Hey folks, just a quicky here on the recent news pieces talking about research indicating gluten intolerance may not exist. I’m earlobe deep in City Zero stuff so this will not be a long breakdown but it should help put some of this into context.
First, what is gluten intolerance? Unlike Celiac which is an autoimmune condition triggered by the protein gluten (gliadan to be specific) non celiac gluten sensitivity (NCGS) has been hypothesized to be an innate immune response which causes GI distress and inflammation. Recent research (please DO read that whole paper) suggests that gluten may in fact not be the culprit here, but rather FODMAPS.
Real Clear Science did a nice takedown on this but with some interesting commentary. First RCS pulls a quote from the original research:
“Reduction of FODMAPs in their diets uniformly reduced gastrointestinal symptoms and fatigue in the run-in period, after which they were minimally symptomatic.”
Followed by some (good) opinion by RCS:
Coincidentally, some of the largest dietary sources of FODMAPs — specifically bread products — are removed when adopting a gluten-free diet, which could explain why the millions of people worldwide who swear by gluten-free diets feel better after going gluten-free.
Can’t argue with this AND it might also be part of the reason why folks who consume lots of gluten-free products still have problems. The next bit of opinion is…well, just kinda wacky:
Indeed, the rise in non-celiac gluten sensitivity seems predominantly driven by consumers and commercial interests, not quality scientific research.
Only to be followed with what appears to be some correspondence with the lead researcher of the paper:
Biesiekierski recognizes that gluten may very well be the stomach irritant we’ve been looking for. “There is definitely something going on,” she told RCS, “but true NCGS may only affect a very small number of people and may affect more extraintestinal symptoms than first thought. This will only be confirmed with an understanding of its mechanism.”
So, “millions of people world-wide” feel better from a gluten free diet, the lead researcher is pretty sure “something is going on,” these effects may extend well beyond intestinal issues…but we are all goofy for tinkering with this stuff and it has ONLY been driven by a profit motive? newsFlash for RCS: That this research occurs AT ALL is due to the volume of people playing with this topic. Might it be mainly FODMAPS and not NCGS? The study that Biesiekierski put together is VERY good and quite compelling. You need to let the data speak for itself but it’s ironic that the problematic foods (let’s say bread in this case) is still, well, a problem.
Here are some thoughts/questions in no particular order:
-Why was celiac prevalence at one point written in stone as about 1/1,000 and is now in the 1/140 range?
-Is it a terrible thing to suggest a gluten free (and low FODMAP) diet to the scores of people who suffer GI problems?
-If people have a health problem, should they wait until “all the research” is in?
I have a couple dozen blog post in que and I’ll get to at some point. One of them is this paper looking at cardiovascular disease and vascular wellness. What’s interesting about that paper is it points out that yes, we know a lot more about CVD, yes we have some great treatment interventions that save lives, but the current model is so expensive it will likely bankrupt westernized countries (I think some folks have said something akin to this at some point). Check out the closing thoughts from that article:
Fortunately, healthcare providers do not need to wait for a national directive. In the arena of arterial disease, which is so costly from a humanitarian and financial standpoint, healthcare providers may choose, as the authors have, to enter this new era of arterial disease care now. It is exciting to practice medicine in an era where we possess clinical tools and knowledge allowing us to migrate to a more superior platform of healthcare. The platform that focuses on managing end-stage arterial disease is too expensive and devastating to an individual’s wellness. We now have the opportunity to shift to a platform designed to prevent disease, or at minimum treating it before it is evident. We do not need to wait for huge randomized double blind prospective outcome studies to prove such a platform will be superior. We have no choice. We have proven that the current platform leads to insolvency. It is possible with a personalized, comprehensive, and holistic approach to determine the causes of the arterial disease in each patient. There are effective therapies for all the inflammatory conditions and adequate biomarkers to judge the effectiveness of the treatment. Arterial inflammation can be extinguished. The new era of CV healthcare can guarantee arterial wellness.
Bolded emphasis is mine.
Ironically, the lead author of that paper, Bradley Field Bale, was one of the early influencers of the risk assessment program in Reno.
I’d argue that we could take “arterial wellness” from above and substitute anything from neurodegenerative disease to GI problems and have much the same story. we have the outcome based medicine potential of solving a lot of these issues, with neigh aRCT to support any of the clinical interventions.
