Preventing Crohn’s Disease With Diet

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Food Additives That May Make our Gut Leaky

Crohn’s disease is an autoimmune disorder that affects more than a million Americans. It is an inflammatory bowel disease in which the body attacks the intestines. There is currently no known cure for Crohn’s disease; current research focuses on controlling symptoms. There is no definitive medical or surgical therapy. The best we have is a plant-based diet, which has afforded the best relapse prevention to date.

Researchers got the idea to try a plant-based diet because diets rich in animal protein and animal fat have been found to cause a decrease in beneficial bacteria in the intestine. So, researchers designed a semi-vegetarian diet to counter that, and 100 percent of subjects stayed in remission the first year and 92 percent the second year. These results are far better than those obtained by current drugs, including new “biological agents” that can cost $40,000 a year, and can cause progressive multifocal leukoencephalopathy, a disabling and deadly brain disease. And a healthier diet appears to work better.

But what about preventing Crohn’s disease in the first place? A systematic review of the scientific literature on dietary intake and the risk of developing inflammatory bowel disease found that a high intake of fats and meat was associated with an increased risk of Crohn’s disease as well as ulcerative colitis, whereas high fiber and fruit intakes were associated with decreased risk of Crohn’s.

These results were supported more recently by the Harvard Nurse’s Health Study. Data revealed that long-term intake of dietary fiber, particularly from fruit, was associated with lower risk of Crohn’s disease. Women who fell into the highest long-term fiber consumption group had a 40 percent reduced risk, leading the accompanying editorial to conclude, “advocating for a high-fiber diet may ultimately reduce the incidence of Crohn’s disease.” 

The irony is that the highest fiber group wasn’t even eating the official recommended daily minimum of fiber intake. Apparently, even just being less fiber deficient has a wide range of benefits, including a significant reduction in the risk of developing Crohn’s disease, but why? The authors suggest it’s because “fiber plays a vital role in the maintenance of our intestinal barrier function.”

Our skin keeps the outside world outside, and so does the lining of our gut, but in Crohn’s disease, this barrier function is impaired. You can see this under an electron microscope as shown in my video Preventing Crohn’s Disease With Diet. The tight junctions between the intestinal cells have all sorts of little holes and breaks. The thought is that the increased prevalence of inflammatory bowel diseases may be due to dietary changes which lead to the breakdown of our intestinal barrier, potentially allowing the penetration of bacteria into our gut wall, which our body then attacks, triggering the inflammation.

We know fiber acts as a prebiotic in our colon (large intestine), feeding our good bacteria, but what does fiber do in our small intestine where Crohn’s often starts? We didn’t know, until a landmark study was published. Researchers wanted to find out what could stop Crohn’s associated invasive bacteria from tunneling into the gut wall. They found the invasion is inhibited by the presence of certain soluble plant fibers, such as from plantains and broccoli at the kinds of concentrations one might expect after eating them. They wondered if that may explain why plantain-loving populations have lower levels of inflammatory bowel disease. But, the researchers also found that there was something in processed foods that facilitated the invasion of the bacteria. Polysorbate 80 was one of them, found predominantly in ice cream, but also found in Crisco, Cool Whip, condiments, cottage cheese—you just have to read the labels.

What about maltodextrin, which is found in artificial sweeteners like Splenda, snack foods, salad dressings, and fiber supplements? Maltodextrin markedly enhanced the ability of the bacteria to glob onto our intestinal cells, though other additives, carboxy-methyl cellulose and xanthan gum appeared to have no adverse effects.

This may all help solve the mystery of the increasing prevalence of Crohn’s disease in developed nations, where we’re eating less fiber-containing whole plant foods and more processed foods. What we need now are interventional studies to see if boosting fiber intake and avoiding these food additives can be effective in preventing and treating Crohn’s disease. But until then, what do we tell people? The available evidence points to a diet low in animal fat, with lots of soluble fiber containing plant foods, and avoiding processed fatty foods that contain these emulsifiers. We also want to make sure we’re not ingesting traces of dishwashing detergent, which could have the same effect; so, make sure to rinse your dishes well. Researchers found that some people wash dishes and then just leave them to dry without rinsing, which is probably not a good idea. We don’t currently have studies that show that avoiding polysorbate 80 and rinsing dishes well actually helps. Nevertheless, advice based on ‘best available evidence’ is better than no advice at all.

Here’s a video about using a more plant-based diet to reduce the risk of relapses: Dietary Treatment of Crohn’s Disease.

I get a lot of questions about additives like polysorbate 80. I’m glad I was finally able to do a blog about it. Here are some videos on some others:

If you, like me, used to think all fiber was good for was helping with bowel regularity you’ll be amazed! See for example, Dr. Burkitt’s F-Word Diet.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations—2013: Uprooting the Leading Causes of DeathMore Than an Apple a Day2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


92 responses to “Food Additives That May Make our Gut Leaky

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      1. I don’t know. I’m 60 and have always done this. My mother always did it. Lots of people I know do this, although I also know some who rinse before drying.

