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Is gluten the new Candida?

Much of the therapeutics I was taught as part of my pharmacy degree is now of historical interest only. New evidence emerges, and clinical practice change. New treatments replace old ones – sometimes because they’re demonstrably better, and sometimes because marketing trumps evidence. The same changes occurs in the over-the-counter section of the pharmacy, but it’s here marketing seems to completely dominate. There continues to be no lack of interest in vitamin supplements, despite a growing body of evidence that suggests either no benefit, or possible harm, with many products. Yet it’s the perception that these products are beneficial seem to be seem to continue to drive sales. Nowhere is this more apparent than in areas where it’s felt medical needs are not being met. I covered one aspect a few weeks ago in a post on IgG food intolerance blood tests which are clinically useless but sold widely. The diagnosis of celiac disease came up in the comments, which merits a more thorough discussion: particularly, the growing fears over gluten consumption. It reminds me of another dietary fad that seems to have peaked and faded: the fear of Candida.

It wasn’t until I left pharmacy school and started speaking with real patients that I learned we are all filled with Candida – yeast. Most chronic diseases could be traced back to candida, I was told. And it wasn’t just the customers who believed it. One particular pharmacy sold several different kits that purported to eliminate yeast in the body. But these didn’t contain antifungal drugs – most were combinations of laxative and purgatives, combined with psyllium and bentonite clay, all promising to sponge up toxins and candida and restore you to an Enhanced State of Wellness™. There was a strict diet to be followed, too: No sugar, no bread – anything it was thought the yeast would consume. While you can still find these kits for sale, the enthusiasm for them seems to have waned. Whether consumers have caught on that these kits are useless, or have abandoned them because they don’t actually treat any underlying medical issues, isn’t clear.

The trend (which admittedly is hard to quantify) seems to have shifted, now that there’s a new dietary orthodoxy to question. Yeast is out. The real enemy is gluten: consume it at your own risk. There’s a growing demand for gluten labeling, and food producers are bringing out an expanding array of gluten-free (GF) foods. This is fantastic news for those with celiac disease, an immune reaction to gluten, where total gluten avoidance is essential. Only in the past decade or so has the true prevalence of celiac disease has become clear: about 1 in 100 have the disease. With the more frequent diagnosis of celiac disease, the awareness of gluten, and the harm it can cause to some, has soared. But going gluten free isn’t just for those with celiac disease. Tennis star Novak Djokovic doesn’t have celiac disease, but went on a GF diet. Headlines like “Djokovic switched to gluten-free diet, now he’s unstoppable on court” followed. Among children, there’s the pervasive but unfounded linkage of gluten consumption with autism, popularized by Jenny McCarthy and others. Even in the absence of any undesirable symptoms, gluten is being perceived as something to be avoided.

What’s been lost in an enthusiasm for gluten avoidance, is the fact that there are some people who do experience undesirable symptoms from gluten consumption, but don’t have celiac disease. It’s this group that was the focus of a recent paper in the Annals of Internal Medicine:  Nonceliac Gluten Sensitivity: Sense or Sensibility? It’s behind a paywall, but I’ll try to summarize the paper in the context of what we know, and what we don’t know, about celiac disease and possible non-celiac gluten sensitivity.

Celiac disease

Celiac disease (CD) is an autoimmune disease, not an allergy or intolerance. The disease manifests with inflammation and injury to the bowel lining when gluten is consumed. It can cause gastrointestinal scarring and villous atrophy – resulting in permanent damage. While it normally presents with gastrointestinal symptoms, symptoms can also manifest as conditions like skin rash.The disease has been described as protean, which is appropriate. A 2001 survey of patients with confirmed celiac disease indicated patients reported symptomatic disease an average of 11 years before a diagnosis was reached. A similar survey of pediatric patients suggested a similar trend: Multiple physicians and other diagnoses. By manifesting in so many different ways, it cannot be diagnosed based on symptoms alone. So why is it so difficult to identify? It isn’t – but you need to look for it.

The immunologic response in celiac disease is a reaction to gliadin, a protein found in wheat, barley and rye. A highly effective test is now widely available. Blood is tested for IgA antibody human recombinant tissue transglutaminase (IgA-tTGA) or endomysium (IgA-EMA). These tests are both highly sensitive (90%–96%) and specific (>95%) for celiac disease. Positive results are followed by biopsy, necessary to establish a diagnosis. That diagnosis is confirmed by evaluating the effectiveness of a gluten-free diet on reported symptoms. (The full diagnostic workup is nicely summarized in the AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease.) Given the availability of a sensitive and specific test for celiac disease, there has been some discussion on whether widespread and routine screening for celiac disease should occur. The evidence and risk/benefit currently suggests screening in the absence of any symptoms is still unwarranted.

Non-celiac Gluten Sensitivity

We have a sensitive and specific test for celiac disease, so diagnosis should be straightforward, right? If you have celiac disease, you must avoid gluten for life. But what about those that test negative for celiac disease, but have symptoms from eating gluten-containing foods? There are at least five possible scenarios:

  • You could be IgA deficient, in which case there’s a false negative. Other laboratory tests may be done, and compared with the biopsy.
  • You may already be on a gluten-free diet, which will cause a false negative result.
  • It could simply be a false negative laboratory test result (no laboratory test is 100% sensitive and specific).
  • There may be some form of subclinical CD present (not yet established as fact, but plausible)
  • It may not be celiac disease, and other causes need to be evaluated.