Is NCGS a dead hypothesis, with FODMAPS being the real issue? Maybe. Time will tell. For now, how about practicing medicine using the best mechanism we have, and evaluating based on outcomes? The news reporting on this topic has been at best ignorant as it seems to gloss over the fact folks DO benefit from a gluten free (reduced FODMAP?) diet. Our understanding of the minutiae may have taken a giant leap forward with this research, how we tackle these issues on a personal or clinical basis may not have changed at all.
Great post. Thank you. Did you see Michael Pollan’s smack down on gluten intolerance? This guy has a huge audience and uses is regularly to spread his gluten intolerance-denial. http://www.huffingtonpost.com/2014/05/14/michael-pollan-gluten-free_n_5319357.html
Pollan is worse than the most mainstream RD one can find. He seems to think there is no distinction between food qualities, the only route to sustainability is planet of the (mainly) vegans.
I find it odd that he would adopt such a stance given how well he wrote about the evolution of bread in his recent book, Cooked. He tackled the development of new wheat varieties and modern processing methods, and how this means that most commercial bread today is pretty much undercooked and just not as nutritious as the fermented sourdough bread our ancestors ate thousands of years ago.
IDK kiddo. Pollan has just slid more and more into the “useless, possibly dangerous” category IMO>
I have two of Pollen’s books and they definitely will be the last of his work I ever read. The Omnivore’s Dilemma & Food Rules were, I thought pretty good books and presented some interesting information. Sadly he now seems to be someone’s puppet. Perhaps the folks behind the grains are good for you site have their hands up his backside now too given his audience.
I haven’t had time to watch the video yet, but I don’t actually see much wrong with the written excerpt. I’ll have to watch the rest later…
In looking at this particular story I’ve been borrowing an idea from one of Pollan’s books: It could be that gluten itself might not always be the problem, but rather a marker for other troublesome ingredients lurking within. In other words, a huge number of otherwise non-gluten-sensitive people might be reacting to something that came packaged together with gluten. FODMAPs, for example, or some kind of chemical additive that people have a reaction to. Thus avoiding anything with gluten in it automatically avoids several broad categories of highly processed industrial food. Pollan made the point (in his rules for eating book) in such words with high fructose corn syrup, but it could just as easily apply to surprise sources of gluten.
I do agree that something is going on biologically, though, and I’m not dismissing gluten as a problem in itself. It bugs me that the standard spin seems to be “nothing to worry about, move along and go eat your bagel…” Someday soon an actual celiac is going to end up in the hospital from a backlash like that.
I continue to have GI problems while gluten free. I discovered that my frequent constipation on a grain-free, veggie, fruit and meat diet was related to my daily consumption of high FODMAP foods. I do think there is a connection.
omgilovethissomuch. Thank you, thank you. My favorite part? “Why was celiac prevalence at one point written in stone as about 1/1,000 and is now in the 1/140 range?”
Just a reminder that what is orthodoxy today is outdated thinking tomorrow. Thanks!
Hello my old friend. I have GI problems and have eliminated gluten and still have issues. Excuse my ignorance but what are FODMAPS?
Charlene-
I linked to what FODMAPS are in that piece, just click the link.
Thanks so much Robb,
My 18 you son showed me the “gluten intolerance doesn’t exist” article last night almost with a smirk. My question to him….What came first? The gluten intolerance or the digestive problems? So, if it is FODMAPS….so what? It’s still in the gluten right? As my grandmother MIGHT say if she were here today and up on the lingo “FODMAP SHMODMAP….If it makes you sick, don’t eat it”!!
You’re like the big daddy that all us “little paleo kids” come running to when someone “hits us” w/ a “you’re wrong” kind of thing. Fix it, Robb, Fix it!!
Thanks for all you do. You rock!!
Ha!
Well, I have my gurus I turn to in various areas, i’m honored to help folks in this nutrition and health scene. So FODMAPS are not “in” gluten, but accompany gluten as part of the bread.
Robb, not everyone who has the gene variants for celiac expresses the disease, but everyone who expresses the disease has at least one of the gene variants.
Do you agree?
Whether the number of true celiac disease has increased is debatable by itself (I grew up knowing the range of incidence in western populations was 1-2%, where did the 1/1000 come from? ).
Even if it has increased though, the change in gliadins in the modern dwarf wheat may explain why more people with the genetic variant/s are expressing the disease.