          1. I always thought it was so ridiculous when I’d see people wash dishes in movies and not rinse them. I thought, whoever directed this film has never washed dishes in their life!
            Sometimes I can still taste the dish soap on glasses even after they have been rinsed. Admittedly, I have a bloodhound’s nose, but I honestly didn’t believe there was anyone who didn’t rinse off the detergent. :)

      2. I do the same thing but if you thoroughly rinse the dishes, my theory is/was that there should no significant residue. Also , unless you launder the kitchen towel after very single use, there is a risk that you are simply transferring pathogens between all your dishes. The idea of one tea towel per dish or piece of cutlery, I find simply impractical. Thoroughly rinsing but not wiping may be the most hygienic option. It ay be best to use a dishwasher for this although I always handwash the dishes. Perhaps I will have to start using the dishwasher after this video – I have lived in my apartment for three years and never used the dishwasher once.

        “The study from the University of Arizona has found enteric bacteria in 89 per cent and E. coli in 25.6 per cent of kitchen tea-towels.

        ‘The common occurrence of enteric bacteria in kitchen sponges and dishcloths suggests that they can play a role in the cross-contamination of foods, fomites and hands by foodborne pathogens.”
        http://www.dailymail.co.uk/sciencetech/article-2800897/are-spreading-germs-time-wash-dishes-researchers-90-tea-towels-kitchens-covered-bacteria.html

        Yes, I had to Google “fomites” too.

          1. Please note a lot of health unit inspectors will request that you leave a film of detergent on dishes or milking equipment , same inspectors dairies as well as restaurants at least here in Canada .

        1. We have dishwasher and barely ever need to wash anything by hand, but what you mention there about sponges and dishcloths, it is well know from long ago, the sponge is dirtier (more germs) than the WC.

          Always use kitchen paper, for any cleaning and drying in the kitchen, otherwise you are just spreading lots of germs around.

          1. Yeah, I usually just use water, abrasive pads and elbow grease. If things need a heavy clean then I use detergent.
            However, I think I need to start using the dishwasher from now on.

    1. The exponential rise in the % of the community with diagnosed illnesses is correlated to the rise in man made products that we eat and use. Its also correlated to many other things but correlation doesn’t prove causation. Given that causation is hard to find we are better off to avoid the frequency of exposure to the riskiest products. I’m not sure where ‘soap’ sits on the risk scale but most of the time I’m happy with a warm water wash. The hard part is cleaning greasy plates etc – for this task I find that if I cook in coconut oil and use soak the fatty frypan (for example) overnight with hot water and 2 teaspoons of baking soda most of the baked on fat comes off easily in the morning with a soft scourer. I also use stainless cookware so I am not adverse to scouring them if I have to remove some really stubborn stains.

      I think the discussion on bugs is a bit overboard though – we’ve been coexisting with the majority for 1000’s of years – the protective systems of a healthy person should be able to cope with fungus and bugs on our food and in the environment. Its only the extreme minority that we have to fear.

  1. After a round of accutane 10 years ago I am left with autoimmunity. When I eat grains and legumes I get terrible joint pain and fatigue which correlates with high ANA on my blood work. Have also shown antibodies for thyroid and rheumatoid arthritis. The only thing that works for me (and many others) is following the paleo autoimmune protocol (AIP). Essentially paleo diet with further restrictions (no grains, legumes, nightshades, dairy, eggs, nuts, seeds). Why is it that AIP can work for some yet there is research saying plant based is beneficial? I would rather eat WFPB but am stuck eating meat and veggies to be able to function. Does anyone have relevent info on this?

    1. Lee Campbell: I don’t know if if this will help, but I have some perspective on the situation. Sometimes a diet that his helpful for a person with a special condition is not the same diet that is helpful for the general population. For a very simple example, consider peanuts. Some people are deathly allergic to peanuts. They absolutely should not eat peanuts as peanuts are not healthy for them. But for the general population, peanuts are very healthy.

      A more complciated example is epileptic children. Such people have been shown to be helped by a ketogenic diet. But a ketogenic diet (one very high in fat) has generally been shown to be unhealthy to the general population.

      Maybe something like that is what is going on with you? What do you think?

      Note: I can’t say anything about what is healthy or a good idea for your particular situation. I don’t know enough about it or you. And I’m not an expert. I’m just hoping to provide some perspective/explanation which may be helpful to you. It may be that there are alternative diets to the one you are following which may help you. Dr. Klaper, a well respected plant based doctor does phone consultations. If you wanted to see what other options you have, you might try that.

    2. Lee have you ever tried going completely WFPB?

      I just can’t imagine taking out grains and legumes. So basically I would take out grains and legumes and add chicken, red meat, pork and fish? (Wild of course)

      Just curious. I swear by WFPB.

