This confirms what has been shown numerous times before: celiac disease interferes with nutrient status, including the all-important fat-soluble vitamins. It's not surprising, since it flattens the villi, finger-like structures necessary for efficient nutrient absorption in the small intestine. But wait, the overwhelming majority of our vitamin D comes from the effect of sunlight on our skin, not through our small intestine! So gluten sensitivity must be doing something besides just flattening villi. Perhaps it does. Feeding wheat bran to "healthy" volunteers caused them to burn through their vitamin D reserves at an accelerated rate. I think this underlines what I've come to believe about wheat: it's problematic for a large proportion of the population, perhaps the majority.
Approximately 12% of Americans can be diagnosed as gluten sensitive using blood antibody tests (anti-gliadin IgA or IgG). A subset of these have full-blown celiac disease. The vast, vast majority are undiagnosed. Gluten sensitivity associates with a dizzying array of diseases, including autoimmune disorders, cancer, and neurological problems. The problem with the blood tests is they aren't very sensitive. The most common blood tests for celiac disease look for a class of antibody called IgA. IgA is produced by the mucosa, including the gut. Unless gut damage is already extensive, the majority of IgA stays in the gut. This may cause the assay to overlook many cases of gluten sensitivity. A negative blood antibody test does not rule out gluten sensitivity!
I recently discovered the work of Dr. Kenneth Fine of EnteroLab. He has developed an assay that detects anti-gliadin IgA in stool. Gliadin is one of the problematic proteins in gluten that is implicated in gluten sensitivity. Dr. Fine has been conducting informal research using his fecal anti-gliadin IgA test (data here). He has found that:
- 100% of untreated celiac patients are antigliadin IgA positive by fecal test, compared to only 76% by blood (n= 17).
- 76% of microscopic colitis (a type of chronic diarrhea) patients are positive by the fecal test, compared to 9% by blood (n= 57).
- 57% of symptomatic people (digestive problems?) are positive by the fecal test, compared to 12% by blood (n= 58).
- 62% of people with autoimmune disease are positive by the fecal test.
- 29% of asymptomatic (healthy) people are positive by the fecal test, compared to 11-12% by blood (n= 240).
- Baby and cow feces are 0% positive by the stool assay.
It gets worse. Gluten sensitivity is determined in large part by genetics. A gene called HLA-DQ is intimately involved. It encodes a protein that is expressed on the surface of cells, that serves to activate immune cells when certain foreign substances are present. Different versions of the gene are activated by different substances. HLA-DQ2 and HLA-DQ8 are classically associated with celiac disease. Roughly 42% of the US population carries DQ2 or DQ8. According to Dr. Fine, every allele except DQ4 has some association with gluten-related problems! Only 0.4% of the U.S. population carries HLA-DQ4 and no other allele.
Not everyone who is genetically susceptible will end up developing health problems due to gluten, but it's impossible to estimate how many of the problems we attribute to other causes are in fact caused or exacerbated by gluten.
The immune system can be divided into two parts: innate and adaptive. The innate immune system is a nonspecific, first-line reaction to a perceived threat. The adaptive immune system is a more sophisticated, but slower system that produces a powerful response by particular cell types to a very specific threat. Antibody production is part of the adaptive immune system. Thus, if your gluten sensitivity test is looking for antibodies, it could still be missing an immune reaction to gluten mediated by the innate immune system!
This question has been addressed in a preliminary study. Researchers took gut biopsies from celiac patients and asymptomatic controls. Five out of six asymptomatic controls showed elevated interleukin-15, a marker of innate immune activation, upon exposure to gliadin. An activated innate immune system (commonly called 'inflammation') is associated with a wide array of chronic diseases, from obesity to cancer to cardiovascular disease. Inflammatory cytokines are elevated in celiac patients and may play a role in their bone pathology. What I would like to see is some negative controls-- would the gut biopsies have produced interleukin-15 in response to benign foods or is it truly specific to gluten?