It’s this last category, deemed non-celiac gluten sensitivity (NCGS) which is the subject of the recent Annals paper. Despite the identification of NCGS over 30 years ago, it’s only recently that interest seems to have exploded – I count about 336,000 Google results, but only 10 results in PubMed. Remarkably, the Annals paper points out that the public awareness of NCGS exceeds that of celiac disease [PDF].

So how do we distinguish between the CD and NCGS, objectively? Here the Annals paper includes a nice table which summarizes the challenge:

Table 1 from Nonceliac Gluten Sensitivity: Sense or Sensibility?

It is the protean nature of CD that makes NCGS seem so prevalent. As there’s a myriad of non-specific symptoms that could signal true CD, any any of these symptoms can also be attributed to NCGS. So what high-quality evidence exists to establish NCGS is real? Not a lot, yet. The Annals paper identifies only a single placeb0-controlled rechallenge trial, which concluded that NCGS “may exist”. There is a lack of systematic research, but lots of opinions. A recent essay [PDF] from Sapone et al in Biomed Central used a consensus-based approach to evaluate NCGS and other gluten-related disorders. It concludes by labeling gluten “toxic”, declaring celiac disease an “epidemic”, and suggesting that the prevalence of gluten sensitivity will continue to increase, supposedly because of a lack of adaptive response to deliberate changes bred into wheat strains.

But is that accurate? There are no accurate prevalence estimate for NCGS – because there are no objective signs or symptoms that can be evaluated. Given the magnification of fears of gluten among the general population,  I suspect prevalence will increase simply because of perceived health concerns and rank fearmongering over gluten: nocebo effects, where an inert substances causes negative symptoms. From a scientific perspective a few possible mechanisms that have been postulated for NCGS, none of which have been established yet:

  • a stress response, rather than an immune response, which is unlikely given the varied manifestations of NCGS
  • an IgE-mediated reaction to wheat flour, possibly to another chemical compound it contains
  • starch malabsorption
  • opioid-like effects of gluten on the colon (opioid receptors in the gastrointestinal tract are the reason narcotics cause constipation)
  • some degree of low-grade inflammation, possibly signalling some sort of subclinical CD, presenting in a way that cannot be diagnosed with the current tests

Conclusion

The idea that gluten sensitivity is real and widespread goes far beyond the current scientific evidence, and the well-established facts of celiac disease. Time will tell if gluten avoidance follows the path of Candida, and other dietary fears and fads that preceded it. But it doesn’t need to. Given the protean nature of CD, symptoms cannot be dismissed as nocebo effects: A CD diagnosis needs to be ruled out before NCGS is even contemplated. Going gluten-free in the absence of a proper medical evaluation may not be directly harmful, but it complicates a diagnosis. Moreover, it can be expensive, and difficult to maintain 100% avoidance – essential with CD, but not established as necessary with NCGS. Besides, who really wants to cut out all gluten-containing products if they don’t need to? Until better diagnostic criteria are established, the N of 1 trial is probably the most science-based (if impractical) approach: single-blind challenges to measure for subjective or objective symptoms. Our challenge in dealing with dietary fads as health professionals is to recognize that some of our patients are suffering, and evaluate them in a science based way: without dismissing the symptoms, and without advocating dietary transformations that may be unnecessary.

Reference
ResearchBlogging.org
Di Sabatino A, & Corazza GR (2012). Nonceliac gluten sensitivity: sense or sensibility? Annals of internal medicine, 156 (4), 309-11 PMID: 22351716

Posted in: Basic Science, Nutrition, Science and Medicine

Leave a Comment (71) ↓

71 thoughts on “Is gluten the new Candida?

  1. inconscious says:

    My current family medicine preceptor harps on gluten a lot and has patients get off it as well as corn and dairy – essentially with any kind of medical symptom. It’s basically his fallback treatment to do these things when medication isn’t absolutely indicated. He also has patients that have done the “candida diet.” Naturally both of these modalities seem to have variable effects – some feel “better” or “cured” and others don’t…sounds like chance to me.

    Oh and of course he does acupuncture and has an allergist that does “homeopathic allergy testing,” whatever that means.

    *sigh

    These days I usually skip a head of him to see the next patient so I don’t have to spend time in the room while he sees them and spouts this garbage.

  2. Chris Repetsky says:

    @inconscious

    If he’s giving advice like this to patients without indication/scientific evidence, that’s potentially dangerous and you might consider speaking to his superiors. At least make them aware that you are uncomfortable working with/supporting an unscientific practitioner.

  3. @ inconsciouson, absolutely do not talk to your preceptor’s superiors. Keep your mouth shut and roll your eyes as hardly as you can. Make mental notes of the type of practitioner you want to be and strive to be different from this guy. Unless your preceptor is generally hated by the faculty, if you complain about him you may kiss a good evaluation, a letter of rec or possibly a residency position goodbye.

  4. windriven says:

    “[B]ut unfounded linkage of gluten consumption with autism, popularized by Jenny McCarthy…”

    Wait, wait!!! I thought MMR vaccines were the one true cause of autism!

  5. chaos4zap says:

    Great….I can just see this going the way of the “peanut allergy”. Child-coddling house wives everywhere will be lobbying schools to remove all gluten from school lunch’s because of their child’s sensitivity to it. Goodbye, disgusting square pizza slices. How someone can make it through the day having Chronic Lyme Disease, Chronic Fatigue Syndrome and….now NCGS, is beyond me. I feel bad for them, I really do. I can’t wait for the NCGS House, M.D. Episode.

