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Update on Gluten

Pros and cons of a gluten-free diet.

August 20, 2010 |
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Acknowledgements

Image thanks to Benediktv.

Transcript

What about gluten? For the vast majority of people, wheat protein, just like quinoa protein or any other grain, has been considered good for us, health-promoting. But only for about 99% of people. The rare 1% or so have celiac disease and they have to stick to a gluten-free diet. But what about people who don’t have celiac, but may be otherwise gluten-sensitive. Last year the possibility was raised that some cases of irritable bowel syndrome, for example, may improve on a gluten-free diet, so if you do suffer from symptoms like chronic diarrhea and abdominal pain your doctor may want you to give a gluten-free diet a try, but if we don’t have those symptoms, gluten is good for us In fact there was a study last year suggesting a gluten-free diet was bad for our good bacteria, so we shouldn’t go gluten-free unless there’s a good medical reason.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by veganmontreal.

To help out on the site please email volunteer@nutritionfacts.org

Dr. Michael Greger

Doctor's Note

Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. And check out the other videos on gluten, and plant protein. Also, there are 1,686 other subjects covered in the rest of my videos--please feel free to explore them as well!

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

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

    Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. And check out the other videos on gluten, and plant protein. Also, there are 1,449 other subjects covered in the rest of my videos–please feel free to explore them as well!

  • http://nutritionfacts.org/members/martin/ Martin

    Can’t get this video, Update on Gluten, to play.

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

      Thanks for taking the time to leave a comment–anyone else having this problem? Do the other videos work for you?

  • http://nutritionfacts.org/members/martin/ Martin

    It works now! Thanks!
    Generally the site works perfectly in Chrome. However sometimes, when using Firefox, the first video in a fresh session plays OK but trying to watch more videos or accessing anything else, results in the page not loading at all.
    Overall ten thumbs up (out of eleven)!

  • http://nutritionfacts.org/members/herehere/ HereHere

    That is a very interesting study on the detrimental effects of a gluten free diet on the good intestinal bacteria. I recently heard an expert (sorry, I can’t remember who), who talked about wheat is not at all like the wheat that was grown 80 or 100 years ago. At my local bulk food store, I managed to find some red fife wheat, which was labeled as an heirloom wheat. I had no idea that wheat would have been selectively bred to make it so different, but I guess that is what our government (at least in Canada) supports through the experimental farm and other agricultural research programs.

  • http://nutritionfacts.org/members/jarethcutestory/ JarethCutestory

    I’ve been diagnosed with a gluten intolerance. I’ve done some looking into it and it seems that just eliminating gluten from a diet does not heal the villi in your intestines. Is there something that can be done without costly “supplements”?

    • Anni

      I’m not an expert, but seriously kombucha helps a lot….

  • http://nutritionfacts.org/members/megann19/ Megann19

    The gold standard for diagnosing celiac disease is a biopsy of the small intestine. Clinical improvement after a period of time on a gluten-free diet is actually part of the diagnosis. I would make sure that you truly have celiac disease before going gluten-free; the first step is to find a gastroenterologist you trust. If celiac disease is established, a lifelong, gluten-free nutrition prescription (strictly avoiding the prolamins of wheat, barley and rye) is indicated. Strict (and the key word here is strict) adherence to the diet is what allows the intestinal villi to heal, thereby resolving the symptoms of malabsorption and preventing complications that can be associated with long-term untreated celiac. As for supplements, I am not familiar with any supplements that are effective in treating this disease (which doesn’t mean they don’t exist). What I am aware of however, is that people who adhere to a gluten-free lifestyle are often not getting enough dietary fiber, and need to pay special attention to B vitamins thiamin, riboflavin, niacin, and folate, and trace minerals such as iron. Supplements are often indicated and do not have to be expensive. The treatment for celiac disease is usually a major lifestyle adjustment, and working closely with a GI specialist and a registered dietitian is crucial!

  • A Big Fan

    What is your opinion of the book Wheat Belly by Dr. William Davis MD, which says that wheat gluten in modern wheat in particular is bad for almost everyone?

    • Toxins

      Wheat belly does not hold much scientific backing, and the recommendations in the book are philosophical at best. Only those with a gluten allergy or sensitivity should avoid wheat otherwise there is no reason to.

