It is no measure of health to be well adjusted to a profoundly sick society.
This statement, made by the early 20th C philosopher Jiddu Krishnamurti, reflected his deep mistrust of prevailing dogmas - in both his native British India and his adopted United States - and an even deeper belief in the power of the self to unlock truths. While he wasn't referring to food, per se, we could easily apply this profound quote to the post-industrial food world, in which we are fed truths with great passion, science and conviction by the powerful until they are no longer expedient, at which point they are readily abandoned for newer clothing.
In 2019, few food words are more hotly debated - whether vilified or extolled - than gluten. Gluten is big business. It's ubiquitous in the modern diet, and most of the most common meals (or snacks) we enjoy are laden with it. Breakfast? Pancakes, cereal, toast, crêpes, muffins and pastries all contain gluten. Lunch and Dinner? Sandwiches, burgers, pastas, fried or crusted meats and fish, salad croutons and dressings, foods with flour tortillas, thickened soups, that bread every restaurant serves, and even potato chips and french fries are all sources of gluten. Snacks? Just forget this category altogether. Cakes, cookies, pies, tarts, muffins, pastries, and even ice cream and energy/granola bars are loaded with... gluten. And let's not forget beer. In short, gluten is extremely difficult to avoid, because the American - and increasingly, global - diet is built on grains, and predominantly gluten grains.
In 2015, wheat - and its gluten-laden sisters, barley and rye, collectively comprised 58 million acres of US farmland that yielded 2.3 billion bushels, making gluten grains the largest use of American farm acres. Globally, that number jumps tenfold, to over 540 million acres of wheat, yielding 730 million tons of harvest. 80% of US produce is called ‘winter wheat’, which is used for breads, cereals, cookies, crackers and pastries, among myriad other industrial food products. Beyond the US, consumption of wheat products account for 20% of global calorie intake, while the world’s 3 most popular grains, which include rice and corn, account for one half of all caloric intake, internationally.
So just what is gluten, and why does it ignite such an inflamed response?
Gluten is comprised of several proteins - called prolamins - found in grain grasses (such as wheat, barley, rice, oats, millet, rye...) whose role is to provide energy to fuel the host plant's own growth. Gluten is stored in the endosperm of the plant's seed, which is the largest of the seed's three components, analagous to the albumen - or 'white' - of an egg. Gluten is primarily composed of gliadin, which allows dough to rise during baking, and glutenin, which gives dough its elasticity. Not all grains contain gluten, though. Sorghum, teff, millet, brown rice, amaranth, quinoa, corn and brown and/or wild rice are all gluten-free, and can contribute key proteins, minerals and vitamins to your diet. Oats fall into this category, as well; however most oat manufacturers use the same factories to produce gluten-containing foods; and so you will need to check labels carefully for ‘certified gluten-free oats’ if you need to avoid gluten altogether. In the same vein, many of the new, so-called ‘gluten-free’ processed foods that proliferate supermarket shelves and freezers today are produced by the same industrial companies that make their gluten-laden predecessors; as such, it’s best to check all gluten-free product labels to ensure they are not cross-contaminated in multi-use factories.
Fewer than 1 out of 141 Americans tests positive for the genetic autoimmune disorder Celiac Disease, and that number hasn’t changed over the decades in spite of our population’s predominant shift from farmer to consumer, and our corresponding increase in carbohydrate consumption. Over the past forty years, American grain consumption rose on average from 400 calories a day to 600 - a 50% increase, according to the Pew Research Center.
For those with the disease, ingested gluten is mistaken for antigens (toxins or other foreign substances, such as bacteria, viruses or mutated cells), that provoke an immune response. In the case of gluten, the body mistakes the small intestine’s healthy tissue - specifically its lining - for a foreign invader. This lining is critical in the body’s defences, and is made of finger-like structures called ‘villi’. It is the villi that absorb nutrients from foods while they are digested, and that simultaneously protect (real) antigens from passing through its cell walls and gaining free access to our other organs and tissue. Beyond the inflammation response that gluten triggers in an otherwise healthy gut, Gluten’s gliadins are experts at breaching the intestine’s protective lining (its so-called tight junctions), where it triggers yet another immune response, such that our body attacks its own GI tract from both sides, widening the breach and destroying the lining itself. If left unchecked, this process can lead to Leaky Gut Syndrome, which allows ingested toxins and pathogens that our intestinal lining typically withholds to enter the body and wreak havoc. Increased intestinal permeability leads to a cycle of ever-increasing inflammatory response, unless the trigger foods are removed, and other dietary changes are made in an attempt to heal the system.
