What’s the big deal with gluten? - William D. Chey

譯者: 杏儀 歐陽 審譯者: Seke Wei

Maybe you've recently seen the phrase "gluten-free" on food packaging,

你最近也許留意到「不含麩質」 標誌開始出現在食物包裝上、

or take-out menus, shampoo bottles, apartment listings, the tag of your shirt,

或出現在外帶菜單、洗髮精瓶子、 公寓清單、你的襯衫標籤、

on a hammer, as a lower back tattoo, or in your friend's resume.

甚至鐵錘上，或成為某人腰背紋身字眼， 或在朋友履歷上。

Next time someone starts telling you about their newfound freedom from gluten,

下次如果有人跟你講 他們新發現自己不能接觸麩質，

here are some questions you can ask,

你可以詢問他們以下幾個問題，

and the well-informed answers that your friend,

如果你的朋友

being a reasonable individual making educated dietary choices,

是理性個體， 會明智選擇飲食，

and by no means just following the latest diet craze, will tell you.

而非盲目追隨最新飲食潮流的話， 則他們會告訴你如下有見識的答案。

What is gluten?

什麼是麩質？

Gluten is an insoluble protein composite

麩質是一種不可溶解的蛋白質混合物，

made up of two proteins named gliadin and glutenin.

由兩種蛋白質組成： 醇溶穀蛋白及穀蛋白。

Where might you encounter gluten?

你在哪裡可能會遇到麩質？

Gluten is found in certain grains, particularly wheat, rye and barley.

在一些穀物內可以找到麩質， 特別是小麥、黑麥和大麥。

What has gluten been doing for the previous entirety of human history,

在過去整個人類史上， 麩質有過什麼貢獻？

and why do you suddenly care about it?

為什麼你會突然在意麩質？

Gluten is responsible for the elastic consistency of dough

麩質讓麵團保持彈性，

and the chewiness of foods made from wheat flour,

也讓麵粉做的食物有嚼勁，

like bread and pasta.

譬如麵包和意麵。

For some people, these foods cause problems,

這些食物給以下一些人帶來麻煩：

namely wheat allergy, celiac disease, and non-celiac gluten sensitivity.

例如患有小麥過敏、乳糜瀉、 非乳糜瀉麩質敏感的人。

Wheat allergy is an uncommon condition

小麥過敏並不普遍，

that occurs when a person's immune system

其成因為人體免疫系統

mounts an allergic response to wheat proteins,

對小麥蛋白作出過敏反應，

leading to mild problems, and in rare cases,

導致一些輕度症狀。 可是，少數情況下，

a potential dangerous reaction called anaphylaxis.

會出現一種潛在危險的「過敏性反應」。

Celiac disease is an inherited disease,

乳糜瀉是遺傳性疾病，

in which eating foods with gluten

患者在進食麩質食物時，

leads to inflammation and damage of the lining of the small intestine.

會出現發炎，並損害小腸絨毛。

This impairs intestinal function,

這會傷害腸道功能，

leading to problems like belly pain, bloating, gas, diarrhea,

帶來一系列症狀，例如腹痛、 腹脹、腹氣、腹瀉、

weight loss, skin rash, bone problems like osteoporosis,

體重減輕、皮疹、骨骼問題 譬如骨質疏鬆症、

iron deficiency, small stature, infertility, fatigue and depression.

缺鐵、身材矮小、 不孕、疲勞和抑鬱等。

Untreated, celiac disease increases the risk

如不治療，乳糜瀉會增加

of developing certain types of cancer.

罹患某些癌症的風險。

Celiac disease is present in one in every 100 to 200 persons in the U.S.

目前在美國，每100至200人中 就有一人患乳糜瀉。

When blood tests suggest the possibility of celiac,

當血液測試顯示 可能患乳糜瀉時，

the diagnosis is confirmed with a biopsy.

