What about gluten?

What is gluten? It’s hard to read nutritional information online or packages in a food store without thinking that gluten is another word for “arsenic.” Avoiding gluten is the newest big food fad, with some claiming that such a diet can cure autism or allergies or asthma or any of a wide variety of conditions. Is gluten something you should avoid? What is it, what’s it used for, and what’s it doing to us?

Someone has probably written a book about the history of bread and its importance to human culture (if not, I’m on it). Long before Superman lunchboxes and Wonderbread, bread made out of crushed corn or plant roots made it possible for people to carry their nourishment with them for long trips. But these early breads were crumbly and fell apart easily and likely tasted like packing peanuts.

Once we evolved to Farmer-man, we figured out that cultivated grains, like wheat, were much better out of the oven. These grains contain the protein gluten, which is a long, tough molecule that gives modern bread dough its bounciness and elasticity. These loaves didn’t fall apart, and could be transported great distances. It’s not a stretch the say that gluten, like salt or cod or gummy bears, played a vital role in the very development of our culture.

These days gluten is used in many other foods as well. It’s useful as a protein supplement, and as an all-natural way to add sponginess to foods. Products like ketchup and ice cream are commonly thickened with gluten. Almost all imitation meats and cheeses prized by vegetarians are based on wheat gluten. And gluten is not just limited to food. Its a key ingredient in some of the new bio-plastic materials as an alternative to petrochemicals, and is commonly used in cosmetics such as lipstick to add firmness or body.

But for mysterious reasons, there’s been a growing trend in recent years to view gluten in a negative light. It is true that a small number of people are born with gluten sensitivities that reduce their ability to tolerate it to varying degrees. Perhaps the thought is that if some people can’t tolerate it, it therefore must be generally bad for everyone? As a result, some promoters of fad diets and various health schemes are now advocating gluten free diets, and shady characters and certain food manufacturers are cashing in.

Gluten free diets actually are necessary for some people, and advisable for others. These situations are quite rare, but they are real. The first is celiac disease (CD), or gluten-sensitive enteropathy. This is an autoimmune disease of the small intestine that occurs in people with a genetic predisposition. It’s not caused by gluten and you can’t develop it by eating gluten, but if you’re one of the unlucky few born with the gene, and you go on to develop CD, eating gluten will cause an adverse reaction. The immune system inside the bowel tissue reacts to the gluten proteins, causing inflammation of the bowel tissue, and this interferes with your body’s ability to absorb nutrients from food. There’s no cure for CD, and the only way to live with it is to adopt a gluten free diet for the rest of your life. Somewhere between 1 and 8 in 1,000 Americans have this, give or take (the exact frequency is not well known).

A wheat allergy is very different, and can be harder to track down since there are many different components of wheats and other grains that it’s possible to be allergic to. A wheat allergy is not a single condition; it is any of a great number of possible allergies. The symptoms are similar to what we expect from most allergies: hay fever type symptoms, hives, asthma, and swelling. More serious effects in the worst cases can include anaphylaxis, palpitations, swollen throat, diarrhea, and even arthritis. Unlike CD patients, sufferers of wheat allergies need not necessarily avoid all wheat products. The allergy is usually pretty specific and only some foods may need to be avoided. Standard allergy treatment with drugs such as antihistamines may prove effective enough to allow the patient to live with a normal diet. You need not eat wheat to have an allergic reaction; some may react by simply coming in contact with wheat. It’s very difficult to attach a number to how many people have some level of allergy to some type of wheat related protein, but it’s probably somewhere in the single digit percentage points.

There’s also a third type of gluten sensitivity, and that’s gluten sensitive idiopathic neuropathy. Idiopathic means the exact cause is not known, and a neuropathy is a disease of the nerves. Symptoms can include numbness or tingling in the extremities, or problems with muscular coordination often evidenced when walking, or even spasticity resembling epilepsy. Diagnosing this neuropathy is difficult. The blood test frequently produces false positives. And sometimes, sufferers may actually have a mild case of celiac disease instead. The number of people with a gluten sensitivity neuropathy is not well-known, but it’s very small.