    • Joe

      Its worth pointing out that the majority of wheat consumed is heavily refined. I’m sure in this state it can do some damage, just as HFCS and white sugar does.

      I’d love to see a study looking at comparing refined wheat with the whole grain.

      Worth mentioning that there is a lot more gluten in modern wheat, so it’s not a naturally balanced food. You could argue that because of this, it has already undergone some ‘processing’ even when just picked.

  • Debby

    I have also read that those with hypothyroidism should avoid gluten.  Any comments on that?

    • AlexanderBerenyi

       http://chriskresser.com/the-gluten-thyroid-connection

      • http://jolkapolkaskitchen.blogspot.com/ WholeFoodChomper

        This really does not seem like a credible source to cite. I’ll stick to evidence-based sources to form my opinions and decisions. I suggest you do the same.

  • AlexanderBerenyi

    http://www.tenderfoodie.com/blog/2011/12/19/interview-w-dr-alessio-fasano-part-1-should-anyone-eat-glute.html

    “No one can properly digest gluten.  We do not have the enzymes to break it down. Gliadin, one of the proteins found in gluten, cross talks with our cells, causes
    confusion, and as a result, causes the small intestine to leak. How your body reacts depends upon how long the gates stay open, the number
    of ‘enemies’ let through and the number of soldiers that our immune
    system sends to defend our bodies.”

    This does not sound good for me…

    • Toxins

      Where is the science behind this statement? Scientific papers trump biased articles every time.

      • http://jolkapolkaskitchen.blogspot.com/ WholeFoodChomper

        Science, it’s funny and reliable like that. :) Gotta love evidence-based information!

    • Joe

      I think its worth considering problems of gluten. Personally I don’t see any problem with whole grain heirloom varieties, but modern wheat has a much higher level of gluten, so theoretically is not balanced the way nature intended. Whatever keeps gluten in check may have been bred down or even out.

      It’s difficult because the vast majority of people consume refined wheat, which makes study almost impossible. Its a bit like fruit juice versus fruit. Perhaps Celiacs disease is only caused by refined, hybridized wheat? Perhaps people who say they do better on Paleo damaged their villi with refined wheat some years before?

      Anyway, I don’t have confidence in most of the Paleo bloggers because they don’t make these distinctions – whereas the difference between grass-fed saturated fat and cafo saturated fat is night and day!

  • WholeFoodChomper

    Lately, I have also been hearing (from friends) and reading (in the popular press online) (and more here) that those with hypothyroidism (specifically Hashimoto’s Thyroiditis) might be sensitive to gluten and should therefore avoid it. Are you aware of what the scientific evidence says about this topic? Your advice, suggestions?

    • http://www.DonForresterMD.com/ Don Forrester MD

      There is a paper which shows the requirement for replacement thyroid in patients with celiac disease is higher than a control group. If the patients with celiac disease ate a gluten free diet or increased their replacement dose it corrected the problem. I know of no direct connection between the diseases. However, it might be that celiac disease increases the body’s exposure to foreign substances increasing the incidence of autoimmune disorders in general. Note this paper applied to just Celiac Disease(prevalence in population about 1 in 133) and not “gluten sensitivity”. See videos… http://nutritionfacts.org/video/is-gluten-bad-for-you/. Gluten is in the news due to the improved testing available but it is still a relatively uncommon disorder.

      • http://www.facebook.com/debrah.mccabe Debrah McCabe

        Suggesting that your patients just up their medication (which you did in a comment to me earlier) rather than getting rid of the offending food stuff is ridiculous. I can only wonder how you treat your obese patients or those with diabetes. Do you suggest they get bigger pants rather than cutting back, or hand out prescriptions for more insulin? I am very glad that my doctor is more concerned about building up my health through proper eating rather than just handing me a new prescription or an additional prescription.

        I take Synthroid and have been on the same dose for decades. And one of the problems I was dealing with was skin so dry on my heels that it was cracking and painful and no amount of lotions or ‘sanding’ ever helped. But I cut the gluten out of my diet and a month later, my doctor was able to give me a lower dose of Synthroid and the skin on my feet is finally almost normal again. My feet don’t burn and hurt now and that’s a first on that score, in years. Eliminating gluten was the only change and the benefits are obvious.