  6. latenac says:

    It’s already taken off. Everyone I know that would have had Candida problems a few years ago now have gluten issues. I have a former co-worker who’s now 5 year old son had a gluten reaction when he was 9 months old (ie mild diaper rash 5 minutes after eating some bread) and as a result her and her son have been gluten free for years and feel so much better and so much more special as a result. In case you don’t treat her special enough she’ll remind you in a loud voice she has to be gluten free. I never had the heart to tell her before I left that her son isn’t gluten intolerant as proven by the dish he orders whenever they go to a Thai restaurant, Pad See Ew, which translates to soy sauce noodles and requires 2 types of soy sauce which definitely aren’t gluten free. But he doesn’t seem to have a problem eating the dish and I get to chuckle at the memory of her telling us how wonder Thai restaurants were for the special gluten intolerant people especially Pad See Ew.

    I do have a friend who has a son who has celiac’s and people like the above make it all the harder for her to get people to take her son’s actual condition seriously. So while the glut now of gluten free products are nice for her son it also is the double edged sword of people thinking she’s trying to be trendy.

  7. inconscious says:

    @Skeptical Health – completely agreed

    I’ve perfected the art of cringing internally alone – although I ALMOST giggled when a patient told me she was relying on “energy medicine” and prayer to help her with her atypical chest pains.

    As I suspect happens quite often my preceptor is genuinely a very nice person who spends quite a bit of time with each patient – which likely has a lot to do with the “positive outcomes” he/I see in the office in response to his “treatments.” He also does practice actual medicine, he just “integrates” it with quackery.

    After initially seeing what happens in the office I told myself that I would just have to better my physical exam skills since I wouldn’t really be learning much else.

  8. idoubtit says:

    I linked to this story at http://Doubtfulnews.com today. But here is another news release that just came out:

    Gluten-Free, Casein-Free Diet May Help Some Children With Autism, Research Suggests
    http://www.sciencedaily.com/releases/2012/02/120229105128.htm

    On first blush, this study looks RIDICULOUS. It asked parents who likely believe that these restrictive diets work to record behaviors of their own children on the diet. Completely subjective, biased and worthless.

  9. cervantes says:

    Slightly OT but worth reading. A righteous rant by oncologist Ranjana Srivastava in the new NEJM about the real, serious harm done by quackery. Behind the subscription wall, alas, for you rabble who don’t have access to a university library. Maybe one of the bloggers here will want to discuss the case he presents.

  10. Scott says:

    @ inconscious:

    It’s sad when such people can’t be properly called on their nonsense due to politics. I’d hate to be in your position – biting my tongue is something I’m not very good at. You (and even more, his patients) have my sympathies.

  11. Chris Repetsky says:

    I should probably clarify that I meant anonymously. Mea culpa. Several times now I’ve submitted anonymous complaints to the powers that be, and seen Professors/Physicians reprimanded for practicing nonsense. I do agree that it’s academic/professional suicide to call out your attending, which is sad because basically they are unaccountable for their actions (in this case.)

  12. CarolM says:

    I made the mistake of going to some health boards for information, and was quickly accused of being gluten intolerant, despite the lack of symptoms. It’s definitely the condition du jour.

    It seems like a very roundabout and pseudoscientific way to reduce the amount of wheat products in the diet, which after the bagel-and-pasta orgy of the last 20 years, might be a good idea. But why do these nuts have to swing from one extreme to the other like that? I’ll never get it.

  13. Chris says:

    It reminds of how fructose is now the evil sugar, except when I was first pregnant over twenty years ago it was the good sugar. I still have my old What To Eat When You’re Expecting cookbook that uses concentrated apple juice instead of table sugar.

    It is all fairly silly.

    My sister has decided that gluten is bad. She has cut it out of her diet (and she has been lactose intolerant since birth), plus convinced her husband and my dad to become gluten-free. At Christmas I send my family a collection of home made sweets, usually consisting of spiced sugared nuts, biscotti and spice rum soaked pound cake. For them I dropped the cookies and pound cake and made homemade peppermint flavored marshmallows with added sugar sprinkles (it took a long time to clean the sticky kitchen). It is debatable which was more evil, the marshmallows or the rum soaked cakes.

  14. Scott says:

    Sounds yummy – wish I were a member of your family!

  15. Chris says:

    Thanks. The marshmallow recipe is from the Martha Stewart website and the pound cake recipe is in two Sunset Magazine cookbooks I own.

  16. Watcher says:

    HA! I just wrote up something about this on a football message board yesterday debunking kind of the same thing. Basically the guy was posting a blog post describing a variant of the Paleo diet, and how the Boston Red Sox current injury problems are a result of not being on his diet.

  17. Geoff says:

    It’s important that we maintain a scientific and skeptical eye toward all fads, including gluten free. I, personally, have been checked out for celiac since my sister has it, and these results have come up negative. Still, I eat wheat free about 95% of the time if not more, and when I have wheat I notice a couple of changes. The top of that list is GERD; I will experience GERD symptoms when I attempt to sleep as much as 6 hours after eating wheat, and these are symptoms that I do not experience if I eat rice, potatoes, milk, meat, popcorn, or really any foods that do not contain wheat. The second is Raynaud’s, I can be sweating elsewhere on my body and still have my hands get chilly to the touch and turn blue. I feel my scleroderma starting to act up, the skin on my face starts to tighten, especially the circumference of my mouth.

    Even for people who are seemingly healthy in every other way, though, wheat is probably problematic. I know of a number of high performance athletes who are negative for celiac and yet experience measurable performance gains on a wheat free diet. I’ve heard specific examples of power lifters at West Side Barbell who already have a 700lbs squat adding an extra 30 pounds of mass while decreasing body fat percentage after switching to a wheat free, whole foods diet. Ultramarathoners demolishing PRs on a wheat free diet. Obviously none of these examples will hold up to scientific scrutiny, but in my opinion they are worth a mention.

