Thursday, January 20, 2011

Eating Wheat Gluten Causes Symptoms in Some People Who Don't Have Celiac Disease

Irritable bowel syndrome (IBS) is a condition characterized by the frequent occurrence of abdominal pain, diarrhea, constipation, bloating and/or gas. If that sounds like an extremely broad description, that's because it is. The word "syndrome" is medicalese for "we don't know what causes it." IBS seems to be a catch-all for various persistent digestive problems that aren't defined as separate disorders, and it has a very high prevalence: as high as 14 percent of people in the US, although the estimates depend on what diagnostic criteria are used (1). It can be brought on or exacerbated by several different types of stressors, including emotional stress and infection.

Maelán Fontes Villalba at Lund University recently forwarded me an interesting new paper in the American Journal of Gastroenterology (2). Dr. Jessica R. Biesiekierski and colleagues recruited 34 IBS patients who did not have celiac disease, but who felt they had benefited from going gluten-free in their daily lives*. All patients continued on their pre-study gluten-free diet, however, all participants were provided with two slices of gluten-free bread and one gluten-free muffin per day. The investigators added isolated wheat gluten to the bread and muffins of half the study group.

During the six weeks of the intervention, patients receiving the gluten-free food fared considerably better on nearly every symptom of IBS measured. The most striking difference was in tiredness-- the gluten-free group was much less tired on average than the gluten group. Interestingly, they found that a negative reaction to gluten was not necessarily accompanied by the presence of anti-gluten antibodies in the blood, which is a test often used to diagnose gluten sensitivity.

Here's what I take away from this study:
  1. Wheat gluten can cause symptoms in susceptible people who do not have celiac disease.
  2. A lack of circulating antibodies against gluten does not necessarily indicate a lack of gluten sensitivity.
  3. People with mysterious digestive problems may want to try avoiding gluten for a while to see if it improves their symptoms**.
  4. People with mysterious fatigue may want to try avoiding gluten.
A previous study in 1981 showed that feeding volunteers a large dose of gluten every day for 6 weeks caused adverse gastrointestinal effects, including inflammatory changes, in relatives of people with celiac disease, who did not themselves have celiac (3). Together, these two studies are the most solid evidence that gluten can be damaging in people without celiac disease, a topic that has not received much interest in the biomedical research community.

I don't expect everyone to benefit from avoiding gluten. But for those who are really sensitive, it can make a huge difference. Digestive, autoimmune and neurological disorders associate most strongly with gluten sensitivity. Avoiding gluten can be a fruitful thing to try in cases of mysterious chronic illness. We're two-thirds of the way through Gluten-Free January. I've been fastidiously avoiding gluten, as annoying as it's been at times***. Has anyone noticed a change in their health?


* 56% of volunteers carried HLA-DQ2 or DQ8 alleles, which is slightly higher than the general population. Nearly all people with celiac disease carry one of these two alleles. 28% of volunteers were positive for anti-gliadin IgA, which is higher than the general population.

** Some people feel they are reacting to the fructans in wheat, rather than the gluten. If a modest amount of onion causes the same symptoms as eating wheat, then that may be true. If not, then it's probably the gluten.

*** I'm usually about 95% gluten-free anyway. But when I want a real beer, I want one brewed with barley. And when I want Thai food or sushi, I don't worry about a little bit of wheat in the soy sauce. If a friend makes me food with gluten in it, I'll eat it and enjoy it. This month I'm 100% gluten-free though, because I can't in good conscience encourage my blog readership to try it if I'm not doing it myself. At the end of the month, I'm going to do a blinded gluten challenge (with a gluten-free control challenge) to see once and for all if I react to it. Stay tuned for more on that.

82 comments:

Daniel said...

Thanks for this informative article.

I'm especially excited about the outcome of your blind gluten challenge.

Keep up the good work :)

Mario Renato said...

Ok, this was done in rats, but last year a brazilian nutricionist, Fabiola Lacerda, did her master thesis on gluten and obesity. Rats feed a diet with gluten had 25% more fat and 33% more visceral fat. She intend to do his PHD studing the effect of gluten in humans.

http://translate.google.com.br/translate?js=n&prev=_t&hl=pt-BR&ie=UTF-8&layout=2&eotf=1&sl=pt&tl=en&u=http://www.ufmg.br/boletim/bol1695/4.shtml

Reijo said...

The same researcher team from Australia has documented that oligofructose, inulin, polyols and other sources of indigestable carbohydrates (FODMAPs) are causing symptoms for IBS sufferers. They have also shown that elimination of these short-chain carbohydrates relieves symptoms. Perhaps the best study on this is by Ong et al. 2010. So in addition to gluten, it may well be FODMAPs. And avoidance of wheat (and some other sources of FODMAPs and gluten) is the key for many, anyway.

http://www.slideshare.net/pronutritionist/ibs-and-shortchaincarbohydratesong

Hekatompedon said...

Been gluten-free (and as a result, low- to moderate-carb) this month and, much to my disappointment, I haven't noticed any difference at all. Nothing. I don't have weight issues, but there are other things I've heard of people correcting by going GF (e.g., skin issues), and I was hoping it would do the same for me. Maybe it's just too early to tell--I'll probably continue this well past the end of January to be sure.

David said...

Great post Stephan!

When i eat bread i get dandruff, i tried it 2 times and both confirmed it. After a month or two away from the gluten challenge (one week eating bread) i see white spots showing up in my fingernails which i think are related to the gluten since they are all at the same distance from the finger.

