Meet the medical expert who is seeing a rise in the number of gut complaints linked to diet
“We’re a bread-based society – it’s the biggest form of carbohydrate that we eat,” says Professor David Sanders, looking thoughtful in his office at Sheffield’s Royal Hallamshire Hospital.
“I mean, it wouldn’t surprise me if you told me you’d had a sandwich for lunch.”
I did. I’m not sure whether I should feel guilty or not, but the gastroenterology expert is keen to make a point.
Officials are now studying the responses to a Department of Health consultation into whether NHS prescriptions of gluten-free bread and other staple foods should be restricted. David thinks curbing the service – already reduced in Sheffield two years ago – would be ‘a shame’, and could have unforeseen consequences.
“The healthcare burden of this decision will not come to roost for a few decades when you start to see people turn up with gut malignancies and cancers because they just didn’t adhere to the gluten-free diet,” he claims.
“By that time the various policy makers will be long gone. People struggle with the idea that a diet can be a medical treatment.
“What you’re asking people to do is far more difficult than is perceived.”
David runs the UK’s leading clinic for gluten-related problems, and is of the mind that good digestion is ‘fundamental to life’.
But there’s still a distinction to be drawn between those with coeliac disease – people who become genuinely ill due to inflammation if they eat gluten, a wheat protein that gives food shape and holds it together – and individuals following the exhortations of lifestyle gurus, such as writers Jasmine and Melissa Hemsley, to follow a ‘free from’ diet in the belief it leads to greater wellness.
David calls the latter category a ‘grey zone’.
“It gets clouded with ‘clean eating’ and celebrity endorsement. It’s made people suspicious and not recognise that there’s a disease process behind this.
“Undeniably industry has pushed that, to increase sales. People don’t always respond kindly if you say to them ‘You have no need for a gluten-free diet unless you have symptoms’.”
Such debates are partly why David feels his specialism is often underrated when compared to other areas of health.
After all, gut complaints amount for 15 per cent of GP consultations, he explains.
“You cannot function if you take away a certain amount of your gut – you will die, unless you’re drip-fed. Some things are emotive – children, hearts, cancer. The gut doesn’t feel emotive. But in terms of wellbeing it’s incredibly important.”
David’s unit, on the higher levels of the Hallamshire with stunning views across Sheffield, is constantly busy, with 24 beds that accommodate 600 patients per month.
Endoscopy – tests that look inside the body using a long probe – are a key element of the department’s work. The team has led the way in providing the examination’s capsule form, where patients swallow a pill-shaped camera that takes pictures, in real time, of their innards.
The professor, who accepts that traditional endoscopy is ‘not dignified or pleasant’, turns to his computer and puts on a demonstration video depicting someone ingesting a capsule, while the theme from Mission: Impossible plays loudly.
“The technology is moving forward.”
David’s story begins in Sri Lanka. His family were Tamils, and came to the UK in the 1970s because of the civil war at home. His father, Sam Sanders, was a well-known consultant in elderly care in Glasgow, and David followed him by training as a doctor in the Scottish city.
The Sanders family seem irresistibily drawn to medicine – David’s two older sisters are both physicians, too.
“If you look at the Sanders family going back to the 1850s they’ve always been medics, or ministers, or teachers,” he admits.
David was appointed as a consultant in Sheffield in 2002, and became a professor in 2010. He met his wife Iman Azmy, a consultant surgeon at Chesterfield Hospital, at medical school, and the couple live in Fulwood with their two children, daughter Samira, 12, and son Daniel, nine.
A youthful 48, David speaks with a gentle Scottish accent, a reminder of his upbringing. But he doesn’t regret leaving Glasgow.
“Wherever I went people said ‘You’re Sam Sanders’ son’. I did think I just needed to leave, and cut my own way. I worked out in my first year of being a junior doctor that I wanted my anonymity.”
He went into gastroenterology ‘completely by chance’, drawn by its mix of the ‘practical and intellectual’.
The Hallamshire unit has gone on to win the most awards of any centre of its kind in Britain – most recently, David won the Benjt Ihre Medal, one of the most prestigious international prizes in his field.
“We’re able to move things and work as a team. There is a drift towards thinking the best comes out of Oxford or London. That is not always so.”
In addition, David really has written the book on coeliac disease – he was the author of Gluten Attack, published last year, which promised to ‘reveal the truth’ about our diets.
“One of the biggest issues is people not making the diagnosis. In 1950, in the BMJ, they said it was a kids’ diagnosis that affected one in 8,000.
“At the turn of the century we documented, in a screening study, that it was one per cent of the population. Something happened over 50 years and it keeps going.
“Most likely it’s increased exposure to gluten and increased consumption.”
The protein is everywhere, he explains, and not just in bread-based foods. A ready-meal chicken tikka masala will contain gluten, and so will a Mars bar.
He believes there is a separate group of patients suffering ‘gluten sensitivity’, said to affect around three per cent of the country.
“It has a different immune pathway and we’re gradually starting to realise there’s something behind this. These individuals are struggling.”
But is it right for non-coeliacs to cut gluten out of their diet?
“It’s not unhealthy. As long as you’re having a balanced diet, there’s no risk to your health.
“There are rice-based cultures where gluten doesn’t exist.
“In India and China, as they adopt Westernised diets, they’re seeing coeliac disease for the first time, because they’re now eating pizza, pasta and so on.”
Professor David Sanders refuses to do private work on a point of principle – and has sounded a warning over the ‘tragic’ level of underfunding in the NHS.
“I think there’s a gradual degradation of the NHS, and at the end of that we will have a system where you will get very basic healthcare, and for everything else you pay for it. I think that’s a tragedy.
“I think there will be a lot of doctors that would agree with me.”
Through its endoscopy service, David’s specialism of gastroenterology is an income-generator that ‘makes lots of money for any hospital’, but the professor rejects the idea of seeing private patients.
“Maybe I wouldn’t be saying that if I lived in London – Sheffield is comparatively inexpensive. But I would like to see out my career without doing private work.”