Reversing Celiac Disease
Healthy Gut Company founder Jordan Reasoner - a Celiac engineer who lost his mother to the same disease, says that elimination of gluten alone has led to full symptom reversal in just 40% of Celiac patients. To a Celiac sufferer, that means the bodies of the other 60% never experience full remission. HGC goes on to point out that the standard gluten-free foods proliferating supermarkets are full of toxins that exacerbate leaky gut syndrome. These include non-wheat cereal grains, soy, industrial seed oils and sugars. Why? As a ‘value-add’ commodity worth billions to food giants, foods sold in packages as ‘gluten-free’ are often just as processed as other gluten-containing foods. Specifically, cereal grain proteins such as zein (corn), avenin (oats) and orzenin (rice) can also cause inflammation, much the way gliadin in wheat does. Soy can cause thyroid and hormone disruption, and in turn, increase the risk of certain cancers. Industrial seed oils are extremely heavy in omega-6 fatty acids, which trigger inflammation response (see Week 3’s post for more on this). And sugars are the primary food for bacteria, which in the presence of damaged villi leads to malabsorption of sugars and a corresponding overabundance of fuel for the bad bacteria (called SIBO, or small intestine bacterial overgrowth) that are busy attacking the intestinal lining. In a sense, we are fueling our own pain.
In spite of the science, the current gluten-free dietary craze - fed by countless Americans who experience some form of gastrointestinal discomfort, and believe gluten to be the culprit - was worth $4 billion USD last year in goods sold to over 100 million Americans, according to William Balistreri, MD - a doctor at Cincinnati Children's Hospital Medical Center, and is projected to exceed $6.2B by 2019. And it's not just the 'average American' who is following the craze. Gluten-free celebrities abound; and in one survey of 910 olympic medalists and world-class athletes, a whopping 41% of them said they followed a gluten-free diet.
So what can a true Celiac sufferer do? As usual, it comes down to choosing healthy foods over convenience or marketing. Eliminate grains, and soy - obviously. In addition, remove processed foods high in seed oils and sugars from your diet, which are present in most packaged foods, gluten-free or not. Avoid added sugars in all forms (anything that ends in an ‘ose’, like sucrose, lactose and dextrose) that have double-digit gram counts per serving, to keep SIBO in check. Eat whole foods (low-sugar fruit and vegetables). Add fermented foods (with good bacteria) to your diet to rebalance the intestinal microflora. And eat animal products that are minimally processed.
Engineered for profit, not people
A final note on Celiac and gluten. Interestingly, wheat’s ‘family tree’, whose genetically modified (GMO) journey transformed it from wild grasses to an arsenal of modern industrial food products, produced branches of cereals along the way with very distinct genomes that according to newer research into dietary gluten, the human body tolerates quite differently. The difference seems to stem from the number of pairs of chromosomes in the wheat. The most ancient grains, like einkorn, are diploid, containing just two sets of seven ‘AA’ chromosome cells (14 total); emmer and durum - the latter of which is the dominant grain in pasta - are tetraploid, containing four ‘AABB’ sets (28 total); while modern wheat is hexaploid, containing six ‘AABBDD’ sets (42 total). There is emerging research from both NCBI (here, and here) and Wiley (here) that suggests the more ancient (diploid and tetraploid) grains react less, and in some cases not at all, to gluten peptides, and are thus better tolerated (or fully tolerated) in patients with Celiac disease. And since hexaploid wheat comprises 80% of the American market, providing 20% of total nutrient intake, it is possible that there is a correlation between this sensitivity and the modern diet.
While the subject of nutritional density isn’t central to this post, ancient grains have also been shown to have far higher concentrations of key vitamins and minerals. The chart at the middle of this post compares einkorn to major crop wheats (winter and summer), as well as to durum. Diploid einkorn (and to a lesser degree, tetraploid durum) far outstrip modern wheat in nutrient density. It’s worth a glance.
