Gluten Attack by David Sanders

I was excited when Dr Alessio Fasano released the excellent Gluten Freedom in 2014 and I was similarly excited when another top international gluten expert - Professor David Sanders - released his first book, Gluten Attack, earlier this year. Finally, I've gotten around to reviewing it ...

I've interviewed Professor Sanders twice, and heard him speak a few times at Coeliac UK conferences or seminars. He's funny, engaging and passionate about gluten-related disorders.

Perhaps I'm biased, as he helped me with some sticking points when writing my own book on coeliac disease, and when I eventually sent him a copy, he told me he enjoyed it - but I in return enjoyed his book, albeit some parts more than others.

I liked his 'Gluten Attack Rules' (Don't self diagnose and place yourself on a GFD; If you do so there's no current proof what you're doing is good or right, eg). There's some good historical background, and fascinating material about genetics and coeliac disease in ethnic groups: I knew about the 5.6% prevalence rate among the north African Saharwi people, but not the 4% suspected among the Amerindian Toba people. His analysis of IBS, FODMAPs and CD - with full list of studies - was very useful.

I enjoyed reading about his ideas on the rise of CD rates. There's evidence that it may be the quantity of gluten we're being exposed to that may increase the risk of CD (supported more recently by a Swedish study). And possibly its processing too. Could German low rates (circa 0.3%) be explained by their preference for 'slow food' sourdough bread, over industrialised bread-making techniques?

His overall approach, which surprised me, but that I eventually came around to, on the whole, is very much "here's the science - you decide".

There were some elements I struggled with, though, and occasionally found contradictory. He confirms there's no evidence to support the popular anti-glutenist view that there is more gluten in modern wheat varieties - yet he endorses the term 'Frankenwheat'.

He also covers Novak Djokovic's kinesiology-based diagnosis of NCGS (which I have written about many times before - perhaps start here if interested), yet insists he has "no negative views" on complementary and alternative medicine - criticising the tennis star's diagnosis on the basis that it was not via orthodox routes, and that CD was not ruled out. This position is enforced later when he expresses sympathy for those who have turned to unorthodox and unproven food intolerance tests after having failed with a conventional medical approach and the NHS - yet still won't criticise the very CAM practitioners who espouse and sell those tests. A subsequent Rule states that the absence of evidence should not be used as proof of no effect, which while correct, I can't help feeling is too liberal towards the unqualified and their unsupported claims.

The editing isn't flawless, which was a surprise given the reputable publisher. There are a few short isolated chapters (including a strange one devoted to how great Sheffield is), terms are used (innate / adaptive immune responses) several pages before they are defined, and other little slip ups that all of us writers make but that should have been caught by an eagle-eyed sub-editor.

But despite its oddities and quirks (smiley faces?) and surprises, this was an immensely readable book for the gluten-curious and gluten-nerds alike, filled with fascinating snippets which enriched my knowledge of the subject.

Gluten Attack: Is Gluten Waging War on our Health? And if so, what can we do about it? is published by Vermillion.

Hear Professor Sanders talking about CD / NCGS on this BMJ Podcast

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