    The other thing about wheat, particularly processed wheat (white flour), is that it is almost certainly a hyperrewarding food when combined with water and cooked. The satiety index of wheat containing foods are all very low across the board. Wheat containing foods are less satiating on a per calorie basis than ice cream, popcorn, jelly beans, cheeses, french fries, potato chips, etc. So if wheat is in fact an inflammatory food, which in my opinion it probably is, the fact that it also is less satiating could magnify any inflammatory effects as a result of overconsumption.

  18. Chris says:

    Geoff:

    It’s important that we maintain a scientific and skeptical eye toward all fads, including gluten free.

    Which was followed by personal anecdotes, and personal opinion.

    By the way the last sentence in the above article says: “Our challenge in dealing with dietary fads as health professionals is to recognize that some of our patients are suffering, and evaluate them in a science based way: without dismissing the symptoms, and without advocating dietary transformations that may be unnecessary.”

    So, please Geoff, understand I am not dismissing your symptoms, and you may very well be a case where the testing for celic is a false negative. But your last paragraph is not science, it is speculation.

  19. Kultakutri says:

    Well, I don’t know what I have, I got the bloodwork done and I’m negative for coeliac but give me a good serving of, say, pasta and I’ll spend two days in the bathroom with nasty diarrhoea and awfully bloated. I guess it’s some digestive problem because I can tolerate a small amount of gluten-ful stuff without repercussions.
    Well, I’m eating mostly gluten-free and I’m just fine. I learned to cook new exciting foods, I’m experimenting with GF baking (so far, I’m in the phase of ugly and very tasty things) and from time to time, I get a slice of normal bread or cake or something, which makes people think that I’m faking it but I don’t care. After all, I keep saying that I’m on almost-gluten-free diet.

  20. passionlessDrone says:

    Hello friends –

    I’ve got very similar behavior sets as Kultakutri, negative celiac test, but an undeniable physical effect from eating things with gluten in them. Immediate coughing, sneezing, nose running and delayed GI distress and dark circles under the eyes.

    @Winning: There are now some OK tasting GF beers.

    Note: An IgG test predicted an intolerance to wheat and was right either by happenstance or by being correct. Go figure.

    - pD

  21. Geoff says:

    @Chris

    My last paragraph is speculation based on the imprical finding that wheat based products are less satiating per calorie than any other type of food. The rest is anecdoes and speculation, which is why I prefaced those statements by stating that they were not scientifically rigorous. Jackass.

  22. Chris says:

    Since celiac is an immune response, which actually destroys cells, some of you may actually have more of an intolerance. My sister is not allergic to milk, she just lacks the enzyme to digest lactose (part of being born very premature, and some genetics since my daughter became lactose intolerant at puberty). There may be some missing enzyme or bacterial flora needed to break down the gluten proteins.

    Anyone proposing a study for some graduate student?

    By the way, neither my father nor my brother-in-law thought they had a reaction to wheat until my sister suggested it to them. Though I suspect any improvement in my sister and her husband would be caused by cutting back on their evening martinis. I know when they last visited my blood alcohol levels went up a bit!

  23. Chris says:

    Geoff:

    My last paragraph is speculation based on the imprical finding that wheat based products are less satiating per calorie than any other type of food.

    I think it would help your argument better if you provided actual supporting documentation instead of resorting to juvenile name calling. I assume that you are not used to your comments getting criticism, so I will let it pass and just wait for that evidence. Thank you.

  24. Geoff says:

    @Chris

    I am quite used to my comments getting criticism, that wasn’t the problem. The problem was that I went WAY out of my way to qualify my statements as not being scientific, and you still felt the need to point out that my statements were not scientific.

    This is the most famous study on Satiety Index: http://www.ncbi.nlm.nih.gov/pubmed/7498104.

  25. Chris says:

    Thank you. And you might make it more clear next time when you start off with “scientific and skeptical eye toward all fads,” and then state it is an opinion in the last sentence of the second paragraph. Because it was not obvious. Sometimes what you mean and how it is interpreted are two different things.

  26. Geoff says:

    @Chris

    Rereading what I wrote, I can see that I probably should have followed up that first sentence with something like “Still, anecdotes are meaningful, as it is primarily through anecdotal experience that we determine what experiments are worth running.” Apologies.

  27. Zetetic says:

    Gluten “sensitivity” or “allergy” is a BIG topic on all the altie blog sites and there are multiple bizarre “flush” protocols described as the remedy. Associated with this, they often refer to “Leaky Gut Syndrome” – a condition I’ve never found an actual medical reference for. Wouldn’t a “leaky” gut precipitate peritoneal sepsis?

  28. aaronupnorth says:

    Is there a disease where you are intolerant of everything except bacon? Because, that’s what I have…
    Aaron

  29. jimbog81 says:

    This is what happens when real illnesses get perverted into fads; people no longer know what the real illness is anymore. Words like “allergy”, “intolerance”, “sensitivity”, “toxic”, “issues” get tossed around and used as a generalization.

    I know a guy who’s mother almost died in hospital back in the 80′s due to Celiac Disease. By the time doctors figured out what she had she was in a hospital bed close to death weighing about 80 lbs.

    When someone has Celiac Disease they don’t usually get acutely ill with bloating, gas, GERD, diarrhea, migraines, brain fog, heavier periods, etc. when they specifically ingest gluten (a.k.a. the new source of everybody’s health problems). What happens is as they eat gluten containing foods over time the autoimmune reaction that takes place damages their small intestine. Once that becomes damaged they start to get symptoms; they can longer absorb nutrients properly. Stomach upset might not even be a problem for them at all. Basically, they are starving even though they are eating.

