Talk About Gluten
There has been a lot of media hype recently surrounding gluten. Practically every packaged food product that can list “gluten free” now does.
What we need is a medical doctor who specializes in weight loss and nutrition to help us understand what is really going on. So I hopped in the Skepchick-super-jet to find the perfect person to answer some questions.
I found Dr Terry Simpson.
Dr Terry Simpson is a surgeon who specializes in nutrition and weight loss. He has written articles about gluten in the past, having discovered that a number of his patients who have undergone gastric bypass ended up by passing the area where gluten was absorbed and therefore developed a sensitivity to gluten. He is an amazing chef as well as a surgeon and whenever I need some realistic information about food he is the man I call on.
One a side note, he travels all across the country to find just the right ingredients for his gourmet meals, so you really need a jet to keep up with him. He answered half of my questions in Alaska and the other half in the wine country of Napa Valley.
Thanks for taking the time to answer my questions, Terry!
Gluten sounds like a scary thing made from glue but really gluten is just a protein composite found in food processed from wheat. Is it found in other foods?
Gluten is a great protein- found commonly in wheat, rye, barley – and is the protein that makes wheat a great bread or dough product. The reason pizza dough can be tossed and stretched is gluten – if you ever try to do that with ground corn it would fall apart. The reason you can roll out dough is the gluten provides an elasticity.
Is there anything that sets apart gluten from other forms of proteins? What makes it special?
The special part of gluten is what it does for baking, for breads, and for people who are vegetarians. For vegetarians gluten is an important source of protein. It is deficient in the amino acid lysine (an essential amino acid that is needed) – but for vegetarians, gluten becomes an important source of non-animal protein.
What is celiac disease?
Like all proteins, one can have an allergy to them. Celiac disease is an allergy that affects the immune cells in the gut. There are many immune cells in the body — so some people develop allergies on their skin, some develop them to where they get a swollen tongue, or closed off airway. Celiac disease is an allergy to gluten that causes a problem in the small intestine. Essentially destroying the absorptive surface of the gut.
Celiac disease is more common in Northern Europeans (fair skin, fair haired).
How is one tested for celiac disease? Is there an objective test that one can take?
There are several blood tests that one can do which are pretty good at determining if you have celiac disease. But they do miss some. The blood tests are far from 100 per cent. The most objective test is to have someone remove all gluten from their diet for several weeks. This is a difficult thing to do as gluten is used in many agents like soy sauce, thickener in soups — so it takes a lot of work. Then introduce a bit of gluten to see if the symptoms happen– this is not subtle. If someone has celiac disease, and becomes gluten free it takes them a few weeks before their gut returns to normal. The introduction of a single Wheat Thin cracker will cause severe cramping, bloating, and diarrhea.
Can one suddenly acquire celiac disease or catch it? Is it passed along genetically?
People can acquire celiac disease suddenly- much like one can acquire any allergy. We discovered a high incidence in patients who had undergone gastric bypass surgery — we assumed that we had bypassed the traditional area for gluten breakdown in the small bowel, and the protein being seen further down began a process of an acquired celiac disease.
The predisposition for celiac disease is genetic- but is expressed at variable rates– meaning, some people will have the tendency for it, but they don’t develop it- or develop it later in life.
Is gluten safe to be eaten by a normal healthy person?
Quite safe– and delicious.
Is it good to cut gluten out of your diet just to be safe even if you have not been diagnosed with celiac disease?
There is no reason to remove gluten from your diet unless you have celiac disease. Going gluten free is difficult. Until recently there was no real flour substitute that made great foods. Cutting gluten out is popular among people who sell “gluten free” products– but there is no evidence that removing gluten from a diet will be better for anyone.
Think of gluten allergies as you would a peanut allergy. If you are not allergic to peanuts, there is no reason to avoid them. If you are allergic to peanuts, there is every reason in the world to avoid them.
Can a diet rich in wheat barley and other grains be beneficial?
A diet rich in grains provides a lot of nutrients – from micronutrients (vitamins, minerals) to the macronutrients – complex carbohydrates. Plus barley is where beer comes from, and that is pretty beneficial to some.
If you think you have a gluten sensitivity what should you do to actually find out?
First- the real tests for gluten should be performed by a licensed physician (DO or MD) — not a chiropractor, or naturopath. Those tests are called anti-endomysial antibody and anti-gliadin antibodies. They are a good indicator as any. They can be fooled if someone is on a gluten free diet.
Celiac disease is real, and an important disease among people. They are typically thin, with problems with diarrhea, abdominal pain and cramping, and have a history of the problem. These people need to know that they have an increased risk of small bowel cancers, and lymphoma – and need to have screening for them.
There is no advantage to going gluten free for people who do not have celiac disease. Gluten is simply a protein- and there is not a good way to bake bread, make good pizza or cookies without it. While one could argue that those highly processed foods are not good for a person- it isn’t because of gluten – it is the quantity of that food. Until recently, there was not a great gluten free flour.
Gluten has become the “hypoglycemia” of this decade. A fad. For those who have celiac disease, gluten free provides the only way to heal themselves. If you have a family history of celiac disease, and are unable to gain weight – then please see a real physician and get tested.
Thank you so much for taking the time to explain gluten and celiac disease to us! To find out more about Dr Terry Simpson, check out his website: yourdoctorsorders.com.
And I’m not sure about the rest of you but I’m gonna try to catch up with Dr Simpson in Italy to grab some pizza!
EDIT 9/20 11:49am: Dr Simpson has posted a more detailed article along with a video on this topic on his site to add to this discussion. You can access it by clicking here.
I love gluten. I eat a lot of it in the pure form: seitan. Seitan is usually sold as a meat substitute, but I didn’t know this the first time I had it. I just knew it was delicious. It has a great, slightly chewy texture and incorporates spices very well. You can also slice it as thin as pepperoni if you like. I like to make a seitan heavy on the paprika, pepper, and cayenne, slice it up and serve it on sandwiches with BBQ sauce and pickles. Pure yum. Now that I think about it a seitan sandwich is basically gluten on gluten. I should be dead now.
