What is This Stuff Called Gluten And Why Is It Trying To Kill Us?
by Greg Hinson, MD
It’s hard to read a food blog or food labels in a store without thinking that gluten is another word for “batrachotoxin” (you know, the frog excretions used on poisonous darts). Avoiding gluten is the newest big food fad, with some claiming that such a diet can cure autism, allergies, asthma, male pattern baldness, or any of a wide variety of conditions. Is gluten something you should avoid? What is it and why does it hate us so much?
Someone has probably written a book about the history of bread and its importance to human culture (if not, I’m on it), but long before Superman lunchboxes and Wonderbread, bread was made from gathered cereals, roots or corn that was crushed, mixed with water, and roasted. Probably hard to stomach but it made it possible for people to carry their nourishment with them for long trips.
Once we evolved from Hunter-Gatherer-man to Farmer-man (also known as the Neolithic period), we figured out that cultivated grains, like wheat, tasted much better, even without butter. These grains contain the protein gluten, a big, strong molecule that gives bread as we know it its bounciness and elasticity. Beyond just making the cave smell good as they were baking, these loaves didn't fall apart and would keep for travel. It’s not a stretch the say that gluten, like salt or cod or gummy bears, played a vital role in the very development of our various civilized states.
These days gluten is used in many other foods as well, as a way to add protein or just sponginess to foods. Products like ice cream and condiments are commonly thickened with gluten. Almost all imitation meats and cheeses made for vegans are based on wheat gluten. And gluten is not just limited to food, it’s a key ingredient in some of the new biodegradable materials created as an alternative to petroleum-based plastics, and is commonly used in cosmetics such as lipstick to add firmness or body.
But for mysterious reasons, there's been a growing trend in recent years to view gluten in a negative light. It is true that a small number of people are born with gluten sensitivities that reduce their ability to tolerate it to varying degrees. Perhaps the thought is that if some people can't tolerate it, it therefore must be generally bad for everyone? As a result, some authors and bloggers and nutritionists are now advocating a gluten free diet, which means there is money to be made.
As mentioned, gluten free diets actually are necessary for some people, and advisable for others. These situations are rare, but they are real. The first is celiac disease (or gluten-sensitive enteropathy). This is an autoimmune disease of the small intestine that occurs in people who are predisposed by their genetics. It's not caused by eating gluten, but if you're one of the unlucky few born with the gene, and you go on to develop celiac, eating gluten will cause bad reactions. The immune system inside the bowel tissue reacts to the gluten proteins, causing inflammation of the bowel tissue, making it harder for your body to absorb nutrients from food. There's no cure for celiac, and the only way to live with it is to adopt a gluten free diet for the rest of your life. Somewhere between 5 and 10 in 1,000 Americans have this, give or take.
A wheat allergy is very different, and can be harder to track down since there are many different components of wheat and other grains that you can to be allergic to. The symptoms are similar to what we expect from most allergies: hay fever type symptoms, hives, asthma, and swelling. More serious effects in the worst cases can include anaphylaxis, palpitations, swollen throat, diarrhea, and even arthritis. Unlike celiac patients, sufferers of wheat allergies need not necessarily avoid all wheat products. The allergy is usually pretty specific and only some foods may need to be avoided. Plus, standard allergy treatment with drugs such as antihistamines may prove effective enough to allow the patient to live without drastic changes in their diet. It's difficult to attach a number to how many people have some level of allergy to wheat or grains—no reliable test for this--but it's probably somewhere in the single digit percentage points.
There's also a third type of gluten sensitivity, and that's gluten sensitive idiopathic neuropathy, a disease of the nervous system. Symptoms can include numbness or tingling in your arms or legs, or problems with muscular coordination often evidenced when walking, or even spasticity resembling Parkinson’s or seizures. Diagnosing this neuropathy is difficult; the blood test frequently produces false positives, as such, the number of people with a gluten sensitivity neuropathy is not well-known, but it's very small.
That’s it for the poor souls that need to or may want to avoid gluten. But some people would have us believe that everyone needs to avoid it. Of course, the people saying this the loudest are the people who sell gluten-free products. For example, GlutenFree.com claims their products help people with autism or ADHD, which is completely untrue according to all the science we have. The autism claim in particular is troublesome and has been picked up across the autism activist community. The treatment of autism with a gluten free diet has been studied a number of times with varying results, but so far no well-designed studies have shown any plausible benefit. In fact, a 2006 double blinded study published in the Journal of Autism and Developmental Disorders tested children with and without autism, on gluten-free and placebo controlled diets, and found no significant differences in any of the groups.
