Doctor's Note

More than 10,000 articles have been published on gluten in medical journals—intimidating even for me! Combined with the multi-billion dollar financial interests on both sides, it makes for a difficult task. But I think I did it! This is the first of a 3-part video series summarizing the best available science on gluten. Stay tuned for Gluten-Free Diets: Separating the Wheat from the Chat and How to Diagnose Gluten Intolerance.

Why this apparent increase in food sensitivities in recent decades? It could be because of pollutant exposure (see Alkylphenol Endocrine Disruptors and Allergies and Dietary Sources of Alkylphenol Endocrine Disruptors).

What can we do about preventing so-called atopic diseases (like allergies, asthma, and eczema)? See my videos Preventing Allergies in Adulthood and Preventing Allergies in Childhood.

The weirdest example of an emerging food sensitivity may be the tick-bite related meat allergy story I review in Alpha Gal and the Lone Star Tick and Tick Bites, Meat Allergies, and Chronic Urticaria.

 If you haven't yet, you can subscribe to my videos for free by clicking here.

  • Merio

    I think there is a typo in the Doc’s Note:

    Stay tuned for Gluten-Free Diets: Separating the Wheat from the Chat and

    Is it not “separating the wheat from the chaff“?

    • brec

      I think he used “Chat” in the video’s title just for pun.

      • Skeptic

        Nice!

      • Merio

        possible… i thought something similar…

        • http://nutritionfacts.org/ Michael Greger M.D.

          Pun it is!

          • Merio

            I take this chance to thank you Dr Michael Greger for all your incredible work, informations and this wonderful site that is one of my favourite in the world of Human Nutrition !!

            I think that one day thanks to sites like this, the importance of Preventive Medicine through Nutrition will be an important part of Med school and related field.

            Best regards,

            Mauro, Italy

          • sf_jeff

            well spun…

  • pm

    IBS and Celiac disease can also be cause by Lectins which are contained in wheat, oats and grains. http://drjockers.com/2013/09/why-you-should-avoid-lectins-in-your-diet/

  • Linda N

    Sometimes it is the amount given that provokes reactions. Environmental medicine physicians know this concept very well. One capsule of say oat flour or oat bran is not going to cause me to blow up and get diarrhea. But a small bowl of oatmeal WILL do so! Wheat is the same. And sometimes it is because these gluten containing grains are considered high FODMAP foods. FODMAP is an acronym, deriving from “Fermentable, Oligo-, Di-, Mono-saccharides And Polyols.” I follow a low fodmap diet to keep my bloating symptoms under control.

    I no longer believe in blind and double blind studies for the most part anymore. They have to take out too many variables by necessity and thus can never tell the full picture of anything. Sometimes they can be useful but they are severely limited. Even for drug testing they are limited as there is always the curve that did not benefit from the drug and the curve that got bad reactions. A statistical average means nothing if one’s individual biochemistry cannot properly metabolize a drug. Same with food

    • Stewart

      Hi Linda, I was going to make a few observations but noted that your point about the problem with blind and double blind studies seemed to be a good take off point.

      I developed psoriatic arthritis about 6 years ago and when my rheumatologist suggested methotrexate I decided to investigate dietary factors to avoid that. Turns out gluten can be a factor in about 15% of cases and since I have a sibling with celiac disease I decided to eliminate gluten instead of doing an elimination diet. 10 days later the arthritis disappeared.

      Case settled right? Well no, I was also vitamin D deficient and had also begun rectifying that with supplements. So maybe there is confusion here. But anytime I inadvertently consumed even the smallest amount of gluten I would wake up with intense arthritic pain in my distal joints.

      Well I kept studying and two years ago came across this site. It did not take long for me to realize that there are a lot of pro inflammatory factors in animal products so I went with WFPBD. Within a relatively short time the remaining swelling in my toes disappeared and I became much less gluten sensitive. That is, I could have my vegan wrap in a whole wheat tortilla with no ill effect. Well at least not for the first one. This week I have had a wrap every day, (they are really good) and this morning the swelling has returned with great intensity.

      So my conclusion is that I am much less gluten sensitive but probably need to limit the gluten. (Maybe I’ll cut those wraps down to 2 a week.)

      Now to your point about double blind studies. Six years ago, I could have participated in one and been part of the proof that gluten was THE problem. Six years latter, the picture is much murkier. Turns out there are a multiplicity of factors and gluten seems to be one. So I’m looking forward to the next two chapters on this.

      • Brian Murphy

        That sounds like what happens to me. I tried wheat pasta and bread once after going vegan without noticing much, maybe a little swelling and pain in my ankles for a day or two, but not much, and I’m used to that happening for unknown reasons. Then a couple weeks later I ate a lot of wheat three days in a row and could barely walk for 3-4 days after I stopped eating wheat. Then a couple days ago I got some vegan green chili sauce on rice and beans at Whole Foods, the swelling and pain came back, along with a really bad mood. It lasted 2 days. I’m guessing the sauce had wheat added to thicken it. Seems like a dose dependent response to me.