      1. Yes i have tried 2 or 3 times both were 100% WFPB. At the end of 4-6 weeks I could barely walk due to pain. Feet usually is a dull pain and hips are sharp pain like there is glass shards in there. Plus fatique and brain fog. My doctor told me if I keep screwing around eating grains/legumes I will end up with lupus or similar autoimmune disease. Its just that I have to eat so much meat I get grossed out sometimes and try WFPB thinking it will work for me but that’s never the case. The book titled Paleo Approach describes the research very well but just looking for info from a plant based perspective. Besides diet and lifestyle the best i have felt is during weekly glutathione IVs. I am also taking low dose naltrexone for about 1 month but it so far has only given me headaches, poor sleep and no appetite.

          1. Hi there! I am a volunteer for Dr. Greger– great question!

            Eating paleo can mean a lot of things to different people. In the context of this article, Dr. Greger is talking about food additives how they can worsen leaky gut. The issue with these additives is that they are found in processed foods. So regardless of the diet you are eating, you want to always limit processed foods (even if labelled a ‘health food’) to keep your gut lining in good working order!

        1. I don’t know if I understand this correctly but it looks like you need to have a name for a diet and only then you can apply it plus you use it without any modyfications.
          So WFPB diet means for you eating grains and legumes without any reflection because basically the diet says so.
          Seriously, consider modifications.
          I also have RA (or some strange form of it – I have inflammation but no markers of it) and I am allergic to grains and legumes (plus tomatoes, paprika, garlic). Looks like too much vitamin C is also harmful for me and I don’t know why. The only thing I found is this paper:
          https://www.sciencedaily.com/releases/2004/06/040604030442.htm
          Crazy and strange, right? So now I can’t even eat fruits high in vitamin C (I am allergic to lemons and oranges anyway but I used to eat a lot of cherries and blueberries and now I can’t)

          Also a meal that has sugar in it (any candies too) or is too energetic can cause a flareup. The worst problem is that I am in this state of flareup for ca. 4 months now. So I am looking for new solutions because doctors are reluctant to prescribe drugs when I don’t have markers of inflammation. And I am left with more natural solutions. Eliminating grains and legumes and other things worked great for me… if I knew that it had to be done I would be much much better right now. But what can you do…

          In the video before this post I complained that there is no information about inflammatory diseases, RA specifically.
          So here it is and it’s a great piece of info. Not because of “rinsing the dishes or not” dilemma but because it says that invasion of harmful bacteria is inhibited by the presence of certain soluble plant fibers. And because it explains the connection of small intestine to inflammatory diseases. This problem has always been bothering me although I couldn’t quite well grasp it because I wasn’t entirely sure that it happens this way. Let me put it here: if leaky gut happens in small intestine then why eating probiotic (or prebiotic – ie. full of fiber) food helps inflammatory diseases when the bacteria thrive on this food in large intestine. One explanation was that they produce a lot of butyrate which is antiinflammatory. Another was that some of LPS A from some bacteria in the gut is antiinflammatory (while other research says that LPS is a potent proinflammatory agent) – there is something I don’t understand here and I probably won’t be able to get to the bottom of this myself. Yet another explenation is that described above (fiber inhibits invasion).

          To continue to answer to Lee – in any case, there are lots of benefits of WFPD diet when it is modified so as not to contain allergens:
          – changing your bacterial flora to that of plant eater (ie. changing bacteria species to more beneficial) while it is proven that some species thriving on meat in our gut (and bladder for that matter) may cause inflammatory diseases because you may be allergic to them (to simplify)
          – you do not get a load of endotoxins with meat (previous video talks about it) and you may be allergic to these endotoxins – and this is the rationale behind not using Paleo diet.
          – you get a lot of antiinflammatory substances
          – your weight will normalize (ie. lower) thus your overall level of inflammation will lower

          – without meat you will not ingest neu5gc which is proinflammatory

          One more thing: seems like fasting is a good way to reset your autoimmune system and after a fast you have to use WFPB diet and that’s it. A fast worked moderately well for me… I will need to try it again when my overall life situation gets better as now I am in some serious trouble. RA doesn’t help with it at all…

    3. Hi Lee- great question! I am a volunteer for Dr. Greger and am happy to help. Eating a WFPB diet overall is an anti-inflammatory diet, which should help many autoimmune conditions. However, most often when people develop an autoimmune condition and find several foods aggravate their condition that they once were able to eat, this leads me to believe that the leaky gut needs to be addressed first. It is always advisable to seek out a qualified health care practitioner to repair the gut first before attempting to re-introduce certain foods. Also, the core concept of WFPB eating is a focus on highly nutritious vegetables as a staple. These foods are overall very well tolerated for many people– so as long as you focus on that category, you too will gain the associated health benefits!

    4. I am not sure why you think that you need to eat meat and avoid nightshade vegetables, nuts and seeds (speculative paleo theories aside).

      It would seem that, if your problem is simply grains and legumes (?), then you could eat a diet based around eg potatoes, sweet potatoes, mushrooms, quinoa, nuts and seeds etc as well as a wide array of vegetables . Some people even use grated cauliflower as an alternative to grains. The AIP may just be throwing the baby out with the bathwater in your case.

