can’t digest gluten, but we don’t have celiac disease. If you have celiac, it’s simple -- you’re experiencing an autoimmune, genetic disorder. But gluten intolerance that’s not genetic is a bit more complicated.

It could be a larger picture of an immune system gone haywire, Michale Pollan told me. Or, I think as Albala leans over the hand mill, beginning to sweat as he turns the handle to grind the grain, maybe something went wrong with milling technology.

TestingFlour

It was the first time I’d seen test tubes full of flour, taken from the bags on the black countertops of the chemistry lab: Bob’s Red Mill. Gold Medal. Pillsbury. Arrowhead Mills.

This was no science fair project. David Killilea, a scientist at the Children’s Hospital Oakland Research Institute, was comparing the mineral content of the different types of flour. He wanted to know what was lost, or gained, during milling.

“We’ve had a couple of flour brands that advertise...based on the package, if I were a consumer, I would think that I was getting a 100% whole grain product,” said Killilea. But that label can be misleading.

I watched Killilea ready samples as he explained what he meant. “The FDA allows for whole wheat labels to be added to products as long as 51 percent or more of the flour is whole grain,” he said, inserting test tubes into slots near a robotic arm.

“So you can have a bread made from 51 percent whole wheat and 49 percent all purpose (white flour),” he explained, as the robotic arm grabbed a test tube full of flour and inserted it into one slot of a honeycomb-like holding cell. “You’re losing a lot of those nutrients.”

A bright light shone through a small window in the machine with the robotic arm. “What does this thing do?” I asked.

“That’s the ICP, which stands for inductively coupled plasma spectrometry. And that,” said Killilea, pointing to the light behind the window, “is the plasma.”

The lab uses plasma to heat up the flour samples to 6,000 degrees Fahrenheit, about the surface temperature of the sun. Like multi-colored fireworks, the heat generates different colored light from the different minerals in the flour -- light which the researchers can then measure and say how much magnesium, for example, a specific flour has.

“So what’s the big deal,” I ask. Who cares if my wheat flour has more or less magnesium?

Turns out, Americans are severely lacking in potassium, magnesium and Vitamin E, nutrients that are found in the whole wheat seed, but not in modern white flour -- and not as much as you’d think in whole wheat flour, either.

“There’s pretty good evidence that being short on zinc, magnesium and certain vitamins make for a weaker gut,” says Killilea, a former nutritionist. Gluten is hard enough to digest on its own as it is -- adding modern flour only makes it worse.

It’s funny, really: modern wheat flour is causing us to lose our ability to digest modern wheat flour.

What happened? For thousands of years, wheat was ground in whole, either by hand or with a hand-powered stone-on-stone quern, like the one Albala used. As populations grew and technology improved, donkeys and horses were used to pull large stone mills, grinding the grain between huge slabs of rock. Later, a water-powered wheel turned the mill to grind the grain.

And then somewhere during the Industrial Revolution, someone invented this thing called the roller mill. Essentially, seeds pass through a series of close-knit spinning steel cylinders, and are broken down into smaller and smaller grains at each pass. Modern roller mills can be six stories tall, each floor dedicated to refining the grain as gravity pulls it downward: floor six, cleaning, floor five, tempering (adding heat to loosen seed parts), and so on. It was quick and efficient, and it made the whitest flour yet seen.

But there was an important difference between the way we’d milled wheat for thousands of years -- called whole milling, or stone-ground -- and this roller milling, which we use today.

The wheat seed is made up of three layers: the outside fibrous layer, called the bran; the chunky carbohydrate, the endosperm; and the nutrient-rich oily substance in the middle, called the germ. At the first pass, roller milling strips out the bran and the germ so the carbohydrate part of the seed, the endosperm, can be made into pure white flour.

“It was a great innovation, and probably one of the biggest changes to the human diet since cooking was invented,” Pollan told me. “Because now you had this white flour. You could put it in a bag and ship it halfway around the world. It wouldn’t go bad.” Pollan was talking about the one fault of traditional whole-milling: rancidity.

The problem was, the oily germ caused flour to go bad, and quickly. “The rancidity that affected flour was not a problem if you could just walk a few blocks and pick up new flour,” said David Killilea. “But with the growth of our nation and when the commercial agricultural and food industry started shipping products everywhere over the United States, that became untenable.”

