Digestive troubles are among myriad health risks
for people sensitive to this problematic grain protein.
By Linda Melone
Extreme fatigue, brain fog and unexplained weight gain made Sandra Beckwith suspect a health issue was afoot. Sure enough, a doctor diagnosed her with an underactive thyroid and put her on medication. When her sister and 20-year-old daughter were both diagnosed with celiac disease, Beckwith decided to take the test as a matter of course. “I knew it was genetic.” She also tested positive for the disease—which is often connected with thyroid problems.
“I had no reason to suspect celiac disease because I didn’t have digestive symptoms, but apparently the disease attacked my thyroid,” says Beckwith, a New York publicist and writer who was diagnosed seven years ago. A gluten-free diet helped heal most of her symptoms but she remains on thyroid medication. “The damage was too far gone,” she says.
A friend with celiac helped Beckwith make a fairly quick adjustment to a gluten-free diet, although she admits it wasn’t easy at first. Recent awareness of celiac disease and the response of food manufacturers, however, now makes it easier to follow the strict diet. “I have no trouble eating gluten-free at home, but dining out terrifies me,” says Beckwith, who becomes incapacitated for a full day if she accidentally ingests gluten. “Wait staff don’t always know what’s in the food.” Wheat germ in her hair care products required her to switch brands as well.
Beckwith’s experiences with gluten-laden products are not isolated, which is why you can walk into any supermarket and likely see a new section devoted to gluten-free foods. Recent research linking gluten to digestive ills, migraines, diabetes and even neurological disorders has sparked heightened consumer demand for products without gluten. Retail sales of gluten-free products are expected to reach nearly $2.8 billion this year.
This trend is being driven by an increase in the number of people diagnosed with celiac disease, a chronic disorder found in people who experience an immune response when they ingest gluten.
“Celiac disease has increased fourfold over the past 50 years, doubling within the past 20 years,” says William Davis, MD, a preventive cardiologist and author of Wheat Belly (Rodale). “Celiac disease is the prototype for wheat intolerance. It’s a standard by which we compare all other forms of wheat intolerance.”
Gluten—a protein found in wheat, rye and barley—provides the elasticity and structure in baked goods. It’s also used as an ingredient in medicines, vitamins, cosmetics such as lipstick, spices, communion wafers and even the glue on stamps and envelopes. People with celiac disease develop an autoimmune response to various proteins within wheat that damage the small intestine.
“The wheat protein lectin (agglutinin), for example, changes the permeability of the intestinal lining and allows unwanted foreign substances into the bloodstream,” says Davis. “The inflammation caused by unwanted foreign substances at the various organs of the body is likely behind the multiple autoimmune diseases triggered by wheat.”
This damage can occur without any digestive symptoms and may be triggered by even a small amount of wheat-based protein.
Digestive symptoms of gluten intolerance include cramping and diarrhea; if allowed to progress over years, it results in a failure to absorb nutrients. Eventually this leads to deficiencies of protein, fatty acids and some vitamins and minerals such as iron and zinc. “About 1% of the population cannot tolerate wheat gluten even in small amounts,” says Davis.
More than 2 million Americans have celiac disease, according to the National Digestive Diseases Information Clearinghouse (www.digestive.niddk.nih.gov). Genetics largely determines the likelihood of developing the disorder. Among those with a first-degree relative (parent, sibling or child) diagnosed with celiac disease, one in 22 may also have it.
The roots of gluten difficulties go back into prehistory. “It began when humans went from being hunter-gatherers to cultivating grains,” says Davis.
But Davis believes changes in the genetic makeup of wheat itself helps explain the recent increase in cases. To create sturdier stalks with greater yields, wheat growers have, through cross-breeding and genetically altering the original einkorn wheat, reaped a harvest that bears little resemblance to the grain of 50 years ago. As a result, says Davis, small changes in wheat’s protein structure make the difference between a devastating immune system response to the protein or no response at all.
A wheat-free, gluten-free diet may hold the key to healing ailments associated with celiac disease. A wheat-free diet may also help with weight loss, even for people without celiac disease.
Although gluten gets most of the bad press, four different components within wheat can cause health issues. “Wheat contains amylopectin-A, a highly and rapidly digestible protein that contributes to the rapid rise in blood sugar from eating wheat products,” says Davis. A rise in blood sugar starts a roller-coaster effect involving glucose and insulin (the hormone that regulates blood sugar), which drives appetite and increases the visceral fat that lies deep in the abdomen and is known to increase heart attack risk. “Removing wheat from the diet stops this chain reaction and appetite shrinks,” says Davis.