Where do you get seitan? I used to enjoy it but got tired of paying too much for it at Whole Foods. Well, actually, I have a whole list of reasons why I no longer shop at Whole Foods. I know that reasonably priced seitan must be out there somewhere as my son tells me that the dining commons at UC Santa Cruz often serves it instead of meat, much to his disgust. There is no way they would serve it unless it was dirt cheap.
Vegan Black Metal Chef recently did a show on seitan appropriately called “Hail Seitan”, it’s great and gives you lots of tips on how to cook with it.
He also rants a little about people being silly about gluten.
I had assumed that “gluten-free” was just a fad the first time I heard about it. Like pro-biotics, it’s something that’s really helpful for people with specific medical conditions, but that has been grabbed up by marketers who want something new to sell as something good for everyone.
Thanks for the post! And conflating that it is an allergy, just like peanuts, why would you avoid it?
I work as a sub. teacher in a big public school district. When I see kids who really do have Celiac Disease, they are very, very thin and usually have circles under their eyes because the disease does leave them fairly malnourished. I think it is great to have options in food choices for those with an allergy like anything else, but we should not scare away people or fool them into thinking they have something they do not.
Furthermore, I routinely see women my age who say they go to their doctor, their stomach might be upset or what have you, then they go gluten free and say they feel better. Then they go on about how awful gluten is to their colleagues and their classes, etc. only reinforcing a negative notion of gluten. When truly, paying attention to your food and being aware of what you are eating is probably more the cause of your weight loss and feeling better, no?
I would be interested in knowing more about the occurrence rate over the years and if the official diagnosis has spiked unnecessarily because of a gluten fad or is it something like autism that just has a greater awareness now so there appears to be a greater diagnosis?
Actually, Celiac disease is not an allergy; it is an autoimmune disorder. I myself had the symptoms of Celiac disease but my bloodwork and endoscopy ended up negative. A few months later, I cut out gluten and felt much better. I’ve since cut out legumes and other grains and feel even better. I have a non-celiac gluten intolerance; a lot of doctors that are behind the curve (probably such as the one interviewed) don’t believe such a thing exists.
I’d recommend getting info on this topic from a biochemist; this doc that was interviewed doesn’t seem too sharp on nutrition- check out http://www.robbwolf.com
Allergies are also autoimmune disorders. In the case of hay fever, the immune system responds to pollen as if it were a virus or bacterium or the like.
“I myself had the symptoms of Celiac disease but my bloodwork and endoscopy ended up negative. A few months later, I cut out gluten and felt much better. I’ve since cut out legumes and other grains and feel even better.”
I won’t deny you thought you felt better. However, extrapolating from this (on a Skeptical blog, no less) that there’s some kind of non-celiac gluten intolerance that you have, and that ‘good doctors’ believe in it, is just plain wrong.
There’s a logical fallacy in what you’ve said; I’ll leave it up to others to spot it.
I am SO glad I am not intolerant to gluten; there’s only one thing I eat less than gluten & that’s tomatoes. NOMNOMNOMNOMNOM.
This is true for me, too :) I eat one (or more) tomatoes a day, and I eat lots of breads, pasta, and veggie “meats” – So, most of my diet is gluten.
I know someone who has to be on a gluten free diet. It is very difficult to do (though far easier than it used to be).
My favorite salad is panzanella (essentially tomato & bread salad), LOL.
As someone who is not able to tolerate wheat gluten, I have experienced this borderline fad from the other side. I read in an issue of Scientific American (this one: http://www.scientificamerican.com/article.cfm?id=celiac-disease-insights) that there may be undiagnosed milder forms of celiac disease. If so, I would surely be a candidate. I had a blood test that came up negative for the antibodies but then I hadn’t actually eaten wheat in over a month at the time of the test. My specialist should have told me to eat a plate of pasta the day before. My GP shrugged and said “Well, if it makes you feel better, then don’t eat wheat.” Thanks Tips. It’s because of attitudes like this in the medical profession that people who suffer from these milder or mysterious forms of illness become easy targets for the alternative health industry.
That said, I certainly don’t go around telling people that gluten is evil and that no one should eat it. That’s just ridiculous. @antoinettemarie I think the incidence of the disease has more to do with the fact that people don’t have to die from it any more. We can now feed people who can’t digest gluten so they don’t die of starvation or gastrointestinal cancers. Just another case of human ingenuity beating out natural selection.
Does anyone know of that “Caveman diet”? Does anyone have any info? Pros? Cons?
I feel like it’s a lot like the Atkins diet, though honestly I don’t know much about it. I always feel like that it’s not a good idea to cut out entire food groups unless you have a medical condition (diabetes, celiac disease), and the “caveman diet” seems to discourage against grains and legumes, which I find silly and likely not healthy (unless you have a medical reason to cut them out).
It always surprises me when I hear discussions of the caveman diet how often insects and grubs are left out of the mix.
RIGHT? The argument is that “that’s how the earliest humans ate!” They also died really, really, really young. “But medicine wasn’t invented yet!” So … we shouldn’t take medicine, then, if we really want to live like the cavemen? It’s such a weird diet argument. “Live like the cavemen, it’s the best way … but only with food!”
I just REALLY feel that cutting out entire food groups is far too drastic and not healthy.
It seems to me to be full of shit. Those “cavemen” had all number of health problems both related & unrelated to diet. It also seriously drives me nuts that there are people who do the no ‘poo do thing. OK, so find a product that doesn’t make your scalp flake. Why do we have to feel the need to revert to the paleolithic all of a sudden?
It’s not so “all of a sudden”. Atavism has been around forever. We just occasionally shift the popular notion of when, exactly, the “golden age” was.
Vegetarians and vegans cut out entire food groups. As a meat-eating, grain and legume eschewing paleo-eater I find it odd that cutting out meat is considered reasonable but cutting out grains and/or legumes is questionable. What is inherently healthy about those foods when you can get much more nutrient density elsewhere?
“It always surprises me when I hear discussions of the caveman diet how often insects and grubs are left out of the mix.”
Not to mention obnoxious cousins.
Bravo! I am always saying …but do you know how often caveman would have failed to bring home the steak and eaten grubs instead? The idea that *his* diet was full of bacon and eggs, chicken and steak is laughable.
You don’t have to cut out any of the food groups for diabetes. You just have to eat a reasonably well balanced diet of normal stuff, and monitor, monitor, monitor your blood sugar (and maybe take your meds if you are type II).
