It's important to note that this article discusses specifically Celiac Disease and not Guten Intollerance.
Failure to distinguish between the two has created a lot of confusion around the subject. For instance: some people believe that it is black or white: a person is either a) a are celiac, or b) deluding themselves into following a fad diet.
This is not the case. A person can be gluten intolerant without necessarily experiencing auto-immune reactions to it. Many people see drastic health benefits by excluding gluten from their diets even though these people are not celiacs.
Aside from the anecdotal evidence I, as a non-celiac, could offer about how life changing it was for me personally to cut out gluten about two years ago, here's a recent study:
Thank you for making this distinction. I've had to sit no less than four close friends and family members down and have a long talk with them about this distinction as they all thought they had caught a sudden case of Celiac. Some in their 50s.
Is anybody else finding this sudden hypchondria and mass hysteria over gluten terribly tiresome? Or like all food fads, like bran, should I just sit tight for another couple years for it to pass and things go back to relative normal?
Here's how you know if you really have Celiac disease. If you eat a little bit of food that contains gluten, you curl up in a ball and want to die as your small intestine slowly necrotises itself. And you eventually find yourself in the ER with a surgeon removing a meter or two of your bowel.
Does gluten make you sleepy? Not celiac
Adhd symptoms? Not celiac
bloated? Not celiac
stuffy nose? Menstral cramps? Muscle weakness? Headaches? Blurry Vision? Arthritis like symptoms? Not celiac.
Really, unless you feel like you just got shot with a gun, it's not Celiac. I'm not saying laying off of gluten may or may not help you with those things, but it's not celiac.
Please stop insulting people who actually suffer from celiac by claiming your bloated loose stools are a sign that you too have joined the swelling ranks of one of the rarest genetic diseases in the world.
I'm merely finding the exploding numbers of supposed celiacs really rather insulting.
People should what makes them feel best. If low gluten does, more power to them. But doesn't anybody else find it so bizarre that people who were entirely asymptomatic for decades suddenly break out with a case of gluten intolerance. The anecdotal cases even in my own personal circles are absurd.
People who complain endlessly about immediate discomfort after eating gluten magically forget to notice these same symptoms when they eat foods they aren't aware has gluten or eat gluten free food and complain anyway
because they heard that xyz has gluten in it When it doesn't.
Never underestimate the power of the mind in creating hypochondriac symptoms in people who have entirely asymptomatic medical histories.
Better yet folks who's mystery symptoms and strict diets change over the years at times that happen to coincide perfectly with changing pseudomedical food fads.
It creates so much noise that people who actually do have problems have trouble getting appropriate treatment.
In 5 years nobody will give 2 cents about gluten. the marketplace will simply have moved onto the next pseudomedical emergency involving millenia old food stuffs that don't seem to bother anybody outside of the country the xfree food is being sold in.
You called the sudden pervasiveness of gluten awareness hypochondria and mass hysteria. You are assuming that the cause for this sudden shift is a bunch of people misdiagnosing themselves as celiac when they are really fine.
What is actually happening is that people are misLABELLING themselves as celiac when they are actually gluten intollerant. That does not take away from the validity of their choice, en mass, to avoid gluten in their diets. You have no right to be "insulted".
Nearly all people with "gluten intolerance" are self-reporting a disease based on little more than their own subjective feelings of illness, helped along by a food fad. The people who are skeptical are skeptical for good reason, and the people who are easily offended by skepticism are best ignored.
Even though there are a few, shoddy studies involving gluten intolerance, the science is weak, and there's no clear mechanism that would explain an "intolerance" that didn't carry the biochemical hallmarks of Celiac. Maybe that will change in the future, but the smart money is still on the bet that most of the people with "gluten intolerance" have nothing wrong with them at all.
> The people who are skeptical are skeptical for good reason, and the people who are easily offended by skepticism are best ignored.
No, the people who are skeptical are (in this case, and many others) following their own subjective feeling, helped by authority. But make no mistake, your skepticism -- unless you have access to primary data -- is nothing more than an appeal to authority.
I'm not saying you're wrong in your conclusion. (Not in this discussion, anyway), but your skepticism likely does not follow from logic, science or knowledge.
Unless, of course, you are working with primary data. I suspect you aren't, though, because I've had the misfortune to be in touch with leading authorities (who work with primary data) in the field recently, and most of them DO believe that gluten intolerance is real, prevalent and very serious.
(And yes, the irony that I'm appealing to authority does not escape me)
p.s.
> there's no clear mechanism that would explain an "intolerance" that didn't carry the biochemical hallmarks of Celiac.
That's definitely wrong. There is not agreement about the delayed allergy mechanisms work (mostly IgA and IgG) to the point that there is no standard lab test for them -- but there is definitely agreement that they are there, and that they can explain a lot of these things. I don't have time to verify the whole entry, but at least the symptoms section in http://en.wikipedia.org/wiki/Gluten_intolerance is decent.
"I've had the misfortune to be in touch with leading authorities (who work with primary data) in the field recently, and most of them DO believe that gluten intolerance is real, prevalent and very serious."
You're just cherry-picking. All of the credible researchers in the field estimate the prevalence of "gluten intolerance" -- at the high end of the spectrum -- to be well under 10%. The guy at the U. Maryland center is on record for a prevalence of ~6%.
I'm sure there are a number of "expert" wackadoos who say that the number is higher, and are happy to sell you a book about it, too.
"There is not agreement about the delayed allergy mechanisms work (mostly IgA and IgG) to the point that there is no standard lab test for them"
Nonsense. There are well-established tests for immunoglobulins to gluten/gliadin, and they're so widely employed that they're in the Merck Manual as part of the diagnostic procedure for Celiac disease.