    Wheat and Celiac Disease has become a craze thanks to things like this:

    (Dr. Oz promo video)
    http://www.youtube.com/watch?v=RDf-1smIuRA&feature=related

    If I started chirping about the people on celiac forums that are “experts” trying to “educate” their allopathic doctor about Celiac Disease, I would never be able to leave my computer. So I will go now.

  30. Mike.Gayner says:

    My fiancé’s sister has full-blown celiac so this is a double-edge sword for her. On the one hand, it’s annoying because people won’t take the disease seriously, and assume she has a “common intolerance” to gluten. For example, I have a friend whose girlfriend would latch on to whatever the dietary/health fad of the day is. She would have been a candida “sufferer”, and so is obviously “gluten intolerant”. Of course, she can tolerate gluten when it suits her, and assumes other “gluten sufferers” can do the same.

    On the other hand, the popularity of a gluten-free diet has meant a massive proliferation of gluten-free foods. We have entire shops and entire supermarket aisles dedicated to gluten-free products now, which means that actual celiac sufferers have a massive range of products that were previously unavailable or obscure.

    On balance this is probably good for her, if not a little irritating.

  31. chaos4zap says:

    I often wonder how much of these things are of the self-fulfilling type as well. I know people that are vegetarians and they say when they eat meat, it makes them sick. If you don’t eat meat for a long time, then you eat a piece of meat (something your body is no longer use too) then wouldn’t you expect that maybe a mild reaction or digestive episode is possible? Then this would be interpreted as evidence to support the initial, generalized idea that eating meat makes them sick. Not to mention the psychological factors of fully knowing (in your head) that it will make you sick. I know we are not discussing vegetarians specifically, but the potential parallels should be obvious.

  32. @chaos4zap, I haven’t been able to politely verbalize it, but I’ve been long thinking that a number of these “afflictions” affect only certain ….types…. of people.

  33. jimbog81 says:

    @SkepticalHealth

    I think I what you are alluding too…

  34. autismum says:

    As a food fad going GF has well and truly taken off. I won’t rant on and on about GF/CF diets for autism (my boy would starve if I had him on one of those) but I think this might make you giggle:

    “When it comes to improving world health, wellbeing and prevention from disease, if I were to take a bullet for all human kind then the number one food I would eliminate would be all and every wheat based product.”

    Who needs vaccines? Just lose the gluten – according to this personal trainer (oh my stars!)
    http://www.dominicmunnelly.ie/2011/10/if-in-doubt-cut-the-wheat-out/

  35. jimbog81 says:

    @SkepticalHealth

    I think I know what you are alluding to…

    (I should make a habit of reading over my comments before I hit “submit”.)

  36. Uther says:

    Scott,
    this new study http://www.biomedcentral.com/1741-7015/9/23 claims CD and GS are distinct entities. However the results to me look like a subclinical CD. Authors mention GS causing an inflammatory process in gut possibly mediated by immune cells like TLRs(Toll Like Receptors).

  37. DKlein says:

    My friend is the new social media manager at a health-supportive cooking school and posted a link to an article about corn gluten being “damaging to celiac patients” on The Gluten Free Society webpage (Dr. Peter Osborne’s website). There, the following prepublication abstract was referenced. I don’t understand much of it, but the results would indicate some celiac patients might have a problem with corn. I have a good friend who was diagnosed with celiac disease.

    http://www.ncbi.nlm.nih.gov/pubmed/22298027

    “Results concur to indicate that relative abundance of these zeins, along with factors affecting their resistance to proteolysis, may be of paramount clinical relevance, and the use of maize in the formulation and preparation of gluten-free foods must be reevaluated in some cases of celiac disease.”

    The website is loaded with nonsense (my BP went up while reading it), and I’ve only just begun to see how profoundly unscientific my “nutrition education” was at a “whole person health institute”; however, I would like to know if corn gluten or something else in corn could be a problem for celiac disease patients. The school is jumping on the corn gluten bandwagon and has already called it the “next restrictive frontier.” Sigh. Thanks.

  38. Chris says:

    What evidence is there that corn even contains gluten? The only information I can find on the Googles on “corn gluten” is as an herbicide.

  39. DKlein says:

    I’ve seen pet foods containing corn gluten. Perhaps it is just corn protein, used as a filler.

  40. jimbog81 says:

    If you guys like Mercola, you’ll love Peter Osborne….

    From his site:

    “Because of recent media exposure on The View, Larry King and Fox News, gluten sensitivity is becoming more and more of a house hold word. Watch the video below to see a recent report by Fox News featuring Dr. Osborne as an expert in gluten sensitivity. Pay particular attention to the symptoms and diseases that the woman had before finding out that she was gluten intolerant (hint – they were the opposite of celiac disease symptoms!)”

    If he’s an expert, why is it that he uses incorrect nomenclature when he describes a sensitivity, intolerance, and allergy?

    Also from his site (some fact mixed with some fiction):

    Those directly related to someone who has already been diagnosed with gluten intolerance or celiac disease should always be tested, but those suffering with any of the following list of diseases should also get tested:

    Those who suffer from chronic intestinal problems
    Infertility or recurrent miscarriage
    Chronic anemia
    Osteoporosis
    Migraine Headaches
    Psoriasis
    Eczema
    IBS
    Bipolar or Schizophrenia
    Low thyroid (Hypothyroid)
    ADD or ADHD
    Autism
    Fibromyalgia
    Chronic Fatigue Syndrome
    Restless Legs Syndrome
    Sleep Apnea
    Type I or II diabetes
    Multiple Sclerosis
    Any Autoimmune Disease

  41. PernilleN says:

    Cervantes, the article you llinked to http://www.nejm.org/doi/full/10.1056/NEJMp1110812 is absolutely terrible! Isn’t it possible to stop these people? He should be prosecuted for ruining this poor woman’s life.