The genetic incidence itself hasn’t changed and even if All genetic celiacs expressed the disease now, it doesn’t come anywhere near accounting for the millions who believe they are “gluten intolerant”.
This is why I don’t see how a change in the expression of celiac disease is part of this argument. Could you explain?
Disclosure 🙂 : I’m a card carrying celiac, have been since infancy. It runs in the family. In our older generations some children died for ‘failure to thrive’ until the cause became well understood.
Meanwhile, the incidence of FODMAP intolerance sounds more and more like a gut biome dysbiosis issue in the last few years, as more as has been learned about that biome.
If so, it would explain why removing wheat (incidental to being ‘gluten-free’) helps symptoms for many ‘intolerants’, but doesn’t solve all their problem. Removing FODMAPs would then be like taking sugar from a diabetic, it lessens the symptoms but does little for the underlying disease.
So, yes, FODMAPS may be the reason for the increase in people identifying an ‘intolerance’ to wheat/gluten, but for them it’s not really the wheat’s nor any FODMAP’s ‘fault’ – this is important if they are to find an actual solution, I would think.
Repopulating the colon with beneficial bacteria and feeding them properly with fermentable fibers/starches is something that should be considered maybe? It’s the exact thing people Don’t do if they avoid all fodmaps, which may be making their situation worse.
Just some thoughts on this subject, your reasoning would be much appreciated.
Annique!
I think YOU should have written this post, fantastic questions and commentary. I was trying to keep that short, which can leave some gaps.
Why the celiac rate mention? Simply making a point that the Orthodoxy draws very hard lines in the sand, only to revise them later. Folks forget how labile science is…I think it needs a “good until further notice” sign hung on it and folks often forget this.
Does all celiac show a specific gene variant? I’m not sure on this. I know some people develop celiac after exposure to something like giardia. somewhat related to your other comments/observations, I believe the giardia not only damages the gut lining itself but dramatically alters the gut flora. And yes, restoration of gut flora is likely important in all this, but can be quite difficult to actually do this for many folks.
Ahaha, sure, and I’d put everyone to sleep.
Your post as usual was informative and engaging, I don’t know how you do it.
Science being “good until further notice” – that’s it, quote of the month 🙂
Anyway, I guess I sympathize with the researcher’s comment about “commercial” influence regarding gluten intolerance, in so far as it muddies the waters!
Of course people can remove the irritant as a first step, in order to get immediate relief. However, relying long-term on a restricted diet is sad and may even make them More intolerant with time if they expand their food restrictions to deprive the beneficial gut microbes of fermentable ‘fiber’.
Wheat itself can be a ‘baddie’ for other reasons (addictive/opiate mimic, effect on BG, minerals binding and malnutrition, etc) so that gluten ‘intolerance’ is something of a distraction.
It was the Real Clear science folks who threw in the commercial interests piece…I really liked their analysis, that part was a weenie shrinker for me.
Your point about the other gluten issues is spot on, and unfortunately, this dust-up will make that whole story much more difficult going forward. From a scientifically credible position it’s important to distinguish between gluten sensitivity and FODMAPS. From an “educate the masses” position, it just makes my job so much harder. Ah well! Job security I guess.
Ok, I see it. Thanks.
As for that job, I’m just grateful you’re on it 🙂
It was at the tail end of doing a Whole30 that I finally discovered FODMAPs were my problem. All of the low FODMAP charts I’ve seen point to gluten as being a food to avoid. So even if it’s not the only problem, it can often be a major contributing factor considering how much some people rely on bread for every meal.
I’m also going to steal the phrase ‘weenie shrinker’. Because it makes me giggle, and one cannot maintain an angry argument against that. 🙂
Steal away!
Also a card carrying celiac here, just wanted to say Annique you are correct about the genes. You can be a gene carrier and never develop Celiacs but if you have Celiacs then you carry at least one gene variant…I was blessed w/ both gene variants and a double copy of one.
About the rise in CD, check this study, that compared sera collected from 9133 people in 1948–54 with those two other present-day cohorts.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704247/
Thanks for the article, Robb.
I got into a facebook argument (which I’m usually smart enough to avoid) with someone yesterday after he very smugly posted a Huffington Post article discussing this study.
I just like the way that if your personal experience in any way contradicts this study, then you’re just a gullible moron.