Also, i stopped consuming gluten and milk products (january 2010) and since then my acne has improved significantly (26 years old here with 12+ years of moderate acne). One of these 2 foods is most probably related to acne, but it is a very slow effect.

DavidL

Melissa said...

I wonder how blinded this was? I mean gluten-free bread products suck, so I bet it was obvious to the participants if they were getting gluten. I'll have to download the paper.

Dr. William Davis said...

Hi, Stephan--

Thanks for highlighting the article. Great insights, as always.

We clearly need better documentation of the effects of wheat/gluten elimination in non-celiac people. However, having eliminated wheat in around 2000 people, I have come to view wheat/gluten elimination as one of the most powerful health strategies imaginable. While not everybody has perceptible improvements in health (as Hekatompedon points out), the majority do. An important minority have life-changing improvements in health.

An important statistic: Only 10% of the people with celiac disease know it. This means that one of the most powerful risk factors for intestinal cancers like colon cancer goes undetected.

HealBalanceLive said...

Ask for gluten free soy sauce and you don't have to go without your sushi! Most places have it. Love the blog, thanks for all the great info.

Daniel said...

Stephan,
Thanks for the write-up. Have you given any thought to Chris Masterjohn's hypothesis that the betaine in wheat may be beneficial for fatty liver disease (and, thus, CVD)?

Dr. Davis, what are your patients replacing wheat with? Other non-gluten grains? Other starches, like potatoes, rice, buckwheat? Fruits? Meat, oils, dairy?

Many thanks, Dan

Charlie said...

I also wonder how blind this was. You've recruited people who are "gluten-aware" and then given them gluten free products.

Let's be honest: a lot of IBS is in the head.

I'd fully agree that wheat makes you "fat" -- especially visible fat. Bloated -- yes a bit well. Is that so horrible from a health perspective?

And what level of gluten product is needed? honestly, the idea that the gluten in soy sauce when eaten with sushi is giving you the runs is a bit extreme.

janeray1940 said...

I was excited to see your mention of fructans, as well as the comment about FODMAPS. I'm fructose intolerant, and this includes fructans too. Onions just about kill me :(

I really appreciate what you're doing to raise awareness of these issues.

john said...

Hi Stephan,

Is it possible the other typical additives in wheat products affect symptoms? I typically don't eat it besides, like you, the small amounts in soy sauce, but I've also never noticed a problem.

Melissa said...

Ah here is the blinding "The muffins and bread were prepared and baked commercially in gluten-free ovens and conditions. The base mixes were gluten free. For the gluten group, commercially available, carbohydrate-depleted wheat gluten (Gemtec 1160, Manildra Group, Auburn, NSW, Australia) was added before baking at the amount of 8 g per muffin and 4 g per slice of bread. Analysis of the baked products using a commercially available assay (Biokits Gluten Assay Kit; Tepnel Biosystems, Flintshire, UK; AOAC 991·19 Method) confirmed the preservation of intact gluten and in the amount expected. "

I would like to see more discussion on whether or not this addition of gluten was detectable.

J. A. Deep said...

The hallmark symptoms of poor digestion we associate with celiac disease may be absent in 87% of patients with gluten related problems!

The gliaden portion of the gluten protein contains a sequence of amino acids that trigger the immune reaction. This same sequence of proteins that triggers celiac disease exists -- in the identical sequence of proteins -- in the cell walls of Candida albicans.

These Candida gluten-like proteins turn out to be the yeast's "hypha-specific surface protein" nicknamed Hwp1. This is the yeast's version of Velcro and allows it to attach and hang onto the endomysium in the wall of the intestine. This Candida gluten-like protein sequence also attracts our immune system cells.

Finally, a post by Robert McLeod explains how nearly half of fat tissue in fat mice is actually not fat cells, but immune system cells -- an amazing idea that illustrates how the many "diseases of civilization" can be largely driven by dysfunction of the innate immune system, egged on by disguised infections and an unnatural diet.

Nancy said...

"Let's be honest: a lot of IBS is in the head."

It was actually a few feet lower than that for me. I was pooping up to 15 times a day before I went GF. Now I'm down to once a day like everyone else.

I think that doctors would like us to believe that anything they don't have the answer to is "all in our head". They really, really, really hate saying "I don't know".

The Real Will said...

My 7 year old son who is PDD (on the Autism scale) was having extreme stomach pain and knee pain. He was actually diagnosed with RND for the joint pain. He was tested for gluten intolerance/sensitivity/allergy and both the IGG and IGE test came back good. His developmental pediatrician suggested making him gluten-free so we tried it. The stomach pain is almost 100% gone and the knee pain is much improved (he goes to physical therapy for the RND). Your article is confirmation of what we have experienced. My 10 y.o. daughter has IBS so perhaps a gluten reduction is in her cards as well. Thank you very much for this information.

The Real Will said...

@David, white spots on fingernails are a common symptom of zinc deficiency. Perhaps the gluten is robbing your body of zinc similar to how high fiber does...or by some other means.

Might-o'chondri-AL said...
This comment has been removed by the author.
Robbie said...

@David - Regarding the white spots on your fingernails, I get those too and I've been told it's due to a zinc deficiency. The lectins in wheat and other grains bind to zinc and prevent absorption. Zinc deficiency can make acne worse.

Even on a GF diet I still get white spots on my nails unless I take a zinc supplement.

Chris Kresser said...

We also know that gluten intolerance produces a systemic immune response that affects tissues outside the gut such as the brain and thyroid gland.