I don't intend to imply that everyone has gluten sensitivity, but I do think the totality of the data are thought-provoking. They also include the association between the introduction of wheat to non-industrial populations and the development of widespread health problems. Another thing to keep in mind is that traditional sourdough fermentation breaks down a portion of gluten, possibly explaining the rise in gluten sensitivity that has paralleled a shift to quick-rise yeast breads. I believe that gluten sensitivity is behind many modern ills, and should be on the short list of suspects in the case of unexplained health problems. This is particularly true of digestive, autoimmune and neurological disorders. Gluten sensitivity is easy to address: stop eating gluten for a few weeks. See how you feel. Reintroduce gluten and see what happens. You might learn something about yourself.
Not everyone who is genetically susceptible will end up developing health problems due to gluten, but it's impossible to estimate how many of the problems we attribute to other causes are in fact caused or exacerbated by gluten.
The immune system can be divided into two parts: innate and adaptive. The innate immune system is a nonspecific, first-line reaction to a perceived threat. The adaptive immune system is a more sophisticated, but slower system that produces a powerful response by particular cell types to a very specific threat. Antibody production is part of the adaptive immune system. Thus, if your gluten sensitivity test is looking for antibodies, it could still be missing an immune reaction to gluten mediated by the innate immune system!
This question has been addressed in a preliminary study. Researchers took gut biopsies from celiac patients and asymptomatic controls. Five out of six asymptomatic controls showed elevated interleukin-15, a marker of innate immune activation, upon exposure to gliadin. An activated innate immune system (commonly called 'inflammation') is associated with a wide array of chronic diseases, from obesity to cancer to cardiovascular disease. Inflammatory cytokines are elevated in celiac patients and may play a role in their bone pathology. What I would like to see is some negative controls-- would the gut biopsies have produced interleukin-15 in response to benign foods or is it truly specific to gluten?
I don't intend to imply that everyone has gluten sensitivity, but I do think the totality of the data are thought-provoking. They also include the association between the introduction of wheat to non-industrial populations and the development of widespread health problems. Another thing to keep in mind is that traditional sourdough fermentation breaks down a portion of gluten, possibly explaining the rise in gluten sensitivity that has paralleled a shift to quick-rise yeast breads. I believe that gluten sensitivity is behind many modern ills, and should be on the short list of suspects in the case of unexplained health problems. This is particularly true of digestive, autoimmune and neurological disorders. Gluten sensitivity is easy to address: stop eating gluten for a few weeks. See how you feel. Reintroduce gluten and see what happens. You might learn something about yourself.
31 comments:
Stephan,
I've been following your blog
for about 6 months and this post
has been the best."Healthy whole
grains"should take on a whole new
definition.THANK YOU for your work!
Stephan,
You're to polite...
Whole grains is WHOLE CR**P!
Fantastic post!! It's too bad the Enterolab results are not 99.9% positive -- we need more accurate assays.
Auto-antibodies actually take 6mos to clear -- 6 mos for complete brain and gut healing... it's a long time for some wheat-addicts!
WONDERFUL JOB AS USUAL!!!
Thank you, G
I would second what Dr. B G said about healing time. I stopped eating wheat in May. I had been eating a low fat diet prior to that. When I tried to switch to a high fat diet in May, I found I couldn't digest fat effectively. I had good reason to avoid fat previously, since I couldn't really handle it, but I upped my protein and added some non-wheat based carbs (mostly corn) and eventually I've found that I can eat an avocado without any trouble. It took a couple months to notice a change.
I was also lactose intolerant, which really limited my diet choices. Hopefully that will go away with time as my gut heals.
Staying totally wheat-free is tough, mostly due to social situations. Of course, I had to test myself to check if I was really gluten intolerant, so I ate a whote-wheat kamut breakfast cereal for a week in September. LOLZ. I'm still recovering.
Great post. One question I have is how much gluten is too much. For example, I eat no bread or packaged foods, so my gluten intake is nearly zero but I made chili last weekend where the chili kit had a bit of wheat flour. I also made a dish with a roux, with ~ 2 tablespoons of flour shared with 2 people. Is that too much?
One more question. Is this particularly bad for children, or about the same as for adults. I have 2 little ones at home and and want the best for them. They do at school have foods with gluten in them. Is there anything known about the effects of gluten on children? I would love an excuse to ask my school to make sure they eat gluten free while they are there.
Hi Stephan,
Re: Only 0.4% of the U.S. population carries HLA-DQ4 and no other allele.