The fact that I have been training for 22 years, tracking my performance and diet, and I feel better and recover faster now that I’ve been Paleo for several years just means I’m an idiot because ONE study disagrees with me.
Thanks amigo, and like I said in the main piece, on the macro level we know this stuff works. The “why” seems to vary a bit as we learn new things.
I think it’s important to note that the study referenced (http://www.gastrojournal.org/article/S0016-5085(13)00702-6/fulltext#appsec1) that highlights FODMAPS and seems to eliminate gluten was funded by an Australian bread manufacturer. That, I believe, is the reason that all the press about the study has been completely misleading about the results of the study.
Interesting article, thanks for sharing.
Maybe this is the wrong place to ask but with FODMAPS, is it possible to have problems with some of them but not all of them? I’m guessing it is; I know personally I can eat broccoli all day long if I wanted to with no problems but beans, no way I can eat those without some issues.
Just curious, thanks.
Justin-
Great question and “yes” different fructans can affect folks in vastly different ways. Which makes the story all the harder to pin down.
Robb,
Thanks for another informational and great read! I am one of the suffers with gluen as well as FODMAPS. I live by a gluten free-low FODMAP diet. I know when I have dairy it all goes downhill. I love cabbage/brussel sprouts although when I have a lot in one sitting I have intestinal issues as well. I found the perfect fit for my body: paleo with a few treats mixed in KNOWING there will be ramifications the following day….it’s just life for me.
Piper
That’s what it’s all about! Figure out both health and how many shenanigans we can get away with!
These articles were driving me crazy yesterday! It’s such a cool study, with very clear results that will help a lot of people. If you have IBS (the population they were dealing with), focus on FODMAPS instead of gluten. Most people I know who figured out they are gluten intolerant don’t mainly have IBS symptoms, its fatigue or migraines or joint pain or skin issues. I don’t think the FODMAPS issue addresses those symptoms too well. I think I read that around 8% of the people in this study (which comes out to like 3 or 4 people, so not much to go on and could be random) did better on the gluten free diet. That’s around what was estimated to be the rate of NCGS in the general population. Maybe it’s just that gluten isn’t a common gut irritant in the IBS sense, and if people knew that they could play with FODMAPS instead, and that could save people a lot of hassle and probably give people better relief from symptoms. That really helpful message was just totally lost in the reporting. It drives me crazy! It’s such an elegant well done study which was just reported in a way so that people can feel all smug and not as gullible and impressionable as their dumb gluten free friends.
Gabe-
Well said. the media mainly wanted to jump, with both feet, on the head of the gluten sensitivity story, with rarely any mention of the fact the FODMAPS elimination really benefitted people. http://en.wikipedia.org/wiki/Sisyphus
Great stuff as usual, Robb… My question after reading about all this: what about the supposed gut-damaging properties of all grains as relates to IBS and auto-immune response/inflammation? For example, I see that neither rice nor corn are listed as FODMAPs, yet eating them causes symptoms in many people… Is it simply a separate subject? And how could avoiding FODMAPs relate to other symptoms, like skin problems? Thanks for a great post.
THAT my friend is a big kettle-o-fish. check out this paper:
http://www.ncbi.nlm.nih.gov/pubmed/7065693
Enteropathy described in response to: cows milk, chicken, rice and fish! Was there a change in the gut biome which changed the way the pancreas functions, hence leaving large, potentially immunogenic protein fragments lying about? Just a guess on my part, shockingly, no RCT’s in site. Just pathology which looks a lot like celiac, but is totally non-gluten related. More questions! And still it looks like at least starting with a paleo template will be the best bet for folks who are having some kind of problem.
A few thoughts, the first being analyzing intestinal distress only. I’d personally be curious to understand inflammation markers and immune response. The second is that I consume so many other FODMAP fruits & vegetables without consequence or reaction anywhere similar to the reaction I have to gluten & other non-gluten grains. After years of tracking my reactions to foods, grains stand alone in their ability to make me ill.
Interesting. Wheat is a total no-go for me. Oats I have a legit food allergy to. Corn, does not seem to be a problem in moderation. Same with rice. Interestingly, i can get “carb head” from rice much easier than corn…IDK if that’s a blood sugar response, immunological etc.
I do know that since doing resistant starch and prescriptassist. my tolerance of fruit and a number of other items that would light me up has really improved.
Hi Rob,
Great post. Do you do resistance starch by way of supplements or through food? If you are taking supplements, I’m curious to know which ones you’re taking?