Current tests only screen for sensitivity to one compound (alpha-gliadin) in wheat, but there are several other constituents that people can and do react to, such as:
- gamma gliadin
- omega gliadin
- wheat germ agglutinin
- gluteomorphin
- prodynorphin
- glutamic acid decarboxylase

We're just scratching the surface in determining how damaging wheat consumption is for human health.

wjones3044 said...

If you get a craving for beer this month, and don't want to sacrifice taste, try Green's. Only gluten-free beer (other than MAYBE Bard's Tale) that is as good (or better than) any beer brewed with barley.

http://www.glutenfreebeers.co.uk/

Not easy to find, mind you, but well worth it. I have found it in my local co-op and one specialty grocery store.

Henry North London 2.0 said...

I stupidly ate a biscuit and a scone the other day ( wednesday) Got the bowel reaction yesterday and the tiredness since yesterday. Wheat and cheap flour definitely does something

Won't be doing that again.

Hekatompedon said...

I suppose I should point out that while I haven't had any noticeable improvements going gluten-free, it doesn't mean I don't think there aren't health benefits to eliminating it. Judging from Dr. Davis' blog, which I have been following for some time along with WHS and others, I'm probably just too young to be sick in the obvious ways his heart patients are.

I introduced the concept of GF and lower carb to my sister, who's been at it for a couple months now, and she has found it to be really helpful in reducing her anxiety, among other things. I don't know how that works, but I'm just glad it does, since her anxiety was severely limiting what she could accomplish in her life. Her success is partly why I want to keep at this for more than just the month of January.

Jack said...

Is the gluten content in beer just as problemtic for sensitive folk as the content in bready type foods? It seems like it would be less.

I've never been sensitive to Gluten at all, but I've been about 98% gluten free for January and much of December actually. I was eating 1-2 pieces of sprouted grain breads daily for a couple months, but I haven't had a single piece since the beginning of December. The only bread I've had is a white sourdough roll at a restaurant a few weeks back.

But I LOVE a good quality microbrew, especially like a pale ale or IPA. It seems that the proteins would not occupy as much of the beer content as breads but I really don't know.

Amy said...

"Let's be honest: a lot of IBS is in the head."

Well, I've already accidentally done my blinded trial and proved that it's not all in MY head.

After being mostly gluten-free for a year, my IBS-D was about 80% better. Then I had a couple of pieces of spelt bread that I believed was gluten-free. (I was totally convinced that it was gluten-free or I never would have eaten it!)

About three hours later the painful cramping, gas, and diarrhea started, and I thought I should look up spelt just to be sure it really was gluten-free. You can all guess where this is going...Spelt is an ancestor of wheat and DOES have gluten, albeit much less than modern wheat varieties.

This experience made a believer out of me!

FYI, it's not the fructans as I can eat onions with no problem. Also, I do have one copy of the HLA-DQ8 allele.

David L said...

Hi Stephan:

What's your take on sourdough bread? My sister has been doing it for almost all her adult life(she even had a starter that was supposed to date back to the Alaska Gold Rush, or so they said). She says that sourdough has been the preferred means of making bread since the Egyptian times. You have always talked favorably about using fermented grains -- does the same apply to wheat?

PS

As far as the gluten-free January, I have done pretty well. The only serious wheat that I ate was due to ordering restaurant food -- you don't always figure out in advance where the wheat will be added, for example, the coating of onion rings. My goal is not to be perfect, but to try to have less than a gram or so a day.

Mrs. Ed said...

That's interesting about the fatigue. In the DC Jarvis Folk Medicine books, written in the 1950's he notes that Vermont folks would not eat wheat because they noticed that those who did tired easier when doing farm work than those who did not. I love reading the older books, there's so much info that got tossed out.

CPM said...

"Let's be honest: a lot of IBS is in the head."

Just to throw this out there too, my IBS and my sister's was actually gallbladder related. We both had several years of on and off IBS symptoms before we became aware that we had stones.

Anna said...

I've been eating GF for two years, LC for 7 years. I'd already made so many changes and improvements to my diet the past few years and wasn't eating gluten very often anyway (I eat LC and little grain for a few years) so strictly avoiding gluten didn't make any obvious improvements right away. We noticed more difference with GF eating with my grade schooler.

But about 6 months into GF (still LC) eating I noticed the inflammation and pain in my index finger knuckle was completely gone, as was the inflammation and pain in a bunion (which had flared up regularly and increasingly for two decades). Neither has come back.

On the few occasions when I know I've had some gluten exposure, I've a range of experiences. Sometimes there is no discernible. Other times I've quickly had brief (20 minutes) but painful abdominal pain. A few times I've had a terrible night's sleep and really ill feeling (but my dining partner, who had exactly the same foods, had no after effects, so I don't think it was food poisoning).

Basically, I don't avoid GF because it alleviates any symptoms I can connect to gluten. I avoid it because I have two copies of genes that predispose to gluten sensitivity, I am hypothyroid, I have positive results for antibodies to gliadin and anti-tissue transglutaminase, and I want to set a good example for my growing son, who seems to have somewhat more issues with gluten. It's not so much about GI symptoms.

At home I find it *very* easy to avoid gluten, as I like to cook and we focus on real food, as well as local/seasonal food. We eat few GF packaged foods and few foods with lengthy ingredient lists.

Away from home GF can be a bit of a challenge sometimes, but not a huge burden IMO, esp if I plan ahead (potluck, pack meals, call restaurants/check menus in advance, etc.) though it does require avoiding processed and junky food in general, which is good to avoid for all sorts of reasons.

IMO, avoiding gluten at social occasions is no more difficult than avoiding vegetable oils/transfats, junk food, excess sugars, soy, and other industrial/fake foods I don't want to eat (actually, maybe avoiding gluten is easier than avoiding those other things). And I don't feel deprived without wheat (though I used to love it).

