Summary: This post details why you may want to reduce, eliminate gluten. In summary, learn that 20% of your calories now comes from wheat (that contains gluten), learn FIVE reasons why you may want to reduce it’s intake, and why so many athletes (41% in a 910 cohort survey) eat gluten-free 50 to 100% of the time (reduced fatigue and GI distress, improved performance and nutrients — OFTEN FRUITS AND VEGETABLES ARE INCREASED WHEN GLUTEN IS DECREASED, lower toxin loads,…). Where is gluten? In wheat, barley, rye, bulgur, couscous, farina, graham flour, kamut matzo, semolina, spelt, triticale & oats (not certified gluten-free) not to mention that gluten is renamed and hidden often in processed foods.
Should you reduce or ditch gluten? If you do, quinoa, properly prepared with acid soak to reduce anti-nutrients (see the recipe How-To’s here, is a great substitute!
Should you reduce, eliminate gluten?
Why are folks going gluten-free? Here are 5 reasons:
Should We All Go Gluten-Free? is a decent Feb., 2016 Medscape commentary that nicely summarizes the nuances of gluten conditions ranging from autoimmune celiac, to non-celiac gluten sensitivity, to irritable bowel syndrome, to FODMAPS, to non-celiac wheat sensitivity. For more detail than this post provides, I encourage you to read this article.
One caution: Consider being excluded for celiac disease before going gluten-free. You can not be adequately assessed for celiac disease without having gluten onboard, and there are risk factors associated for undiagnosed celiac disease: There is not yet any direct evidence to suggest that a gluten-free diet is detrimental to follow outside of coeliac disease.. following a gluten-free diet may lead to the under diagnosis of coeliac disease if not adequately excluded. There are risks associated with untreated coelic disease (bone health, nutritional deficiencies, and long-term mortality). Two in three patients with self-perceived NCGS do not have coeliac disease adequately excluded.25 Excerpt adapted from here.
Reason #1: Daily consumption of wheat products and related grains could contribute to the manifestation of chronic inflammation and autoimmune diseases by increasing intestinal permeability and initiating a pro-inflammatory immune response.
Chronic low grade inflammation is a big deal for everyone; this is behind most all chronic disease. -See Obesity, inflammation, and the gut microbiota, full text here. Inflammation is a double-edged sword. It is required to protect the body, but too much of it can create disease. Sooner or later, chronic low grade inflammation will get you. Dietary factors associated with inflammation include a shift towards a higher Omega-6:Omega-3 fatty acid ratio  and a high intake of simple sugars . Other substances in our daily food, like those found in wheat and other cereal grains, are also capable of activating pro-inflammatory pathways. Inflammation is the response of the innate immune system triggered by noxious stimuli, microbial pathogens and injury. When a trigger remains, or when immune cells are continuously activated, an inflammatory response may become self-sustainable and chronic. Chronic inflammation has been associated with many medical and psychiatric disorders, including cardiovascular disease, metabolic syndrome, cancer, autoimmune diseases, schizophrenia and depression [1,2,3]. Furthermore, it is usually associated with elevated levels of pro-inflammatory cytokines and acute phase proteins, such as interferons (IFNs), interleukin (Il)-1, Il-6, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP). –The Dietary Intake of Wheat and other Cereal Grains and Their Role in Inflammation.
Relevant studies are:
- There is some evidence in patients believed to have NCGS of gluten-induced activation of innate immunity in the absence of detectable changes in intestinal barrier function.31 Furthermore, in an Italian study, positive coeliac serology (IgG AGA) was shown in more than half of cases but mostly without specific antibodies associated with coeliac disease (IgG deamidated gliadin peptide antibodies, IgA tissue transglutaminase antibodies or IgA endomysial antibodies).32 Genetic predisposition to coeliac disease has also been suggested as a factor for NCGS where patients carrying the HLA-DQ2 allele, but without villous atrophy on duodenal biopsy, have been shown to symptomatically improve on a GFD.27,28 -Non-coeliac gluten sensitivity: piecing the puzzle together, 2015
- This study was a randomized controlled 4-week trial of a gluten-containing diet (GCD) or gluen-free diet (GFD) in 45 patients with IBS-D; In patients with diarrhoea-predominant IBS, consumption of a gluten-containing diet was associated with higher small bowel permeability than with a GFD.35 Conclusion: Gluten alters bowel barrier functions in patients with IBS-D, particularly in HLA-DQ2/8–positive patients. These findings reveal a reversible mechanism for the disorder. The effect could not be concluded to be gluten-specific, but rather is attributable to the GFD. –A Controlled Trial of Gluten-Free Diet in Patients with Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function.