Coincidentally, that is also (supposedly) a percentage of the population that is capable of reaching a very old age (centenarian) on the standard Western diet with no health problems. Perhaps there is a connection.
Dr. B.G., RobertM:
That's true! It takes about 6 months to adjust one's digestion to the low carb high fat diet.
Re: innate immune system
I am curious if ketogenic metabolism has some influence upon it. Many reports indicate that the inflammations very often subside and one's immune resistance (innate and/or adaptive) increases by a huge factor under ketogenic metabolism. It would be interesting to know what exactly goes on.
Stephen,
I agree that this is one of your best posts ever. It read as if it were published in a well-edited, highly-informative science book written for laypeople. Your blog posts tend to read this way, which is why I encourage you to publish a collection of your posts as a book to make it more assessable to the public.
I have a specific question. Is the gluten in wheat broken down to a benign state through sprouting? The reason I ask is, I have a 3-year old who won't give up her bread. I switched to rice bread which she finds palatable, but this is from non-sprouted (i.e., typical) rice flour. I have tried the Ezekiel sprouted wheat bread and she likes that, too (yeah!). But, given your post, I'm wondering if I should avoid wheat all together, even sprouted. Are there data bearing on this question?
Thanks!
I always get very excited when I see you have a new blog entry. I love your blog. I'm sorry, I think I've said that before... now I sound like a Fan Girl.
Anyway, now that my gushing is done, I was curious about the gluten content in sour-dough bread. Can you point me to anything that shows that fermentation does break down the gluten?
I was very sick for many years with gluten intolerance (diagnosed by Enterolab, by the way). I'm just not sure I can trust anything that has ever contained gluten.
Hey Aaron,
you might try French Meadows BAkery Sourdough bread....they make it by leavening for along time to breakdown the phytates. Its in the frozen bread section too.
t r o y
G and Robert,
Thanks for pointing out the healing time, that's a good point. I know several people who are fat intolerant and have gluten issues. Gluten sensitivity often causes fat malabsorption. It interferes with gallbladder function, which may be part of the reason.
How many people do you know who have had their gallbladders removed? I know several. How many people do you know who have trouble digesting fat? Again, I know several. I think both problems are likely caused at least in part by gluten. Robert, glad you're healing. I'm beginning to suspect I'm gluten sensitive as well. I'm testing it out right now.
Jeff,
I don't really have a clear cut answer for you. In celiac patients, even a small amount of gluten is too much. In someone who's less sensitive, I would guess you can get away with small amounts sometimes. But that's just a guess, because it's not really known (at least by me). If your kids are antigliadin IgA positive by the stool test or are genetically susceptible (EnteroLab does genetic testing), that would be a good excuse to ask for gluten-free. Another thing you could do to save money is test yourself or one of them genetically. If one of you is genetically susceptible, there's a high likelihood the others are as well.
Stan,
Good point! I took a quick look, there doesn't seem to be any consistent association between HLA genes and longevity, although some studies have found associations. It may depend on the lifestyle, for example, in a pop that eats wheat, HLA-DQ4 might be associated with longevity but not in a rice-eating pop. I haven't looked into it far enough to see if that's the case.
Interesting about the effects of a ketogenic diet on the immune system. The thing I find difficult to resolve is: are the effects of a low-carb or ketogenic diet truly due to reducing carbohydrate, or simply due to reducing wheat and sugar and increasing the intake of animal nutrients? Maybe both?
Apparently Vitamin D is cleared by those cells which are sensitive to it. So, if grains cause an increased immune response, one might expect higher Vitamin D utilization. Vitamin D is also involved in insulin sensitivity and possibly leptin sensitivity as well (a quick Google seems to indicate if nothing else, D suppresses leptin secretion). Yet another potential connection between grains and metabolic syndrome.
Hey Stephan
I am sorry to hijack this thread but this is the only place I know to ask a question like this.
What would you say is limit on calf's liver a week? I ate raw calf's liver 2 days in a row for lunch and I felt a little restless. I know it may be different for everyone but how often do you eat liver?
Thanks
Aaron,
Not a bad idea. I'll think about it. Sprouting partially breaks down gluten and breaks down anti-nutrients. I consider it superior to unsprouted wheat. But I wouldn't recommend it to someone with true gluten sensitivity.