And so roller technology, which got rid of the germ at the first step, seemed like the perfect answer.

Until an epidemic of malnutrition struck.

Ever turned over a package of bread at the grocery store and seen that endless list of ingredients? Well, I have, and wondered, whatever happened to just flour, water and salt?

Turns out, in the course of the two world wars, more people started getting sick with beriberi and other such diseases that are caused by vitamin deficiency -- in particular, B vitamins, that are plentiful in whole wheat bread. Generals started to worry that their troops would become malnourished and lose the strength to fight.

The problem was that the bread was not as whole as it once was. Thanks to roller technology, most bread was white, and those subsisting on a white bread diet were missing out on all the vitamins and minerals from the bran and the germ that were once inevitably part of bread. And even “whole wheat” bread was different, because millers were essentially taking white flour and adding back some of the separately milled bran and calling it whole. No germ, which was full of nutritious Omega-3 fatty acids. Even the bran had lost value at this point, for though its minerals were mostly maintained in the milling process, its vitamins had been destroyed by oxidation when exposed to the air.

So in response, the government mandated that the lost vitamins and minerals be added back in, as supplements. Why destroy a perfectly good technology and start from scratch when you can just add more technology to improve it?

“It was a classic solution. Rather than return to whole grain milling, and say return to improving the quality of that, they figured out that they could just add these missing vitamins back,” Michael Pollan explained. “They could boast about the fact that they had extra nutrients in this food.”

That’s why, when you turn over a package of sliced bread at the grocery store, you will typically find niacin, riboflavin, folic acid -- the list goes on.

Back in the lab, David Killilea introduced me to his colleague, Mark Shigenaga, who had very some interesting insight on my gluten-intolerance issue.

According to Shigenaga, traditional whole milling is still practiced in Europe. For white breads, the whole milled flour is sifted until the desired granulation and color is met -- though a lot of the bran is sifted off, the germ, which has been ground into the endosperm, remains, along with much of the seed’s original nutrients. Even a white baguette in Paris, if made with traditional whole-milled flour, will have specks of light beige -- leftover bits of bran and germ -- in its doughy interior.

The shelf life of this flour remains a point of contention among millers, a very secretive bunch. Not even Killilea knows how whole milled flour keeps from going rancid immediately, but he suspects it may have something to do with using a cleaner source of high quality wheat berries. Though whole milled flour will never last as long as its starchy cousin, white flour, it certainly is easier on our intestines.

Which brought up a surprising realization for me. Before my trouble with gluten three years ago, I had spent a year in France -- gorging myself on artisan baguettes, pasta, pastries, you name it. And I had no problem eating them. But as soon as I got back on American bread, something went wrong.

The differences in milling would explain why I could eat bread in Europe, if I was indeed eating whole-milled flour, but not in the United States, where whole-milled flour is rare.

But this didn’t explain why I didn’t seem to have an issue eating bread before I left for France.

“Every person could have a gluten sensitivity at any point of time in their life,” Killilea told me when I asked him about it. “Every time you eat a really high enriched flour or all-purpose flour generated products at high levels, you’re taking a chance.” I certainly ate my fair share of bread and pasta while in Europe, so it’s possible that my high wheat consumption triggered a reaction.

At this point, I didn’t care what triggered it -- I just wanted to find a bread I could eat. Whole-milled flour was maybe an option, but I had my fair share of failed attempts at making bread at home. So I looked elsewhere.

The Bakery

At 7:30am, there’s already a line 20 people long at the door, waiting to devour the buttery croissants, sweet morning buns and rich coffee whose aroma wafts out into the foggy San Francisco morning on Guerrero Street. But at Tartine Bakery in the Mission District, it’s really all about the bread.

Tartine owner and baker Chad Robertson came to San Francisco with a tradition and a purpose: make bread the old-fashioned way, with a sourdough starter, and make it so it’s not only delicious, but easy to digest.

It was this last point that most interested me, but not for selfish reasons, for once. I had learned about someone else who was intolerant to gluten, someone who must have found it even more devastating than I did: the baker’s wife.