Another class of proteins called lectins found in wheat work much like our own antibodies, only they protect the plant. Lectins from plants are usually harmless, but Davis says, “They’re different in wheat. As mentioned earlier, they unlock normal intestinal barriers and allow bacterial byproducts to enter your bloodstream. This may explain why those who consume wheat are more prone to autoimmune diseases such a scleroderma, lupus and rheumatoid arthritis.”
Lastly, gliadin, a protein unique to wheat, stimulates the appetite even in healthy people and increases calorie intake by 400 calories per day. “Eating wheat makes you want more of both wheat-containing and non-wheat-containing foods,” says Davis, who adds that people who eliminate wheat from their diets can lose as much as 22 pounds within six months. In addition, gliadin consumption can have behavioral and emotional effects. It is known to trigger the manic stage in those with bipolar disorders and can cause paranoia in schizophrenics.
“It’s like a bunch of evil scientists got together and decided to create this monstrosity that has maximum power over humans,” laughs Davis. “On top of it all, the US government advocates eating more of it by pushing ‘healthy whole grains.’”
Celiac disease is not the only wheat- and gluten-related disorder. “‘Gluten-related disorders’ defines the new terminology, which includes celiac disease, wheat allergy, dermatitis, gluten sensitivity, etc.,” says Peter H.R. Green, MD, director of The Celiac Disease Center at Columbia University, New York (www.celiacdiseasecenter.columbia.edu).
Not all adverse reactions to gluten elicit the same physical symptoms. Aside from the autoimmune response to gluten found in celiac disease, another health issue is classified as a wheat allergy. This includes a skin disorder called dermatitis herpetiformis, an immediate immune allergic response that causes an itchy, bumpy rash.
A third reaction category, non-celiac gluten sensitivity, refers to gluten-induced symptoms other than digestive issues. Fatigue, headaches, abdominal pain similar to that of irritable bowel syndrome (IBS) and tingling of the extremities are common symptoms. As many as 18 million people, or 6% of the US population, suffers from gluten sensitivity, according to the Center for Celiac Research at the University of Maryland School of Medicine (www.celiaccenter.org).
Unlike celiac disease, non-celiac gluten sensitivity does not cause an autoimmune response. “However, since many people who self-report gluten sensitivity have never been tested for celiac disease, they may actually have the disease,” says Green.
Because symptoms of celiac disease often mimic those of other disorders, an accurate diagnosis can be difficult. Irritable bowel syndrome (IBS), inflammatory bowel disease, diverticulitis and chronic fatigue syndrome often cause similar symptoms.
The “classic” form of celiac disease is associated with digestive-related problems, says Vikki Petersen, DC, CCN, certified clinical nutritionist and co-author of The Gluten Effect (True Health Publishing). Blood tests for celiac include a tTG antibody test. “This blood test and an intestinal biopsy are considered standard tests for celiac,” says Petersen.
However, many people are not “classic” celiacs. “Tests may be negative for those with no digestive complaints but they may have other symptoms. So patients are told they’re fine when they’re not,” says Petersen. A false negative can result from numerous other reasons, including inadequate test sensitivity and testing positive only in cases of severe intestinal damage.
Testing after a patient stops eating gluten can also create a false negative. “A negative test while on a gluten-free diet doesn’t mean gluten is no longer a problem,” says Petersen. Removing gluten may improve health status so the test no longer shows positive. Often, upon seeing a negative follow-up result, doctors tell patients they can resume eating gluten and once again health deteriorates.
“New tests can check for more types of gluten proteins than in the past, but we still have a long way to go,” says Petersen. These newer tests include those that can test for the influence of dermatitis and neurological influences of celiac disease. “The best way to test for gluten sensitivities is to eliminate gluten for 30 days and see how you feel,” says Petersen.
Not all symptoms of celiac respond as dramatically as others, however. “If you’re depressed and you eliminate gluten from your diet, it may be hard to see improvements for yourself. Something like the occurrence of migraines triggered by gluten is easier to identify,” Petersen notes.
Navigating the Store
The Food and Drug Administration (FDA) is working to establish a gluten-free definition, which would clarify how food producers may label their products. In 2007 the FDA proposed to allow a food to be labeled “gluten-free” if it did not contain an ingredient:
• of any type of wheat, rye, barley or crossbreeds of these grains
• derived from these grains and that has not been processed to remove gluten
• derived from these grains that has been processed to remove gluten, if the resulting food contained 20 or more parts per million (ppm) gluten
The agency recently opened up the proposal to public comment and will soon issue a final rule that defines the “gluten-free” labeling guidelines.