Oh, I know that. Most diabetics I know don’t cut out grains completely, but they do minimize them quite a bit because it can be harder to maintain their blood sugar with them, especially if they aren’t eating properly otherwise. :)
I’m on a paleo diet. Basically you cut refined sugar out of your diet, and try to minimize carbohydrates. It’s thought that the typical “american” diet causes Type II diabetes and metabolic syndrome, as well as actually increasing the risk of Cardiovascular Disease. I know you want proof, and I’ll admit, it’s a bit hard to come by since it’s a different way of thinking. For so long, they lipid hypothesis has been the official hypothesis for what causes CVD, and information counter to it has been disregarded. (That sounds conspiracy theory-ish, doesn’t it?) For me, I watched Fathead, which doesn’t offer tons of proof, but did make me think differently about why we eat so many carbs and sugar in our diet. But, it’s proof for me, I certainly don’t expect it to be proof for anyone else.
I think also, the Paleo diet helps you lose weight, and can increase your HDL cholesterol. In my case, and my friends’ cases, we have lost weight, and we no longer get a sugar crash in the afternoon. In my SO’s case, his HDL is higher than it has ever been since we started keeping track 11 years ago, and his HDL to cholesterol ratio is below 4, which it never has been before. He was only on the diet a few months when he had that lipid panel done. I will say that his total cholesterol went up, but then, it has to, since his HDL level increased. Also, we were on a low fat diet, pretty much most of those 11 years.
It’s probably not enough for you, but I think it works for us. I’m very encouraged by his cholesterol numbers, especially because a low fat diet, and drugs never had this great of a result.
” I know you want proof, and I’ll admit, it’s a bit hard to come by since it’s a different way of thinking.”
So it’s based on … thinking and feeling instead of science?
Yeah, I’m not seeing much in a way of evidence there, bubs. It sounds suspiciously like another diet fad.
If you want to get healthy, eat less, exercise more. Eat everything in moderation. Do it for the rest of your life. I lost 77 lbs & have kept it off since ’08, doing just that. I drink alcohol, I eat junk food, fatty food, and god forbit, a fuckload of carbs (and not even low GI ones sometimes), but the difference is I do that in moderation now instead of every fucking day like I used to.
Just wanted to put in my two-cents. There’s a lot of misinformation out there about the “caveman diet.” In particular, there’s a lot of blanket condemnation because it sounds goofy. I agree, it sounds very goofy.
The whole idea is based on one principle: Animals evolve digestive systems that are specifically tailored to the foods they eat. Individual foods are not healthy or unhealthy, rather individual animals are designed to eat different foods. Tigers are designed to eat meat, if you feed them something else, they get sick. Cows evolved to eat grass, when you feed them something else (like corn), they get fat and sick. That’s it. The whole idea of the paleo diet is that there is not a single animal on this planet that becomes sick or malnourished by eating precisely the foods that it evolved to eat. Since evolutionary biologists agree that 10,000 years is hardly even a blink of the eye in evolutionary terms, this means that one should look to pre-agricultural times to see what kinds of food “man” eats.
There is of course room for debate about what those foods are, but it would be pretty naive to argue that those foods are not nutritionally “the best” for people. One would have to make a similar argument about cows getting sick from eating grass.
The idea of the paleo-diet is indeed simple, perhaps a bit too much so. The basic idea might be sound but it doesn’t account for any possible evolution since paleolithic times which in turn fails to explain why diets as diverse as Japanese, Greek, Italian, and Indian are healthful.
Are you saying all of these cultures are in need of reverting back to pealeo-diets?
If not does that not put a huge hole in the necessity of such an approach?
If so which area’s diet?
If evolution does not account for the new tolerances in these areas what would?
The idea of the paleo-diet is something to look at but it is not the magic bullet that some think it to be but I feel it is naive to believe that all humans have a “best diet”, I also feel that believing those who say there is without question (especially when those advocating that approach have a book to sell) is naive, and I believe that bold assertions to the contrary do not make said approach correct; that is what makes it a fad.
There’s a book on the bestseller list right now “Wheat Belly”: http://www.amazon.com/Wheat-Belly-Lose-Weight-Health/dp/1609611543/
It takes a pretty jihadic stance against gluten. Just as we bought a breadmaker. *sigh* Soon as I finish up this batch of wheat flour, I’ll be working on at least reducing our gluten.
And yes, there’s wheat in soy sauce. Tamari is easier to get gluten-free and Kikkoman make a wheat-free soy sauce.
I’m confused. Do you have celiac disease? Why is one book stopping you from eating bread? Popularity does not equal legitimacy.
It’s the paleo diet. They eat like cavemen.
Honestly? Silliest fad diet ever.
It’s the new Atkins.
I think I might be in love with you ;)
Hahahaha, thank you. The whole argument doesn’t even make sense! “Eat like cavemen ate!”
Why is it just “eat like cavemen” — why not live like cavemen? Not use medicine like cavemen?! If you’re gonna live like a cavemen, then I say go all the way and grow out your hair, grow a beard, and stop showering. Kill a rhino and wear the skins. Carry around a club. You know, since that’s how cavemen lived! Why just stop at food? Why is that what they chose? Oh, fad diet. That’s why.
I just like, whenever I ask about this diet, I get no actual science, but apparently “feelings” should be enough when it comes to diet now.
I thought the point of the post was that there does not seem to be any reason to think gluten is a problem for anyone who does not have Celiac Disease. If not that, what point is the book you mention making?
One of my close friends has Coeliac disease, and when she was first diagnosed there was bugger all variety in the foods she could eat. Take-away food was a huge risk. Now there’s a gluten-free everything. Not too long ago she ate her first worry-free pizza.
So thank you, unscrupulous marketers. Thank you, fad-following twits. Thanks to your greed and ignorance, my friend is no longer missing out on so many of those wonderful meals.
But there’s a dark side, which is that people don’t take gluten free seriously. There’s a whole lot of mean-spirited people who get a kick out of “messing” with people’s diet fads, such as sneaking meat into a vegan’s food, sneaking pork into a Muslim’s food, or sneaking something with gluten into the food of someone asking for gluten-free. These tend to be family members, but I’ve heard of restaurant cooks doing it as well.