Nancy,
I think you're right to be cautious. So you had a good experience with EnteroLab? What tests did you get, if you don't mind my asking? Here's a link to a post by Debs on the effect of fermentation on gluten content of bread:
http://www.gofrolic.org/gofrolic/food_blog/Entries/2008/11/28_Sourdough_and_Gluten_II.html
The problem with fermenting away the gluten is you lose the elasticity that makes bread nice to begin with!
Daiikkon,
Eating liver two days in a row is no problem. I definitely recommend eating liver regularly, but just skip the CLO on days you eat it. And make sure you're getting plenty of vitamin D to balance it. D3 supplements are OK if you can't get sunlight or live in the upper half of the US (or anywhere of similar or higher latitude). I eat liver every 2-3 weeks myself.
My wife is allergic to wheat (causes stomach upset and asthma) so we don't eat wheat. I have had very good success making wheat-free French bread that you really can't tell from supermarket French bread (I'm sure that anyone could tell the difference with real French bread). It is based on white rice flour and tapioca flour with thickeners.
It is, however, a very sensitive dough to work with and takes a lot of effort to get it right. I started with a recipe from a book but ended up writing out a full sheet of instructions to get all the steps right.
I'm working on converting this to a sourdough recipe now to make the rice flour healthier through fermentation and maybe minimize some of the problems with using rapid-rise yeast.
The point is that gluten-free home-made bread can be done well, but it does take quite a bit of effort to produce something that is comparable in taste.
When I get the sourdough French bread figured out, maybe I'll mail a baguette to Stephan and see if he can tell the difference.
Scott
Thanks Scott.
Stephan--great post and question regarding problems with fat digestion/gluten and gallbladder removal--follow up on this would be great.
Aaron--regarding Ezekiel bread/products. Personally, I think that sprouting grains is much better than not, but I still would avoid wheat and feel that anything rice is fine (soaked/spouted or not), especially if eaten with some healthy fat and/or protein to slow the insulin response.
Also, I have no problem with eating soaked quinoa, and oat groats on occasion as a small side. Get her used to rice (try fried rice cakes as a sandwich type finger food replacement with a short grain rice) and she won't even be interested in wheat bread after a short while.
The Food for Life (Ezekiel) company tries to put out some healthy products; however, I think that they're use of soybeans, lentils, and millet (even if sprouted) should be avoided for reasons other than gluten issues (e.g., antithyroid issues, etc.)
Informative post.
This just reinforces my opinion that nobody NEEDS to eat grains, and in fact most people will do far better without them.
Thanks Calvin. I've tried rice bread and my daughter likes it, so perhaps I'll switch to that. As far as I know I don't have a gluten sensitivity (I'm a mix of Lithuanian/Ukranian Jew and English/German) and neither does my wife (who's Han Chinese) nor our daughter (who's all of the above). But given the numbers in Stephen's post, it wouldn't hurt to avoid wheat.
I tried rice pasta, but it is really gummy and gums up the entire cooking pot! I found sprouted wheat noodles at Whole Foods and will give them a try. But they are wheat and so not ideal.
It's amazing how wheat has become the foundation of the Western diet! There are very few alternatives.
Hi Stephan
I have been taking 1 teaspoon of High Vitamin CLO for breakfast and dinner. The label says to take 1 teaspoon per day. Could I be taking too much?
Thanks
Hi Daiikkon,
Yes, that sounds like too much. I'd take no more than 1 tsp per day.
daiikon
Omega 3 / fish oil intake.
There is more than one issue here.
You need to consider both A and D intake and consider the content of A and d in cod live oil. Stephan is the undisputed A and D wiz.
The amount of long chain Omega 3 needed depends in part on your Omega 3:6 plant fat intake currently and historically. Many vegetable oils are very high in Omega 6.
Omega 6 is highly stored in body fat. Only a little Omega 3 is stored.
So if you have a long history of eating lots of vegetable oils you are likely to have a large store of Omega 6.
Omega 3 as well as having its own roles works to balance the effect of Omega 6.