Tim said...

I had definite positive improvements stemming from my participation in Gluten Free January.

o My mood is greatly improved, in general. I'm less irritable, and more patient, and happier in the mornings according to my wife and son.

o My energy levels are much higher than they were. I used to procrastinate at everything, as I just didn't have the energy to even do something as simple as take out the rubbish. Now, sometimes I feel like I'm going to pop out of my chair, and am constantly looking for things to do.

o I have lost 8 lbs in 3 weeks. I'm pretty much living on meat, fish, fowl, eggs, butter, and broccoli, with the occasional salad.

I am definitely going to stay gluten free, after the end of Gluten Free January.

Me said...

The tiredness symptom is fascinating. It took me years to trace my seemingly random tiredness unequivocally to an intolerance to eggs. (I often ate 2 for breakfast.)

SkolVikings said...

I've had occasional bouts with IBS and full-time 24/7/365 GERD for the past 10 years. Then in October 2010 I decided to stop eating gluten. Since then, I haven't had any bouts of IBS, I'm almost completely off my GERD medication, I don't get bad headaches every other day, and I have a lot more energy and stamina.

Nicole said...

Giving up gluten has been a miracle for my skin. I have tried absolutely EVERYTHING to help with acne. After two months of being GF, I am virtually acne free. And I have a lot more energy.

Might-o'chondri-AL said...
This comment has been removed by the author.
Tom said...

I'm doing the GF January and have only had two transgressions, a 5-ounce beer chaser that came with a Bloody Mary I ordered at a bar, and some cheese fondue at a restaurant in which the shredded cheese was lightly dusted with flour (supposedly to make it melt better...I am skeptical).

I have not noticed a significant change in my health or the way I feel. I tend to eat low-grain anyway, so it's not been a huge change. I have purposely been eating a bit more of other grains and carbohydrates in an attempt to control for gluten alone.

Honestly, I'm starting to think that milk is more of an issue for me. I have been drinking raw milk from grassfed cows for about 7 years and some days I will drink 3-4 cups of milk. When I was away from home for a month without access to raw milk (I never buy commercial milk) I noticed the skin on my forehead getting noticeably smoother, and fewer blackheads.

My hunch is that acne is tied to the insulin response, and even high-quality raw Jersey milk has IGF-1 and a heavy dose of lactose, among other potentially harmful components. My plan for February is to cut out unfermented milk. I'll drink plenty of kefir and eat lots of cheese and butter. At some point I may consider a completely dairy-free trial as well.

js290 said...

Heka, check out the Evolutionary Psychiatry blog. It may explain why LC has helped your sister's anxiety.

Kurt G. Harris MD said...

@Ja Deep

You are correct. Relying on n=1 signs and symptoms in the case of gluten is a complete fail. You can have celiac or develop type I DM or TTP or hashimoto's or whatever with no GI symptoms at all

@Stephan

That group is doing interesting work.

4) No one who is human should eat gluten grains
(sorry I couldn't resist)

Regarding the FODMAPs issue, when I eat a lot of onion, I get terrible IBS and gas, but I can eat a whole thin crust pizza with no GI symptoms (yes, I do that every few months) Your onion suggestion is good as they are notorious, but there is some idiosyncracy in the FODMAP reactions. Folks who have problems with tomato sauce should not invoke the "nighthade" theory wihout considering the FODMAP load in tomato sauce. Chili made with tomatoes and onion can be potent.

IBS is clearly both psychosomatic and physical. It is related to FODMAP fermentation but there is probably a stress related component as well. Subjects with identical gas symptoms and with similar breath test hydrogen can be either asymptomatic or not. The same person can have symptoms wax and wane.

I don't have celiac nor overt symptoms from eating wheat acutely, but I stay virtually gluten free most of the time.

A variety of allergic symptoms and a mysterious neuropathy I had on and off for years were attenuated or disappeared when I radically reduced wheat by about 3 years ago, though.

Neolithic agent of disease #1. Not fit for human consumption unless you are a gambler.

Kurt G. Harris MD said...

The other thing to mention is that there may be opioid peptides in gluten proteins- they may cause motility disturbance that contributes to GI symptoms - a milder version of what Mark Renton experiences with opiate withdrawal in "trainspotting".

David said...

If someone had touted results of a study with a similar design to support eating gluten or vegetable oils you would have ripped the study to shreds... As other commenters have mentioned, IBS is largely psychosomatic and the subjects clearly knew whether they were consuming wheat products.

Reijo said...

Many have commented on the psychosomatic aspect of IBS. Yes it's partly in the head, but not as much as some believe. I don't think it's more psychosomatic than migraine, for example. How often we accuse migraine as being primarily psychosomatic? It's been clearly demonstrated that IBS patients are sensitized to pain in the same manner as patients with chronic back pain. In other words, there are biochemical and neurological changes that lower pain threshold.
Data also points out that IBS can have post-infectious history in c. 20-30 % of cases, ie. gastroenteritis caused by Campylobacter, Salmonella or Shigella. IBS is still poorly understood and a lot of misconceptions and prejudice exist, even among health care professionals.

Justanordinaryweirdo said...

Going gluten free has changed my life, and I tested neg on the celiac blood test. My mystery symptoms which I had many tests for at the doctors, included- stomach pain, needing to rush to the loo, GERD, headaches, tiredness, uncontraollable weight gain, uncontrollable blood sugar crashes, racing heart, fluid retention/ hot swollen hands and feet leading to restless leg syndrome, aching joints and muscle soreness.