- Another read on both in vitro and in vivo studies showing that gliadin and wheat lectin agglutinin (WGA) can both increase intestinal permeability and activate the immune system is at: The Dietary Intake of Wheat and other Cereal Grains and Their Role in Inflammation, 2013
- See too Gluten: What You Don’t Know Might Kill You, by Dr. Mark Hyman, MD, chairman of the Institute of Functional Medicine, and Director of the Cleveland Clinical Center for Functional Medicine.
- See too Whole Grains: Dietary Angel or Demon? by Dr. Gerry Mullin, MD, a board-certified internist, gastroenterologist and nutritionist. He is an associate professor of medicine and serves as the director of Integrative GI Nutrition Services at The Johns Hopkins Hospital.
Reason #2: Wheat- and rye-derived products often contain the highest FODMAP content, predominantly fructans & GOS. Many have gut symptoms consuming fructans & GOS substrate beyond that which they uniquely tolerate.
According to the United Nations, 20% of calories consumed come from wheat… bread, pasta, cereal, breakfast or energy bars, and pastries! That is a lot of FODMAP substrate of fructan and GOS. Non-coeliac gluten sensitivity: piecing the puzzle together, 2015 explains: After ruling out coeliac disease,] non-coeliac gluten sensitivity (NCGS) should be regarded as a sub-group of IBS and distinct from coeliac disease. Lowering the dietary intake of FODMAPs continues to be the first line therapy for patients experiencing GI symptoms…The thin line between coeliac disease, wheat allergy, irritable bowel syndrome and non-coeliac gluten sensitivity (NCGS) is not always clearly distinguishable; making it difficult to exactly differentiate between these disorders (outlined in Table 1).
The clinical picture of NCGS is a combination of IBS-like symptoms, behaviour disturbances and systemic manifestations.8 …systemic manifestations (tiredness, headache, fibromyalgia-like joint or muscle pain, leg or arm numbness, ‘foggy mind,’ dermatitis or skin rash, depression, anxiety, and anaemia) may be common.9,10 The symptoms occur soon after gluten ingestion, improving or disappearing within hours or a few days after gluten withdrawal and then relapsing following its reintroduction.7
The main carbohydrate in wheat is non-gluten components called short chain fructans or fructo-oligosaccharides. These carbohydrates are part of the FODMAPs (acronym means: Fermentable Oligo-, Di-, and Mono-saccharides And Polyols). These substrates are poorly absorbed in the small intestine; a diet low in FODMAPs provides symptomatic improvement in 74% of patients with IBS.17 FODMAP foods include: lactose (in milk), excess fructose (in pears, apples), fructans and fructo-oligosaccharides (in artichoke, garlic, onions, wheat and rye), galacto-oligosaccharides (GOS; stachyose and raffinose in legumes), and sugar polyols (sorbitol and mannitol in stone fruits and artificial sweeteners).18–21 Wheat- and rye-derived products often contain the highest FODMAP content, predominantly fructans and GOS. Cereal products with the lowest FODMAP contents are mostly gluten-free, based on rice, oat, quinoa and corn ingredients.
Reason #3: We very likely are consuming A LOT of glyphosate toxins eating wheat gluten.
Just to repeat: According to the United Nations, 20% of calories consumed come from wheat... bread, pasta, cereal, breakfast or energy bars, and pastries! That’s a large proportion of calorie load coming from a product having residue of glyphosate, the active ingredient in Roundup® that now has safety questioned. I pause given WHO labeling glyphosate as “probably carcinogenic to humans” and the Seneff, MIT 2013 paper, Glyphosate’s Suppression of Cytochrome P450 Enzymes and Amino Acid Biosynthesis by the Gut Microbiome: Pathways to Modern Diseases, and the Seneff PowerPoint, Roundup, Is there an Elephant in the Room?
