The gluten-free industry is booming. 1 in 10 people now eat gluten-free, and ‘pro-science’ and pop culture websites alike love to dismiss food intolerance as a ill-directed fad. Here’s some memos they missed.
1. Gluten sensitivity
In 2011, Peter Gibson coined the term ‘non-celiac gluten sensitivity‘ in a double-blind, placebo controlled study which showed it existed as a condition. Then in 2013, he published a poorly designed and poorly named study which said in essence, that perhaps gluten intolerant people have trouble with other sugars as well as those found in wheat. He titled it ‘No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates‘. A lot of people only read as far as ‘no effects of gluten’, went and wrote angry blogs hating on maldigesters, completely missing the underlying message: those people have to remove gluten as well as other foods. To illustrate the point, in that same year Peter Gibson gave a lecture mentioning gluten sensitivity. The next year, he published a study saying that gluten causes depression in sensitive individuals and was author on a lit review stating that non-celiac gluten sufferers are a heterogeneous group. In spite of the PR-disaster titles (and one has to wonder if it was accidental, given the funding bias of George West Foods, who’s main product is—you guessed it—bread), the rest of the field work on the perplexing effects of gluten continued to grow.
Even if you side with a man who coined and proved a condition, only to widen its scope enough to confuse and befuddle the mainstream (worse when combined with that dramatic title making it seem he actually made it up in the first place) there’s still enough studies to show a gluten-free diet relieves Irritable Bowel Syndrome symptoms in most people. These go back as far back as 1989, and the relief effect is moreso for people with a marked immune response.
Between 7-20% (or even 25%) of people have ‘IBS’, which is a diagnosis of exclusion. (More on that later). So given that at 1 or 2 in 10 people have IBS, this lends credibility to at least 1 in 10 people feeling better on a GF diet. In the absence of actual diagnosis and treatment, people are becoming aware of a GF diet as a self-treatment option—a fact sites like Cracked like to be skeptical of, dismissing it as nothing more than a popular trend.
To be clear: ‘Some patients with IBS symptoms exhibit immunological evidence of gluten sensitivity but have no overt intestinal mucosal injury. They have symptoms that meet the diagnostic criteria for IBS and respond symptomatically to exclusion of gluten from the diet. Thus, gluten sensitivity may be involved in the pathogenesis of a subgroup of IBS patients.’ Thanks for that , Pubmed.
3. Non-IgE mediated allergies.
Most people think ‘allergy’ if you break out in hives immediately. That’s an IgE allergy. There’s also IgG and IgA allergies (this is a known, undisputed biological concept) which can take between 3-4 hours and 3-4 days. So if you ‘accidentally’ feed me gluten at your party on Friday, I might not break out into a rash immediately. And given that I won’t call you on Sunday night to let you know I am doing the stinkiest of all unholy farts and rolling around in my bed in agony, it’d be easy for you to think I was making the whole thing up. Because it is so convenient for me to not eat donuts, or pizza, or even fucking soy sauce on my sushi.
As Food Allergies for Dummies Pocketbook puts it ‘the naming of non IGE-mediated allergies is basically an admission that this is the other type of allergy, the one they don’t understand’. Hmm, that sounds familiar, IBS. Or to use a more scientific source, ‘Unfortunately, there remain many unanswered questions regarding the mechanistic link between gluten sensitivity and functional gastrointestinal symptoms’…..studies have ‘failed to elucidate a mechanism.’
So, noone knows what’s happening or why, and with no known biomarkers so we can’t measure or diagnose (that’s the part Cracked doesn’t like), but we have observed something happening, and guys, observation is part of science.
Some studies have shown that patients who meet criteria for IBS may actually have latent CD or a CD variant, or that celiac disease may fall on a spectrum, like autism and other conditions. Who knew, life is grey, not black and white. Either way, there’s a distinct possibility that non-celiac disease gluten-intolerant people are have an innate immune response to gluten.