Believe me, I understand the crazy allure of packaging that actually tells you that there is no bad stuff inside, and then the excitement of that stuff being not only edible but tasty (and more affordable these days, too).
I just don’t understand people choosing to eat that way voluntarily. Why cause yourself all that hardship and heartache (and even the best gluten free breads and pizza doughs are still poor facsimiles) for no real reward? It doesn’t make sense!
My best friend is a celiac, so we are always looking for restaurants that serve gluten free product.
Although there is no reason for a person without celiac disease to avoid gluten, I absolutely think it is a terrific thing when food producers and restaurants make it clear which products are gluten free. Those without celiac disease can ignore that information, but for those with, it is vital.
If you put yourself in the position of someone with celiac disease, understand that often it is very difficult to find out which meals are gluten-free, sometimes you go out with friends for a meal and get stuck with a garden salad because even the server can’t tell you what is gluten free.
Other places are really good about it. They get our business now consistently. There is an italian place nearby that has gluten free options for just about everything on their menu. We go there all the time.
“Celiac disease is an allergy that effects the immune cells in the gut.”
i realize that the gluten will cause the immune cells to do something, hence “effects” could work here, but shouldn’t it actually be “affects”?
Well, the paleo-diet argument isn’t really that you’re supposed to eat and behave just like a caveman, it’s that you’re supposed to eat the kind of diet that our body is most naturally adapted to. Or predisposed towards. Or something.
I’m not really a proponent of this or any other kind of special, magic diet, and I think chances are good that it’s totally bunk, but I think the stuff about “well why not eat bugs, then?” and “I guess we shouldn’t use medicine!” and “the cavemen died young” don’t really apply to the actual rationale, which is simple that our bodies are designed for a certain kind of diet, and haven’t had the time or means to adapt and evolve to the massively different kind of diet we now eat.
I think that idea is, at least, worth thinking about seriously and deserves some research. I won’t hop onside until there are some very conclusive, scientific, unbiased results saying that a certain diet has clear health benefits beyond those provided by our already established nutritional guidelines. But I also don’t think it’s so silly or far-fetched a notion that it deserves to be dismissed out of hand, or characterized by extremes and misrepresentations like the “well why not eat bugs then?” thing.
At the very least, it understands the concept of evolution well enough to know that almost nothing has changed physiologically between modern humans and neolithic humans. Gotta at least give them credit for that, right? ;)
Well not really, because it’s based on the perception of what the paleo diet was like, not the reality. It also does a LOT of generalizing. Which hunter-gatherer diet should we base this paleo diet on? Which region? How is that particularly scientific?
Don’t get me wrong: I’m all for healthy eating and living, but it’s dangerous to jump on the latest fad diet bandwagon without being armed with all the facts. I get what you’re saying, but really, this just smacks of Atkins, and we all know how healthy that one was.
And yeah: I’m super tired of this whole anti-carb thing. You know what? Our paleolithic ancestors were opportunistic scavengers. This meant that they only ate meat when they could get it. What the hell did the eat the rest of the time? And big hint: their predecessors ate fruits, nuts, leaves, grains, and a boat load of other stuff.
That is all.
Yeah, I agree with everything you said. Like I said, I’m not really on board with it, and am (naturally) highly skeptical about it. The paleo diet as it’s actually being practiced has all the problems you mentioned, and those are legitimate criticisms. But I don’t think the *idea* behind it is totally silly, and I would be interested to see actual research into whether or not there might be some benefits to basing our diets more closely around what they’re evolutionarily “designed” for. I think it’s an idea that merits further thought. And although the criticisms and questions you’ve raised are very good ones, the stuff about bugs and no-medicine and the life expectancy of cavemen aren’t very valid, and don’t really address the actual thinking behind the paleo diet, just misconceptions.
Another thing all those cave men had in their guts were parasites. A gut full of parasites does reduce things like inflammation because the parasites tend to suppress the immune system.
A gut full of worms is an excellent treatment for Crohn’s disease. It would probably help celiac disease.
Yes, but a large part of the paleo diet is cutting back on grains (carbs) & refined sugars, and that is where it falls down because both hunter-gatherers and their predecessors ingested high volumes of both – well fructose rather than refined sugars – but you get my drift.
P.S. I wasn’t saying it’s scientific, by the way. I was saying I’d be interested in seeing the results of proper scientific research into it. And was also saying that until we get that scientific research, I’m not willing to buy into it.
Good to know. Sorry if I’m coming off rather strong about this, it’s just that I have an anthropology background from my uni days, and misinformation like this just drives me seriously up the wall.
No worries. Your posts didn’t come across hostile or anything. I just wanted to clarify that I wasn’t taking a “paleo diet is totally scientifically verified!” position (which would be silly). :)
I had a little Twitter fight with someone about gluten and the paleo diet just a few days ago…so I wrote a blog post about some of the research on the paleo diet and gluten he sent me for Skeptoid. Enjoy!
Some of Dr. Simpson’s info above is out of date or not correct. Most significantly, a proper diagnosis of celiac disease is based on blood test confirmed with intestinal biopsy, not trying out going gluten free and then seeing if you react to gluten. This is an important point, because the medical tests (blood and biopsy) don’t work if you are already gluten free.
Also, my understanding is that recent studies have shown that Celiac Disease is not more prevalent in Northern European populations, that was just an artifact of greater awareness and screening in that demographic.
(I’m not an MD, just a patient. If you think you have gluten sensitivity, see a GI specialist who knows something about it — many gp doctors are unaware or out-dated in their knowledge)
@Mishkakim, I was coming here to say just that. The diagnosis for celiac disease isn’t “do you feel better when you don’t eat gluten?” It’s a biopsy of the small intestine.
In regards to the earlier question about the increased incidence of celiac these days, there is some thought that, in addition to increased awareness, that there is increased prevalence as well.
Now, the theory is based on some 50-year-old blood samples, so I’m not positive what the exact methodology was. So take it with a grain of salt.
Also, celiac disease isn’t an allergy. It’s an autoimmune disorder. Most people with celiac, myself included, tell people it’s an allergy for simplicity’s sake. People are less likely to do things like put gluten in your food if you tell ’em it’s an allergy.