The situation here is that these test results don't correlate with the self-reported symptoms of people with "gluten intolerance". People who desperately want to blame their low-level health problems on gluten take this to mean that the tests are inadequate; the medical community concludes that the tests are fine, but the "intolerance" (if it exists at all), is not mechanistically related.
Finally, not that it will change your mind, but a Wikipedia article about a diet fad is not a reliable source of unbiased information. If that's your source of "primary data", then you need to find another source, because Wikipedia articles are notorious for cherry-picking extremely questionable, "fishing expedition" studies, and presenting them as consensus. Looking over the page you linked, I see a mess of incoherent speculation, but no one mechanism. Aside from the usual immunological markers of Celiac, there is nothing canonical.
> to be well under 10%. The guy at the U. Maryland center is on record for a prevalence of ~6%.
5% prevalance is very prevalent, given that in the west, unless you make all your food starting with basic ingredients, you have to work very hard to avoid wheat. It's used everywhere as a cheap filler, including (but definitely not limited to) candy, soup, salads, protein supplements. And that's before considering that a significant part of western diet is wheat based.
The most recent guy I discussed this with (who heads one research department in a top tier medical school) estimates it as 5-10%, which seems to be in line with the U Maryland guy you quote. That's ridiculously high for a condition that many people disagree actually exists.
> Nonsense. There are well-established tests for immunoglobulins to gluten/gliadin, and they're so widely employed that they're in the Merck Manual as part of the diagnostic procedure for Celiac disease.
That is correct. I was talking about general delayed allergy mechanisms. There are some experimental tests that are supposed to figure out specific food intolerance (of which gluten is just one example), and there is no standard for those in general. Some reputable labs offer a panel of running IgA and IgG from blood against (say) 90 different foods and their metabolites. These tests have no standards and are not generally accepted (yet, anyway), despite the fact that it is undisputed that this is a mechanism of action that can cause a >24 hour delay of response.
> People who desperately want to blame their low-level health problems on gluten take this to mean that the tests are inadequate; the medical community concludes that the tests are fine, but the "intolerance" (if it exists at all), is not mechanistically related.
Indeed, and that's correct, for the specific mechanism tested. But unfortunately, many also take this to mean no such thing as gluten intolerance exists. (similarly for other substances). That's not a valid position to take.
I have my own n=1 and enough of other anecdotal n=1 stories (and enough opinions from people I trust, and you would too given their credentials) to believe that wheat products -- not necessarily just wheat gluten, though it is probably the worst offender -- are bad for many.
I've gone through many elimination diets over the years trying to determine which foods aren't good for me - long before I heard of gluten intolerance. It might not be gluten at all, for all I know, but it has been consistent that removing stuff with "wheat" on the label from my diet makes me feel much better. (The most recent example was protein powder, which I figured was making me fill bad after 3 months or so -- and only then checked and realized that some wheat protein was among the components).
> Finally, not that it will change your mind, but a Wikipedia article about a diet fad is not a reliable source of unbiased information.
No, that's not reliable nor primary data. But Wikipedia is, more often than not, a good intro to a discussion, and some beginning pointers. I only referred to a couple of paragraphs as reasonable intro.
One of the reasons for exploding numbers is new tests for coelliac disease have become available over the last 20 years which had made it easier to diagnose. Unfortunately I cant provide relevant links; I know this from discussion with doctors, as someone who has been diagnosed with coelliac disease.
I'm not talking about the last 20 years, i'm talking about the epedemic sized population explosion in the last 2 or 3. an epidemiologist friend of mine remarked to me that if even 10 percent of the people had a real problem, it would be one of the largest outbreaks of disease since the black death and the largest outbreak in food born illness in recorded history.
If you had actually read the article, you would have discovered that the epidemic outbreak of the disease is precisely what scientists are trying to figure out. And, it's not a global outbreak - certain remote regions of the world haven't been impacted.
It's pretty analytical as well - they are comparing blood serums that have been stored over time to determine when it first showed up in the population.
Maybe people are finally waking up to it. The articles that people read, such as this one, prompt them to go out and get tested, or do their own experiments with good. I've not actually been tested but I dropped gluten out of my diet and feel great because of it
The problem, as has been repeatedly mentioned in this thread, is that many people use "celiac disease" and "gluten intolerance" interchangeably, but medicine does not.
As a big time skeptic when it comes to popular diet advice, it is simply difficult to take the gluten intolerance stuff too seriously just yet. Not because I don't believe in celiac disease or even in gluten intolerance, but if we take a historical perspective there is a constant pattern of these kinds of "food science breakthroughs".
My current approach is to simply ignore popular food science advice until it is 5-10 years old. If it sticks around that long, I figure it warrants further examination.
Other people can do whatever they like with their own diets. This is just me.
Symptoms of gluten sensitivity may include bloating, abdominal discomfort, pain, or diarrhea; or it may present with a variety of extraintestinal symptoms including headaches and migraines, lethargy and tiredness, attention-deficit disorder and hyperactivity, autism and schizophrenia, muscular disturbances as well as bone and joint pain. [1][2][3][4]
Whilst the research surrounding gluten sensitivity is still very much emerging, coeliac disease is a well-defined condition. It is a lifelong autoimmune condition characterised by the chronic inflammation of the intestine... In comparison, in a recent clinical paper, gluten sensitivity was defined as ‘one or more of a variety of immunological, morphological or symptomatic manifestations that may also be shared by coeliac disease and irritable bowel syndrome (IBS) [5]. In cases where there is reactivity to gluten, yet coeliac disease and wheat allergy are eliminated as possibilities, gluten sensitivity may be considered. Whilst the general clinical picture for gluten sensitivity is similar to coeliac disease in particular, it is usually less severe and neither anti-tissue transglutaminase antibodies nor autoimmune comorbidities are found. It is believed that approximately 40-50% of gluten sensitivity patients may have IgG or IgA anti-gliadin antibodies (AGA) [6][7]. There is also a study identifying approximately 50% of gluten sensitivity patients, few more than the general population, carry either HLA DQ 2 or 8 [8].
