Wheat is the most widely consumed food staple globally, is difficult to digest and known to cause inflammatory intestinal reactions [1]. This has largely been attributed to gluten which is the most abundant protein in wheat.
However a study [2] published in 2023 explored the possible effects of a group of proteins called amylase trypsin inhibitors (ATI's) on inflammation in a mouse model of MS. The results showed that an ATI-containing diet exacerbated disease severity in the mice. Meanwhile, gluten itself did not appear to influence disease severity relative to a control diet without these proteins.
A more recent German study [3] of 290 PwMS has found ATI's also contribute to inflammatory responses in MS.
The study reported "the wheat-reduced diet, which was well tolerated, patients also experienced significant improvements in pain-related quality of life. Other life quality categories and overall disability did not significantly change.
“Our studies show how important diet, its interactions with the gut microbiome and the gut immune system are for health,” Schuppan said.<
“A wheat-free diet can reduce the severity of MS and other inflammatory diseases. Further studies combining a wheat-free diet with other drug therapies, among other things, are planned,” he added."
However it is not only Gluten and ATI proteins that are bad for MS. For some time I have been advocating a reduced starch diet is also essential for MS'ers. Wheat is a major contributor to starch in our diet. As much as 80% of a 00, also referred to as Bakers flour, is starch [4]. There are different starch containing flours used to change to properties of different products [5][6] but all contain a lot of starch.
So why is too much starch bad for us? Well starch is converted to sugars which are the predominant form of energy our cells use to function properly [7]. There are different forms of starch:
- Rapidly Digested Starch (RDS),
- Slowely Digestable Starch (SDS),
- Resistant Starch (RS),
The different starches are converted to sugars differently when ingested but when coupled with the large amount of added sugars in the modern diet they contribute to excess sugar we get, and we all know how bad excess sugar is for us. The conversion process starts as soon as the starch passes our lips [7,8]. Which is why starchy foods taste sooo good! Enzymes in our saliva start to act on the starch breaking bonds to convert the starch into various sugars. Predominately glucose and sucrose. This process continues as the starch passes through our digestive system until 100% of the RDS and SDS has been converted. Which is why we get a blood sugar spike when we consume starchy products such as bread, potatoes rice etc..
This is a very simplistic summary and Starch is an important component of our diet, we need it. However if you find it too hard to cut a sizeable slice added sugars from your diet then also reducing the high starchy foods will help reduce the overall amount of sugar we are getting in our modern diet.
Live Well with MS
Alan
Any questions/comments make below or email: info@multiplesupplements.com
- Cenni, S.; Sesenna, V.; Boiardi, G.; Casertano, M.; Russo, G.; Reginelli, A.; Esposito, S.; Strisciuglio, C. The Role of Gluten in Gastrointestinal Disorders: A Review. Nutrients 2023, 15, 1615. https:// doi.org/10.3390/nu15071615
- Dietary wheat amylase trypsin inhibitors exacerbate CNS inflammation in experimental multiple sclerosis https://gut.bmj.com/content/73/1/92
- Wheat-free diet in patients with multiple sclerosis https://drks.de/search/en/trial/DRKS00027967
- J Food Sci Technol (October 2019) 56(10):4474–4481 https://link.springer.com/article/10.1007/s13197-019-03954-9
- https://millingmea.com/starch-the-architect-of-baked-products/
- https://caputoflour.com/blogs/learn/the-different-types-of-flour?srsltid=AfmBOooOyyScUDKMJo-SWTQzXaR-619EuJguqa3GDEcW2B84G5VrAP5k
- https://www.medicalnewstoday.com/articles/what-is-starch
- Roman L, Martinez MM. Structural Basis of Resistant Starch (RS) in Bread: Natural and Commercial Alternatives. Foods. 2019 Jul 19;8(7):267. doi: 10.3390/foods8070267. PMID: 31331021; PMCID: PMC6678428.