    Pernille Nylehn
    MD
    Norway

  42. PernilleN says:

    I wonder: if people who don’t have celiac disease feel bad after eating bread, how do they know it’s the gluten? Some years ago they’d say it was the yeast. Some (many) people say it’s the carbs.

    Maybe they just don’t chew their food properly?

  43. wilibrord says:

    Its not just the gluten in wheat, its the carbs, at least according to the author of Wheat Belly, which unfortunately was in the top 20 at Chapters last time I was there. In my circle of friends I know of three or four people, who aren’t celiac, who quit eating wheat completely, basically because it is so evil.

    I don’t know how prevalent this trend is, but anecdotally I hear a lot about how healthy you feel if you quit eating wheat.

  44. mousethatroared says:

    PernilleN
    “I wonder: if people who don’t have celiac disease feel bad after eating bread, how do they know it’s the gluten? Some years ago they’d say it was the yeast. Some (many) people say it’s the carbs.
    Maybe they just don’t chew their food properly?”

    Good question. A few years ago, I experience some stomach pain, my upper right side. Mentioned it to my doctor. They checked my gallbladder. It was fine. Couldn’t really figure it out, until I realized it seemed to flared up after my twice weekly visit to the bagel shop for a dense, chewy, cheese cover bagel (yum). Stopping the bagel habit, seemed to almost cure the stomach pain. I have no problems with other lighter breads. I even can have an occasional bagel with no problem. I’m not really sure what the deal is. I might be a victim of not chewing enough, sensitive teeth.

    I think some people might take an experience like this and tie the symptom to an ingredient, wheat products or yeast or gluten. To me it seemed more intuitive to tie the symptom to the texture (dense and chewy) maybe that’s no more sensible, but it seems to work for me.

  45. chaos4zap says:

    @mousethatroared,

    What about the dairy? (I assume you mean cream cheese). That’s how I discovered I was lactose intolerant. In high school I was plagued by bad cramps by the end of the day…I mean crippling. It took a little while to realize it was the milk in my morning cereal causing it. I cut out the milk and the issue went away. That being said…I still eat dairy and only certain things really bother me, straight milk and anything with cream seem to do a number on me but I can eat most cheese (in something resembling moderation) and the effects are minimal and tolerable.

    The gluten is evil documentary’s have to be coming, right? There is a documentary on netflix now about Chronic Lyme Disease, told from the perspective of the “persecuted” few that the medical establishment won’t listen too because of their arrogance and collusion with big Pharma. Documentaries on health topics provide me the chance to play my favorite game…..count the red flags and logical fallacies. When I watch a TV show or movie that is thought provoking, I think to myself “that’s interesting….I should look into that more” Unfortunately, it seems like the vast majority of the population take anything they see anywhere (as long as it’s not from a source that they are opposed to for whatever ideological world-view they may have) and they just accept it as gospel and try and find to find the fastest way to work their new wisdom into their life’s and share the world-shattering info with everyone they know.

  46. mousethatroared says:

    chaos4zap, It was actually baked on asiago cheese. Since I can drink lattes and eat cheesy dishes with no stomach pain, I figured the dairy wasn’t the issue.

  47. Chris says:

    wilibrord:

    Its not just the gluten in wheat, its the carbs, at least according to the author of Wheat Belly,

    Which is why my homemade peppermint marshmallows (essentially hot sugar syrup whipped into some gelatin) was so much better than crispy Italian biscotti!

  48. WilliamLawrenceUtridge says:

    A lot of cheeses are very low in lactose, it gets eaten by the bacteria used to turn milk into rotten milk. I mean cheese.

    Cheese is really disgusting when you think about it.

  49. mousethatroared says:

    WLU – In my experience, most really yummy things are somewhat disgusting. Conversely, somewhat disgusting things are not nessasarily really yummy (unless you are a puppy).

  50. Chris says:

    Let us give a tiny bit of thanks to those tiny little bacteria and little yeastie beasties that help make yummy food and drink, and to the populations in our intestines that assist in digestion.

  51. Disgustingly DELICIOUS!!! :D

    Building off a few earlier comments, I have often wondered if you don’t eat a certain food (like meat or milk) for a number of months, if your body just quits making the digestive enzymes needed for a full breakdown (like lactase and that spectrum for milk, and I dunno what all one needs to process meats completely). I know that if I fail to drink milk for a while, then pick it back up again, I do experience the symptoms of lactose intolerance for a few days before evidently adjusting.

  52. DavidRLogan says:

    I love this article! Thank you Scott Gavura!

  53. Alia says:

    @Perky Skeptic – it’s probably true with milk, if you don’t drink it for some time, your body stops producing enzymes that are necessary to digest lactose. My mother had no lactose intolerance for years but she stopped drinking milk (and eating many different foods) because of stomach problems. And when after several years she was finally diagnosed and killed off all H. pylori, she wanted to go back to drinking milk. And it made her sick.