      1. Potatoes are part of the nightshade family, so tomatoes. My mother has AR too, but so far (no matter I told her) she never tried an elimination diet, nightshades can affect a % of people with AR.

        1. I do not recall any actual studies linking nightshade vegetables with AR although the claims that they do are all over the internet. Unfortunately, the internet is full of people making false claims about health and nutrition and such myths can become ingrained in people’s minds …. “everybody knows that ….”.

          This of course is another reason to be very wary of crank nostrums like the paleo AIP which are based on a mix of real evidence and blinkered ideology.

          According to arthritis.org, a study on potatoes showed that they actually reduced inflammation not exacerbated it.
          http://www.arthritis.org/living-with-arthritis/arthritis-diet/anti-inflammatory/food-myths-arthritis.php
          http://www.besthealthmag.ca/best-eats/nutrition/4-myths-about-nightshade-vegetables/

    5. Hi Lee, I had a similar experience when I made a minor change towards a more grain/legume based diet recently. Prior to that my diet was quite ‘healthy’ and far removed from the standard western diet. I also have decades of experience with ‘health food’ diets including Veganism, Vegetarianism and Macrobiotics. If I had any health issues induced by those diets I wasn’t aware of them at the time (although that is not to say they did not exist). I was stunned by the sudden reversal in my health, plus the extreme nature of the symptoms, and I had enough experience to immediately swallow my ideals and hit the pause button. Like you I was forced (temporarily for now) onto the AIP diet. For various reasons I would prefer to be vegetarian. I have some other commitments to attend to so I can’t go into detail but to share with you the core of what I have found out so far:

      – Dr Laura’s recommendations are the most relevant you have received in this forum;
      – get some help from a health professional and shop around until you find the right person (don’t try to go it alone);
      – I am fortunate to be a well developed intuitive and so the initial course of action for me to take was clear … I did some research on ‘Leaky Gut’ and found a local GP with access to the Lactulose Mannitol challenge test and also experience with the LG treatment protocols and immediately went to see them… I tested mildly positive;
      – my Doctor recommended an 8 week dietary intervention (no gluten, no processed sugar and no dairy plus supplementation with Intestamine). I figured he had set the bar pretty low but he insisted that he had treated others and the above protocol works ;
      – when I pressed him on the issue he suggested the AIP as the go to diet for LG and Dr Garland for reference material;
      – I have completed the 8 week program and in 2 weeks return to my Dr for a retest;
      – at this time LG is still not widely accepted as a disease by the wider medical community and amongst the small number who are familiar with it there is no universally agreed cure;
      – based on my own reading and thinking I can only say, “how deep does the rabbit hole go?” ….for those who have LG we shouldn’t necessarily blame the grain, although Wheat/gluten/Zonulin is a prime suspect;
      – in cases of severe LG it is likely that food sensitivities will abound so it isn’t a certainty that, say, gluten sensitivity, came before Leaky Gut.
      – my instincts, and research, are telling me there is more involved than the obvious and of course we always have to allow for individual variance;
      – some of the suspects on my short list are not straight out of the manuals … one of them is food additives so credit to Dr Greger for being the first to publically raise this issue.
      – absolute confirmation of LG can only be obtained via Gastroscopic inspection of intestinal villi.

      FYI
      I’m 64 yrs old and a medical lay-person.
      I might have some free time next week to report back here with 1 or 2 links to resources that I like.
      I’m reluctant to post all of my thoughts on this subject because I am concerned some people might not use the info wisely (as I said please get professional advice because IMO arthritis/Leaky Gut are systemic issues and should be taken seriously as they are putting pressure on other bodily functions).

    6. In addition to my previous post please also be aware that Leaky Gut is a multi-dimensional disorder ….. it can trigger food sensitivities/auto immune issues, inhibit nutrient absorption and over-work the liver so it is best to incorporate wider testing.

    7. Lee, I’d suggest following Tom Goff’s reasoning. The AIP approach seems like a skotgun diet, restricting whatever some people react to, e.g. nightshade family members. (If the reactant in that case is nicotine,eggplant passes.)
      After looking at videos/blogs here on leaky gut and auto-immune responses, you may find alternatives to AIP that follow the science.

        1. Out of curiosity that there was but one post on leaky gut, I clicked it and saw four videos; therefore, I didn’t bother looking for permeability or auto-immune response.

          1. Which four videos are you referring to?
            ‘The Leaky Gut Theory of Why Animal Products Cause Inflammation’ is part 1 of a three part series. I watched all three but they have little to do with Leaky Gut per se.