That’s it for the poor souls that need to or may want to avoid gluten. But some people would have us believe that many more of us should avoid it. Of course, these people are generally the people who sell gluten-free products. For example, GlutenFree.com claims their products help people with autism or ADHD, which is completely untrue according to all the science we have. The autism claim in particular is broadly repeated across the autism activist community. The treatment of autism with a gluten free diet has been studied a number of times with varying results, but so far no well designed studies have shown any plausible benefit. A 2006 double blinded study published in the Journal of Autism and Developmental Disorders tested children with and without autism, on gluten-free and placebo controlled diets, and found no significant differences in any group.

In addition to those that seek profit from the fad, many well-intentioned naturopaths routinely list gluten as a potential cause of disease. This is a bizarre and unfortunate claim. Proteins are essential for nutrition, and there is certainly no evidence that disease has increased worldwide since wheat grain became a staple. Indeed, prior to this, life expectancy was probably something like 16.5 months, give or take. It’s true that bread itself is a rich source of carbohydrates, which are not essential and can be safely minimized in the diet, but this is true of gluten-free breads as well. By no logic should the strategy of avoiding carbohydrates be misconstrued as avoiding gluten.

Given this fad, I have heard from many people that a gluten-free diet has helped them recover from various maladies. In my own observations, it is not uncommon for people to say they feel better since going gluten-free. Is this all placebo? And if it is, isn’t that okay? I mean, if someone is paying closer attention to their diet, and they feel better, is there reason to encourage such actions?

I think there is a good reason why the science and these perceptions are not contradictory. When you try to cut out gluten what are you cutting out? Let’s look at food that are high in gluten, foods like processed cheese, chocolate milk, ice cream, baked goods, cereals, pastas, breaded meats, lunch meats, gravy, jams, fruit-filled pastries, French fries, and flavored potato chips.

I propose that anyone that cuts the above foods from their diet will feel better! This is not because these foods contain gluten, even high levels of gluten. It is because these foods are also loaded with simple sugars and fats.

So think of gluten sensitivities in the same way you’d think of bee stings or peanut allergies: of great and very real concern to a small number of people, of some concern for a few more, and of no concern to most of us. Don’t let anyone tell you that gluten is harming you in some way that’s so far not supported by science. And yet, look at your diet with the vigilance of those that are aggressively cutting out gluten and find ways to balance your diet with complex carbs like fruits and veggies, healthy proteins, be they from animal, soy or even gluten sources, and fats. Eat food. Not processed imitations. Eat local whenever possible. But eat less overall. And you will indeed treat and prevent disease and just plain feel better!

21 Responses to “What about gluten?”

  1. Grant Sanders Says:

    Based on a few books I’ve read, the reason many people are losing weight and feeling better when they cut our gluten is not because they are reducing sugars and fats. It is because they are, by and large, eliminating wheat from their diet. The wheat we eat today is very different from the wheat we cultivated a few hundred years ago. It is dwarf wheat that is highly processed. I agree that gluten is not the culprit many people make it out to be. But if you believe what is written in books like Good Calories Bad Calories, Wheat Belly, Why We Ge Fat and The Zone, it’s clear that getting rid of wheat in one’s diet can reverse a number of real problems. Yes, sugar is bad, too. Very bad. Fat has gotten a rather bad (and largely undeserved) rap. Meat has also taken its unjust knocks. But until recently, wheat has worn a halo. The data, however, points to wheat being the main culprit in the rise of diabetes, cancer and heart disease, at least from what I’ve read. G.

  2. meg Says:

    World Sourdoughs from Antiquity, author: Ed Wood. Absolutely fascinating.