Interestingly oats and corn cause me a milder version of the same symptoms, I found an article recently which said that they have gluten like peptides in them. I am super sensitive, even a trace of cornflour in a sauce leaves me sore all over for several days. I have recently gone grain free to see if that clears up the slight linering symptoms I have. So far I have noticed better digestion and improvement in the soreness I still have in my shoulders.

I am also casein intolerant, this often goes hand in hand with gluten issues so for those who improve off gluten it can be worth trying that too.

futrzak said...

For past month (or maybe longer) I am strictly non-gluten. I occasionally eat a bit of rice, quinoa or buckwheat, rest is meat, fish, seafood, eggs, butter, sour cream, yogurt and vegetables.
During this time I did not have any IBS symptoms.
Before I changed my diet I had been constantly bloated, having abdominal pain and diarrhea.

Friend of mine had for years terrible migraines. Someone told her to try non-gluten diet and it worked - no more migraines.

Justanordinaryweirdo said...

Just to add, when you do you challenges make sure you leave plenty of time between them. Some of my symptoms don't kick in until 4 or 5 days after ingestion.

Justanordinaryweirdo said...

Responding to the comment above saying IBS is in the mind... I didn't consider myself to have IBS, I thought my GERD was caused by my weight gain and my urgency was due to having given birth to my 4th child, and it was only when I stopped eating wheat and the sensations in my stomach went away, that I realised I'd had stomach soreness for as long as I could remember, I thought that was just how a working stomach felt.

I stopped eating wheat as a friend suggested it as I developed asthma. I was taking ventolin 4 times a day and constantly wheezy. Within a few days of stopping wheat, I no longer needed the ventolin and my stomach issues had almost completely disappeared too. I didn't expect that result and can see no way it could have been in my head.

Sarasavoy22 said...

I have Celiac and all you people who think this is a fad, please STOP. If I have even the tiniest traces of gluten I am violently ill for at least 3 days. The reason I can't go to restaurants is because Chefs think of this as a fad and most people GF are doing it without serious consequences if the accidentally eat it. You are ruining my chances of being taken seriously! If Gluten makes you sick like it does me there is NO WAY you would eat it "once or twice a month" or "when you want beer". Celiac is a serious disease and you people all think this diet is like Atkins or something. Please just stop. You are hurting those of us that have a serious medical condition.

Sarasavoy22 said...
This comment has been removed by the author.
Laurie D. said...

Hmm, I would disagree with the statement that the increased popularity of GF diets is affecting celiac disease patients adversely. The fact that many restaurants now offer GF food produced in safe conditions and have waitstaff that are versed in GF ordering has been a godsend. I agree it is an all or nothing proposition and one cannot cheat if you have a true sensitivity to gluten. The few times I have been exposed to gluten (soy sauce added to a dish for example) has resulted in a recurrence of symptoms which can take several weeks to clear up again. I have been GF for 3 years and in that time my migraines have reduced in frequency and severity to almost nothing. All joint pain that I attributed to getting older are gone, and so are a myriad of other symptoms that I thought were just normal aging problems. Perimenopausal symptoms also gone, completely. My sensitivity to gluten was mostly neurological, not intestinal, and it certainly is not in my head. My sister had severe IBS, went to several doctors trying to find the solution, finally listened to me, went GF and is now completely symptom free.

Kurt G. Harris MD said...

Just to be clear - psychosomatic does not mean "in your head" in the sense of faking or malingering. It is not meant to be pejorative. I am using the term the way mind-body medicine uses it.

It means that it involves an interaction between the brain and other parts of the body via the autonomic nervous system, often related to powerful emotions (of which you may or may not be consciously aware)

Many pain syndromes, migraine, IBS, asthma, vasomotor rhinitis, urticaria., tension headaches. basically anything mediated via the ANS can have a psychosomatic component.

That doesn't mean they are not caused by diet, but it also does not mean everything that happens to your body is a result of what you ate, or that diet can fix everything.

Sometimes exercise or meditation or other non-diet maneuvers oriented at brain chemistry do MORE than diet for such problems.

My observations are based not just on the medical literature but considerable experience both with myself and many patients affected by these diseases.

Donald Kjellberg said...

I eliminated wheat after reading Dr. Davis' blog. I also eliminated 120 pounds. For January, we cut wheat out of our family diet. My 5 year old's sinus problems immediately dissipated and his intermittent stomach pains are dramatically reduced. My wife also experiences less joint/body pain, increased energy, and improved attitude. Now that is quality secondary prevention.

Might-o'chondri-AL said...
This comment has been removed by the author.
water said...

Thank you for the explanation of the term, psychosomatic. Would endocrine effects be related to the ANS?

joey said...

Gluten Free does not have to taste bad. There are some excellent products on the market, that taste great, even breads. We prefer to make our bread at home instead of store bought, always better. If you don't like store bought GFree breads, avoiding the ones with bean flour in them will great improve your chance of liking the product. As for beers, Green's makes an excellent product. Think I'll have one with lunch! Gluten by the way is hard for EVERYONE to digest as the gluten molecule is large. You will not be harmed by going Gluten Free even if you don't necessarily need to.

GlutenFreeBeer.org

Laura said...

I would love to see a discussion of milk products and how they do/do not fit into the paleolithic diet. Certainly nomads have been herding much longer than we have been cultivating!

Stephan said...

Hi Mario,

Thanks.

Hi Reijo,

In this study, the effect of FODMAPS was controlled for, so we know it was the gluten. I believe you that some people react to fructans in addition. That's not something I've looked into much yet.