可通過切片檢查來確定診斷。

The most effective treatment is a gluten-free diet,

最有效的治療方法是 無麩質飲食，

which helps heal intestinal damage and improve symptoms.

這會幫助治愈腸道損傷， 改善症狀。

Some people don't have celiac disease or a wheat allergy,

有些人沒有乳糜瀉或小麥過敏，

but still experience symptoms when they eat foods with gluten.

但他們吃麩質食物時， 仍然會出現一些症狀。

These people have non-celiac gluten sensitivity.

這類人有非乳糜瀉麩質敏感。

They experience painful gut symptoms

他們會有一些痛苦的腸道症狀，

and suffer from fatigue, brain fog, joint pain or skin rash.

出現疲勞、腦霧、關節痛或皮疹。

A gluten-free diet typically helps with these symptoms.

無麩質飲食 一般會幫助緩解這些症狀。

So how many people actually have this gluten sensitivity you speak of?

那到底有多少人有這種麩質敏感症？

Gluten sensitivity's occurrence in the general population is unclear,

麩質敏感症在一般人口中的 盛行率並不清楚，

but likely much more common than wheat allergy or celiac disease.

但可能比小麥過敏或乳糜瀉 要廣泛得多。

Diagnosis is based on the development of symptoms,

麩質敏感的診斷 要依據症狀如何發展，

the absence of wheat allergy and celiac disease,

沒有小麥過敏和乳糜瀉，

and subsequent improvement on a gluten-free diet.

以及採用無麩質飲食後的改善狀況而定。

There's no reliable blood or tissue test,

現今沒有可靠的 血液測試或組織測試來確診，

partly because gluten sensitivity isn't a single disease,

部分原因是麩質敏感不是單一疾病，

and has a number of different possible causes.

而可能由一系列不同原因引起。

For example, it may be the case

譬如，起因可能是

that gluten can activate the immune system in the small intestine,

麩質可以啟動小腸內的免疫系統，

or cause it to become leaky.

或者讓小腸變得瀉漏。

But sometimes, people claiming gluten sensitivity

但偶而一些人說自己麩質過敏，

are actually sensitive not to wheat proteins,

其實並非對小麥蛋白過敏，

but sugars found in wheat and other foods, called fructans.

而是對小麥和其他食物內的糖分過敏， 這種糖叫果聚醣。

The human intestine can't break down or absorb fructans,

人體腸道無法消化或吸收果聚醣，

so they make their way to the large intestine or colon,

因此果聚醣會去到大腸或結腸，

where they're fermented by bacteria,

然後與那裡的細菌發酵，

producing short-chain fatty acids and gases.

產生短鏈脂肪酸和氣體。

This leads to unpleasant symptoms in some people with bowel problems.

這給一些人帶來不快的腸道症狀問題。

Another possible explanation behind gluten sensitivity is the nocebo effect.

另一種說法是以為有害的 「反安慰劑效應」引起敏感。

This occurs when a person believes something will cause problems,

即一個人相信自己對某些東西敏感時， 會出現敏感症狀，

and because of that belief, it does.

正是這種想法讓敏感症狀出現。

It's the opposite of the more well-known and much more fortuitous placebo effect.

上述效應和更廣為人知、更偶發， 以為有利的「安慰劑反應」剛好相反。

Given how much bad press gluten is getting in the media,

由於麩質的媒體形象日益低下， 這種情況下，

the nocebo response may play a role

反安慰劑反應也許影響到

for some people who think they're sensitive to gluten.

那些覺得自己對麩質敏感的人。

For all these reasons,

上述種種原因，

it's clear that the problems people develop

清楚顯示人們食用小麥等穀物時 遇到的種種問題，

when they eat wheat and other grains aren't exclusively due to gluten.

不能完全歸咎於麩質。

So a better name than non-celiac gluten sensitivty

給「非乳糜瀉麩質敏感」 更恰當的名字，可能是

might be wheat intolerance.

「小麥不耐症」。