  3. Greg Says:

    I’m not ready to anoint wheat the next big bad thing (like we have already done with fats, eggs, meat, gluten, corn, etc.). Is wheat bad for you? Yes. Is wheat good for you? Yes. Foods made from grain are like the energy bars of yore. They have a lot of pent up energy stores. This is what made them important in the developing world, i.e., before you could buy breaded, fried processed chicken parts at a Cumbies. Modern ways of processing it have and cultivating it have likely improved the energy delivery system of these foods, and yet we have to move so much less than we used to. We’ve replaced being chased by predators and our nomadic habits with sitting on a couch and clicking a remote. And now food is everywhere and we don’t have to chase it. We’re not fat and diabetic because we eat wheat. We’re fat and diabetic because we eat way too much of it. And everything else. Given its halo, it’s place at the bottom of Mr. Sanders’ 5th Grade plastic food pyramid model (which in my classroom at Blanchard Elementary, Columbus, GA also had a cockroach that had managed to get inside the pyramid before it was sealed, and died, and was on permanent display on the meat shelf and was always good for some 5th grade humor) as being the most important staple in our diets, I think it is good that the Wheat Belly books are taking it down a notch. But it’s not the next big bad thing.

    On one side of the Wheat Belly argument, for those that have not read the book:

    http://boingboing.net/2011/10/26/triticum-fever-by-dr-william-davis-author-of-wheat-belly.html

    On the other side:

    http://www.thebestgrains.com/wheat-improvement-the-truth-unveiled

    As with most things in life, the truth probably lies in the middle.

  4. Claudia Says:

    From a series of genetic testing it was found that I am sensitive to gluten. For the most part I have cut it out of my diet along with sugar, dairy and fried foods. Naturally I have lost weight. I do not eat a lot of “gluten-free” products. I agree with what Grant is saying. The wheat here in the US is completely different than other countries simply because it has been grown and processed in such a way that it is deprived of any food value. You might as well eat glue for the way it sticks to your intestines and wreaks havoc on digestion. Your body has to expend so much more energy to digest this “food” that has very little nutrition in it. Sure, you can analyze it to death but the most important thing to remember is what makes you feel well and healthy. Try to knock it out of your diet (most people can’t or won’t) for one month and see the result. I found it significant and so did my husband. Our allergies cleared up and we both have more energy and less gut issues.

  5. Claudia Says:

    Greg, it’s not the “next” bad thing, it “is” already the “bad thing”! I have to say that the way it’s processed does not give us much nutrition and I agree about chicken nuggets too!!!! The need to cut down on it is great, but unless you go cold turkey to clear your body out and balance your sensitivities than you will not know how it feels to be gluten-free. I had a great blood test done, very extensive, through the Marino Center that showed food sensitivities and allergies. It showed I was sensitive though not allergic. I would love to share my results with you. BTW I do eat a bit of gluten now and am not so strict after 2 years and it doesn’t seem to bother me. I’m just gaining weight! Smile.

  6. Greg Says:

    Claudia, FYI. I addended my comment to Grant above with a link from the Grain Growers discussing Facts and Myths in Dr. Davis’ book. I would never question your response to cutting wheat out of your diet, and if you’re someone that is allergic to wheat, then that is absolutely the right thing to do. But what makes it difficult for a lot of people is that it is tough to cut out wheat in isolation. When someone goes wheat-free or gluten-free for a month, they are often paying close attention to their diet for the first time in years. No longer mindlessly eating chips or cookies or crackers or ice cream. And often they are doing it because they feel bad or need to affect some sort of change in their health, so they (like you) cut out sugar and dairy and alcohol and fried foods too. All I’m saying is, of course they feel better when they do this. And, scientifically, it is impossible to relate that improvement in how they feel back to just one thing they cut out. Wheat. I’m not an agricultural scientist (neither is Dr. William Davis) so I really cannot comment on the science behind modern wheat. But there is some good info in the second link above.