    My mother-in-law was diagnosed with gluten intolerance when she was about 60. Strange thing is, she’s overweight and weight loss wasn’t one of her symptoms, what she complained of was rather abdominal pain, cramps, bowel irritation. Anyway, she tested positive on IgA and that settled it. Her doctor said one of the reasons for her intolerance could be the fact that she overused proton-pump inhibitors, which distroyed cilia in her intestines. I’m not sure how sound is that diagnosis, has anyone heard about it. Anyway, in her case the gluten-free diet seems to be working – of course, when she keeps it, she always has problems with resisting wheat-based cakes.

  54. SuziQ says:

    As another example of the smear campaign against wheat, I recently read about something called the “Two Week Test” for Carbohydrate Intolerance. The creator of this test doesn’t villify gluten, but he does blame carbohydrates (wheat in particular) for all of these signs and symptoms:
    “1. Poor concentration or sleepiness after meals
    2. Increased intestinal gas or bloating after meals
    3. Frequently hungry
    4. Increasing abdominal fat or facial fat (especially cheeks)
    5. Frequently fatigued or low energy
    6. Insomnia or sleep apnea
    7. Waist size increasing with age
    8. Fingers swollen/feeling “tight” after exercise
    9. Personal or family history: diabetes, kidney or gall stones, gout, high blood pressure, high cholesterol/low HDL, high triglycerides, heart disease, stroke breast cancer
    10. Low meat, fish or egg intake
    11. Frequent cravings for sweets or caffeine
    12. Polycystic ovary (ovarian cysts) for women”

    Also, it is claimed that Carbohydrate Intolerance can cause diabetes, cancer, and heart disease. More info here: http://philmaffetone.com/2weektest.cfm

    I know very little about nutritional science, but I have to say, it all sounds pretty dodgy. That being said, it’s very difficult, even for science-minded people like myself, to determine what’s real and what’s quackery in nutrition.

  55. @SuziQ, it sounds totally fake. After experiencing a ten point IQ drop from clicking on that website, I have to ask. Is anyone else sick of all of these naturopaths, chiropractors, and online-schooled PhDs (and other assorted dumbshits) referring to themselves as Dr. xxxx?

  56. Harriet Hall says:

    @SuziQ,

    “Pretty dodgy” is too polite.
    If “waist size increasing with age” is a sign of carbohydrate intolerance, every one of us is carbohydrate intolerant. This list is ideal for eliciting symptoms from everyone and achieving placebo responses.
    Lots of claims, no evidence.

  57. Bogeymama says:

    SuziQ, that checklist resembles the symptoms of “adrenal fatigue” that Scott blogged about last year! That diagnosis is pretty dodgy too…

  58. AlexisT says:

    I also admit to skepticism about this gluten free craze. (BTW, the person who got a positive IgG test? Might want to read back, because I remember a post about those tests.)

    I wonder if some of the people who report feeling better on a GF diet are either experiencing placebo, or if they are actually eating better overall. I am one of those people who normally can’t eat just one cookie, or one piece of bread: I’ll keep eating until I’m bloated and vaguely ill. If I went on a diet that had enough carbs to keep me from being crabby and hungry, but not enough to overeat like that, I’m sure I would feel better, and I wonder if that’s what some of these people are doing. I wonder if all the gluten free substitutes are actually counterproductive for this group–rice flour is all starch.

  59. PernilleN says:

    @chaos4zap the reason you can eat cheese is that is normally doesn’t contain lactose at all. Cheese is made from milk protein and fat, the whey (containing lactose) is not part of the end product. And if there is some lactose in it, it is broken down in the process, either to lactic acid or other sugars.

    People with lactose intolerance aren’t allergic or hypersensitive to milk per se, they just don’t have the enzyme lactase, which is necessary to digest lactose, i.e. cleaving lactose into glucose and galactose. But they can eat yoghurt and other sour milk products, because the yoghurt bacteria have done the digesting.

    @Perky Skeptic, I don’t think the body quits making digestive enzymes if we don’t eat a certain kind of food for a while. But sweet milk is not very digestible, so it might slow down your digestion for a few days.

    Pernille Nylehn

  60. papertrail says:

    “Is anyone else sick of all of these naturopaths, chiropractors, and online-schooled PhDs (and other assorted dumbshits) referring to themselves as Dr. xxxx?”

    YES! And I’m sick of paying for health insurance that covers 6 real doctor visits and 12 quack visits per year.

  61. lizditz says:

    I am naturally eating a fraction of the gluten I was eating say, 5 years ago. Kids moved out of the house, I quit buying bread products (bread and bagels and similar) and I quit eating so much pasta cause I never really liked it that much. Do I feel any different? And my daughter and I went on an “avoid white foods” kick for a month (white foods = white flour products, potatoes, rice) for weight loss reasons. So did I notice a difference? Well, we were upping the exercise and also eating fewer “empty” calories, so we did lose the weight, but overall health? Not really.

    @Perky Skeptic & @Pernille, I think the idea is that if you avoid a certain kind of food (say meat), it’s not the digestive enzymes that change, but the ecological balance of the bazillions of microbes that live in your gut and help with digestion.

  62. Calli Arcale says:

    SuzyQ: Carbohydrate Intolerance? Wow! That’s some grade-a woo by the sound of it. I wouldn’t think a person would get fat if they had carbohydrate intolerance — on the contrary, part of what drives many of our expanding waistlines is tolerating carbs all too well. ;-) I would think if you couldn’t eat carbs, you would be *dead*. OTOH, I suppose it accidentally has a sort of truth in it, in that people with diabetes do have problems with carbohydrates, but it’s not at all the same thing.

    Alia:

    Her doctor said one of the reasons for her intolerance could be the fact that she overused proton-pump inhibitors, which distroyed cilia in her intestines.