I do know people who have celiac or some gluten disorder whose family, for the longest time, used to sprinkle gluten on their food to see if they were lying. Awareness of the severity of the actual condition is the only way to prevent people from being, pardon my French, utter douches about it.
Let me clear up a few things here: yes- traditionally to get a diagnosis of celiac disease we do and did biopsies. Something I have done a number of (as a GI specialist and surgeon). The blood tests, however, are very accurate, and are far less traumatic than an intestinal biopsy. Don’t get me wrong- I’m a surgeon, so taking biopsies of an intestine are something I like to do. The duodenal biopsy is not as diagnostic as a distal small bowel biopsy (gastroenterologists can’t reach that far). The vast majority of celiac disease we discovered in patients following gastric bypass we diagnosed with surgical biopsy of the distal intestine – and the blood tests were uniformly negative.
In terms of auto-immune vs. allergy- you have to understand the mechanism of action here- an allergy is a response to a foreign protein (or a protein modified by a hapten) and causes a large inflammatory response bringing in white cells – and essentially an auto-immune response). This isn’t a matter of semantics – stating it is an auto-immune response negates that this is caused by a foreign protein – which isn’t “auto” immune.
Prevalence in populations is difficult to assess– we have good data from Northern Europeans, and good data from others. Where the data gets confusing is what people call celiac disease, gluten enteropathy- and their criterion. They were better- but there has been some great screening studies done with other populations (Chinese, Japanese, and Dominican Republic).
Celiac disease is not something to fool around with- and most people who have it will tell you within seconds if they have consumed something with gluten.
In terms of the paleo diet- well, I’m getting in enough trouble already- suffice to say- if it does not involve running after and catching small vermin – oh, never mind, some of you take that too seriously.
Diets- are fads. They do not result in long term weight loss – lifestyle changes are not fads.
Gotta catch a plane for Rome to meet Amy for pizza– while Naples came up with the original Margarite I prefer the pizza by the parthenon – so will meet you there
The most important thing about the cave person lifestyle was the bathing part, or rather the lack of bathing part. In the “wild”, humans have a natural and commensal biofilm of ammonia oxidizing bacteria. These bacteria set the normal basal nitric oxide level by oxidizing the ammonia in sweat into nitric oxide and nitrite. This is rapidly absorbed and is very important for proper health.
One of the important things that NO and nitrite does is regulate the activity of the immune system. NO is a normal regulator of inflammation (NO inhibits NFkB which triggers inflammation), so low NO leads to a hyper-inflammatory state.
When I adopted my cave person lifestyle, my hay fever went away.
Your link calls this a hypothesis and the abstract states “If proven correct, this will…”. In the article itself we have the statement “Our hypothesis is based on numerous assumptions the validity of which need to be experimentally tested.”
Do you have other sources supplying such experimental verification, or are you bombastically promoting this as fact based purely on anecdote and your own judgement?
I have developed an insensitivity to sobriety and am going on the wine and cheese diet.
Based on your anecdotal evidence, this sounds like me too!
Damn I need an editor for my stuff:
auto-immune– inflammatory reaction to “self” tissue – examples include lupus, some arthritis, etc.
Allergy- an inflammatory reaction to a foreign protein (or protein modified by another agent).
Both are similar in that they elicit a response. When you have an overwhelming inflammatory reaction to a foreign body you will get destruction of normal cells. In the case of gluten- when the immune cells of the gut are bringing in more white cells, causing oxidation- the normal villi of the small intestine are killed by the “friendly fire,” or are “collateral damage.” When you remove the foreign protein (gluten) the small bowel can heal itself (most of the time – sometimes it can degrade to cancer).
If celiac were auto-immune then when you removed the foreign protein you would still have an ongoing reaction – or auto-immune response – against the intestinal tissue.
Hope that clears it up.
Amy- I retract what I said about diets being fads and not lifestyle- I think wine and cheese should be called a lifestyle change. I’ll bring the Zin
I’m packed for Rome and I am excited that you are joining me in the wine and cheese lifestyle change. It’s for the greater good of everyone. Or at least for everyone that comes in contact with me. ;)
Thank you for clarifying your points about the autoimmune vs. allergy comment. I was just about to make a statement against what you had said in the interview.
As a celiac I’ve usually read (or been told by medical professionals) that the response is autoimmune instead of an allergy due to the fact that it will not cause you to go into anaphylactic shock and can’t kill you in the short term (although malnourishment and cancer may get you in the long). They seemed to be using that distinction for classifying the internal response instead of the presence of foreign compounds.
I also just wanted to mention that not all celiacs are underweight although that is the most common in children. One of the signs that started me going to the doctors was a sudden gain of 40lbs within a year time frame without any major dietary changes from before that period. In adult (undiagnosed) celiacs sudden weight gain and obesity are not uncommon, although the underweight still outnumber them. I just wanted to stress this because I have heard of many people going to a doctor to get a diagnoses (blood test) and being turned down because they were overweight and not the typical “only skinny people have celiacs”.
On a side note: Do you have an opinion about the EU vs. US standards for gluten free and the possibilities of producing gluten free foods from gluten containing products through the use of enzymes that break down the protein structures?
I recently found out about a product called brewers clairex that will reduce the gluten count below 5ppb on beer which it has been added to. This would meet the EU standard for gluten free but not the US’s.
I have celiac disease, and it drives me crazy when I hear someone say they’re willingly avoiding gluten without good reason. Do you know what I would give for REAL pizza, or an everything bagel, or a krispy kreme donut? JUST EAT IT!
Thanks for the post, Amy!
Oh man. I have almost XXX-rated fantasies about everything bagels with cream cheese and dark beer.
Mrs Nurke, and the Nurke offspring are not celiac sufferers, however they clearly have a gluten intolerance of some form. Eating food with gluten results in very nasty and inconvenient digestive problems. Removing gluten from their diets eliminates the problem (sorry about the pun).
Avoiding gluten is very hard to do in restaurants and with packaged foods. Even french fries cooked in the same oil as battered foods are a source of gluten. So they follow pretty much the Paleo diet. It’s safer for them, and it works for them. They, and I, don’t really give a damn what you or anyone else eats. It’s your own business of course. So please, spare us the eye rolling when we ask for a gluten free menu.