      1. The AIP is the Paleo version of an elimination diet. Like all elimination diets it relies on avoiding all of the main allergens (dairy, corn, eggs, soy, gluten et.c) so of necessity they all take a shotgun approach. If we wanted to take a logical approach to elimination diets we would compile a list based on the % of people in the community who react adversely to any particular food with the most reactive food at the top of the list… I don’t know to what extent this has been done or whether the current elimination diets are just somebodies opinion. I guess we just have to start with the main ones. In my experience, if you have to do an elimination diet you don’t want to leave anything off the excluded list because it is hard to comply with restricted diets so you want to avoid having to do it again. Trust me, the motivation to get it right the first time is high.

        P.S I’ve done an SCD elimination diet that started out with only grass feed organic beef patties, mashed carrot and grape jelly, made with gelatine, allowed for the first few days. It was tough going after day one. I guess no scientist has reported anyone being allergic to beef patties :-)

    8. You could try using sweet potato as your main starch. Since they’re not part of the nightshade family.
      It might get a bit repetitive 7 nights a week but maybe every other night just so you can eat less meat which would be beneficial.
      Do chickpeas come under legumes? They’re also handy. I have a few food intolerances and find chickpea flour with almond meal and tapioca flour/starch is great for pancakes. If you can’t use chickpeas perhaps quinoa, since it’s not a true grain? I’ve used the flakes in pancakes too (a little bit bitter and an aquired taste). Currently trying different experiments for baking. Still a work in progress. :)

      Edit to add: just noticed the no nuts so no almonds. Sorry. It may take a bit of trial and error but you’ll find what’s best for you. Best wishes for your health.

      1. The traditional Okinawan diet as reported in 1949 obtained 80% of its calories from Japanese sweet potatoes. And since the Okinawans eating this diet have the highest percentage of the population making it to 100 years old of any population in the world. So centered a diet around sweet potatoes morning, noon and night has been tried and it works fantastically well.

      2. The traditional Okinawan diet as reported in 1949 obtained 80% of its calories from Japanese sweet potatoes. And since the Okinawans eating this diet have the highest percentage of the population making it to 100 years old of any population in the world. So centered a diet around sweet potatoes morning, noon and night has been tried and it works fantastically well. @disqus_xGzWWxgRQI:disqus

    9. Hi Lee,

      Even if we read all of the science diligently it’s difficult to come up with a definite answer. On top of that people interpret the science in different ways and some people post uninformed opinions. I understand what it’s like to have an illness and to need some answers that help in a pragmatic way. While Leaky Gut might not be an answer for you it is one on the things that you could place near the top of your list of possibles. Further to that it is a relatively cheap and simple diagnoses and protocols are readily available so it is not ‘a bridge too far’.

      Here are 2 links to some reasonable introductory resources. For advanced info there here are 100’s or 1000’s of scientific research articles available (search NIH for leaky gut or intestinal permeability)….. so far I am only part of the way through my first reading of that long list. I did watch Dr Greger’s post/video on the subject and I didn’t find it to be very helpful or accurate.

      http://mdheal.org/leakygut.htm

      Dr Leo Garland

      https://www.youtube.com/watch?v=lh8RBV6eAow

      Dr Nikolas Hedberg YouTube ‘How To Heal leaky Gut Syndrome’.

      Their presentations do not include all of the positive causations identified by the research scientists, however they are a good place to start. Note that their combined list of the most likely cause of Leaky Gut Syndrome does not include food generally eaten by Vegans except for gluten (allowing for the fact that there are a lot of different ways to implement a Vegan diet).

      In my case I was not exposed to any of the high risk factors (alcohol, NSAIDS, medication etc) and was on a quite healthy diet prior to being diagnosed with LG. As I mentioned before my Dr is a qualified MD with experience in diagnosis and treatment of LG. While I don’t necessarily agree with his protocol I am following it out of respect for his experience etc.

      The 8 week protocol he gave me was:

      – no gluten
      – no dairy
      – no processed sugars
      – supplement with Intestamine and probiotics.

      I also took it on myself to increase my prebiotics although that might not have been a good idea because the science shows some fibre is adverse for LG.

      Based on the science my Dr’s protocol seems too good to be true – it is based on his experience so I assume it works for the majority. If it doesn’t work for me life will become a little more complicated.

      Good Luck in your pursuit of good health.

  2. This evidence fits in well with the emerging paradigm of mycobacterium avium paratuberculosis as the cause of Crohn’s. Interestingly, New Zealand is rife with the MAP bug and also rinsing dishes is not in the majority.

      1. Whole grains aren’t just gluten. The prebiotic arabinoxylan that comprises 21% of wheat bran, 7% of whole wheat, and 2% of refined flour appears to reduce permeability through its effects on the gut microbiota (1, 2), and I think its a good candidate to account for the markedly lower disease risk seen with whole grains (3). Given the controversy created by the cherry picking of paleo advocates and Dr. Perlmutter, we could definitely benefit from a study in which healthy humans consume whole wheat diets, and their plasma endotoxins and intestinal permeability to large marker molecules (like polyethylene glycols) and are measured. Alas, there’s only been animal studies.