    At the bottom of Dr. Davis’ post from above, he concludes by saying, “That’s a lot to cut out, true, but there’s still plenty of real, nutrient-dense foods like vegetables, fruit, nuts, cheese and dairy products, meat, fish, soy foods, legumes, oils like olive oil, avocados, even dark chocolate that you can eat in their place. If after that 4-week period you discover new mental clarity, better sleep, relief from joint pain, happier intestines, and a looser waistband, you will have your answer.” What I’m saying is, look at the list of things his book recommends you replace wheat with. This is real food. The best there is. People who feel better and lose weight do so because they change the diet to this stuff, instead of the pastas, breads, and pastries that had their diet out of balance towards simple carbohydrates in the first place.

  7. Claudia Says:

    I hear you and appreciate this comment. I took a different approach. First I cut out all white flour and sugar. Several months later I cut out dairy and gluten. Later I cut out alcohol and most recently anything fried, gluten-free or not.
    But, after doing that a year plus I have been adding in some of it again, specifically when I travel. Imagine Italy gluten and dairy free? It’s nearly impossible! Smile. I love food, but my health now comes first.
    Saying that I’m enjoying a green juice as I write…

  8. Greg Says:

    Yep! That’s what I’m talking about. The beauty is… Though it is hard to do this in today’s world of convenience, fast food, drive thrus, and processed food… The beauty is, eating right means you can really, actually enjoy food. Real food, not imitation food from the middle of the supermarket aisles. And eat less of it. (Even in Italy!)

  9. Katya Says:

    Actually Italy it’s the country with large amount of people having a celiac disease. They have a lot of gluten free products all over the world. Every year and a half old child is tested for celiac. The gluten and wheat are not bad for your body, but lately the amount of gluten in product is way more then every normal person can handle it. This is my opinion of course:). I am gluten free because of my son. Do I feel better, yes, but I think mostly because I cut the carbs. Is he feel better, yes, but he has a celiac.

  10. Rachel Says:

    I agree with Grant’s and Claudia’s comments as well. I never understood how much grains were making me sick until I gave them up at Christmastime. I had nothing showing up in blood work or a colonoscopy, but my body had gone into an acute state of inflammation. Grains contain anti-nutrients that work against their actual benefits, and a certain acid that over time actually alters the make-up of our intestinal cells, injuring them so that they cannot produce digestive enzymes or do the work of breaking down food and absorbing nutrients. This damage can be reversed by introducing foods that are more bioavailable, allowing our bodies to heal and absorb nutrients. There is also a lot of compelling evidence out their linking gut health to both autism and many auto-immune conditions. Check out The Boy With THorns in His Joints, recently published in NYT.

  11. Greg Says:

    Grains do not contain “anti-nutrients.” Grains do not contain a “certain acid that…alters the make-up of our intestinal cells” making them useless.

    I loved the Boy with the Thorns article. Here it is:

    http://www.nytimes.com/2013/02/03/magazine/the-boy-with-a-thorn-in-his-joints.html?pagewanted=all

    I think the author did an excellent job showing just how little we know, overall, about the interface between nutrition, gut flora, disease, quality of life, novel intestinal infections and traditional medicine’s ability to adequately treat this. It has long been well-known that there is a relationship between inflammatory arthritis and inflammatory bowel disease but we are not good at treating these things and it just may be that careful nutritional support might be the only treatment needed.

    But I refuse to accept the notion that grains are inherently bad for you, and this, I would argue, would be the stance of the majority of scientists. There are too many examples of cultures noted for their longevity for whom whole grains have long been an important staple of their diets. There are strong studies showing improved life expectancy, lower disease rates, and reversed heart disease for people following Dr. Dean Ornish’s Spectrum Diet, which relies heavily on grains.

    Here’s a link that shows just how varied opinions are on this right now:

    http://www.huffingtonpost.com/jay-williams-phd/best-diets_b_2268460.html

    And another that does a good job of showing just how complicated the science is, i.e., trying to sort out all the players and what sorts of interactions actually contribute to disease:

    http://gaps.me/preview/?page_id=344

    After all, distilled water will kill you if you drink too much of it.