    As a long-time Prilosec user and a great lover of bread, this definitely gets my attention. I did a quick Google search and found only wacky stuff like naturalnews.com. Anybody know anything else about this? Is there some truth to it, or is it just more of the general hate on reflux treatments that’s so fashionable right now?

  63. Thanks for answering the question about enzymes, people! Very interesting– I had forgotten entirely about the role of gut ecology in digestion, so that makes a lot of sense.

  64. stanmrak says:

    The article completely missed the connection between gluten and Hashimoto’s/Hypothyroidism.

  65. Chris says:

    Possibly because when you put the words “hashimoto hypothyroidism gluten” into PubMed only one paper in Portuguese comes up. If you have actual scientific papers with something definitive, then please present them.

  66. LMA says:

    It’s very frustrating nowadays as a lay reader trying to figure out what’s b.s. and what’s legitimate science in the whole field of bowels, intestines, intollerances, etc. I was diagnosed as lactose intollerent (with the blood testing over an hour thing … after a half hour I had to stick my arm out the bathroom door for the nurse to do a draw because I was so sick I couldn’t depart the porcelain throne) almost two decades ago, and saw dramatic results once I removed the evil but delicious milk sugar from my diet. However I continued to suffer — and I do mean suffer — from severe IBS symptoms — several times in the last five years I’ve had to go on Short Term Disability because I was unable to leave the house. I was tested for all the obvious things — celiac — and even had an MRI of my bowels to rule out Crohn’s or IBD. We tried adding more fiber, less fiber, I already wasn’t taking any caffeine, etc. I tried various experimental medicines, probiotics to no avail. Finally my gastroenterologist literally gave up and told me he had no further suggestions for me.

    For the last year a friend kept suggesting an elimination diet and since I was at the end of my rope, I decided I had nothing to lose (except burning up more vacation time at work — having long since used up all my actual sick days) and decided to humor him. Every single day for the last wow, maybe five years, I start the day with a glass of Lactaid milk and a bowl of oatmeal. So I decided to trade my hot breakfast for Wheaties. I haven’t had a single problem with my stomach since. It’s been over six months. I’d *never* gone for six *days* without at least one day where I felt bloated, or had the runs, or severe cramping, etc. before. Is this an anecdote? Of course. Am I discounting it? No — as long as I live, I’ll never eat oatmeal or granola or a Clif bar again. My Mileage May Vary From Everyone Else of course. But WOW would I ever love to see any investigational studies of what I’m assuming for me is an oat intollerance. I saw a very, very brief mention on a Mayo Clinic page, but that’s it.

    Does anyone here know if anyone has investigated various grains and determined if there are some kinds of non-gluten grain intollerances? (I routinely eat “fake meat” dishes made from 100% wheat gluten and it’s no problem for me).

  67. Alia says:

    @Calli Arcale

    Well, even though my mother-in-law has a tendency towards woo, she heard about the relation between proton-pump inhibitors and her celiac disease from her gastroenterologist, a well-known specialist in his field. But she was definitely *over*using her medicines, so perhaps that’s something one should take into consideration. Or perhaps she would become celiac anyway and the proton-pump inhibitors are just correlation, not causation, I don’t know.

  68. LMAO says:

    Don’t know about oat intolerance, but I was diagnosed with IBS more than 25 years ago (back when it was called spastic colon). I have been mostly symptom free for the past 20 years, with only brief, mild flare-ups every 2-3 months on average, and I no longer take any medications to manage the condition (other than a couple days of PEG less than once a year).

    My #1 trigger is and always has been unusually high stress. Otherwise, too much fiber and too little fat is usually the culprit. Insoluble fiber is bad enough for a person who’s crazy about nuts and vegetables, but it’s the soluble fiber that guarantees misery for me, with oats being the worst of all, and certain legumes and fruits pulling up a close second. Eating more than a very small amount means severe cramping, gas and constipation, with the added fun of nausea.

    Various gastroenterologists have advised me to learn to manage/eliminate stress, try not to go too crazy with my nut/veg consumption (my favorite foods), avoid a low-fat diet, and limit the most problematic soluble-fiber sources, and it has worked for me. I’m a bit of a foodie, so I’m certainly not rigid about it — I just know that too much deviation may lead to a couple days of discomfort. But it’s not the end of the world, so I try not to obsess. (As an upside, I’ll never get fat from gorging on my beloved oatmeal-raisin cookies… :D)

    Anecdotal, I know, but the soluble fiber may be a clue to your reaction.

  69. Calli Arcale says:

    Alia,

    If you ever hear more about it, I’d love to know. I don’t know whether the well-known gastroenterologist was speaking of a known risk or not; it is worth pointing out, after all, that Dr Jay Gordon is a well-known pediatrician, but I wouldn’t trust him to give worthwhile advice about childhood vaccines or infectious disease. Mileage varies even among the experts. It’s enough to give me pause, though, and make me want to know more.

  70. RD says:

    This might be a little disappointing for some of you. I watched the oz show earlier this week (I am hoping it will help me hear some of the health claims sooner so that I can provide pt’s more accurate responses when they come in with odd ball questions)…. and part of the show was on diet mistakes every woman makes (???) The first point he made was on gluten free foods….that some of the gluten free options have more calories, fat, sugars than their gluten containing counterparts. (Music to my ears!!) He then mentioned that unless there is a medical necessity, woman should not avoid gluten but instead focus on whole grain items. (I wish he would have emphasized some of the info in this article since viewers may be thinking…yes I DO have a medical necessity to avoid gluten…even though I have never been examined, tested, or discussed with a qualified person about this.)

    Maybe he is getting the message and is changing his ways?????

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