        1. Good point: What is the effect of all the components of a whole grain together. Given the dearth of studies on humans, and knowing that some people are sensitive to gluten, and that lab tests can miss some people, it might be best for each of us as individuals to assess our personal reactions to gluten. I notice minor health problems when I eat gluten, so I avoid it–really no big deal.

        2. Re your statement: ‘we could definitely benefit from a study of intestinal permeability with whole grains in whole humans. I’d take 20 healthy volunteers and measure their plasma endotoxins and intestinal permeability to large marker molecules (like polyethylene glycols) after a grain/gluten free washout period and after a week’s high whole-wheat diet,”.

          That wouldn’t work because pre-selecting a healthy group would filter out those with a pre-disposition towards developing Leaky Gut (LG). Also LG takes time to develop and heal and that varies from individual to individual. Your hypothetical experiment shares the same extreme difficulties that all population health studies share (costly and require a large randomly selected group to adhere to the diet). Unfortunately I think we are basically stuck with the evidence from lab tests. While these don’t give us a complete answer they do point the way (or possible ways). Thereafter we have to rely on practising physicians to make the science work in the real world. Unfortunately, wrt LG, either not enough of them are doing it or the ones who are, generally, aren’t talking about it (most professionals are probably too handcuffed by fear of litigation to speak too freely).

          Re other points from your post:

          – Lactulose/Mannitol testing appears to be the gold standard and accepted as the most ‘bang for our buck’ by the practitioner/lab/patient trifecta. Don’t you have confidence in that method?

          – Your first two referenced studies use wheat derived Arabinoxylin and wheat germ separated from the wheat protein (Gliadin)? The first study finds a positive result for Araboxinolyn plus a High Fat diet? That’s two variables … it might be the fat?

          – your third link is broken (require a login to read the article).

          There’s plenty of research out there that cautions against eating wheat for a selected number of people (I’m not aware, as yet, of the % or how that is measured, if at all)
          Here is a link to a current blockbuster paper … the first tial to confirm Non-Caelic Wheat Sensitivity is real.

          http://gut.bmj.com/content/early/2016/07/21/gutjnl-2016-311964.short

          “Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease”, Melanie Uhde,1 Mary Ajamian,1 Giacomo Caio,2 Roberto De Giorgio,2 Alyssa Indart,1 Peter H Green,1,3 Elizabeth C Verna,1 Umberto Volta,2 Armin Alaedini1,3,4

          BMJ Journals Gut – full doc available as a PDF download

          Wheat protein Gliadin triggers Zonulin to open the intestinal wall tight junctions.
          My readings from elsewhere suggest that this is a high risk pathway for autoimmune attack on joint tissue (collagen) based on protein mimicry?

          https://en.wikipedia.org/wiki/Zonulin

  3. This is a super-helpful blog. I was happy to see the comment about xantham gum! One of my favorite thickeners in nut cheeses and sometimes desserts.

  4. I wonder if this advice, at least in part, might be also applicable to psoriasis? With my limited understanding, the whole leaky gut argument seems very similar.

    1. I am no specialist (although a very advanced amateur) but I will allow myself to answer this one because all of parts of my answer above is relevant also here. And yes, the whole leaky gut argument is very similar although it’s always like “it may work but it doesn’t have to and you may have to keep looking”. One of the last papers I read about psoriasis described it’s connection with dairy. Ie. there was this lady who could instantly switch on or off her symptoms by ingesting or not ingesting dairy. So there is no one size fits all solution which makes at least me very pessimistic about the whole venture.

        1. Thanks for taking the time to reply, Mick. Yes, I have also read about a possible dairy connection (but personally it seems to make no difference for me).

  5. The reference to maltodextrin is interesting – I avoid it as I can’t digest double sugars (Lactose, maltose, fructose etc.) Unfortunately many vegan processed foods include maltodextrin including nut milks. Don’t think I’ve seen polysorbate 80 in Australia (yet!).

    1. “Unfortunately many vegan processed foods include maltodextrin including nut milks.” Is this a joke…?

      Who in their right mind on this forum would consume ‘vegan processed food’…?

      1. Igking: From the posting rules for this site: “The intention of the comment section under each video and blog post is to allow all members to share their stories, questions, and feedback with others in a welcoming, engaging, and respectful environment.”
        .
        A little more kindness and understanding on your part would be in order.
        .
        As for myself, I drink store bought nut and soy milks all the time, and I’m not above buying vegan processed foods as treats. I am sure I am not alone. This site is a great place for people who are not eating ideal diets to learn and grow. Please consider fostering growth and supporting fellow posters who may not be eating ideal diets, but are working on it.
        .
        Also, I appreciate hearing from people from other countries and am glad that Helen posted.

      2. I am now stressing over my vit B-12 supplement! Why can’t I find just B-12. Trust me….I don’t need it to be sweet. A simple drop.
        Stressing is an exaggeration but really! Right?