[1] Sapone A et al. Differential mucosal IL-17 expression in two gliadin-induced disorders: gluten sensitivity and the autoimmune enteropathy celiac disease. International Archives of Allergy and Immunology. 2010;152:75-80; Ford RP. The gluten syndrome. A neurological disease. Medical Hypotheses. 2009; 73 (3):438-440
[2] Elder JH et al. The gluten-free, casein-free diet in autism: results of a preliminary double-blind clinical trial. Journal of Autism and Developmental Disorders. 2006;36(3):413-420
[3] Dickerson F et al. Markers of gluten sensitivity and celiac disease in recent onset psychosis and multi-episode schizophrenia. Biological Psychiatry. 2010;68(1):100-104
[4] Hadjivassiliou M et al. Myopathy associated with gluten sensitivity. Muscle Nerve. 2007;35:443-450
[5] Verdu EF, Armstrong D, Murray JA. Between celiac disease and irritable bowel syndrome: The ‘No Man’s Land’ of Gluten Sensitivity. The American Journal of Gastroenterology. 2009;104(6):1587-1594
[6] Sapone A et al. (2010). Differential mucosal IL-17 expression in two gliadin-induced disorders: gluten sensitivity and the autoimmune enteropathy celiac disease. International Archives of Allergy & Immunology; 152: 75-80
[7] Bizzaro N et al. (2010) Cutting edge issues in celiac disease and in gluten intolerance. Clinical Reviews in Allergy & immunology.
[8] Sapone A et al. (2010). Differential mucosal IL-17 expression in two gliadin-induced disorders: gluten sensitivity and the autoimmune enteropathy celiac disease. International Archives of Allergy & Immunology; 152: 75-80.
Oh, look. One very recent study, cherry-picked because it goes against the prevailing wisdom. Someone does not understand science. Try loading up on more healing crystals until you do. Or try sprinkling salt over your shoulder; I hear that's a good way to keep away the evil spirits.
Despite commonly held beliefs, the scientific method is not at all about proving things. It is about making testable hypothesis and being unable to refute them IN SPITE of testing.
Now, specifically about gluten intolerance, the claim that "if you are not celiac, gluten can't hurt you" can be disproved (as has been shown in the reference above).
I would like to note, that Gluten does not equal Gluten as there are variations of this protein. There is a modern type of Gluten called "Super-Gluten" a larger molecule that gives bread it's puffiness. This type of Gluten causes much more trouble to some.
If you think gluten intolerance is a fad then you're grossly mistaken.
Then again saying
"Here's how you know if you really have Celiac disease. If you eat a little bit of food that contains gluten, you curl up in a ball and want to die as your small intestine slowly necrotises itself. And you eventually find yourself in the ER with a surgeon removing a meter or two of your bowel."
pretty much discredits anything you have to say on the subject.
Whoah, celiac doesn't cause your small intestine to necrotise. And it doesn't put you in the ER if you eat a little gluten. For one thing, every celiac has a different set of symptoms. Many many people go there whole life not knowing they have celiac until they come down with a very specific type of cancer later in life, when they find out they were celiac.
Which ones in particular? Nothing on that list disagreed with mine. Most of the listed recognized symptoms are due to malnurishment caused by the autoimmune destruction of the small intestine.
PLEASE NOTE that not all people with celiac disease experience -- at least initially -- gastrointestinal pain. Lack of pain is not a conclusive negative indicator.
I don't want to throw people into a panic, and I don't know the percentages, but I do recall reading that some cases of celiac disease can be relatively or completely pain free.
No, that doesn't mean "everyone" has the disease. Just that, when considering whether to make a diagnosis, pain is not a conclusive factor. (IANAD, and this is to the best I recall from some fairly casual and brief reading.)
If you are one of the lucky less than 1% of the population you don't get celiac...you are born with it. If your parents have it your chances increases to between 5-10%.
It features as primary symptoms significant abdominal pain and eventually an inability to absorb specific nutrients due to the disease destroying your small intestine. Secondary symptoms stem from those primary symptoms.
These will be noticeable in most patients at around 6months to 2 years in age as gluten is introduced into their diet.
DO NOT mistake gluten sensitivity or gluten intolerance for celiac disease. Do not mistake non-gluten related health problems for any of the above.
a case study about this exact thing. There's actually a lot of literature on giardiasis and celiac as they're often confused initially. Biopsy usually sorts it out.
The tests look at possible effects of celiac, but there is no direct blood test for it. If a series of tests come back positive, your doctor will order a second round that will probably include a complete endoscopy and biopsy of a suspected area (if any is found free of villi).
There is an antibody test available, but it is not generally routine and may indicate other diseases as well and would be followed up with the biopsy above.
I think all these intolerances are a disease of the "worried well". Like "Chronic Fatigue Syndrome", it's one of these diseases that only people in the 1st World seem to get.
I don't feel I have a fad belief. Until about a year ago, I never censored any food. I have always enjoyed a high protein and vegetable diet, but a ton of pasta and pizza too. About a year ago, my wife and I (and by proxy, our kids) cut out gluten, wheat, and sugar. Within a week (closer to three for the wife), we all noticed higher energy levels and just felt better. Our oldest kid had complained of stomach issues for quite some time, up until this change in diet. Interestingly enough, these issues come back when she has bread or pasta (or pizza, as you point out). We all feel worse after eating these foods. We still do it every couple of weeks because, hey, it tastes good. But by avoiding these mostly processed foods, we genuinely feel better. We all still eat burgers; just with no bun. I'd encourage you to try it for two weeks and see if you feel better or not. If not, more ammo for your argument.