Celiac vs. IBS
While Celiac Disease affects less than 1% of Americans, a full 7 to 20% of the US adult population tests positive for IBS - or Irritable Bowel Syndrome. While IBS is not life-threatening, it can cause significant abdominal discomfort (bloating, cramping) and either constipation or diarrhea. Because wheat grains are high in starches and sugars, which are easily fermented by ‘bad’ intestinal bacteria, if you suffer from IBS, certain grains, like quinoa, buckwheat, corn, oatmeal, rice and oats are all better tolerated, according to the Cleveland Clinic.
Beyond this, IBS-tailored food recommendations depend on how your IBS manifests itself. According to Everyday Health, it depends on whether your IBS expresses itself via constipation or diarrhea. If the first is the culprit, you want to ‘up’ your intake of foods with insoluble fiber to help push things through, such as broccoli, leafy greens and zucchini. If, however, you suffer from the second, then the opposite is true, and foods high in soluble fiber will help absorb excess fluid, such as apples, berries, oranges and peas. WebMD echoes these thoughts, and goes further to include advice related to lifestyle, including the ‘usual suspects’ of stress, exercise, caffeine and alcohol consumption, as well as a potential IBS-related cross-reaction with drugs such as antibiotics or antidepressants.
FODMAPs are a specific grouping of carboydrates that can cause gastrointestinal distress, like bloating, cramping, diarrhea and constipation. This unwieldy nickname stands for “Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols”. Eating foods that are low in FODMAPs (or avoiding those that are high) can generate considerable relief from IBS sufferers. The culprits include fructose (fruit sugars) in high concentrations (think bananas and mangoes); fructans, which are fructose polymers that are found in obvious culprits like wheat, barley and rye, but also in the allium family (garlic, onions and their cousins); lactose (the sugars found in all dairy); we now know that 65% of the population cannot produce adequate lactase [enzymes] to break down lactose - a number that climbs to 90% in those of East Asian descent; galactans (found in legumes, like beans and peas); and polyols, which are sometimes called ‘sugar alcohols’ and which occur naturally in some fruits, but proliferate the market as low-calorie sweeteners like erythritol, sorbitol and xylitol, among others (the last of these is common in chewing gum, toothpaste, mints and candy).
Some foods that are otherwise among the plant world’s healthiest - delivering significant amounts of vitamins and minerals - are on the list of foods that can cause GI distress in IBS sufferers. These include legumes (beans, peas), allium (garlic, onions, as stated above) and crucifers (broccoli, cauliflower). While under normal circumstances these are the powerhouses of a vegan diet, they can cause real distress to IBS sufferers. A good list from www.ibsdiets.org on high and low FODMAP foods can be found here.
The reason FODMAPs cause gastrointestinal distress is because of the high presence of SIBO, which we discussed above. The overgrowth of these so-called ‘bad’ bacteria is fueled by sugar (carbs), and unlike the good bacteria that are absolutely essential to a healthy GI tract and produce mostly methane as a byproduct, the bad bacteria generate hydrogen, which as one would expect is found in higher concentrations in IBS sufferers and is a direct cause of GI distress. This NCBI research paper demonstrates a direct correlation between hydrogen presence in the gut and bowel frequency, which is borne out by the symptoms those with IBS typically suffer.
Celiac is a serious and life-threatening disease. Not all gluten seems to affect Celiacs in the same way, as we’ve learned, and ancient grains with fewer chromosomes seem to be tolerated better than the modern wheat that saturates the food supply today. Beyond ancient grains, there are many non-glutinous grains that can deliver nutrients in familiar form while avoiding autoimmune triggers. We have learned that the proliferation of gluten-free processed food products made by companies seeking to profit on this new ‘craze’ can equally stimulate an autoimmune reaction, and don’t represent any particular benefit over gluten-containing packaged foods. Thus making healthy dietary choices irrespective of gluten have a direct influence over GI health, and one should opt for an anti-inflammatory, low-sugar, whole food, probiotic diet to calm the GI tract and slow or reverse intestinal permeability, aka Leaky Gut Syndrome.
With respect to IBS sufferers, the advice is similar, though here the way sensitivity manifests itself must be considered when using food as functional medicine to remove irritants and reverse irritability. In all cases, a diet low in FODMAPs is recommended, to lower hydrogen production and reduce SIBO.
Beyond food choice, since both IBS and Celiac express themselves in the gut, which also hosts our enteric nervous system and is known as our ‘second brain’ (see Week 17’s post, here) our lifestyle choices, stress and energy levels all play a role in gut health and have been shown to influence the expression of IBS.