Finally the FDA will begin testing for glyphosate in fiscal year 2016 in soybeans, corn, milk, and eggs, other potential foods. Given that 20% of your calories come from wheat, hopefully FDA testing will include wheat which is directly sprayed with glyphosate before being harvested to help dry it out (see this Univ Minnesota post, Pre-harvest management options for wheat and this pre-harvest clarification). Hopefully too the FDA will look at oats which are pre-harvest sprayed with glyphosate for drying. About 40 to 50% in West Canada use pre-harvest glyphosate to hasten and even up crop maturity. Grain Millers, a West Canada major oat buyer will no longer buy dessicated oats due to problems with oat groat quality. When mills cut, flake or roll the groat, it is chalky, it’s brittle, it breaks apart and the finished product doesn’t make spec, in terms of granulation or absorption… The level of glyphosate residues were below the established maximum limits. Glyphosate is now off patent; it is the most widely used herbicide in the world.
While this is not a post on toxins, regarding glyphosate suppression of the liver P450 enzyme… suffice it to say that P450 enzyme is our main liver detox gene whose role cannot be compromised given our total body toxin loads including those from:
- Vegetables and fruits — see this study, detailed below my signature, which showed all 364 children exceeded cancer benchmark levels for arsenic, dieldrin, DDE (a DDT metabolite), and dioxins (there are other contaminant loads cited as well), and
- Personal care products — see this UC Berkeley study, teens using personal care products labeled free of chemicals such as phthalates, parabens, triclosan and oxybenzone (these chemicals have been shown in animal studies to interfere with the body’s endocrine system) for 3 days found significant drops in levels of these chemicals in their urine. Metabolites of diethyl phthalate, commonly used in fragrances, decreased 27%, methyl and propyl parabens, used as preservatives in cosmetics, dropped 44 and 45% respectively, and both triclosan, found in antibacterial soaps and some brands of toothpaste, and benzophenone-3 (BP-3), found in some sunscreens under the name oxybenzone, fell 36%.
- Also, realize your exposure is not just from eating food toxins… if you live or work near industry or farming, or are downstream of water runoff or wind current, you drink/inhale toxins increasing disease risk.
If we eat “foods” and absorb chemicals that are poisoning us we shouldn’t be surprised when they start making us sick.
Side tip: Buy to EWG for produce that should be organic, and if that is not possible, use this TOOL #ConsumerReports for sourcing non-organic. #ConsumerReports shows for specific non-organic produce the countries having a low risk of pesticide exposure and conversely, the countries with high risk. This tool shows never buy an apple from the US unless organic, but non-organic low risk apples can be sourced from New Zealand. Or cucumbers… non-organic is high risk is both US and Mexico but low risk is Canada. Know your farmer if in a high risk country and you are buying local. It’s a neat tool to use along with EWG Clean/Dirty since you learn where low risk of pesticide exposure is for other countries for non-organic produce.
Reason #4: How many ATHLETES are going gluten-free and why? What we can learn from the athletes!
I was blown away to learn that a 17 question online survey of 910 non-celiac athletes (528 female, 5 no gender selected) showed that 41% (including 18 world and/or olympic medalists), ate gluten-free 50 to 100% of the time. Of that, only 13% adhered to gluten-free due to a medical condition whereas 57% self diagnosed their gluten sensitivity. Read the study, Exploring the Popularity, Experiences and Beliefs Surrounding Gluten-Free Diets in Non-Coeliac Athletes, see full text here. Check out some greats:
That is a lot of athletes eating gluten-free for perceived performance and health improvement!
Health improvements included: reductions in GI distress, reduced inflammation, improved exercise performance, resolution of nutrient deficiencies, and that the diet supports a favorable body composition for sport. Also striking is to understand that while exercise alone can increase intestinal permeability due to reduced splanchnic perfusion, dietary factors such as high carbohydrate intake may also contribute to GI dysfunction (Pfeiffer et al., 2009; Pfeiffer et al., 2012; van Wijck, Lenaerts, van Loon, Peters, Buurman and Dejong, 2011).
And isn’t that what athletes are encouraged to eat? Tons of low glycemic loaded carbs that are high FODMAPs for fuel (wheat bread and pasta); seems time to scrutinize the sources of those carb loads. You can have a “low-GL diet” full of wheat pasta or an equally low-GL diet full of gluten-free grains, fruit and tubers. Which would be better for your gut, waistline, and performance? Seems the athletes know!
The study found that gluten-free perceptions can be based in metabolic and physiologic realities; there are a lot of food substrates that contribute to gut dysfunction. The athletes reasons for eating gluten-free were:
Abdominal/gastrointestinal symptoms alone (16.7%) or in conjunction with two (30.7%) or three (35.7%) additional symptoms (e.g. fatigue) believed to be triggered by gluten. 84% indicated symptom improvement with gluten-removal. Symptom-based and non-symptom-based self-diagnosed gluten-sensitivity (56.7%) was the primary reason for adopting a GFD.