Hi Melissa,

Good point. I'm glad they added extracted gluten to gluten-free baking mix; that controls for the possibility of fructans and also reduces the risk of the participants tasting the difference. Still, I agree it would have been nice if they had addressed the issue of whether or not they could taste the difference.

Hi Dr. Davis,

Thanks for your observations.

Hi Daniel,

I think any traditional food is going to have some positive aspects, wheat included. Betaine is probably one of its positive aspects. However, keep in mind that fatty liver is rampant in countries that eat wheat as a staple, so it can't be that protective. Also, you can get betaine from other sources.

terrence44 said...

@ Charlie at January 21, 2011, 6:52 AM

Let’s be honest Charlie – you do not know anything about gluten and gluten free products – if you did you would know it is TRIVIAL to make them appear identical. You can even buy ready made gluten-free products that look IDENTICAL to similar gluten filled products.

Let’s be honest Charlie – you comment was either massively or completely uninformed or it was all “… in [YOUR] head”, and says nothing about anything except the content, or lack thereof, in your head.

Again, let’s be honest Charlie – you know NOTHING about allergic reactions, NOTHING! Many people, including me, have very definite IMMEDIATE allergic reactions to tiny, tiny amounts of allergens; and yes, they have been independently identified and confirmed by professional Medical Allergists (people whose education, training and practise are solely involved with allergies).

Let’s be honest Charlie one more time – your completely unfounded presumptuousness about this post and the comments says NOTHING about the post or the comments, and it does not make you look very good at all. Charlie, I honestly wonder if you know the difference between making completely unfounded presumptions (as you did) and engaging in intelligent, logical discussions (as the post and comments do).

Stephan said...

Hi John,

Yes, I think it's possible, but I don't have any evidence to support it. I would be surprised if bromation didn't have any adverse effects on it.

Hi Wjones3044,

I've had Green's. It was decent but it didn't blow me away. I'd still rather have a barley beer. I'm actually brewing a batch of GF beer right now that I expect to be better than what I can find in stores. I used sorghum malt extract, malted buckwheat (for flavor, not sugar), roasted chicory and Willamette finishing hops.

Hi Jack,

Beer doesn't agree with me very well, but I can't be sure it's the gluten. I doubt beer contains much gluten, as it's mostly broken down during fermentation. Although the smaller fragments may well continue to be immunogenic.

Hi David L,

I think true sourdough bread is considerably better than typical white bread, especially if it's made from non-bromated, unbleached flour. A lot of what's passed off as sourdough in the stores is just regular bread with lactic acid added to it.

Hi Tom,

I think dairy is another food that is problematic for some people, typically the protein and/or lactose. It doesn't surprise me that you would see improvements after eliminating it.

Hi Kurt,

Thanks for the comments about fructans. Like you, I don't have much if any of an overt reaction to wheat. I get fatigue and slow digestive transit when I eat a lot of bread that may or may not be related to gluten. It could have to do with the gluteomorphins, I don't know.

Hi Donald,

Wow, that's remarkable!

Might-o'chondri-AL said...
This comment has been removed by the author.
Justin said...

Al,

The point about the absence of helminths facilitating an overreaction of the immune system to some of these problematic substances is very interesting. I have an acquaintance who has Lupus and I wonder if Helminthic therapy would be an option for her.

When you say "sugar" do you mean sucrose?

I will have to be honest that I originally found your comments to be abstract and hard to follow but now that I have read them again I see the value in the information that you are contributing to this blog and other blogs. It just takes a few readings to absorb all the information and understand it. By all means keep it coming. (If Stephan doesn't mind, of course :)

Regards,
Justin

Justin said...

Stephan,

Thanks again for all of the time and effort that you put into your blog. It has had a huge impact on my life. Let me know how that gluten free brew turns out. My bother brews his own beer and works for Ballast Point (http://www.ballastpoint.com/) in San Diego. I keep telling him that he needs to work on developing a gluten free beer. I am drinking a Green's Tripel Blond Ale and I will have to agree with you that it is OK but wasn't anything special. Thanks again.

Justin

Facetguy said...

@ Chris Kressor:

A new lab opened last week that goes beyond alpha-gliadin testing:
http://www.cyrexlabs.com/CyrexTestsArrays/tabid/136/Default.aspx (see Array 3).

Sarah said...

I am a 44 year old female. I don't know how long I've been gluten-sensitive because it seems to have just so gradually affected me until one day I realized, wait, this is NOT how I used to be. I've been experiencing symptoms which include gas/bloating, irregular BMs, cramping, and for all of my adult life, cystic acne.

Last summer I stumbled upon Mark Sisson's website and I decided to cut way back on grains in all forms and to eliminate caffeine. I estimate I cut back to the equivalent of about one half of a serving of a grain product per day, and some days I ate no grain.

My symptoms were gone almost immediately and for the first time in my adult life, my face cleared up completely. (For the life of me, I cannot fathom how dermatologists do not offer this information to patients.)

Now, as soon as I add back more grain, all symptoms return.

Last week, after sailing through the holidays, I binged and had at least one full grain serving each day. (I didn't know about the gluten-free challenge for January--sorry.) I was extremely tired, depressed, and my chin broke out within two days. I literally felt like I was somebody else.

I'm still trying to figure out to live with this reality because I'm the person who fixes meals for my "normal" family, and they're not about to give up bread, oatmeal, or cookies.

That's my very unscientific testimony, such as it is. But all of this is definitely not just in my head.

joe said...