        • http://www.DonForresterMD.com/ Don Forrester MD

          I totally agree with your comment and your approach to your health. However you read something into my post that wasn’t my intent. My comment reflected the study which tested both ways to improve thyroid. As a physician I always recommend eating better. I would always recommend avoiding the gluten in lieu of adjusting dose in patients. However in the real world I have patients who don’t follow my dietary recommendations in which case I would be stuck to just adjusting their medications. That doesn’t mean I wouldn’t keep trying to get them to improve their diet. In fact given my current practice as staff physician at the McDougall clinic and Medical Director for Meals for Health I take patients over 80% of medications and only occasionally write new prescriptions. I’m glad you have a physician who is knowledgeable about diet. Sorry for the confusion but hope this clarifies my post. Congrats on improving your diet and improving your health.

          • http://www.facebook.com/debrah.mccabe Debrah McCabe

            My apologies if I came off a little harsh. I have spent the last number of years fine tuning my diet and also my Synthroid needs and in the process have learned a great deal about the apparent lack of real nutritional education that most doctors seem to get when in med school. And in the twenty plus years that I’ve been on this medication, not once has any doctor that I’ve seen, ever inquired as to diet and dietary issues that I should be aware of in connection with this kind of medication. The only reason that I’m even fully aware of the effect of some plant foods goitregens is because I came across that first article online, and then researched it myself.

            While I am sure that the majority of patients ignore dietary recommendations, I can’t help but be aware of the great gaps in the knowledge of doctors, regarding diet. I even watched a discussion (online) between a registered dietician and someone who claimed to be a doctor, and the doctor made the astounding assertion, that diet has far less to do with health than the dietician was claiming.

            I’m very glad that you weren’t actually recommending just upping the meds in lieu of adjusting the diet, as being the ‘best’ answer to a medical issue. So my apologies and I do hope that you will have a great holiday season and new year. Merry Christmas Don.

          • http://www.DonForresterMD.com/ Don Forrester MD

            Not at all… apology not necessary. It is always nice to hear from folks who are passionate and ready to challenge their physicians. I believe that one way to improve the medical profession is to have patients lead by example. It is of course important to be taught nutrition in medical school and residency. For the most part it more important to have systems in place where health care providers are able to keep up with the best and newest science. For me even if I got alot of nutrition education in med school and I did get a little we have learned alot since the early 1970′s. Keep up the good work. Happy Holidays.

          • http://jolkapolkaskitchen.blogspot.com/ WholeFoodChomper

            Debrah McCabe, I can totally relate to your frustration regarding your health condition. It took years before I was diagnosed with a thyroid condition, and ever since I have
            been, it seems everything I have learned has been through my own research and question asking, especially when it comes to the role of diet. Like you, not a single doc to date has ever brought up the issue of diet as it relates to hypothyroidism (not even the endocrinologist). Med regulation seems to be the only way that docs I’ve seen have addressed my Hashi’s. That could be b/c hormone replacement therapy is the best way to regulate the condition. And, that is fine, but I do think that it is odd and even irresponsible to not bring up diet as an important factor. The nature of this situation is very frustrating for me, so I turn to sites such as this to educate myself so that I can make the best health decisions possible, and to obtain information that my doctor does not have the time to share with me.

        • http://jolkapolkaskitchen.blogspot.com/ WholeFoodChomper

          @facebook-1621869949:disqus it seems to me that you have misinterpreted @DrDons:disqus response to my comment. He was just summarizing the findings of the paper he referenced on the topic of CD and thyroid replacement therapy (which addressed both a gluten free diet and increased thyroid replacement therapy), he was not making any specific therapeutic recommendations.

      • http://jolkapolkaskitchen.blogspot.com/ WholeFoodChomper

        @Don Forrester MD: Thank you, for your reply. I have already seen all of Dr. Greger’s videos on the topic of gluten. Actually, based on what I have learned on NF, I asked my doctor to be tested for celiac disease (CD) about a year ago, as it turns out I am negative for it, which makes me very happy. Yet, I still have the Hashi’s, which does not make me very happy.