I had stomach issues for 32 years and tried everything to resolve the issue. I was tested for celiac, among other things, but the results came back negative. Finally I decided to try a gluten free diet. I threw away everything in my kitchen that contained gluten and started from scratch. The results were dramatic. Within about 7-10 days most of the issues dissipated and my stomach was 80-90% improved. Stomach issues no longer interfere with my life.
Do I miss eating bread, spaghetti, desserts, etc that contain gluten? Sure. But it's a small price to pay for not being uncomfortable for 8-10 hours a day. Besides, you can now find excellent gluten free products at trader joe's, whole foods, and just general grocery stores (even bread, spaghetti, that tastes like the real thing).
I'm not a doctor and take this advice with a grain of salt, but if you're experiencing persistent and long term stomach issues and you've been to a GI doctor and ruled out other causes (like celiac) then you might try a gluten free diet to assess whether you have gluten intolerance. It's a bit of a hassle at first, but the benefits are well worth it, should this solve your problems.
You know, it may work for you, but it's probably no more than (and no less than!) placebo. Somatic gastrointestinal issues are very common, and are often resolved by placebo treatment. You can't tell unless you're in the context of a real study that uses blinding to tease out the placebo effect.
I find it fairly absurd that so many people suddenly feel better when they stop eating gluten (poorly, might I add, if you monitor most gluten-free diets they're a complete failure) this decade. Is it just recently that everyone has started having issues?
Prior to understanding gluten intolerance, many people would just struggle through life with low-grade malaise that they felt was normal. Loose stool, constipation, low energy, poor metabolism, malnourishment, cloudy headedness. These problems have been around for a very long time with very little understanding as to their causes.
So, as you asked: Is it just recently that everyone that everyone started having these issues? No. The issues have been around for a long time. It's just recently that there was this possible explanation and remedy for these issues.
I'm an n of 1. That said, I tried various diet changes (i.e., dairy free, vegetarian) and life changes (e.g., exercise) and none had a substantive effect. When I removed gluten from my diet the effects were dramatic. In addition, I do have gluten on a rare occasion and my old symptoms return. Is this a placebo effect? Perhaps, but then why didn't any of my other significant experiments have any meaningful impact?
Note, I'm not suggesting that anyone with stomach issues has gluten intolerance. But if you do have persistent and long term stomach issues it is one of many conditions that should be seriously considered. Based on personal experience and research on the issue gluten intolerance is not a fad and shouldn't be dismissed as such.
> But if you do have persistent and long term stomach issues it is one of many conditions that should be seriously considered.
I completely agree. I just think it's ridiculous that so many people have assigned themselves 'gluten intolerance' without even talking to a doctor or specialist in the matter. And no, naturopaths don't count. The man who treats himself has a fool for a doctor.
I did the same experiment to an extent blindly: after four years of stomach problems, I thought it was lactose intolerance. Leaving out milk helped quite a lot. Later I was tested, and found to not be lactose intolerant. Milk back on diet. Stomach problems reappeared, if just not that bad.
Later on was diagnosed with something called "cereal allergy" (quite possibly not a real diagnosis, the army MD who explained this to me was preparing her dissertation on the subject). To wit, leaving out all cereal made all my stomach problems disappear.
Now, what was the deal with the milk? I used to eat a lot of bread, and take milk with that. Leaving out milk, I inadvertantly left out bread as well, seriously limiting cereal in diet.
This all happened in the first half of 1990s, long before the current popularity of the subject. Yes, not a real study (N=1 etc). OTOH, I would claim it was definitely blind for me.
If your standard for differentiating between placebo and "real" effects is participation in a "real" study, you've by definition eliminated pretty much all introspection as a source of data about ones body.
Although you might find it absurd that folks are feeling better from a dietary modification that hasn't been around for a long while, I find it equally strange to dismiss out of hand the lived experience of "so many people".
People are surprisingly incompetent when it comes self identifying and describe symptoms as well as self monitoring disease progression (people here includes doctors). That's precisely why the placebo effect exists.
For example, what would you bet that most people describing improvement on a glutenfree diet are merely experiencing the benefits of an overall healthier diet that has little to nothing to do with their gluten intake and has everything to do with them not eating half a pizza twice a week.
Also the gluten free diet theory (or at least the paleodiet) is the only diet theory that resorts to evolution to try explaining what´s happening when we eat. It is strange that no other theory is looking in evolution to explain what we have to eat, we do it for our pets and for wild animals, but we consider ourselves out of that possibility (people actually has told me that).
It is true that studies are still scarce, and surely it will change a lot during the next years due to new studies and insights. But if I have to bet to one theory that explains human feeding, I´ll do it to the one that is trying the evolution path. Surely there is also the intelligent design diet out there, for those who need options ;).
I'm okay with both the idea that the mechanism is either purely psychosomatic or the result of some coincidental element being cut out of the diet.
As a mechanism, it seems quite hazily understood.
I'm less okay with the wholesale exclusion of the lived experiences of my fellow humans; at some point, people have only one body that they can reliably poll for information.
The placebo effect is NOT well understood, definitely not to the point that you can make that blanket statement.
> For example, what would you bet that most people describing improvement on a glutenfree diet are merely experiencing the benefits of an overall healthier diet that has little to nothing to do with their gluten intake and has everything to do with them not eating half a pizza twice a week.
Oh, I would take that long bet easily, if we would agree on a way to resolve it, though I guess we wouldn't be able to reach such an agreement.