Thanks.
Hey Robb,
Nice little article, always enjoy reading your stuff! I like your “I may not be exactly right but this shit works” attitude.
Just thought I’d bring to your attention Kiefers recent research “review”. In it he looked at a study (http://bod.io/6W)that aims to refute various claims in Jonathan Davis’s Wheat Belly. I’ve read the study very quickly and it seems like a nicely cherry picked but literature based rebuttal.
Kiefer seems to have taken it at face value as “destroying” Davis’s claims in wheat belly. However, I get a slight whiff of bs given that the study is published in a publication that relies on there being a cereal industry. I am not making any accusation, but the simple statement that “the authors have no conflict of interest” simply doesn’t satisfy me. There’s no mention of funding sources or of what role each of the three authors took in producing the paper. Which makes me uneasy (especially having read Bad Pharma).
Not to bash Kiefer too much but he also “reviewed” a study on the cardio metabolic effects of “conventional” vs “grass fed” butter. His review seems to have ignored a few glaringly obvious methodological issues, one of which is that the subjects consumed a standard carbohydrate based diet and that the butter was fed to subjects in buns!
Sorry for the ranting!
I’ll check that out!
Don’t get me wrong it’s a well written study,but any research I’ve seen recently seems to ignore the state of the human microbiome. Sure, for the most part many populations have survived on diets containing or based around wheat and other grains, and by no means are grains the sole driver of modern obesity.
I have a hypothesis (supported by recent research on gut bacteria that play a role in gluten metabolism http://www.ncbi.nlm.nih.gov/pubmed/24499426)that a situation has arisen where a lot of people just don’t have the diversity of bacteria to cope with certain proteins. Case in point; lactose intolerance can be treated to some extent with probiotics (http://www.ncbi.nlm.nih.gov/pubmed/17927751).
As with everything biological it’s a nuanced, genetic and epigenetically (not just human)driven mess. Great news for people who like puzzles though!
When I am becoming what is to be comming called sick from the food that I am becoming to have eaten I an finding that is no good to eat the food of gluten. I am stopping this bread foods and eating how they do it in old mother Russia. Eat boiled meat and cabbage no problem. But if you are becoming to be eating the bread is no good. You come and I will make boiled meat and cabbage for all!
This doesn’t seem to account for the people who eat gluten free but don’t cut out other problematic FODMAPs and still see recovery. “Something going on here” is an understatement.
I’ve had the same experience of those above who seem to experience different effects with gluten compared to FODMAPs. FODMAPs just seem to cause mild digestive problems and gas. But gluten exposure seems to cause something akin to hypomania with a foggy depressive state for a day or two. This happened the last time I had a large cookie while I was otherwise 90-100% eating paleo and quality meats. I felt this arising anxiety within about 2hrs of the cookie and this veil of a foggy depression came over me and I stared into space for about 20 mins. I didn’t want to move or do anything.
And I’m highly tolerant to grains. Corn, rice, oats do not bother me in single does.
Question:
If there are no conclusive tests, Dr. Peter Gibson comes to the conclusion that GLuten Senstitivity/Intolerence does not exist and it’s all in the brain.
Why then is the APA, FDA so convinced that mental illness exists when there are NO definitive tests to diagnose ANY mental illness?
There are some prelimitive tests for Gluten Sensitivities but NON on mental health!!! Why are we drugging adults and children???
Do I see a double standard? Until this question is answered, I still assume my gluten free diet whivh does help me depression/anxiety.
We did see from the text the benom against alternative medicine. Of course, there is no money making when drugs cannot be produced. Sorry Eli Lilly and your cronies, including the USA Health, APA, and FDA governmental institutions.
Good Luck with dumb Medical Science!
I think that if it works for you then it doesn’t matter if it’s real and verifiable or all in your head. What matter is that it works!
Hey Robb: If I’m understanding all this right, FODMAPs are bad because they incompletely digest and fuel the growth of microbes in the gut. Meanwhile, resistant starch is good because it incompletely digests… and fuels the growth of gut microbes… What’s the difference? I’m confused.
Might make a good podcast question!
Totally late on this…but I have the same question. Any answers?