        I empathize with those who have CD; however, I am also wary of all the anti-wheat hype one hears and reads about today. Given all the “talk” I’ve been hearing regarding thyroid health and gluten, I was just wondering if there were any studies out there related to hypothyroidism, specifically related to those who are negative for CD but have thyroid issues. I suspect more will come out on this topic as the science develops. And, I look forward to future updates on the topic.

        Again, thank you for your input as always.

      • http://jolkapolkaskitchen.blogspot.com/ WholeFoodChomper

        Don Forrester MD : Thank you, for your reply. I have already seen all of Dr. Greger’s videos on the topic of gluten. Actually, based on what I have learned on NF, I asked my doctor to be tested for celiac disease (CD) about a year ago, as it turns out I am negative for it, which makes me very happy. Yet, I still have the Hashi’s, which does not make me very happy.

        I empathize with those who have CD; however, I am also wary of all the anti-wheat hype one hears and reads about today. Given all the “talk” I’ve been hearing regarding thyroid health and gluten, I was just wondering if there were any studies out there related to hypothyroidism, specifically related to those who are negative for CD but have thyroid issues. I suspect more will come out on this topic as the science develops. And, I look forward to future updates on the topic.

        Again, thank you for your input as always. BTW: Could you please share the source of the article you cite?

        • http://www.DonForresterMD.com/ Don Forrester MD

          Virili et al, Atypical CD as cause for increased Lthyroxine, J Clin Endocrinol Metab 2012, Mar:97(3). If you go to Pub Med and type in celiac disease and hypothyroidism you will see some other pertinent articles. I had a bicycle accident 2+ years ago, needed a right total hip… I’m not happy about it but as with hypothyroidism based on what we know now we both might have done things differently in the past. Good luck.

          • http://jolkapolkaskitchen.blogspot.com/ WholeFoodChomper

            Thank you @DrDons:disqus , I’ll check that out and the other listed articles on PubMed, as well.

            Sorry to hear about your accident and your hip. I hope you have recovered and healed up. So true about doing things differently now. I’m trying my best. ;-)

  • Jen E

    Can gluten be the cause of someone being really tired after eating & headaches from sores popping up on the scalp. This usually happens to me about after a hour or more after I eat. Sometimes when I don’t eat gluten I get the symptoms too.

  • angeltherapy52

    I have IBS, I have become a vegan completely the last 7 days, prior I was a vegetarian until I watched the video uprooting the leading cause of death. I don’t have the constipation affect (rarely) of IBS just the opposite. However, after going completely vegan I find myself in the bathroom 4 to 5 times a day. Will this level out eventually?

    • http://www.facebook.com/debrah.mccabe Debrah McCabe

      I would think it will, however, this is not a bad thing but only something that you’re not used to. It’s probably because you’ve upped the amount of veggies that you’re eating to compensate for not filling up on wheat stuff.

    • http://www.DonForresterMD.com/ Don Forrester MD

      The adjustment of the bowels to a plant based diet can take a while but typically most problems reflux, constipation and diarrhea get better relatively quickly. There are plants that cause problems and natural substances such as fructose that if consumed in large enough quantities can cause difficulties even in “normal” folks. I would recommend you read two newsletter articles by John McDougall MD available for free on his website… http://www.drmcdougall.com. The first is November 2002, Chained to the Bathroom and the second is December 2002, Diet for the Desperate. They contain some practical suggestions for helping with diarrhea. I would also recommend avoiding GMO foods especially corn… see website Institute for Responsible Technology for a link to information about avoiding GMO foods. Good luck on your journey and congratulations on taking a big step in improving your health.

    • JenJen R

      Did you try avoiding gluten completely? I have a good friend who was told she had IBS (and later endometriosis too), but has been able to eliminate all of her symptoms by avoiding gluten 100% (along with eggs, most dairy, onions, garlic, and reducing tomatoes and hot peppers). Turns out she had celiac along with multiple food sensitivities, but had to find that out on her own.

      • angeltherapy52

        thank you, I was never diagnosed with celiac or did I have sensitivity that I knew of, but I eliminated wheat (I’m a vegan) and interestingly having less symptoms. I do have food sensitivities to citrus fruits but eat outside of those and sensitive to tomatoes, but I have found eliminating wheat seems to do the trick :)

  • eleorest

    Gluten light seems to work for many people who are a bit sensitive to the glutinous foods…this is not a black a white, gluten or gluten free issue. My science has been my gut, which feels happiest when taking it easy on gluten.