        • Stewart

          Yeah, I’ve gotten in trouble trusting things from Whole foods that were done in their deli. A few years ago I saw some gumbo, read the label and had it for lunch. That night while in pain I remembered blindly following the ingredient list. It was perhaps my own fault as I do know that wheat is in gumbo but I was on auto pilot. Another time I was reading ingredients in another of their deli dishes and came across the precise ingredient, “sauce”. At that point I brought out the manager.

          • joeboosauce

            “Sauce”??? Wow, can’t believe that was allowed! LOL. And I have had the similar auto-pilot experience you mention when looking for vegan food.

          • J.

            Been going over so much info on this website and learning a BUNCH! So, what happened with that “sauce” ingredient? did they tell you what the heck it meant or ?… haha

          • Stewart

            Hey J. She was as mystified as I. And she’s promised corrective action. Alas I did not see much conviction in her response so we’ll see. I did tell her how dangerous that was (actually I ranted a bit) so she might have been feeling that.

      • joeboosauce

        Interesting stories from all you guys. Thanks for sharing. Now, Stewart, I have held the theory that some of these sensitivities can be corrected if they did not exist at one point in a person’s life. Since you noticed the corrective potential of a WFPBD, what do you think about trying raw? I recently did raw before 4pm and noticed some great benefits and I’m not suffering from anything specific except occasional bloating. Thoughts?

        • Stewart

          Oh come on joebosauce. Anyone posting here is likely to be opinionated to some degree and I’m no exception.

          The bio availability of phytonutrients might be enhance or destroyed by cooking. And, as is the case with mushrooms,certain toxic aspects can be reduced or eliminated without compromising the useful phytonutrients by cooking. I have heard (though not confirmed) that there is a problem with raw cabbage. But cooking cabbage can destroy myrosinase that is necessary in forming sulfurophane which is really beneficial.

          The bottom line is, I’m not convinced that raw as a rule is a good idea. So, I try to go raw when that seems best and cook when that seems best. It depends on the food. Indeed I suspect your mild gastric distress could easily be countered by cooking some of those veggies. Unfortunately we don’t always know which ones.

          Good luck on finding out. I’ll sure be interested.

  • Jean123

    Just a random thought since I notice digestive issues with gluten free and gluten products with or without eggs or dairy…its not the gluten but something else. There are so many different ingredients how can anyone know for sure…it could be increased fiber causing the bloat as well.

  • Amir

    Have you heard of the theory that it is actually not gluten that supposedly causes certain symptoms but adenosintriphosphate-amylase (ATI) that is enriched in modern grains through century-long cultivation?

  • Panchito

    Panchito

  • Karl Young

    Yikes, that was pretty complicated (though well done). I wonder if this suggests that we should look for environmental triggers of broader automimmune conditions like leaky gut syndrome (I think that’s an autoimmune condition though I’m not a health care professional…) which could lead to wider classes of food intolerance. E.g. I think there’s been speculation that one type of pesticide that works by giving leaky gut syndrome to pests, might have a similar effect on humans.

  • Karl

    Let’s take wheat and treat it like an herb or drug. What if it has upper limits? What if it has contra-indications? It might have both benefits and non-benefits. Of coarse there might be a type of pollutant. Seems to be a lot of variables. But we eat so much of it it’s worth it. I deprived myself of a lot of food with the “eat right for your blood type” diet. Don’t want to do that again.

  • Judy

    Almost ten years ago I read some information that made me decide to start grinding my own wheat and making my own bread for health reasons. At the time gluten was not even an issue. It was about the lack of nutrients and health benefits eating store bought bread/flour vs. the over abundance of nutrients and the benefits of using fresh ground wheat. It wasn’t until recently that I came across an article from a blog I subscribe to that the whole gluten sensitivity and fresh ground wheat “came together” for me.

    http://www.millersgrainhouse.com/milling/gluten-may-not-be-your-problem/#sthash.JNfZ6Yha.dpbs

    From a health perspective, it makes so much sense. Whole foods, not highly processed, is what will give us better health and store bought bread or flour is HIGHLY processed!

  • Anna Kelly

    As a person with high gluten sensitivity but non-celiac, I can say there is a flaw in the study (as presented above). I know I can swing low doses of wheat products where gluten is not added as an additional ingredient. But, when consuming low doses of high gluten, or any added gluten product, my stomach swells like a balloon and gas is a huge issue. It took me years to figure out the issue and I discovered the major difference by removing gluten and being careful that should I desire delicious (note below) bread that it has to be ‘no added gluten bread’ to be remotely tolerated. And small doses.
    Aside from that: good bread is airy, light, and cooked— not this dauby, dense, damp junk called bread today. I miss the good baguettes…

    • Jocelyn

      I bake bread and in my experience, the light airy-ness of bread is usually a direct result of its gluten content – the more gluten in the flour, the softer,more fluffy loaf you will have. I now grind my own organic grains and my bread is dense peasant bread (which I have absolutely grown to love as it is so rich in flavour and texture). Also, if you’ve eaten gluten free bread it is rarely light and fluffy. Just a note.