N=5, so this goes down as anectodal, but it’s pretty hard to argue that they should not have to avoid gluten!
BTW, I on the other hand, have no such intolerance, but following their diet (which is easier all around for us, resulted in me losing 25lbs (and no, it wasn’t “conscious eating” resulting in calorie reduction). So, I’m pretty happy with it too.
Nobody mentioned one of the main reasons “gluten free” has become so popular. It’s being touted as a treatment for autism an is being pushed on CAM and Antivax as well as many autism “information” sites. Desperate parents with few options are putting their autistic kids on gluten free-casseine free diets hoping it will help.
I can’t believe that so many suggest “the caveman diet” has little or no scientific backing, and then admit they don’t know much about it… That is just as bad as what this article is condemning.
Yes, paleo has become a fad diet, but that does not mean it does not work or scientifically baseless. There is a quite a bit of scientific evidence that paleolithic people lived longer than the early agrarian societies. There are lots of reasons for that, but one is that high carb, *low fat* diets contribute all sorts of degenerative diseases. The most important thing I took away from my research on paleo diets is that fat is good for you. For me, personally, I find that I feel better when I eat less grains of any kind (no, that is not very scientific).
Last thing, do yourself a favor and at least read the wiki article if you want to talk about it: http://en.wikipedia.org/wiki/Paleolithic_diet.
From your own link:
“Evidence suggests the diet of Stone Age humans did include, in some form, the refined starches and grains that are excluded from the paleolithic diet. There is evidence that Paleolithic societies were processing cereals for food use at least as early as 23,000 or 30,000 years ago, and possibly as early as 105,000 or 200,000 years ago.”
Which is what I mentioned above. Additionally, there’s a whole section devoted to the genetic arguments in the opposing section that is well worth a read.
You make it sound like I didn’t read the article. My point was everyone should do their homework. I feel like the Wikipedia article does a descent job of showing both sides of the issue, there are citations on both sides.
No, paleo not without it’s holes, and I agree with the general idea that just cutting out gluten is a fad. I don’t really agree that no one should cut it out unless they are celiac. I changed my diet (in a big way, not just cutting out gluten) and I feel better for it. My doctor did not support my diet, however when my blood work improved after a month on the diet and I fell better, he can’t really tell me it’s a bad idea.
I have done my homework, thanks. I did anthropology (specializing in archaeology & biological anthropology) at uni. Your anecdotal evidence aside, my main problem with this essentially boils down to 2 things: 1) it claims to mimic the paleo diet, and 2) the genetic variation since them apparently hasn’t kept up with our dietary change. Since you have read the article, I guess I don’t really need to delve into why these bug me.
You changed your entire diet, which leads me to believe that you’re making better choices over all. How can you know for sure it’s cutting out gluten, rather than just eating better overall and getting rid of the crap?
I think a LOT of people who start doing gluten-free because they think it’ll make them skinny, see a change in how they feel because they are now not eating crap, and not because they’ve cut out gluten. They just generally eat better. I bet they’d still feel fine if they included gluten in with the rest of their much-healthier diet.
Correlation does not imply causation and all that, you know.
Great points – this is a confusing disease- but I tried to help with a new video and post on my site. I hope it helps (yourdoctorsorders.com) –
The autism people have tried to say this helps – it doesn’t help or change autism.
Most use gluten-free as a way to avoid processed foods– which is ok- but seriously- life without a great piece bread they way they make it in Paris (Amy, that’s the next stop, Paris for rolls).
For those who suffer from Celiac disease- it is a difficult way to live- however, there is one bit of good news. Thomas Keller (of French Laundry and Per Se) – a great chef- has come up with a gluten-free flour that you should try.
I find this to be a better intro to paleolithic eating than the wiki entry. This is an intro not an end all be all:
I’m not sure where this idea that gluten-free is a fad originates from, perhaps a knee jerk skepticism of anything new?? Why should this be a fad especially as more and more science supports a low to no gluten lifestyle? More importantly, people are seeing results on these diets–this is where the “think and feel” aspect of science (empiricism is a part of experimentation, particularly where the human body is concerned) comes into play. If a food or diet makes you feel better in the long term (not to be confused with instant gratification of fast food) why wouldn’t you continue to eat that way?
Well, considering that the idea of the paleolithic diet has been around for some 30+ years and yet the only people who seem to be currently advocating it are those who have books touting it as a magic bullet (see Leren Cordain, Robb Wolf, et al) there is good reason to be skeptical. As far as the gluten argument there is no good reason for anyone who does not have a gluten sensitivity to avoid gluten beyond “better to be safe than sorry”.
You say there is more and more science that supports it; could you show some science that supports it that does not come from a source with a book to sell?
Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease!
So the statement from the article
“There is no reason to remove gluten from your diet unless you have celiac disease. Going gluten free is difficult. Until recently there was no real flour substitute that made great foods. Cutting gluten out is popular among people who sell “gluten free” products– but there is no evidence that removing gluten from a diet will be better for anyone” should be taken with a grain of salt.
From the study you linked to of 34 people: “despite increased prescription of a gluten-free diet for gastrointestinal symptoms in individuals who do not have celiac disease, there is minimal evidence that suggests that gluten is a trigger.” “CONCLUSIONS: Non-celiac gluten intolerance may exist, but no clues to the mechanism were elucidated.”
Sorry, but you’re cherry-picking.
The text that you quote is from the Objectives section, which is the rationale why this study ha been conducted and not the result of the paper.
Secondly, you omit the following sentence from the conclusions: “On a visual analog scale, patients were significantly worse with gluten within 1 week for overall symptoms (P=0.047), pain (P=0.016), bloating (P=0.031), satisfaction with stool consistency (P=0.024), and tiredness (P=0.001).”
Whether or not these symptoms arise due to gluten (alone) remains to be seen. But the study surely warrants further research on this. And I only said that Dr Terry’s statements should be taken with a grain of salt…
What do you mean I was cherry picking? I quoted the conclusion verbatim.
Yeah, there may be something to look into, sure, but a study of only 34 people that came up with no mechanism and tested primarily subjective symptoms is by no means a reason to throw up our lawn chairs, cross our arms and start eating only berries.