I have my own n=1 story with respect to wheat (not sure if gluten or another component) - two years ago, I decided to drop it, and lost 30 pounds within a month. My diet changed, of course - but not to the extent that would induce a 1-pound/day weight deficit (that's 2000kcal/day if you believe in the provably wrong caloric theory of weight management).
And it happened to me several times in a restaurant that I asked beforehand if something contained wheat, was told "no", ate it, felt "wheat symptoms", asked again, and it turned out that wheat was a non trivial component (seriously, it's in everything. really avoiding it is freaking hard).
People are surprisingly incompetent when it comes to identifying symptoms, I'll give you that. They are also surprisingly incompetent in the trust they assign to the knowledge they came by. test yourself: [1] is dietary cholesterol harmful? [2] does dietary salt cause hypertension? [3] Does artificially lowering cholesterol (e.g. with statins, rather than a diet change) increase your life expetancy? Medicine got all of these wrong for the last 50-100 years, and is only now (very very slowly) making a U-turn. It doesn't get everything wrong, of course - but it sure as hell doesn't get everything right either.
[1] not really. Dietary cholesterol accounts for 5-15% of serum cholesterol, the rest is made by the body. The recommendation to avoid dietary cholesterol is NOT based on evidence (or logic, for that matter)
[2] for over 80% of the population, the answer is "definitely not". Once you already have hypertension, for 80% of the population, the answer is still "not". For the other 20% (which can be characterized) it is "yes". However, the recommendation for low sodium is made to the entire population. NOT BASED ON EVIDENCE or logic.
[3] No. Statins reduce the probability for a heart attach, but actually increase all-cause mortality.
People have no insight. The man who treats himself has a fool for a doctor. Nobody is a better example of this than myself. I had gastrointestinal issues, I ran through a variety of elimination diets under the care of a doctor, and it was something that I hadn't even considered.
Some doctors are only interested in getting paid and seeing you out the door as quickly as possible. An alarming percentage of them from my experience, actually, if you don't fall within what they perceive as "well defined problem".
Especially if your symptoms do not immediately point at a specific problem, you have to be the primary contractor in caring for your health - no one else will do it for you.
I find it fairly absurd you combine a scientific concept (the placebo) with an emotion based reaction lacking in any evidence. The effects of gluten on the digestive system isn't imaginary - there are plenty of studies that prove otherwise. A simple google search would have turned up a few.
The more likely scenario as to why this is becoming a larger issue than it has in the past is people eat more now than they used to. More wheat means more aggravation of the stomach. Another possibility is people didn't used to have access to the information we do now, thanks to the internet. The only option used to be go see a doctor or suck it up.
Supposedly, a lot of grain sensitivity issues have been exacerbated by new high-yield wheat strains introduced in the 60s and 70s. But I think it's mostly that glutens simply weren't on most people's radar until recently, and so people simply assumed any resulting health issues were inherent or chronic. After all, everybody is supposed to eat bread, right?
Disclaimer: Strict paleo here, with staggeringly positive results. :)
Research indicates its may not be a placebo, eg: "Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial" (The American Journal of Gastroenterology 106, 508-514 (March 2011))
A potential contributing factor for the recent rise might the use of drugs such as be Accutane/Isotretinoin. 2 million US people have taken Accutane since 1982, and recently it has been linked to intestinal/bowel issues (including increased sensitivity to gluten).
If she eats any grains at all, she's most likely not eating gluten free. The standard for gluten free is extremely, extremely sensitive, and cross contamination is almost certain.
You have to be eating things that are 100% certified elisa tested to be gluten free - so far as I am aware, only a few products meet this standard.
Are you suggesting that if I eat some grass fed beef that hasn't been elisa tested, there's a good chance I'm eating gluten? This seems patently ridiculous to me. The elisa test is also flawed - there are situations in which it can't detect hydrolized gluten.
In any case, quantity matters. Trace amounts of gluten due to cross contamination may not be enough to cause people significant problems. You don't have to be 100% gluten free to derive benefits from it.
Functional gastrointestinal disorders affect ~10-20% of the population and respond well to placebo and antidepressants, much like somatic pain. I don't have citations, but you can look it up, it's very interesting reading.
If your grains were stored in a silo next to one with wheat in it, it has wheat in it.
If your food was prepared in a kitchen that uses flour anywhere in the facility, or has in the recent past, it has wheat in it.
It's surprisingly hard to achieve <10PPM gluten in modern foodstuffs. Even things that don't necessarily list wheat on the allergies list may or may not contain gluten.
Four years of stomach trouble. Dropped gluten on the suggestion of a friend with celiac. In 2 days the problem was gone. After four years. I honestly couldn't believe it.
Sure, I miss pizza and beer to a certain extent, but, as you rightly point out, it's a small price to pay for feeling normal and healthy.
A nice piece which stands in stark contrast to the alarmist and shallow FUD that so often accompanies this topic.
It's amazing how little we know about nutrition and biology. A lot seems to come down to common sense: breast feeding is good, exposure to microbes is good, being overweight is bad.
Hopefully the era of tonsil-removing and antibiotics overdosing is behind us
I'm often amazing that there are people out there that are so extremely against breast-feeding. I'm not even talking about breast-feeding in public, either. For example, I met someone from France whose friend had to argue with the nurses in the hospital about whether or not she would be 'allowed' to breast feed her child. [According to this acquaintance there is a lot of breast-feeding == BAD sentiment in France.]
| tonsil-removing
Is tonsil-removing something in over-abundance? So far as I understand it, it's possible for your tonsils to be really infected (I've heard of holes in your tonsils that excrete puss), which would seem like a removal is a good thing.
> she would be 'allowed' to breast feed her child.