Diagnosis of Celiac Disease is slowly moving from outdated anti-gliadin studies to IgA anti-transglutaminase (sensitivity & specificity about 90%), and new IgA testing is being developed. Non-celiac gluten sensitive people may be seropositive for the less specific anti-gliadin antibody tests but not for anti-transglutaminase. They often have 2 of the 3 celiac HLA genes, too. And in others such as those with hashimotos, thyroid autoantibodies may cross react with gluten protein.
4. Indigestible sugars.
FODMAPS. When Peter Gibson declared no effect of gluten, he didn’t mean no effect at all. He meant, no effect more so than if you take out all the sugars, including lactose, broccoli and beans, that are hard to break down. This later theory is a convenient conclusion given his book of the same name, but is an inadequate explanation for gluten sensitivity in the face of studies suggesting an interaction with the immune system, involving inflammation and gut permeability. Either way, a lot of us can’t eat it.
5. Harvesting with roundup.
Changing track a little here, taking a few steps back from plate to paddock. Round-up is often using prior to harvesting wheat to ripen green stems, dry out grains and kill weeds. It’s feasible to think there is a level of absorption of glyphosate in the crops where it is used for drying and ripening, with such massive harvesting fields, and the use of a reasonably arbitrary 30% moisture rule. Even if only a very small percentage of the crops are too green or wet, and absorb the pesticides, the omnipresence of wheat in foods means that people consume a large amount, which increases the likelihood of their exposure to glyphosate (less hypothetically, the chemical has actually been found in human urine). So, if there is any chance that the human immune system responds to herbicides (likely), it is feasible to think that some people’s bodies may learn to attack, or be triggered by, the protein found alongside those toxins, gluten.
This theory is as feasible of an explanation for the unexplained intolerance as any other.
6. Processed gluten replacements
Yo, IFLS. Whether or not gluten-free replacement foods contain less fibre and nutrients isn’t exactly relevant, if removing them removes a sickness you already have.
This is a good one: ‘if the patient eschews the typical packaged gluten-free products and instead steers towards fresh fruit, vegetables, nuts, meat, and dairy, then a GFD could in fact be the healthiest diet of all.’ Packaged foods are not healthy, leave the gluten-free out of this.
That said, there is reason to suspect gluten causes weight-gain:‘The data suggests that diet gluten exclusion should be tested as a new dietary approach to prevent the development of obesity and metabolic disorders’.
7. Good bacteria & the physical brain
It’s taken a long time for science to accept that IBS isn’t ‘just an emotional disturbance’. While it is true that there is a feedback loop of stress causing the die-off of good bacteria and an exacerbation of IBS symptoms, it’s also true that depression is caused by, as well as correlated with, food intolerances, as it can be improved by their removal. This is not suprising, at the very least as serotonin is recycled in the gut.
The essence of psychology is that it can only be a science if ‘the mind’ is located in the physical brain. As the mind is a physical thing, ’emotions’ are a biochemical process subject to cause and effect mechanisms, not free will. If you want to be scientific, it makes no sense to look first to an ‘all in your head’ diagnosis, without first excluding physical causes.
This victim-blaming approach has gone as far in minimizing the disorder as to recommend CBT as a treatment method for IBS, with limited success. While it’s true that meditation and stress management can help control the symptoms of IBS, the same is true for most illnesses and diseases.
Update: A number of additional/new studies on wheat sensitivity
– Zevallos: Amylase-trypsin inhibitors, a protein in wheat, are a natural pesticide now shown to elicit an adaptive Th1-mediated immune response (causing the release of proinflammatory cytokines) in individuals carrying HLA-DQ2 or HLA-DQ8 genes. ATIs have been shown to accelerate lupus, and even enhance experimental autoimmune encephalomyelitis in mice. An overview published 2016 stated: ‘Concentrations of ATIs found in a normal daily gluten-containing diet increased low-level intestinal inflammation’.
– Non-celiac wheat sensitivity has been established with bio markers. Patient blood shows significantly higher levels of systemic inflammation and reactivity, and markedly higher levels of fatty acid-binding protein 2 (FABP2), a marker of intestinal epithelial cell damage (that signifies damage to the intestinal lining).