I used to use two different inhalers on a fairly regular basis, and in the fall my nose would run constantly. Then, about 15 years ago, I went on the Atkins diet and all those problems went away. Through trial and error, I determined it was the wheat-other grains don't seem to have the same effect. I have used an inhaler since then, and I never have seasonal allergies anymore

joe said...

oops, I meant haven't used an inhaler.

Kurt G. Harris MD said...

@water

The autonomic nervous system and the endocrine and immune systems are all linked together.

They can't really be separated any more than the mind and brain (and body) can be.

You might google "psychoneuroimmunology"

Might-o'chondri-AL said...
This comment has been removed by the author.
Might-o'chondri-AL said...
This comment has been removed by the author.
Sarabeth said...

Four years ago, due to my then-three-year-old's severe gastrointestinal issues and other autistic-style behaviors, we took him off gluten entirely (as well as casein, although he wasn't eating any dairy much anyway). His diarrhea reduced somewhat, as did his stomach cramps, but he remained a severely picky eater and was definitely not thriving.

(Incidentally, I can warn against one of the pitfalls of consuming a "gluten-free" diet with no other restrictions--there are currently enough super-unhealthy gluten-free grain/sugar products out there to power anyone's chronically deficient diet. And even in my son's case, though I was (by the end) fermenting our own whole-grain gluten-free bread, he was consuming a deficient, difficult-to-digest diet. Not to be melodramatic, but the autistic haze was growing, and day by day it was like I was losing my child.)

It wasn't until he was over six years old that we finally began investigating the role of gut flora and its effects on mental/physical health. I was flabbergasted...and continue to be incredibly floored that I never heard any of this stuff before April 2010. I am so amazed that I write about hardly anything else, at www.lifeisapalindrome.com (with particular emphasis on resources for parents with severely picky, sick children).

It is now my understanding that "celiac" or "gluten intolerance" is intimately connected with our inner microbial ecosystem, or lack thereof. Gluten and casein are only two particularly tiny proteins that can wreak havoc in the body when they slip right through the "holes" in a leaky gut. Many other proteins can also cause problems, which explains why GF/CF doesn't work spectacularly for all people with digestive issues.

We've been doing the GAPS Specific Carbohydrate Diet (entirely sugar- and grain-free, and nearly starch-free), for nine months now. I don't know what the future holds, but I actually can't imagine going back to eating grains. I thought it would only help my son--and yet my depressive tendencies, hellacious menstrual issues, digestion (which I never thought problematic!), dry skin, and energy level have all hugely.

Most importantly, I have hope that our son will soon be incredibly more functional than I'd ever hoped.

Not to distract from the central point of this post--but I do think that for many, gluten really is only part of the picture, and is sometimes inextricable from many other associated and equally health-damaging factors.

Regards,
Sarabeth

Might-o'chondri-AL said...
This comment has been removed by the author.
Anna said...

I've never been a regular beer drinker, but I do enjoy a good one now and then. When I drank beer in the past, I typically chose hefeweizens or the darkest available beer, so when I went GF, I just dropped beer entirely (and didn't miss it much).

I'm not a beer connoisseur, but I tend to prefer stronger flavored beers with some body, not pale, weak flavored "watery" beers (I'd rather have water in that case).

A few months ago I tried Bard's beer, a malted sorghum GF beer made in Utica, NY, and I liked it a lot - enough to buy it a few times. I found it at BevMo (BevMo also stocks Green's and Redbridge, another sorghum GF beer). I've used Bard's when cooking dishes which call for braising in beer and enjoyed the results, too.

Has anyone else tried Bards, and if so, what was your verdict?

When I visit the in-laws in England, I usually drink hard cider instead of beer in the pub. Sometimes there's more than one cider to choose from, so I go with the driest.

Justin said...

AL,

Thanks a lot for responding. Whenever I hear someone use the term "sugar" I pretty much automatically think of the disaccharide sucrose. Thanks for the clarification.

Also, thanks for the info on Lupus. She has had a few cytokine "storms" since I have known her (2 years). The low activated serum D is interesting. I will have to see if she has ever had that checked. She just got the Lupus diagnosis not to long ago but not sure how they confirmed that.

The Schistosomosis information is just what I was looking for. I will pass this on to her and do some further searching of PUBMED for anything else related to this.

You should check out Dr. Ayers blog if you haven't already. It is right up your ally.

http://coolinginflammation.blogspot.com/

Thanks again for all of the information. You should definitely start your own blog, it would be a pleasure to read.

Justin

Dr. Curmudgeon Gee said...

Hi, Stephen, thanks

i suspect that % of people that is gluten intolerant is much higher.

i have been largely wheat free for months. (that is i don't knowingly eat wheat anymore.)

it just gave me "stasis" for hours (that's the best way i can describe it).

i'm not sure if it's the gluten or opioids(?) that causes it.

regards,

pam

David said...

@Tom 21/2011: Milk intake correlated with acne (link)
Milk has a lot of bio-active compounds. It is proven that supplementation of milk in boys change their hormone balance (link).
I think it might be better to just cut the milk out.

bee said...

gluten-free for me means
- ten years of joint pains gone
- much less fatigue
- a flat belly

i was a bread addict. now i don't even think about bread.

Apolloswabbie said...

Thank you for a reasonable perspective on this important topic. A post like this makes the information accessible to many that may be turned off by more impassioned objections to gluten.

Tom said...

David, Thank for the links. There are many potential problems with milk consumption, but looking to evolution, many humans have been drinking (raw, non-commercially processed) milk for thousands of years, so it seems likely that there has been some adaptation to it.

On that note, here is a new cohort study that found that fermented (but not unfermented) full-fat milk consumption was inversely associated with all-cause mortality. Stephan, if you have time take a look.