It seems that was also the thought in the 70s to mid 80s in in US. My mother in law for example (as a retired nurse even!) thinks breastfeed is "disgusting" and how "it can kill babies because they can get smothered". I was just floored when I heard that from her telling it to my wife. Now we didn't listen of course to such crazy talk. But I wonder where it came from. One suspicion is lobbying and re-education campaigns of formula manufacturers. What better way to make a pretty penny than convince women to stop feeding their children like they have since the dawn of time and instill in them the belief that it is "disgusting" and "animalistic". It would take an enormous drive and a sustained campaign to do that. But I don't really have any other explanation for it.
My mother, as an assisting nurse in the late 60s, said she could probably do a tonsilectomy in her sleep (though of course she never did one conscious either). My dad did hundreds, or thousands, of appendectomies over a career as a surgeon, but they took a lot of effort.
There's little evidence of a useful role for an appendix, and most theories involve supposition about some past role.
Whether something is easy or not should not play a role.
It's like looking for your lost keys under a street lamp, because it is lighter there. Terribly harmful food-born diseases were contained by giving the animals that became food antibiotics themselves. Yet, that meant the meat ends up giving a dose to the people who eat it, and there have been fewer studies about how those antibiotics affect our symbiotic partners (the bacteria that by count make up most of our bodies).
Once you take something that might have a small effect, but spread it across hundreds of millions or even billions of people, then there should be increased sensitivity with regard to even the most outlandish effects, and they should be studied carefully.
> There's little evidence of a useful role for an appendix, and most theories involve supposition about some past role.
Oh, the hubris of modern medicine. There is a very useful role for the appendix, but our modern (as in, last 2000 years) lifestyle has rendered it mostly ineffective. http://www.news-medical.net/news/2007/10/08/30907.aspx
While verified discoveries about the role of the appendix are quite recent (2007 or so), I've read about similar theories back in 1996, and they were old (as in, 40 years old) at the time.
As a data-disposed person, my first response to practicing physician's regular resistance to "evidence-based" medicine has often been one of astonishment. Those on the ground with patients are very careful, and also figure out how to manage incomplete information pretty well.
You may especially have missed my points that tonsils are rarely, if ever, removed anymore, and appendices are removed less often, too. I don't know if anyone knows why we need these organs, yet currently practicing physicians just choose to assume that we shouldn't remove stuff without a very grave reason.
Indeed, it was too subtle for me to detect (even on second reading, probably my bad)
> As a data-disposed person, my first response to practicing physician's regular resistance to "evidence-based" medicine has often been one of astonishment.
As an engineer and stats person, I find blind acceptance of "evidence based" medicine astonishing. The idea is robust and noble, but the execution is beyond horrible - to the point that it ISN'T clearly better than the alternatives. (It's practically impossible to compare false-negative=wrongly-rejected-treatment vs. false-positive=wrongly-accepted-treatment of today's EBM; but if the now-known-false-positives are any indication, we're in really bad shape).
> tonsils are rarely, if ever, removed anymore, and appendices are removed less often, too.
That's only true if you compare to 1940-1980. If you assume they are needed, both are still removed with alarming frequency.
> I don't know if anyone knows why we need these organs,
The functions of both are known. Tonsils are an "early warning" outpost of the immune system - they sample pathogens while still in the throat, to give a "heads up" to the immune system in the gut. Removal of tonsils is associated with higher all cause mortality (especially heart attacks). The appendix is a curated cache of the good bacteria that the body needs in the gut (and possibly in other places), and there are circumstances in which the body will release another dose of good bacteria (though those are not well characterized yet, to the best of my knowledge).
> yet currently practicing physicians just choose to assume that we shouldn't remove stuff without a very grave reason.
I don't think that's really true. For one, most physicians in the US are still antibiotics-trigger happy (for whatever reason, even though most of them surely know it's harmful). That removes symbiotic organisms much more efficiently than it does harmful organisms, causing such things as yeast infections, the low B12 epidemic, and more.
They are more careful now with surgically removing stuff, true, but only recently, and only just.
If your appendix gets infected and ruptures, you will likely die in horrible agony. The fact we know (not suspect, know) you can live a healthy, full life without an appendix means that once it begins to cause problems, there's really no reason to risk keeping it.
France scores pretty poorly in terms of breast-friendliness. I have the feeling it comes a lot from formula-making companies capitalizing on feminist movements back then.
The marketing terms are way more pervasive in France than in the US (Where I have most of my experience). This is biased, of course, but most often I heard about "Formula" here, but in France I heard: "Lait de croissance (growing up milk)", "Lait Maternise (`maternalized` milk)", "lait infantile (infantile milk)", etc...
The idea is that at some point they (being the first line) succumb to infection and can be come the site of a persistent infection that in turns causes more sore throats and re-infections.
At least that was my experience. I was advised to take them out in my mid 20's. It does seem that there is correlation, now that they are out I get less colds and sore throats.
Switched to a different doctor and went for a consultation. Complained about by frequent sore throats. He looked in and said, we should take these out. (This wasn't in US but in Europe)
I lived in the third world (Africa) and mine were taken out in 1975. Amusingly several years later a doctor looked down my throat and asked if they had been taken out. When I said yes, he said they left some behind!
For those in the camp of "gluten is harmful to everybody and will kill us all"...
there is a massive experiment which has been running for over 100 years with tens of millions of people being administered massive daily doses of gluten (mostly from 100% refined white wheat in the form of pasta, bread and pizza) from birth to death.
The results show that these people live healthier and longer than average lives[1]. The experiment is called Italy :)
This is non trivial evidence which should not be ignored, although it is by no means "scientific". Furthermore, wheat today and wheat from 100 years ago are not comparable - even the non GMO wheat these days has been thoroughly optimized ("slow GMOd") for shelf life, is exposed to insecticides it wasn't exposed to 100 years ago, and has recently started to be irradiated as well.