  12. Ema Hudson Says:

    thanks for standing up for gluten. i’m tired of the fad. eat what works for your own body and allow others to make their own decisions.

  13. Rachel Says:

    Dismissing the path to wellness that many people are finding in avoiding gluten and grains (and sugar and most dairy) as a fad is preposterous. The Boy With the Thorn in His Joints shows what can happen when people trust their instincts and follow their own hearts (and bodies) instead of the constant naysaying and skepticism from most doctors.

    I challenge you to go grain free for a week and see how you feel. Then we’ll talk.

  14. Rachel Says:

    Other cultures that eat a lot of rice, for example, also don’t eat any of the processed foods whereby so many grains are snuck into the American diet. They also eat a lot of coconut oil. There are a lot of variables at stake which make it hard to compare to other countries at face value. The only real way to find out is to try it for yourself. “Anti-nutrients” is a new term, and not a fruitcake one. Also, the digestive cells are in fact impaired over time from overexposure to too many carbs. If one is producing a lot of mucus, it is the body’s inflammatory response in an attempt to protect those cells from further damage. I will get back to you on the name of the acid that is so abundant in grains.

  15. Rachel Says:

    FYI, on anti-nutrients:

    http://paleolithicdiet.wordpress.com/2008/06/22/antinutrients-your-key-to-bad-health/

  16. Rachel Says:

    Phytic acid is the word I was looking for. Lectin in another.

  17. Greg Says:

    That such a diet has helped you to feel better is enough, isn’t it? That’s great to hear! No further justification by marginal science is even needed.

  18. Georgia Raysman Says:

    Greg– here’s another post on food and medicine. Not related to this gluten topic, but I don’t have another email to send it to you. http://opinionator.blogs.nytimes.com/2013/02/20/our-m-i-a-surgeon-general/?nl=opinion&emc=edit_ty_20130221

  19. AckShedHunter Says:

    Never eat anything man has made or that comes in a package.

  20. Rachel Says:

    Here is an interesting study published on the CDC website examining the role of gluten and increased intestinal permeability in autoimmune disease.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886850/

  21. Greg Says:

    That is an excellent summary of the link between auto-immune diseases like Celiac or various arthritis conditions and the gut. What we know is that it takes a genetic predisposition towards these changes being able to happen, and then some sort of activation. Some people carry the genes for it, and never develop Celiac; this article states that fewer than 10% of people that carry the genes actually develop disease. Gluten is a definite trigger. The article surmises that it takes some sort of combo of excess gluten intake, specific more-toxic forms of gluten, and infant feeding patterns in order to activate the disease (i.e., not breastfeeding). The article also mentions that by arresting the exposure to the triggers, you can “turn off” the disease as well, which is exciting and certainly why some people feel so much better off the protein. Without the benefit of science to back this up, it’s my opinion that a large percentage of people carry the gene and, historically, have never suffered from the disease. However, over the past 50 years, we have seen tremendous changes in our diets. We are Super-sized. The Low-fat movement just resulted in increased sugar and grains. We are eating more and more grain-based and grain-fed products. And, accordingly, more people with the predisposition are getting “acitivated,” hence the increasing incidence. This means that we need to, on the whole, be more careful about our diets. Eat less. Eat less processed foods. Eat more real food. But it doesn’t mean that gluten is, for the vast majority of people, a problem with being a part of this diet of moderation. There is no doubt that these gut and diet related autoimmune diseases exist. We’ve known that for a long time. And, for some, it is extremely important to avoid all traces of gluten. There is also reason for everyone else to be careful about the quantity (and quality) of the grains they eat. But the idea that the entire population is somehow better off avoiding gluten is just a fad and any attempts to restrict our diets of specific nutrients just impedes the path to moderation.

Leave a Reply

© 2009 ackdoc - Greg Hinson, MD 508/325-9981 info@ackdoc.com Purchasing help RSS feed