      3. Ah, I do. I have neither time nor interest in making absolutely everything from scratch. So we drink commercial soy milk and almond milk, eat a packaged veggie burger once in a while. We’ve even been known to eat a slice of vegan cheese on that veggie burger served on a premade whole wheat hamburger bun with bottled catcup, mustard and pickle relish for a packaged vegan food meal top to bottom etc. So until I retire and can spend all day puttering in the kitchen, processed vegan food will have to represent a small but steady part of our diet.

    2. Helen Weder: I live in America. It is always interesting to hear about situations in other countries.
      .
      re: digesting double sugars problems
      While it’s never really fun to have restrictions, I sometimes wish I had problems like that. It might keep me on the straight and narrow. ;-O

  6. That’s a British thing, not to rinse the dishes. Isn’t it crazy? I guess maybe during the British Empire, all the British had household servants, and the knowlege of dishwashing was lost.

    1. All the British had household servants? No. Only the wealthy.

      You might just as well say that Americans lost the knowledge of dishwashing because of the huge number of slaves in that country – almost 4 million according to the 1860 US census (slavery was abolished by the Brits in 1833. It would be another 32 years before it was abolished in the US.

      The US 1870 census also recorded that there were over 975,000 domestic servants in the US .

      So I think your guess is wrong.

  7. Same, whenever I washed any dish or anything at all by hand, I keep there rinsing and rinsing with lots of water at high pressure… I tend to make a mess around the sink and with a good amount of water on myself too :D , because I always fear that some soap remain might still be there. I really cannot believe anyone would leave soap purposely. Can you imagine soup in a dish with soap still clinging in the surface, that would literally foam up again? :S

    Food would taste of soap, not no mention the fact that you are literally *eating* it. Even if you cannot taste it, that NEVER can be a good thing, avoid doing that.

    Personally I never knew of anyone doing that, though.

    1. Thank you Darryl – very helpful. But a bit concerning too as soy lecithin is one of the most concentrated sources of choline on a vegan diet. The relationship between choline and TMAO notwithstanding, presumably some choline is necessary from the diet for its precursor role in acetylcholine. So given what this paper has found, are you concerned about a) consuming soy, and if you don’t consume much soy, b) getting enough choline from a vegan diet.

      1. I’m not concerned with eating too much soy, because Asia exists, and was fairly healthy with respect to chronic desease, eating less refined soy and less refined oils. I’m not concerned with soy lecithin consumed as supplement by some, as its not the lecithin alone, but the fat emulsion made with it that increases endotoxin transport.

        I’m not concerned with getting enough choline, because I’ve read the justification for the current AI. The daily adequate intake (AI) was set using total intravenous feeding studies which found 2 mg/kg/day of choline didn’t prevent elevations in alanine aminotransferase (ALT), but 31 mg/kg/day did. Its a rather wide range for the actual requirement to lie. Moreover, the parenteral nutrition studies didn’t provide betaine, the choline metabolite abundant in spinach and other veggies, which spares most metabolic requirements for choline. On my yearly blood panels it reports ALT, so I know I’m getting enough choline to prevent deficiency on about 250 mg/d.

        I’m very concerned with entotoxemia, which offers a compelling explanation to account for the postprandial inflammation, oxidative stress, endothelial dysfunction and sometimes clinical events that occur with fat and especially saturated fat ingestion, as well as an explanation for how unabsorbed dietary fiber (especially fermentable fiber) and poorly absorbed polyphenols could markedly reduce these effects and clinical disease, through their effects on the gut microbiota. More here.

        1. Thank you, that is reassuring. What I don’t understand, even after reading the articles you posted, is how dietary fats end up emulsified – is this through emulsifiers added in processed food, or is it an inevitable part of digestion and therefore something we have no control over – or both?

          1. Any creamy suspension of microscopic oil droplets in water (mayonnaise, ice cream, mayonnaise, creamy salad dressings, béarnaise, hollandaise, cake batters) is an emulsion: it just takes water, fat, an amphiphilic emulsifier compound like polysorbate 80, or the phospholipids of egg or soy lecithin, and some mechanical agitation. Our bile acids serve a similar function emulsifying fats in the digestive system. The studies found emulsifying sunflower oil with soy lecithin before giving it to the mice increased endotoxemia compared to sunflower oil alone, and also that emulsions made with comparable milk phospholipids didn’t lead to the same adipose tissue inflammation that soy lecithins did.

            Obviously this isn’t an issue for a strict whole food diet. It has made me look at secret indulgences like Vegenaise in a new light.

        2. Do all those Asians with low chronic disease risk you refer to, eat only fermented soy?

          In antiquity the only drawings of prised foods of the time show images of the soy root, never any other part of the plant, that is until the Chinese finally saw the light.

          1. Edamane, tofu, and soy milk aren’t fermented, and I expect soy intake from these would exceed that from fermented natto, miso, doenjang, douchi etc, which were more expensive and used primarily as condiments and soup/sauce bases.