It's going to take 50-70 years until we can evaluate this experiment with respect to modern wheat (and by then, we'll have postmodern wheat ....)
I've just returned from Italy and observed that they do eat a lot of gluten. However we must consider adaption: children being introduced early to small doses of gluten while still breastfeeding might have less incidence of celiac disease. Also, there might be some benefits from Mediterranean diet for this particular type of climate. It is also possible that they cultivate more traditional types of grains that does not include Super-Gluten (a type of Gluten molecule that may cause more trouble).
What I'd like to see is a breakdown of those reporting symptoms to what their actual diet is. I know people that claim celiac and avoid all gluten based products including things like beer. That said, a few of them I've known for years, the main gluten product I saw them consume was beer. Which has other aspects to it that can impact the digestive system.
I know many Europeans that have a very bread heavy diet with no problems. Bread-heavy being relative, in the sense that they actually eat a well rounded diet of which bread is a part of.
I know for myself (and project a bit on friends who's diets I know) we don't always get the full rounding of nutrients we should (dairy, vitamins, etc).
I wonder how much overall balance plays into things.
I wish there was more known regarding the type of bread/gluten exposure.
I know someone who has an 8 year old daughter who has weird reactions to gluten: causes her to feel sick, often get hives, and most of all get a cough that can't be controlled. Eliminating gluten fixes this. Normally reintroduction to gluten reintroduces the symptoms shortly thereafter.
However a year or two ago they went on vacation in Europe. At some point their daughter had bread at a cafe and the symptoms never popped up. Puzzled, they let her eat bread at other destinations during the trip; nothing.
Granted this isn't directly related to the article because this pertains more to a gluten sensitivity (which is a whole different can of worms) not celiac disease specifically.
Nevertheless I think it's interesting that often times it seems to deal with how the product is made.
I once read when researching the topic that a typical piece of bread (in the states) contains 100x more gluten than bread that was consumed in the 50's. This might be stretch, but with all the health oddities that have been surfacing it's certainly believable.
A relative of mine thought she had a gluten intolerance - turned out it was something in enriched white flour. She can eat any kind of wheat product if it's made with home-ground flour.
My endocrinolost relayed a similar story to me. His wife can not tolerate gluten in the US but does fine digesting gluten in Europe.
I believe most of the strains of wheat grown in the US are potentially more harmful to our digestive systems than elsewhere.
I've heard the US stains are genetically modified to be more resistant to pesticides and that this resistance comes with other deleterious effects. This last part, is a questionable claim that I have no support for and remain skeptical of.
I appreciate your remarks but think it is even more complicated than that. I have a form of cystic fibrosis. CF puts people at higher risk of also having Celiac and even without Celiac it is common to have trouble with wheat and dairy. Getting myself healthier has made me more tolerant of wheat and dairy. And I sometimes am okay with x oil but sick if the same thing is expeller pressed. I have noted a lot of weird things like that.
I don't have the specific link to the article I was thinking of, which is why I think 100x could have been a number pulled out of the air and wildly inaccurate. But the concept may not be as far off.
A little Googling will turn up that there is research and theory that shows bread/wheat today does contain notably larger quantities of gluten (now, probably not 100x) than in the past.
"Scientists suggest that there may be more celiac disease today because people eat more processed wheat products like pastas and baked goods than in decades past, and those items use types of wheat that have a higher gluten content. Gluten helps dough rise and gives baked goods structure and texture."[1]
Bottom line is it's still a complete mystery, but likely _something_ has changed in our environment over time. I find it pretty interesting though hopefully more breakthroughs are in the near future. I know a fair amount of people who are legitimately celiac and some who are gluten sensitive and it takes a lot of discipline to say the least.
Until food science catches up, you can get anecdotal data yourself. Try cutting out all breads/wheat/gluten/sugar for two weeks and see how you feel. If you feel better, then you can devote more into looking into it. If not, then you have data for that then. For me and my family, we feel better all around after removing the majority of it (we still eat that stuff about once or twice per week or two).
I was diagnosed with Celiac, last year, after 22 years of suffering since no doc could figure what's wrong. Eating gluten filled foods foods made me sleepy, and behave exactly like any ADHD adult. I'm an avid cyclist. My performance/endurance jumped about 40% since I went gluten free. I really miss Pizza and sour beers :(
If you're on the west coast, you need to hunt out this beer called Omission: http://omissionbeer.com/
They use some kind of magic to take the gluten out of real beer, so it tastes like a proper beer, not that sour sorghum stuff. Fantastic! Pale ale is the best but the lager is pretty decent too.
It's not entirely gluten-free. I can drink a little, but not a ton of it, which sucks because I miss real beer. Here's the disclaimer on their website:
Product fermented from grains containing
gluten and crafted to remove gluten. The
gluten content of this product cannot be
verified, and this product may contain
gluten.
I've found it at nearly every co-op and Whole Foods in Seattle, btw.
My wife is gluten intolerant, but we also enjoy chebe as a pizza crust. Just an alternate idea. We have found quite satisfying, gluten-free alternatives to almost everything that she wants.
Haven't quite cracked the doughnut, so if anyone has ideas...
In this thread: People experiencing somatic issues have relief of their symptoms by placebo diet changes, and are angry when other people point this out.
Does the placebo effect work in reverse? If you try something, confident that it wont do anything, then it wont? If so, then a simple proposal. Cut gluten/wheat/bread/sugar out of your diet for a couple of weeks. If all goes your way, you will feel the same you do today. Or, maybe a bunch of people have found something that works and in a couple of weeks you will feel overall better.
No, the placebo effect works through any intervention at all.
Also, I have tried a gluten-free diet extensively under the care of a gastroenterologist, in the course of investigation into stomach problems. I've had all the tests you can have, and all came up negative.