Gluten is a protein, and proteins are essential for nutrition. It is a strange and potentially harmful thing to say that gluten is universally bad for people. It's true that bread itself is a big source of simple carbohydrates, which are not essential and can be safely minimized in the diet, but this is true of gluten-free breads as well. There is no connection between minimizing or avoiding carbohydrates, which is probably a good idea to some degree, and avoiding gluten.
Others say that it’s not the gluten per se, it’s wheat in general. There’s a popular book out right now called Wheat Belly by cardiologist Dr. William Davis. He sums up his theory in this post. He’s not a big fan of the plant. The grain growers have responded here, and summed up the science with passion as well. I’m not ready to anoint wheat the next big bad thing either. Is wheat bad for you? Yes. Is wheat good for you? Yes.
Foods made from grain are like the energy bars of prehistory. Power-packed calories. This is what made them important in the developing world, i.e., before you could buy breaded, fried processed chicken parts at Cumbies on your walk to the village. Modern ways of cultivating and processing wheat have likely improved the energy delivery system of these foods, and yet we move so much less than we used to. Unlike when being chased by predators or preparing for a long nomadic hike, we don’t need to carb load to sit on a couch and use the clicker.
We’re not fat and diabetic because we eat wheat. We’re fat and diabetic because we eat way too much of it. And everything else. Given its lofty place in food advice over the years (like its place at the bottom of plastic food pyramid model from elementary school) as being the most important staple in our diets, I think it is good that the Wheat Belly book (and others) are taking wheat down a notch. But it shouldn’t be labeled as the next big bad thing.
With the fads’ popularity, I have heard from many people that a gluten-free diet has helped them recover from various maladies, and from others who are having success in losing weight by cutting out wheat. In my own observations, it is common for people to say they feel better since going wheat or gluten-free. Is this all placebo? And if it is, isn’t that okay? I mean, if someone is paying closer attention to their diet, and they feel better, is there reason to discourage such actions?
I think there is a good reason why the science discussed above and these perceptions are not contradictory. When you try to cut out gluten what are you cutting out? Let’s look at food that are high in gluten, foods like processed cheese, chocolate milk, ice cream, baked goods, cereals, pastas, breaded meats, lunch meats, gravy, jams, fruit-filled pastries, French fries, and flavored potato chips. And when you follow Dr. Davis’ advice and cut out wheat, what’s left? From the link above, Dr. Davis answers:
“That’s a lot to cut out, true, but there’s still plenty of real, nutrient-dense foods like vegetables, fruit, nuts, cheese and dairy products, meat, fish, soy foods, legumes, oils like olive oil, avocados, even dark chocolate that you can eat in their place. If after that 4-week period you discover new mental clarity, better sleep, relief from joint pain, happier intestines, and a looser waistband, you will have your answer.”
I say, look at these lists. Compared to the first list, Dr. Davis’ list is real food. The best there is. People who feel better or lose weight do so because they eat this stuff instead of the pastas, breads, and pastries that had their diets out of balance (with excess simple carbohydrates) in the first place. And looking at the first list, I would propose that anyone that cuts these foods from their diet will automatically feel better! This is not because these foods contain gluten, even high levels of gluten. It is because these foods are also loaded with simple sugars, saturated fats, and are nutrient-poor.
Finally, when someone goes wheat or gluten-free, they are often paying close attention to their diet for the first time in years, no longer mindlessly eating chips or cookies or crackers or ice cream. And often they are doing it because they feel bad or need to affect some sort of change in their health, so they cut out sugar and dairy and alcohol and fried foods too. All I’m saying is, of course they feel better when they do this. And this is a good thing.
So think of gluten sensitivities in the same way you'd think of bee stings or peanut allergies: of great and very real concern to a small number of people, of some concern for a few more, and of no concern to most of us. Don't let anyone tell you that gluten is harming you in some way that's so far not supported by science. And yet, look at your diet with the vigilance of those that are aggressively cutting out gluten and find ways to balance your diet with complex carbs like fruits and veggies, healthy proteins, be they from animal, soy or even gluten sources, and fats. Eat food. Not processed imitations. Eat local whenever possible. But eat less overall. And you will indeed treat and prevent disease and just plain feel better!
Greg Hinson, MD blogs at www.ackdoc.com, which is also where you will soon find more information about his new solo medical practice.