Owen said...

Stephan (and other barley beer fans):

Whole Foods stocks a Spanish beer made by Estrella Damm called Daura that is brewed with barley but has an enzyme added that breaks down the gliadin peptides to a point where is registers under 6 ppm of gluten. I didn't seem to react badly to it, even though some people have theorized that the peptides might be too small to register on the test, but still large enough to cause an immune response. The beer is a lager-style so I won't be too excited until they start adding that enzyme to beers like Rochefort 10 or Two Hearted Ale...

Also I tend to think of Thai food as pretty safe b/c fish sauce is used more often than soy sauce and the most common one (Tiparos) is made with only anchovy, salt and water. I think it tastes a hell of a lot better than soy sauce anyway and should have none of the hormonal components.

Jeffrey of Troy said...

@Tom

"There are many potential problems with milk consumption, but looking to evolution, many humans have been drinking (raw, non-commercially processed) milk for thousands of years, so it seems likely that there has been some adaptation to it."

It is at least as true that after thousands of years of selective breeding, we have adapted it to us.

K diet said...

Hi, I'm a dietitian working for an Australia based charity and I was recently asked to review this article.
My main concerns regarding this article are:-
1) only 34 participants, this is not representative of a large group of people who suffer IBS symptoms.
2) There was no mention of how closely the participants diets were analysed for gluten content before commencing the placebo or the gluten muffins and bread.
3) There was no dietary assessment for FODMAP's. FODMAP's are fermentable carbohydrates that have been linked to IBS type gastrointestinal symptoms. Were the participants excluding FODMAP's themselves or had the 34 participants all been found to not be susceptible to FODMAP symptoms.
4) There was also no mention of resistant starch content in the participants diets. Resistant starch is also considered to induce IBS type symptoms.

Whilst this is an interesting area to investigate, particularly as many IBS sufferers are excluding gluten, there needs to be a lot more randomised placebo-controlled studies with far more participants, and detailed dietary analysis/control before commencing a gluten test.
K

Stephan said...

Hi K diet,

Here's my take on your concerns about this study:

1) The study was large enough to detect a highly statistically significant difference between diets, so I don't see study size as a problem. Participants were self-selected people who felt they benefited from avoiding gluten before the intervention, so it's true that they aren't necessarily representative of IBS sufferers as a whole.

2) I don't see that as a major problem-- the main concern there would be that the factor you mentioned would introduce too much "noise" into the data to detect a significant result. The study found a statistically significant difference between randomized groups, so the variability did not obscure the result.

3) This is unlikely to be a concern. The two groups were given gluten-free products with or without purified gluten added to them. Purified gluten should not contain FODMAPS, so the two groups should have gotten the same amount of FODMAPS.

4) Same as #3. Resistant starch should not be present in purified gluten, so that factor was controlled for.

Overall, I think the study gives a good rationale for trying a gluten-free diet as a treatment for IBS. GFD won't do you any harm, and if it doesn't help, you can just start eating gluten again.

David Clancy said...

at least with the bread, the added gluten represented about 10% dry weight, so is probably detectable by taste.

The subjects were experienced in gluten-associated symptomatology by virtue of their histories, whether this was psychosomatic or not, so with the combination of detectability and knowledge of symptomatology and, let's face it, probably some levels of food craziness in some subjects, there is likely to be some confounding. It would have been worth asking the subjects whether they noticed a change in the food upon addition of the gluten. 10% is equivalent to the highest gluten content wheat cultivar.

All that said, the effect sizes are large, especially the tiredness. And this echoes my experience. I don't eat much gluten any more. When I do at lunchtime I now get quite fatigued and sometimes experience headaches, despite my love of pizza and baguettes. This has come as a complete surprise to me, and is kind of a shock. I did used to get tired before, but not to this degree, and never got headaches. Still haven't tested whether it's due to high GI or wheat, but having had rice lunches I don't experience the same effects so I'm thinking it's wheat.

I should also point out that I have been quite skeptical about all this gluten hysteria up until now.

lumin smith said...

leaky gut syndrome
is a proposed condition of an altered or damaged bowel lining.Although leaky gut syndrome is not an established diagnosis there are several research and clinical diagnostic tests that actually measure permeability of the gut wall.

HirondelleAndalouse said...

Hi, Stephan

As a dietitian, I never believed that gluten can be harmful in anyway to healthy people, unless those with celiac disease or with some kind of gluten sensitivity. But, I have decided to do further extensive research about the topic lately in hope to reach a clearer understanding about the in light of recent and solid scientific evidence. I am finding that all the authors or the researchers defending and promoting the gluten-free diet to the general public are basing their conclusions either on hypotheses, or on facts and research results on celiac and gluten-sensitive subjects. The mountain of scientific evidence does not prove gluten to be harmful to healthy subjects. In fact, omitting gluten (which means omitting wheat and the other gluten-containing grains) can put an individual at risk of some B-vitamin deficiency, in addition to insufficient fiber intake.

Multiple experiments have been conducted excluding gluten from the diet of subjects complaining from different kinds of symptoms such as fatigue, GI disturbance, etc, and have yielded desirable effects. Some of these studies are preliminary, while others are done on non-representative samples, or as I mentioned, subjects with existing conditions of celiac disease or gluten sensitivity. Why is the blame always on gluten? In the study you mentioned in your article, the subjects already had IBS, which means, they will naturally be irritated by any high fiber-containing food that they consume. Is it not the wheat in this case?

We need large studies on thousands of healthy subjects... before we can hopefully and finally reach a clear conclusion.