3 comments
Dear Alan,
In a systematic review of the literature, the authors of a paper (Thomsen et al., Multiple Sclerosis and related disorders, Vol 27, p. 156-163, January, 2019.) showed that ‘There is still not sufficient evidence to state whether gluten plays a role in MS (Multiple Sclerosis), but limitations of current evidence have been identified and directions of future research have been suggested.’ The second paper (Engel et al., Ther Adv Neurol Disord 2023, Vol. 16: 1–12) presented actually states ‘Our results suggest that the wheat- and thus ATI-reduced diet was associated with changes in monocyte subsets and improved pain-related quality of life in RRMS (Relapsing-Remitting Multiple Sclerosis) patients. Thus, a wheat (ATI or amylase–trypsin inhibitors)-reduced diet might be a complementary approach accompanying immunotherapy for some patients.’. The important words in their conclusion are ‘associated’ and ‘might’. Thus, the authors are concluding that the research does not show a clear sign whether a wheat-free or reduced-wheat diet is an added benefit to the current disease modifying treatments (DMT) in MS.
Then you stated that ‘Starch is converted to sugars when ingested and we all know how bad excess sugar is for us.’ When we digested a carbohydrate-containing food, the aim of digestion is to digest the macronutrients (protein, fats and carbohydrates) into the smallest state (amino acids, fatty acids and sugars) to be absorbed into the human body. Thus, carbohydrates from any food needs to be reduced to its simplest form and eventually to glucose, which is the body’s primary energy source. ‘Excess sugar’ in the diet is in the form of added sugar. Typically, these might be added sugar in beverages (e.g., fruit drinks or juices – depending on the food regulations – or carbonated beverages or soft drinks) or foods (e.g., lollies and chocolates, cakes and biscuits, etc.).
More importantly is the classification of foods based on the effect it has on our blood glucose levels. This is called the Glycemic (Glycaemic) Index or GI. The University of Sydney is the source to go to to learn about it (https://glycemicindex.com/). Basically, a high GI food is one that is digested quickly and raises the blood glucose levels faster (e.g., white or wholemeal breads). Whereas a low GI food takes longer to digest and raises the blood glucose levels more slowly (e.g., whole grain, multigrain or sourdough breads). Typically, glucose is the standard and has a GI of 100. A low GI food is particularly useful for those with diabetes (e.g., type 1, type 2 and gestational diabetes) or looking to reduce their risk of developing type 2 diabetes. Many of the gluten-free breads available may have a high GI. An article (https://www.gisymbol.com/going-low-gi-when-youre-gluten-free/) discusses the ways of eating gluten-free and low GI.
You then stated ‘As much as 70% of a 00 flour used in most baked products is starch.’ Firstly, Type 00 [doppio zero or double zero] flour is an Italian classification system of flour types. 00 flour is typically used for cakes and biscuits due to it being a finer and lower protein (8-12%) flour compared to Type 0 or Farina Manitoba, which is used to make breads and pastries due to the higher protein content (14.5%). I’m not sure where you obtained this percentage (70%) as the FSANZ (Food Standards Australia and New Zealand) does not classify flour into numbers, as in Italy.
Your conclusion, ‘This new research is adding a second component to why we MS’ers should be staying away from wheat’ does not match the conclusion the authors’ paper you presented to your readers and what I have presented in my reply. Thank you.
Hi Graeme, thanks for your comments. I am with you! I tried a gluten free diet a number of years ago and although I felt, generally, a little healthier I don’t feel it helped my MS much if at all. This article was meant to highlight ATI’s have more of an effect on MS than Gluten. I have advocated a diet low in wheat for some time. Mainly because the 00 wheat flour than is used in most baked goods, particularly breads, is far too highly processed. It is ground to fine and contains as much as 70% starch. Hence 70% sugar! But now ATI proteins have been shown to exacerbate MS. All the more reason to keep wheat to a minimum!
Hi Alan
I really appreciate your caring and would consider a gluten free diet BUT it sounds too difficult to manage. MS is definitely a drag but I don’t really need anymore hardship in my life. I’m sure it would be hard.