People can argue the science all they want whether gluten intolerance is a farce. I have never tested positive for being Celiac, and Dr’s said I could eat whatever I wanted it didn’t matter. What I know is that by listening to Robb’s advice, I was able to “cure” myself of Ulcerative Colitis. I was on medication to treat this that was causing my kidney’s to fail and I gave Robb’s advice “to just try it and see how you feel” a whirl, and shockingly was able to stop taking the medication and have had no issues since with my UC for the last 3 years. Robb, thank you for saving my life. I appreciate everything that you do, and if it wasn’t for your struggles I would never have found the same relief. Thank you
So what about stuff like WGA? I also saw a piece by Stephanie Seneff on the interaction between gluten and glyphosate that might have something to do with it?
http://www.alternet.org/food/meet-controversial-mit-scientist-who-claims-have-discovered-cause-gluten-sensitivty
I don’t think this study implicated FODMAPs… symptoms returned in participants assigned to the whey protein isolate group just as quickly as they returned to those assigned to gluten.
If FODMAPs were the culprit, those assigned to whey should’ve stayed in remission. Right?
That is a decent explanation. There are a lot of terms that are undefined in the modern vernacular of gluten free diet and conditions are attributed that may be from another aspect of the those proteins.
My concern has always been the slow over time destruction of the intestinal villa and microvilli causing a long term inability of nutrient absorption, properly described as: “shortening and villous flattening in the lamina propria and crypt regions of their intestines.”
Additionally the peptides break off and get in your blood.
Robb,
Love your work. I am a long time sufferer of digestive / autoimmune issues that I am slowly working out and getting on top off. In my 20’s I realised that gluten and lactose didn’t agree with me. I was better without them but still not right. I dropped FODMAPS in my 40’s and feel much better for it. Meat, fish and eggs are all good, I live on rice, spinach, olive oil and 70% dark chocolate (one that doesn’t contain soy). Since reading your book I have been encouraged to try almonds, which seem to be going ok so far. Fruit does not work well for me. Any fructose and I am peeing like crazy for hours, until wrinkled up like a prune.
The medical establishment doesn’t seem to have a clue about what is going on. With blood tests prior to dropping FODMAPS showing elevated CRP levels, otherwise every else was within normal levels.
It’s work like yours that hopefully will shine a spotlight on what is going on and get some research happening in this area. To help the masses. For me however, I guess research isn’t going to change much. I know what happens when I eat the wrong stuff and could’t go back to eating all that processed stuff. I didn’t know it, but I’ve been eating Paleo for years.
No doubt Gibson’s findings (and the resultant media response) will lead to a certain amount of pendulum swinging in the opposite direction with folks diving back into their bread baskets and stuffing their pizza holes with gawd-knows-what quantity of bread-based substances.
The paleo skeptics will also see this as some sort of victory.
[yawn]
So it’s not the gluten that’s causing the GI disturbance according to this one study.
There’s still plenty of other reasons not to eat wheat, just to pick on one grain. Whether it’s the FODMAPS or the the insulin spike, starches or monkeying with opiate receptors in the brain, I’m steering clear of the stuff.
My “study-of-one” (i.e. moi) tells me not to eat it and that what does work well for me is good, clean meats and veggies.
I think people put way too much weight on these studies. They are great data points but they shouldn’t cause us to toss out our own observations and, in turn, our own truths.
As an aside, if you want to see a great case against double-blind studies, watch the latest Burzinksi movie: Cancer Is a Serious Business. (Might want to watch the original one first–both can be found here: http://www.burzynskimovie.com/). Absolutely fascinating.
This article was discussed on Fox News yesterday. Unfortunately the discussion did not reveal some of the disconnects in the report you talk about here so I am happy that you did a brief summary of the article. I have been paleo for 15 months, lost 57 pounds all total ( a wonderful outcome), feel amazing, and in great health. Maybe FODMAPS are part of the problem, I don’t know, I just know that I avoid bread as much as I can as it makes me sluggish and tired. I am 53, and now in very good shape, active, and so happy I adopted this lifestyle. I guess what I’m trying to say is, that regardless of the research, for me, gluten is a culprit to poor health. I suspect this debate will go on for years (like eggs) and I don’t have time to wait on the research, I have a life to live! Thanks Robb.