Packaged gluten-free foods should be eaten with caution—they are not necessarily healthier than those made with wheat. “Avoid substituting unhealthy foods for wheat-based foods,” says Davis.
For example, gluten-free foods are typically made with starches taken from corn, potato, rice and tapioca. “These dried starches raise blood sugar even higher than wheat. If these products raise blood sugar they’re also triggering small LDL particles, the number one trigger for heart disease,” says Davis.
In addition, this rise in blood sugar triggers glycation; glucose binds to proteins and fats, leading to oxidation and inflammation. It’s the process that causes cataracts and hardened arteries, among other health hazards. “Any time your blood glucose rises above 90 mg/dL, which is normal, it starts to glycate at an accelerated rate. So if you take out wheat and replace it with these products you cause glycation,” says Davis.
The best way to avoid wheat-related troubles, including glycation, is to replace wheat with gluten-free whole foods in their natural form. “Food such as fruit, vegetables, nuts, tomatoes, olive oil, cucumbers and salmon do not contain gluten,” says Davis.
Gluten-free is not a fad. Davis says, “At the end of the day we’re going to find that wheat is a trigger for gastrointestinal cancers and a host of other health problems. A wheat-free diet can be fulfilling and much healthier.”
For further information:
Tips on eating gluten free, including recipes: www.wheatbellyblog.com
Celiac Disease Foundation: www.celiac.org
Great Gluten-Free Recipes
Chicken and Vegetable Yakitori
3/4 cup teriyaki sauce (see step 1), divided
1 1/2 lbs boneless, skinless chicken thighs, cut into 1” cubes
6 green onions, white parts only, cut into 1/2” lengths
1 green bell pepper, cut into 1” dice
1/4 lb cremini mushrooms, wiped clean, halved or quartered if large
2 tbsp vegetable oil, plus more for oiling the grill
1/2 teaspoon salt
1/4 tsp freshly ground black pepper
1 tsp grated orange zest (from 1 orange)
1. In a small saucepan, combine 1/2 cup mirin, 1/4 cup soy sauce, 2 tbsp honey, 2 thin slices fresh ginger, 1 smashed garlic clove and pinch of red pepper flakes. Bring to a boil, lower the heat and simmer until thickened, about 10 minutes. Remove ginger and garlic, and set aside.
2. Thread chicken and vegetables onto 12 small bamboo skewers (presoaked in water for 15 minutes); leave space for even cooking. Place on a plate, brush with oil and sprinkle with salt and pepper.
3. Preheat grill to medium. Put about 1/3 cup teriyaki sauce in a small bowl for basting; add zest to remaining amount to use for dipping. Oil the grill racks and cook skewers, turning occasionally and basting with teriyaki, until browned and cooked through, about 12 minutes.
Serves 6 as appetizer. Analysis per serving: 211 calories, 25g protein, 9g fat (2g saturated),
1g fiber, 7g carbohydrate, 792 mg sodium
Reprinted with permission from The Gluten-Free Asian Kitchen:
Recipes for Noodles, Dumplings, Sauces, and More
(Celestial Arts, an imprint of Ten Speed Press
and the Crown Publishing Group, Berkeley CA;
Reduced Sugar Coconut Ice Cream
1 can (13.5 ounces) unsweetened coconut milk
2 cups coconut milk beverage
1/4 cup sugar
1/4 tsp pure stevia extract powder (can increase to 1/2 tsp to taste)
1/2 tsp liquid stevia extract (can increase to 1 tsp to taste)
1 tsp guar gum
1/8 tsp salt
1. Combine the coconut milk, coconut beverage, sugar, base amount of stevia, guar gum and salt in a blender. Cover and whirl at top speed until thoroughly blended, about 2 minutes; taste and add additional stevia in small increments as needed.
2. Place the blender jar in the refrigerator and chill for 1 hour. Remove from the refrigerator and pulse the mixture to incorporate. Pour the mixture into an ice cream maker and process according to the manufacturer’s directions.
3. To store the ice cream: Transfer to a plastic container with a tight- fitting lid. Place a piece of plastic wrap on top of the ice cream, cover, and freeze. To serve, allow the ice cream to soften slightly at room temperature.
Makes 1 quart. Analysis per 1/2 cup serving: 146 calories, 1g protein, 11g fat
(10g saturated), 12g carbohydrate, 52 mg sodium
Reprinted with permission from The Dairy-Free &
Gluten-Free Kitchen: 150 Delicious Dishes for Every Meal,
Every Day (Ten Speed Press, an imprint of Ten Speed Press
and the Crown Publishing Group, Berkeley CA;