Because a substantial minority of people have functional gastrointestinal issues that are well addressed by the same treatments as somatic pain: antidepressants, stress reduction, and placebo treatment.
The rate of actual gluten intolerance is some 4-5 fold less than the rate of functional disorders - it's nigh on impossible that all those eating a gluten-free diet have gluten intolerance (let alone celiac), but it's extremely likely that they have functional gastrointestinal disorders.
Great article on the subject. As someone with a self diagnosed allergy, which I was unaware of for years, raising awareness can have a big impact. By just making minor tweaks to my diet, I am able to run again and back pain has decreased significantly, also thanks in part to acupuncture.
Keeping an eye on this company developing a vaccine.. should be out 2018, fingers crossed.. based out of Kendall Square, too! http://www.immusant.com/news/
There are people with celiac, and then there are those with wheat allergy, gluten intolerance, and gluten sensitivity. The celiac people do everyone else a disservice by making light of anyone in the other categories. My mom, myself, and 2 daughters all have tested positive for gluten antibodies, after dealing with Hashimotos, Parkinsons, Non-Hodgkins lymphoma, chronic sinusitis, and bipolar in our family. Friends with diabetes, osteoporosis, gall bladder problems, and out of control children have tested positive for gluten antibodies, with a range of different doctors and tests. None of us have had an invasive, risky, expensive biopsy, which is the only way to "prove" celiac, but going gluten-free has changed us all for the better, and cured the easier sicknesses including the bipolar. This is a silent and much more widely reaching epidemic than most people realize, and causes serious health problems, which drive our collective healthcare costs up. No one needs bread to survive, more people should see if gluten ails them, too. Celiac is just the tip of the iceberg, subclinical gluten intolerance affects up to 30% of Americans. I could quote dozens of legitimate research studies that back this up, having researched this issue over the past 5 years. Learn the facts - this is not quackery. Thank you New York Times! One last thing, if gluten is a problem, your intestinal bacteria are likely unbalanced and you probably have nutritional deficiencies. Get tested, and fix these problems before your problems snowball into cancer, autoimmune Disease, etc.
My personal experiences on gluten intolerance supports the views in this article.
I started fixing my health problems with gluten-free low carb paleo in 2003. After 6 years I had to face the fact that even though my weight was optimal, my health was deteriorating.
I switched into a diet optimising gut bacteria and hormonal balance. To my surprise, it seems I am no longer gluten intolerant. I still don't eat it much, just to be on the safe side. But when I do, I get no adverse effects.
> I switched into a diet optimising gut bacteria and hormonal balance. To my surprise, it seems I am no longer gluten intolerant. I still don't eat it much, just to be on the safe side. But when I do, I get no adverse effects.
Sure. The diet I follow is Schwarzbein Principle, but I've had lots of influences from Art Ayers (http://coolinginflammation.blogspot.fi), SCD and Paul Pitchford's Healing With Whole Foods. And from several other sources too...
I came out from paleo/lowcarb with very high insulin levels. Also had my adrenals exhausted (ASI test show this one). It took me several years to regain my health.
I follow up the situation using Genova Diagnostics Comprehensive Digestive Stool Analysis (CDSA2.0) and measuring certain vitamin and mineral levels.
I didn't see any mention of anti-biotics and the resulting alteration of the intestinal flora in this article.
I am of the opinion that the causes of these increasing gastrointestinal problems are multi-faceted, and a variety of factors (our diet, environment and lifestyle in general all in effect) are coming together to affect people's lives dramatically and negatively.
The bacteria that lives in our gut is sensitive. We throw all kinds of nasty toxic things at it and expect it to survive.
While anti-biotics are still a necessary evil, I cannot help but feel that we do not truly understand the real affects long term of its usage. Living with a gastro problem is tiring, depressing and challenging.
I wonder if there are differences in yogurt (and other sources of probiotics) consumption in people who tend to develop celiac and other autoimmune disorders.
Do the Russians mentioned in this article tend to consume more yogurt than the Finns?
I'm from Ukraine and love me some yogurt, but the first time I have even heard about celiac was at my first US doctor visit. Plus it looks to me that the whole industry of non-gluten food is so big here, while non-existant at home.
Americans tend to go through sudden waves of sick food fads, where perfectly healthy people, eating perfectly healthy food are suddenly struck by a kind of mass hysteria that some basic food staple we've been consuming just fine for tens of thousands of years is suddenly the source of all of our health problems.
This is interesting. I think have the opposite of this but no idea what that would be called. I can eat all the white bread, pasta, dough and other gluten rich foot but the moment I eat a (mildly) spicy curry, 5 mins. later it's running for the toilet...
It's seems to have gotten worse now I'm a little older (40). Sounds familiar to anyone?
Spicy foods hit some people really hard. You may be surprised how much better, overall, you feel if you were to cut down on the bread/pasta/dough/wheat/sugar/gluten down to once a week or so. For me, I did not even realize I wasn't feeling as great as I could be. Maybe after that, you'd be better able to handle the curry?
Failure to distinguish between the two has created a lot of confusion around the subject. For instance: some people believe that it is black or white: a person is either a) a are celiac, or b) deluding themselves into following a fad diet.
This is not the case. A person can be gluten intolerant without necessarily experiencing auto-immune reactions to it. Many people see drastic health benefits by excluding gluten from their diets even though these people are not celiacs.
Aside from the anecdotal evidence I, as a non-celiac, could offer about how life changing it was for me personally to cut out gluten about two years ago, here's a recent study:
http://www.ncbi.nlm.nih.gov/pubmed/22825366
and write up:
http://celiacdisease.about.com/od/glutenintolerance/a/Gluten...