It’s part of science to criticize your own results as well as the results of others. One should not take everything at face value. If the study was poorly designed, it was poorly designed, and that lends some incredulity to the results.
Also all patients in the trial had IBS (not indicative of the population at large), and the sample was small for a heterogeneous population.
@Mrmisconception, everyone’s body is different and bodies respond differently to different diets at different times in their lives. I used to eat a diet with a ton of white flour and gluten when I was an competitive cyclist in my early 20’s. I also had a ton of energy. I’m now nearly 40 years old and the slightest bit of gluten causes digestive issues and leaves me feeling run-down. I’ve had to switch to nearly a vegan diet 75% of the time with bits of chicken and fish thrown and gluten free. It doesn’t necessarily please my palate, but that’s how my body feels its best.
I’ve never bothered to be tested for gluten sensitivity.
If everyone’s body was different we would never be able to develop effective medications or vaccines that work on mass majorities of the population.
Yes, digestion and metabolism changes as you age. Eating healthy is important and some food will make you feel more tired than other foods but without an objective test or conclusive evidence I don’t think it’s wise to vilify a protien especially when you are basing your conclusions on subjective anecdotes.
It’s very easy to convince yourself of something that may in fact not be true. I spent about 6 months convinced I was allergic to egg. It would make my mouth itch when I ate it. I was really concerned, so I stopped eating eggs and I went to the allegist and actually got tested. And guess what? No allergy. The test came up negative and then suddenly the symptoms went away. Seriously. I consider myself a pretty rational person and I have learned that I can not trust anecdote alone, not even my own. It is easy to convince ourselves and others of things that may not in fact be true or blame things that do not deserve blame. That is why we need to trust in science and empirical evidence and not anecdotes or people trying to sell books on the latest fad diet.
You may have gluten sensitivity. Perhaps you should go get tested.
@Mrmisconception, everyone’s body is different and bodies respond differently to different diets at different times in their lives.
Well, yes exactly. The very reason that any one diet should ever be advocated for everyone is wrong, as is vilifying a protien because some have a sensitivity.
Remember monosodium glutamate? That was the additive to fear at one point and lots of people had awful symptoms attached to it’s ingestion; even when it was never used in their favorite Chinese restaurant’s dishs, meaning they had only thought they had eaten it. Plenty of people develope symptoms when those symptoms are suggested; seems we all seem to have a little hypocondriac in us.
Taking celiac disease, and other actual food-caused disorders out of the equation, perhaps one reason a good number of Americans suffer from food-related disorders and illnesses, is not the food we eat, but how we eat it.
We don’t have to go back to the paleolithic era to eat a healthy diet. We simply need to follow the example set by our ancestors, e.g., grandparents, in the times before the fast food culture.
Eat slowly, chewing food thoroughly, so that the enzymes in the saliva have time to do their thing before food reaches the stomach. Of course, our grandparents didn’t know an enzyme from a quark, but they did know the inner workings of the body in a way that we have lost touch with.
Slow down and enjoy your meal, even if you’re eating at Burger King (my personal weakness exposed ;-).
My roommate has been plagued with every digestive system problem in the book for decades. In addition, she has severe osteoporosis at 51. Finally – out of sheer desperation, I think – her doc told her a couple of weeks ago to try a gluten-free diet for 6 months. Now she’s going around bitching about how expensive it is and what a pain it is to stay on.
(Trust me, I KNOW how expensive it is, and what a pain it is to stay on. I tried it myself 20 years ago. But that’s a whole ‘nother can of worms…to make a long story short, it didn’t make a bit of difference.)
I’m not in a position to say whether her doc is right to try her on a gluten-free diet, or whether it will do her any good, but at the very least, it won’t hurt her, and I just wish she’d STAY THE HELL ON IT until they find out if it helps or not!
I also wish I didn’t have to be the one to explain to her what it’s all about. Her doc & nutritionist should have done that – if she brings me one more thing & asks, “Can I eat this?” I think I’ll strangle her.
Wow: this whole thread blows me away – we can be skeptical about Jeebus H. and the Hairy Snowman, but diet? How has diet cultivated such a high level of woo in the skeptical community?
It’s interesting how angry and irrational people get when you bring up food. It happens every time we bring up diets. At least this wasn’t a thread on being vegetarian.
People on both sides of the vegetarian equation bring the woo-factor to the diet debates. I really wish people would actually look at the ‘facts’ they bring to bear in these arguments. Particularly if they’re going to bring up biological evidence like teeth as an adaptation to meat eating. Have they SEEN what carnivorous teeth look like any time recently? Never mind that hominid teeth have been adapted over millions of years to grinding down PRIMARILY on hard nuts and consuming foliage, fruit (fructose), and grains & more rarely: whatever bugs, grubs & meat that they could scavenge (and then later hunt).
Which ties into my point re: the paleo diet. Do these people really think that we only started eating grains & sugars post neolithic. REALLY? Motherfuckers need to check the pollen records some time. Grains didn’t just appear post agricultural revolution. And HELLO. Fruit is fucking sugar bag.
Sensitivity to gluten and other wheat toxins should not be so summarily dismissed on such scanty reasoning. There is good reason to suspect that gluten and/or other wheat compounds can contribute to poor health in otherwise healthy individuals.
I’d suggest that you read the following articles and either admit that there might be reason for concern or counter the arguments made within:
Whether or not you agree with everything in these articles, please do not dismiss them on the basis that the author is selling a book. If the author is (in your opinion) wrong, then please do us all a favor and tell us why you think so. Remember, “Skepticism is not a position; it’s a process.”
It’s all well-and-good to be skeptical of the rush (and the push) to be “gluten free,” but as the husband of a woman with apparently real food sensitivities that aren’t full allergic reactions, I leery of Dr. Simpson’s dismissive stance.
To avoid the anecdotal trap (and nitpicking Dr. Simpson’s points), let me just point to two relevant articles, one of them a peer-reviewed study published in BioMed Central earlier this year:
1. What’s the difference between a food intolerance and food allergy? (http://www.mayoclinic.com/health/food-allergy/AN01109)
2. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity
One minor direct quibble (can’t help it): My wife makes an awesome gluten free bread – soft, spongy, eminently toastable and full of flavor, and easily three times as large as the tiny Udi’s brand sold at the local Martin’s.