Most on western diets high in Omega 6 need 1- 2 grams of DHA and EPA in total. 1-2 grams is one to two teaspoons of quality refined fish / cod liver oil.
The American Heart Association recommends a gram.
The American Psychiatric Association two grams.
So maybe look at mixing Stephans more natuural cod liver oil hihg in A and D with a more industrial oil low in A and D but high in DHA and EPA.
This paper may help. IF you stick to the grit and skip the technical and look at the pictures (-: it is very readable and gets the point across well. It is written by some of the Worlds best.
Cutting down on the vegetable oil based Omega 6 is the other half of increasing Omega 3intakes of both vegetable and long chain fats.
http://www.ajcn.org/cgi/reprint/83/6/S1483
Healthy intakes of n3 and n6 fatty acids: estimations considering
worldwide diversity
Robert Brown
Author; Omega Six The Devils Fat
www.omegasixtehdevilsfat.com
This reminds me of something I was reading a while back about celiacs and HDL cholesterol; a large percentage of hdl is synthesized in the villi. It's the good hdl, too, from what I remember. I guess it might make sense for that location to produce a lot of the vitamin d precursor stuff, (or maybe if the villi atrophy, the external skin then has to produce some of the things that would otherwise have been produced in the villi, and has less resources available for the production of vitamin d?) And stuff.
aaron, have you tried Tinkyada rice pasta? It is really very good and does not get gummy. I have no connection to the company. In fact, because too many carbs raise my blood glucose, I cannot eat any of the pastas now.
I used Enterolab to confirm my need to be gluten free. I don't know if I ever had or have flattened villi, but I do know that I react to invisable amounts of gluten.
How much gluten is too much? They experts are still trying to decide as you will get some gluten if you are eating grains and processed foods. It looks like there are different thresholds for different people. Go to www.pubmed.gov and search for 18315587 for an article about tolerable amounts of gluten for those with celiac disease.
Great post Stephen.
I've been dealing with Rheumatoid Arthritis for 5 years, and after following Paleo for almost 6 months with Vitamin D and Omega 3 (EPA + DHA), I feel great. After receiving a small article from Cordain's Paleo Diet on Vitamin K (which said that our ancestors favoured the organs and that liver was a good source of K2)and seeing your great article on Vitamin K, I added K2 to my regimen.
Now, I'm also thinking about adding choline to my program (I understand that the best way would be to eat organ meats, since they are great sources of nutrients, but I just can't eat it - I find it discusting, so supplements are the only way to go).
Regarding Wheat and Vitamin D, I know, from a friend who works with Cordain, that he is working on a paper on the role of wheat on the genetic selection for Adult Lactase Persistence and Extreme Dermal Depigmentation, and he mentioned that, not only high fibre diets increased Vitamin D excretion, but Wheat Lectin could interfere with Vitamin D metabolism - let's see what comes ou of there.
Anne, regarding how much gluten is too much, I found this in Medscape:
http://www.medscape.com/medline/abstract/18315587
Donny,
Good point. A portion of HDL is made in the intestine. Putting a celiac patient on a gluten-free diet raises HDL.
Anne,
Thanks for the reference. 10 mg. That's not much gluten.
JMC,
Glad paleo is working for your RA. That's very interesting, because it also often responds well to low carbohyrate diets. That suggests that it's not the carbohydrate per se, but the neolithic carbs.
I've heard rumors about Cordain's vitamin D work. There have been speculations about it at the Hyperlipid blog. I'll be interested to see what the final paper looks like.
I just talked to my friend, and, aparently, Cordain is going to first publish a paper with just the fibre link, since the lectin evidence is just hard to be accepted in a mainstream journal and he still has some details to sort out.
From what my friend has told me, I suspect he wants to connect this with MTHFR and some other polymorphisms.
You know, I'm a student of Biomedical Sciences and I'm planning on pursuing my studies in Immunology applied to RA. If I was a millionaire, I would organize conferences with various specialists on diverse topics. One topic that comes to mind is lectins. Would you enjoy being in a round table with Peter from Hyperlipidic, Cordain, Puztai and others?
JMC,
I wonder if the effect is specific to wheat fiber, or applies to fiber in general? The vitamin D depletion paper I linked to in my post used wheat bran.