Robertson’s wife, Elizabeth Prueitt, was the lead pastry chef at Tartine for many years, despite her gluten intolerance. What I found most startling, however, was that the couple had once lived in France, where Prueitt had no problem eating bread, just like me. But as soon as she got back to the United States, she, too, could not eat bread without getting sick.

I had to know how a woman with gluten intolerance was married to a man who made his living working with bread.

My discussions with Robertson at his bakery were torturous, as delicious bread smells swirled around me. How did he get his bread to be so bubbly and soft on the inside, under the thick leather-like crust? How did he make it easier to digest?

It all comes down to a technique we once depended upon to keep our food from going bad, but now only think about with pickles and yogurt: fermentation.

Originally, all breads were sourdoughs. I’m not talking about the white sour bread San Francisco is known for. I’m talking about a sourdough starter, also known as a natural yeast.

“Sourdough starters, despite all their mystique, are very simple,” journalist Todd Oppenheimer, who praises the benefits of fermentation, told me. “You let flour and water sit for days, you gotta tend it a little bit, refresh it, and it becomes this fermented, kind of stinky goo.”

This stinky goo gathers its own natural yeast from the air around it, and when mixed with dough, the yeast helps bread rise during the fermentation process. While the bread is sitting there rising, the microbes from the yeast get busy breaking down the gluten, essentially pre-digesting it for us.

For Chad Robertson, good bread is all about the fermentation. “The longer you ferment something,” he said, “the more flavor you’re creating and you’re also making it more digestible, so it’s all connected.”

To ensure proper flavor and digestibility, Robertson ferments his bread sometimes for 24 hours. In comparison, instant yeast packets, like Fleischmann’s, need only three or four hours to get bread to rise. But that’s not enough time to break down the gluten and let the flavor layers unfold.

Robertson’s few hundred loaves sold out within minutes. Interestingly, he used a flour blend that was more white than whole wheat, so he depended a lot more on fermentation than whole-milled flour when it came to digestibility.

Robertson had me convinced. I tried his Tartine bread, and sure enough, I didn’t get sick! The long fermentation had apparently broken down the gluten in the flour enough for me to handle it without my usual symptoms. I was stoked -- the doughy, crumbly, delicious manna could again be a part of my life. Except for one thing.

A loaf of Tartine bread costs $8.25.

Eight dollars? This, too, was not an everyday solution for me. Heritage wheats, whole-milled flour, long-fermented bread, all of it took enough time and money so that the end product was not a financially feasible substitute for me and my love of bread.

I asked Pollan what he thought about this. He suggested that while I wait for those prices to hopefully drop, I should take another outlook.

“Celiac and gluten intolerance may be a door through which we can learn something much larger about where we’ve gone wrong in our relationship to these plants and these foods that have served us well for thousands and thousands of years,” he said.

I’m not quite sure where we went wrong, if it was with the wheat itself, the way it’s milled, the change in fermentation, or all of the above. I’m just happy to have a few options to appease my hopeless habit, even though those options are not cheap. I can buy them at least every once in a while.

But Ken Albala thinks even those options may one day go out of style, that they are part of the “20- to 30-year food cycles” he’s noticed throughout history, in which we move back to artisan, or handmade foods whenever there’s a downturn in the economy. Take the 1930s and 1970s, for example, when homemade bread was seen as not only the healthy choice, but the socially just choice, as well. And now, today.

“Every single one of those periods, they said, make bread at home,” Albala said. “It should be by the sweat of your own brow, made at home, by a family.” And as those periods end, you find more sophisticated foods dependent upon technology emerge, like the highly processed enriched flour products of the 1950s and all the microwave meals of the 1980s and '90s (Hot Pockets, Bagel Bites, need I say more?).

In about 10 years, Albala thinks, when our economy picks up again, we’re going to return full-force to machine-made food. Cutlery, ovens, even kitchens will become obsolete, he predicts. “People will sell food in a package that has the heating elements in it so that you can just plug it in...and then throw it away.”

I fear what new digestive and immune problems new food trends might introduce. But for now, I can’t help but feel that my precious drug, the delicious doughy crumb I so crave, has been sabotaged. For what the industry has already made cheap and accessible -- that is, most of the bread I find stocked on today’s grocery store shelves -- has become quite problematic, beyond even the gluten itself. And that’s the trouble with bread.