  • HereHere

    I’ve heard a few people go on about eliminating wheat. Given that meat causes C-reactive protein levels to increase, I wonder if there are any measures to test for possible inflammatory effects from wheat or gluten. This could be helpful in managing heart disease, arthritis, and other inflammatory conditions.

  • Meg

    For vegetarians, are green beans considered to be in the same category (as healthy) as red and white? They aren’t often mentioned. Thank you!
    Also, the kiwi for IBS video did not work.

  • Susan

    Dr. Greger, Your recent series on the inflammatory nature of meat has made me wonder: might gluten-sensitivity and/or celiac disease be caused by chronic inflammation due to animal protein consumption and, if so, might gluten sensitivity/celiac disease be reversed with a change to a plant-based diet? Also, how reliable are skin and blood tests for gluten issues? Thank you!

  • Karen Brokken

    Have you any medical advice about treating depression and other mood disorders with a gluten free, sweetener free diet? It seems I’ve tried everything else with little or no success, I might as well try this. My naturopath says that up to a third of people with gluten sensitivities don’t have gastronomical distress, but have many of the mood disorder symptoms I went to see her about hoping she’d find a cure where SSRIs and Talk Therapy and other mainstream treatments have failed. I’ve met other people like me who had treatment resistant depression, who were anxious, had trouble concentrating, trouble with time management, and were easily irritated by loud noises and chemical smells among other things who felt better when they made changes to their diet including giving up gluten. I remember what it was like before the depression and I’d like to be able to function like that again. So I’m trying a gluten free diet.

  • ChristineE

    Dr. Greger, thank you for all you do. I have not jumped on the gluten-free band wagon, but I’m now wondering if I should reconsider. I am hypothyroid and was tested for Celiac disease which was negative. I have read some theories that gluten may contribute to hypothyroid and have read some anecdotal accounts of people being able to go off of their thyroid meds after going GF. It’s the only med I take, but I’d love to be rid of it. I would appreciate any information you or others may have regarding a gluten-hypothyroid connection. Thanks!

  • katherine

    Is there any evidence that a gluten free diet helps asthma?

  • Jules

    Recently our local PBS station taped a show promoting Dr David Perlmutter’s best selling book called “Grain Brain”. He claims that in the scientific literature,( he reviewed 275 papers ) grains contribute to the rise in Alzheimers disease. He even states that eating eggs and grass fed beef is healthy. Since I am plant -based and want to eat the healthiest diet, I would like your take on yet another MD promoting anti-grain eating.

    • Toxins

      I know of not a single study showing that whole grains are harmful to health, not one. I think people may try and lump whole grains and refined grains together, which would indeed show negative health outcomes. All the studies I have seen on whole grains show that it is protective in preventing chronic disease. Check out this review gathering the evidence.
      http://www.healthgrain.org/webfm_send/251

    • Brian

      Very few MDs know anything about nutrition. It’s not their fault. Med school doesn’t spend much time on this subject. 1 credit hour at most. Dr. Greger is one of the few I would trust.

  • Valerie

    What about gluten and acne?

  • Anelle

    I have been reading the book “The Gluten Free Edge” and a gluten free diet seems to help sooooo many professional athletes perform at the top of their game. It is a very interesting read that claims that Gluten is toxic to our bodies whether or not we are allergic to Gluten. It states that Gluten causes inflammation throughout our body and in our intestins interfering with the absorption of healthy carbs and other nutrients. I think it even has some studies cited on this information.

  • Sharon Montes

    Can you help me make sense of Esseltyn/Barnard et al research that plant-based low-fat is healthy vs research supporting Perlmutter’s advocacy of high-fat low carb no gluten nutrition recommendations?

  • DanielFaster

    Is it the gluten or the glyphosate they spray on wheat to dry it down before they harvest? http://www.mdpi.com/1099-4300/15/4/1416

  • DanielFaster
    • DanielFaster

      just like Monsanto to arrange to blame the victims