“If everyone’s body was different we would never be able to develop effective medications or vaccines that work on mass majorities of the population.”
I see your point but you have to admit it’s a bit more complicated than that. How many people will get a headache after their vaccine, throw up, develop a rash or feel fine and exactly the same? Sure, the mass can tolerate,/i> a vaccine, but there’s individual responses happening, some good and some bad.
Just like with food.
Yeah, some people have allergies. You can test for those allergies. This in no way establishes that gluten is bad for the mass majority of the population.
And I guess I should add that in the case of getting a headache or feeling sick in some way after getting a vaccine does not mean the cause is from the actual vaccine. Correlation does not imply causation. Maybe just the idea of getting a vaccine stresses you out and then you feel sick or maybe you get sick from another source. They are many other valid explanations. That is why you need objective tests to validate that there is an actual connective relationship between subjectively reported feelings and actual things.
Of course not. I was just replying to the notion that all of our bodies must be the same because vaccinations work on just about everyone. It’s not that simple.
Like others have mentioned, even though an allergy test indicates no reaction, that does not mean some people aren’t better off without gluten (or soy, or dairy, or meat, whatever) if they feel better without it. Is it anecdotal? Yep. But who wants to wait for some study to confirm or deny what their body is already telling them?
Now I think the point of this post was just to point out that people who don’t need to worry about gluten are avoiding it because of the sudden anti-gluten wave. Which is great and I hope it encourages people to chill out and use their own logic to conclude what’s the best diet for them.
However, as someone who suffered with acne for 13 years and the only thing that made it go away was to avoid certain foods, that’s good enough for me. I could care less if a test shows I’m intolerant or if Dr. Cupcake tells me not to worry because his study of 137 people eating no cake for 3 weeks saw no improvement in their acne. (Not an actual study) Having said all that though, 5 years ago if someone told me to change my diet to get rid of acne, I’d have laughed in their face…lol I guess my point here is that when it comes to diet, just make it your own responsibility. There will always be fad diets, there will always be superfoods, and they will always change.
I find the whole gluten-free movement utterly bizarre.
Of course, I’ve been allergic to wheat since I was born, and was diagnosed at age 2, after a heavy exclusion diet and a battery of blood tests since I was eating like a horse and failing to thrive.
(And on what other posters have said about ceiliac children – yes, I know the look. I was one of those vomity waif children as a toddler)
In the last 22 years I’ve eaten practically every wheat-free replacement food on the market. And while I’m personally grateful that a there’s now a market for Options! That are Tasty!, the sheer concept of someone voluntarily removing all wheat products from the diet still does my head in.
It’s in everything. Especially restaurants, fast food and party food and really, any food that you eat out of the house. And I still remember the good old days when the options for “breadlike food” consisted of rice cakes (styrofoam! Yummy!) or those corn wafer things (cardboard! Even tastier!). I remember the heady excitement of the introduction of rice thins and corn thins, and when rice crackers got more than 4 flavours (original, sesame, seaweed and chicken).
I understand the allure of the forbidden from my side. But watching people voluntarily tell me that they want to make their life 5x harder and put up with eating crumbly bread – it puzzles me.
Just as I suspected. It is huge in the pet food market now too. It is just a fad. Really does nothing unless you are part of the very few people that have allergies to it.
I need to ask a vet about how many dogs have allergies to gluten.
Oh, *bleeping* please. Human civilization is practically coincidental with agriculture (specialization of tasks leading to food surplus).
Rice has been demonized as “empty calories.” Are east Asians chronically fat?
Potatoes are demonized as “empty calories.” Are the Irish chronically fat?
Veganism has been touted as the only way for humans to live, despite the success of Mongols, Aleuts, Inuits, and others.
If you are a human and eat a balanced diet consisting of the types of produce and animal products locally available, you are probably not going far wrong. And if you want to subsist on a paleo diet, make sure to do it right. Get the calorie input correct, and move at walking speed or more for at least half of your waking hours. Those paleolithic humans that you wish to emulate did not sit on their fat butts in Volvos to drive a half-mile to a grocery store.
Regarding the science behind these claims, has anyone heard of a book called “The Science of Why we Get Fat?” by Gary Taubes. He was interviewed by Swoopy on Skepticality a few months ago.
He goes into great lengths to explain why the “calories in, calories out” argument that is dietary orthodoxy is not true. Also: there is obesity in the developing world, contrary to popular belief: obesity and malnutrition frequently go hand in hand, and he cites many case studies and surveys done by the UN as examples.
Not that this has anything to do with gluten intolerance…..
As a mom of a child with celiac, I wanted to address some info in this article that I feel may be incorrect. As stated, a blood test, while not always correct, is the first step in addressing the possibility of a celiac diagnosis. The second step is a biopsy. The biopsy is the gold standard for celiac diagnosis, and you should not cut gluten out of your diet until that has been done.
Also, if your facing a celiac diagnosis, take heart. Its not all gloom and doom for your favorite food items. While non-celiacs avoiding gluten may be silly, its also lead to the creation of some wonderful products that are as good if not better than many of thier gluten containing counterparts. I can make a gluten free chocolate chip cookie that is identical to toll house. Corn and Rice pastas are excellent. The downside, of course, is that its more expensive to eat gluten free.
It is true that blood tests these are very accurate and that they are much less traumatic than a biopsy or similar. What’s more they are easy to come by these days and you can even buy them from pharmacies or online. But I also think a blood test should be used as a screening test for a follow-up biopsy as I agree with yelena36 that this is the gold standard. But I would proffer the question do you really want to know? Symptoms of coeliac / gluten intolerance vary across a wide spectrum from barely noticeable discomfort to severe pain, bloating, cramping etc. I would only look to do initial blood screen I were on the “hard to tolerate symptoms” end of the scale. This is largely because, in my experience, having a totally gluten free diet is actually quite hard to achieve (not to mention often times really expensive). Gluten is ubiquitous in most processed foods and it’s hard to eat out truly gluten free. Like most things in life things have to be evaluated carefully; it’s often a case of settling for the “lesser” of 2 evils.
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