          2. I’m not criticising either of you, in fact I think you are circumventing a very interesting point. To increase my understanding …. are you trying to establish a fact in history or are you trying to identify the nutritional relevance of soy, and it’s variations, within the context of a modern ‘health’ diet. I don’t think there is a lot of relevance in studying historical dietary patterns, although I have a deep respect for the wisdom of some of the older cultures (there’s a lot to like about the nutritional value of established Asian or Mediterranean eating habits, especially when we consider they didn’t have access to science).

            A lot of evolutionary water has passed under the bridge since, for example, Okinawans lived out their long lives. Older racial groups like that probably have no relationship, genetically, to many modern day people e.g. Caucasians lack the enzyme to digest seaweed, so although it has a good nutritional profile and was a stable for some long lived cultures it doesn’t have the same value to everyone.
            In addition to that I believe we should take a holistic approach to health and so the environment and culture we live in impacts our health just as much as the food we eat. We are living in a time where the impact of Mankind on the environment has created a feedback loop of escalating consequences (its official that this month we crossed the 400ppm level for CO2 in the environment).

            So, for dietary guidelines we should look to the impact of todays food on todays people and where possible fit that to the individual. Science is our best hope in that regard however science has its limits and we have e to supplement it in various ways e.g. nutritional science might be missing some of the Soy story or we might be missing it ourselves:
            1. Edamane is a vegetable like form of Soy…. according to Dr Ray Peat at raypeat.com potato starch, which is ‘alive’ until cooked, has different properties to ‘dried’ starch i.e. grains. So Edamane is a different cup of tea to dry soybeans.

            2. starch/carbohydrate/fibre content and type might be more relevant than some people think.

            3. a lot of selective breeding has occurred since ancient Chinese walked the earth (now we have GMO soy!)

            4. The ‘secret sauce’ in fermented soy is the bacterial type and their by products e.g. Natto is the best source of vitamin K2 for Vegans.

            5. processed Soy products are subject to variance and are an unknown quantity (it depends on the processor, truth in labelling and what the producer has to do to keep in stored ‘on the shelf’ for long periods without going off.

        3. Re your statement: ‘the whole of East Asia had low chronic disease risks while eating considerable soy and little animal products or highly refined food’.

          What is your info source for that conclusion and what era are you referring too?

          Symbolically we have eaten from the Tree Of Knowledge – the forbidden fruit – and now we have to pay the price.

          There is no comparison between the past and the present i.e. number of trained medico and our current capacity to identify and keep readily accessible records of our citizens who have a chronic disease.

          Our desire for the forbidden fruit is ramping up the exponential curve and going off the charts – fasten your seatbelt.

  8. I have heard that lectins and phytates in beans and legumes and grains increase leaky gut–what is your take? Just a couple articles below:

    The dietary intake of wheat and other cereal grains and
    their role in inflammation. [and intestinal permeability]
    http://www.ncbi.nlm.nih.gov/pubmed/23482055

    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0000687

    Do Dietary Lectins cause disease? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115436/

    Effects of dietary lectins on ion transport in epithelia http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1575184/

  9. Need some help.. I cannot find the maltodextrin in the article on enhancing bacteria to glob onto our intestinal cells. Is maltodextrin a polysorbate maybe?

  10. Here is a case study of Leaky Gut/Candida overgrowth (PDF download available).

    [quote]

    Diagnostic Assessment
    Comprehensive Digestive Stool Analysis (CDSA) 2.0 (Genova Diagnostics, Asheville, NC, USA) revealed potentially pathogenic levels of C albicans and low levels of pancreatic elastase 1 and β-glucuronidase, supporting a diagnosis of dysbiosis (Appendix 1). An IgG Food Antibody Assessment (Genova Diagnostics) revealed moderate to high reactivity to several different foods, indicative of multiple immunoglobulin G (IgG) food sensitivities. Her symptoms were suggestive of leaky gut syndrome (Figure 1; Appendix 1). Her vitamin D level was 28.4 ng/mL (low). She was diagnosed with CRS, IBS, overgrowth of C albicans, multiple food sensitivities, and leaky gut syndrome.

    [unquote]

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982648/

    The document includes:

    table 2 Prescribed Interventions in Course of Care

    appendix 2 Yeast-free, Anti-Candida Diet

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  12. I was hoping to find something about Guar gum in this article…Can anybody tell me how it affects our health? Today I used it the first time to bake a cake. Works very well . But then I looked up some information and its a bit confusing. Now I am not sure anymore what to think…

      1. Thanks I had a look at the full article ( very complex) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520894/ (free access :D )

        It doesn’t really say how to prevent any negative side effects if one has to take small doses regularly for example in medication/supplements… (the stuff is also added to some animal medication weirdly enough,as a bulking agent I think)

        From what I could understand from the article most populations can tolerate it without any serious problems,but some few who are at risk could suffer.I don’t really want to gamble when it comes to Crone’s Disease which is a rather life quality diminishing illness.

        Any research on neutralizing/diminishing it’s effects? Only thing I could thing of is high fiber diet to limit it’s contact with the gut wall.Any other ideas?

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