  • Gurgle

    Ataxia? I though the real dilemma with gluten sensitivity according to its leading researchers was that you might have no gut symptoms but get damage (irreversible) to your brain (also nerve system, and it’s associated with leaky gut), therefore by that theory, a little is never ok.

    I have AI and stay well on a healthy diet etc, but my Dr keeps me gluten free even though I feel fine when I eat wheat bread or other gluten grains. It would make my life much easier, happier and cheaper if I could eat some gluten. Even gluten free, I get IBS (d) which I think is caused by caffeine eg even in cacao and/or hot drinks. Does anyone have any thoughts or suggestions on any of this?

    • Gurgle

      And I should add, my blood rests & genetic tests don’t show celiac.

    • Julie

      Absolutely gluten can silently harm any organ over time, even in those without celiac disease. I would definitely follow your doctor’s advice and stay gluten free, especially since you have AI.

      • Gurgle

        BUT.. the same Dr also gave me other recommendations which go against Dr Gregrs reported general medical science and specific recommendations for my condition. Ironically for my gut health, the part 2 to this series says stopping gluten can harm gut health. I feel fine when I eat gluten. But those Drs filled me with anxiety over the issue, besides expensive testing (none of which showed gluten to be a problem for me).

        Ive read the leading science into ” silent ” gluten sensitivity but I don’t think there’s yet any reliable science behind it? Unless you have unexplained internal issues, why go gluten free on a medical suspicion? Ive also had other wacky medical theories put my way which turned out false

        • VegeMarian

          Gurgle,
          If your blood tests and genetic tests don’t show gluten sensitivity, and you don’t notice symptoms from gluten, it sounds to me like eating some gluten may be fine for you. I have known people who have IBS (d) who see a reaction to cacao and caffeinated beverages so those may be culprits for you. I haven’t seen the research that is the basis for people being so opposed to gluten. I would ask the drs who have filled you with anxiety over gluten to cite the studies showing it’s harmful.

  • Brian Murphy

    After going vegan 3 months ago, it has become clear that I react to wheat gluten. Previously, I could not tell if it was the dairy/eggs or the gluten. Now, I’m sure it’s wheat. However, my reactions are not primarily GI problems. Within a day or so of eating wheat gluten, my ankles and hands swell and are painful, my muscles cramp and ache, and my mood gets really really bad. The symptoms last for 1-4 days depending on how much wheat I ate. Does anyone have any information about these types of symptoms?

    • Julie

      Wheat can give you all kinds of symptoms, and they don’t have to be GI problems. Also gluten can silently damage organs over decades, leading to serious problems later on. “Wheat Belly” is an excellent book about the variety of ways wheat can harm our skin, heart, nervous system, mood, blood sugar, etc.

      • Brian Murphy

        Thanks.

    • Stewart

      I have had a non celiac gluten sensitivity that causes inflammatory arthritis in the extremities. It’s actually one of the constituent proteins in gluten that causes the problem rather than gluten per se. Therefore barley and rye can cause the same symptoms. Eliminating all animal products in my diet greatly reduced the gluten sensitivity so that a little occasionally has no effect now. I’m suspicious of blanket condemnations of foods that have been shown to be so valuable in human nutrition. I keep thinking of peanuts. They are great nutrition unless they cause you anaphylactic shock.

  • lentower

    This list from the “Transcript” should have had an “, MA, and others.” at the end, or an “including PTSD” at the beginning.

    It missed many, including Lyme Disease, Fibromyalgia, CFIDS, and ALS.

    Quote: “The medical profession has a history of dismissing diseases as all in
    people’s heads—PTSD, ulcerative colitis, migraines, ulcers, asthma,
    Parkinson’s and MS.”

  • corrine

    Have any of you found relief from gluten sensitivity by taking gluten peptide digesting enzymes with your meal?

  • Karl Holtzer, M.D.

    As always, I am quitie impressed by Dr. Greger’s efforts. I have some thoughts here as it pertains to gut permeability:

    Fasano and collegues reported that only 57% of those identified as gluten-sensitive carried the DQ2 or DQ8 genes, the genes that are tested when determining gluten metabolism disorders. This finding indicates that those two genes are less involved in gluten sensitivity than they are in celiac disease. On the blood tests, just under half (48%) of those diagnosed as gluten-sensitive had positive antigliadin (AGA-IgA) or AGA-IgG antibodies.

    What is interesting is that more than half of the gluten-sensitive group carried the celiac DISEASE genes, while the rest did not, indicating that the genes aren’t necessary to produce the antibodies.

    A. Fasano, et al, Divergence of gut permability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011 Mar; 9(23).

  • sf_jeff

    Is there any news on studies of “amylopectin-a” and blood-sugar spikes? Some on the internet are saying that this polysaccaride increases blood sugar levels faster than straight sugar and therefore is a reason by itself to avoid wheat.

  • Christine Havmark Wells

    So what about gluten causing inflammation in the body? Do you perhaps have any information on that, since I have been hearing about it here and there.

  • Keivan

    What I found even more intriguing about this video was the reference to PTSD and its physiological basis. Does anyone have any good references on this?