I would be thrilled to participate in a roundtable with the people you mentioned. I think it's great that you are pursuing the immunology of RA. It's an interesting topic that seems to be another facet of the disease of civilization.
JMC
I think the idea of cross specialism conferences is a great one.
Fish oil has been shown in numerous trials to improve RA.
When fish oil is considered A and D are not generally brought in as factors.
If we did develop as shoreline gatherers fish would have provided Omega 3s, A D Some K choline, mineral iodine etc. The more I see of Stephan's posts the more I grasp in an outline sense that they are a dietary package.
DHA is a COX blocker.
Omega 6 links to some of the inflammatory factors.
This is a really useful paper from the Adelaide Rheumatology Unit aimed a doctors
Fish oil: what the prescriber needs to know
Leslie G Cleland,1 Michael J James,corresponding author1 and Susanna M Proudman1
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1526555
Robert Brown
Author Omega Six The Devils Fat.
www.Omegasixthedevilsfat.com
Stephan,
Good question. I don't know if it is wheat fiber or fiber in general, but it is hard to know,
since in neolithic times, in Northern Europe, the most likely sources of fiber were barley and wheat and also since wheat flour was a widely consumed food in 1800s in England. Moreover, eskimos don't eat cereal grains or other sources of fiber, like vegetables, and ingest foods containing Vitamin D, so their skin is not white as in Northern Europe, and in Africa, various people eat or ate a high fiber diet, but with all that UVB radiation, that didn't pose any problem to them.
But, again, your question is intriguing.
Yes, I plan to study RA, but since very few researchers are interested in lectins, dietary antigens and auto-immune diseases (in fact, from the limited scientific literature I've read, I believe Cordain was the only one who went along and publish a paper on the subject exploring both dietary antigens and lectins in RA), I think I'll have a hard time convincing my professors.
Regarding the round table, that would be great, and I have some friends (nutritionists) that are planning on creating some kind of Institute to organize conferences and seminars and they are very open minded, so who knows if something like that won't be possible in the future.
Robert, thanks for the information and the paper.
I have also read a lot on Omega 3 and inflammation and the evidence in RA seems strong, so I personally take 3 grams of EPA+DHA every day, having started 6 months ago, although I started with 6 grams for the first month.
...are the effects of a low-carb or ketogenic diet truly due to reducing carbohydrate, or simply due to reducing wheat and sugar and increasing the intake of animal nutrients? Maybe both?
My impression is that wheat is the cause #1 of most diseases that we are talking about (because of gluten, WGA etc), then sugar and HFCS are #2 (because of fructose) while starch is probably neutral since there are populations that experienced very little health problems and are long lived on a diet full of rice and root vegetables. Public enemy #3 would be polyunsaturated vegetable oils, not starchy vegetables.
In fact some of the longest living people in the Andees survive eating mostly potatoes.
I think that a starchy (non-wheat) diet can only be problematic if mixed with equal caloric amount of fat - a medium fat medium starch diet is unhealthy, even without wheat, because of the negative synergy between fat and carbohydrate, not because of unhealthiness of each one of the macronutrient.
Stan (Heretic)
Stan said ---- "are the effects of a low-carb or ketogenic diet truly due to reducing carbohydrate, or simply due to reducing wheat and sugar and increasing the intake of animal nutrients? Maybe both?"---
Multifactoral is my 'guess'.
Ketogenic diets in trials are often quite low in Omega 6. Omega 6 causes inflammation and oxidative stress.
Inflammation and oxidative stress leads to leaky gut membranes so giving greater access to 'foreign bodies'.
Inflammation and oxidative stress goes hand in hand with over activation of the immmune system.
Over activation of the immune system leads to increased sensitisation to all sorts of things including protective agents in plants, foreign proteins etc.
Excess Omega 6 has been linked at varying levels to inflammation oxidative stress, poor digestion, leaky gut and increased sensitivity to allergens.
Add to that declining vit A D K, (thanks Stephan) falling mineral and iodine intake, higher sugar and fructose, highly refined food, additives, etc and it seems reasonable a reasonable proposition that the body will not function as well as it might.
Robert Brown
Author Omega Six The Devils Fat
www.omegasixthedevilsfat.com
Post a Comment