There may be subgroups of athletes that have even greater gut dysfunction. For example, 15 to 30% of endurance athletes self report higher gut dysfunction compared to other types of athletes (Jeukendrup, Jentjens and Moseley, 2005; Pfeiffer et al., 2009; Pfeiffer et al., 2012).
Speaking about physiological changes of reducing gluten: The elite Division 1 athlete Litholink test slide shown above is N=1 biological proof (thank you #Litholink) of dramatic improved kidney function moving onto fermented gluten foods during Division 1 elite performance demands, for mild chronic kidney disease impairment. Not causation here, just association.
And last, there are a lot of studies now documenting the genetics of NCGS and real symptomology:
- Genetic background: The genes encoding DQ2 or DQ8 molecules (their markers are commonly used in the disease diagnostics) are present in 95% of celiac patients. Negative results for both HLA-DQ2 and HLA-DQ8 excluded the diagnosis of celiac in at least 95% (>95% negative predictive value). Half of the NCGS patients have the genes encoding DQ2 or DQ8 molecules in their HLA system  and . It has also been reported that HLA-DQ2 genes are frequently observed in patients with NCGS and with the diarrhoea-predominant irritable bowel syndrome (IBS) . These genes are present in healthy people as well (30%), but less frequently than in the case of the NCGS patients (50%) .
- 2016, Including neurological: Patients with celiac disease and NCGS have similar neurological manifestations, which respond well to a gluten-free diet. This suggests that the two conditions share common pathophysiological mechanisms. -Neurological Dysfunction in Coeliac Disease and Non-Coeliac Gluten Sensitivity, 2016
Reason #5: Maybe it is the fruits and vegetables you increase eating when eating gluten-free that is the benefit!
The perceived physiological improvements may coincide simultaneously with other dietary changes. The survey showed that athletes eating gluten-free actually increased consciousness of nutrition intake which increased micronutrients from fruits and vegetables as well as gluten-free whole grains and decreased processed food consumption.
What trumps? They all are significant as Dr Fasano explains in the below YouTube, Gluten: A Gut Feeling. He says to go “natural” gluten-free using whole foods such as fresh fruits, vegetable, meat, fish, nuts… this will be nutritionally sufficient and you will lose weight coming off the Standard American Diet. But eat gluten-free pasta, cookies, cakes, and beer… and you will gain weight since these foods are a lot of fat and sugar. He’s seen it time and again in clinic.
Watch the 26 minute YouTube, Gluten: A Gut Feeling, for the latest on gluten, celiac, non-celiac gluten sensitivity, FODMAPs, and PALEO. Mandatory gluten elimination is necessary for celiac, but improvements realized on the other diets may be due to carb restrictions which eliminate many FODMAPs. The YouTube includes:
- Interviews by Drs. Fasano and Gibson, celiac & FODMAP experts.
- Bread preparation: bread fermented overnight has sufficient enzyme degradation of the “toxic” gluten whereas bread today is quick rise lacking sufficient degradation of the gluten protein.
- Or maybe it is the added chemicals used in wheat grain milling.
- Lastly, it is great to know if you lack the genes for celiac since that means you may be able to be a bit lax on total gluten elimination.
- Is the surge in popularity of the gluten-free diet just a fad? Gluten is the new dietary enemy. Millions of people around the world are giving up gluten in pursuit of better health. With celebrity endorsements and best selling books there is ground swell of support for gluten-free diet.
- The believers say it can cure a wide range of diseases like arthritis, depression, even autism. But is this unprecedented uptake of the diet justified? Many doctors say that if you don’t have coeliac disease, you don’t need to avoid gluten. But emerging evidence is challenging this belief.
- In this special investigation, Dr Maryanne Demasi cuts through the hype of the gluten free diet. Should we all get on board or is it just another fad? #ABCcatalyst
If you decide to reduce, eliminate gluten, a great substitute is quinoa but be certain to proper soak prepare quinoa ALWAYS not just for culinary taste but to be kind to your gut too.
♥Last updated: February 15, 2017 at 15:54 pm to add this post to SEO category NCGS/NCWS. Prior update added SEO category and tag ‘microbiome & wheat’.