When I was pregnant with my first daughter, I started getting aphthous ulcers constantly. I thought it was triggered by hormones. I had them on and off since I was a child, but never to the extreme as when I was pregnant. Once my daughter was born and we started the breastfeeding relationship, it became evident that she was reacting to something in my milk. I found a book (Whole Life Nutrition) that led us on the path towards finding out she was intolerant of gluten. We later had her tested via US Biotek and she is more sensitive to gliadin than gluten, but gluten has a familiar ring that people are starting to recognize. Anyhow, I eliminated gluten for her so my milk wouldn’t be passing on the proteins. Voila! No more aphthous ulcers ever again. By the time my second came around four years later, I was tinking with the idea of giving up grains. I finally let go of grains, legumes and sugar and things were going well, except that I was (and to a degree still am) bloated from nearly everything I eat. It is very frustrating. So, on to the FODMAP elimination which seems to be helping–I’m only five days into that project though, so it’s early to tell. The thing is, my blood work is always great. I exerise, I sleep as well as a mommy can with a night-nursing toddler, and I am very particular about eating well. My regular doctors are like, “Just keep doing whatever you’re doing…” and ignore my whines of “But I am still bloated!! Don’t you have any ideas?” The FODMAP diet is a bit like my journey into the gluten free world, “Gluten, what in the world is that? Who’s allergic to that? What about bread??! I have no food allergies” and now I am like, “FODMAPS? What in the world are FODMAPS? Why would anyone react to those? What will I do without onions? How will I cook?” I’ll get through it. Seriously.
Another piece of the puzzle that I always wonder about is gluten sensitivity on my mother’s side of the family. My mom died of pancreatic cancer at 45. Before she died she had a host of problems (which were likely exacerbated by smoking, alcohol and coffee) ranging from digestive problems, hypoglycemia, anemia, to a diagnosis of paranoid schizophrenia when she was 40. I obviously can’t sort out causal relationships of all her ailments, but I suspect a grain free diet might have helped her get her to a point where she could think clearly again.
We are the only ones who can truly take charge of our own health and wellbeing. Thanks for all you do that help us along on these less well traveled paths. Now how to explain FODMAPS to extended family? (They’re going to love this variation of my food insanity…).
The whole “gluten free diets are a fad” thing is a bit ridiculous. I know more and more people are getting into it now that it’s more widely available but non-celiac gluten sensitivity is real and there’s scientific evidence to back that claim up.
I think you raise some interesting points here, Robb. I just wonder why people aren’t going after Paleo eaters with as much gusto?
(Thoughts?)
I don’t care what medical science says. I went through menopause & my thyroid function “died” both in 1992; I went on levoxylthyroxine & HRT. 10 yrs later, I started having bone scans. I yearly lost 2-3% bone mass (except for the year I went off HRT; that year I lost 11% bone mass). On my own, I went gluten free. I noticed a change in my nails (strong in my youth, but gradually weak, split & peeling by this time) within 6 wks. My next bone scan showed no additional loss of bone mass. I have been stable (except for losses due to the natural aging process) for 5 years simply by eliminating gluten. I’ve never been officially diagnosed but who cares!! I’m not a crippled mess due to gluten ingestion. I’ve never had gas, bloating, indigestion due to gluten; all my ‘symptoms’ are of the silent variety. I’m now wondering if much of the depression of my youth wasn’t also do to gluten intolerance. Thx for this fine article; just had to add my two cents worth.
How can this study be taken seriously when all experimental groups (including the control) were fed Whey protein, which is a cross-reactant of gluten? This is a HUGE flaw in the study and completely invalidates the findings.
THAT is but one of the problems, but a very good point.
I do not believe that FODMAPS alone are the cause of an irritable bowel or the supposed gluten intolerance. I never had gut problems unless I consumed onions, broccoli, cauliflower, cabbage or legumes. If I ate any of those things I would be in for a night of severe stomach pain. Onions especially were the worse for me. What I have found though is I can eat those items now without any gut irritation at all. The only change I made was going paleo. After just a week of paleo I could eat all of those foods with no trouble. The same still holds true 30 days later. However, I did notice the one time I had meal high in grains and sugars that when I ate broccoli later that night it gave me gut trouble once again. I now know that foods high in FODMAPS only give me gut trouble when I have been consuming foods containing high levels of gluten and sugar. It is the interaction of the two compounds that causes the trouble and not the high FODMAP foods alone.
I think it’s not black and white. Gluten and co. may take years to have a huge impact. Of course there are people much more sensitive who have serious issuse right away, but this doesn’t mean that the other people are issue free.
It’s like the drop that digs the rock in many people, thus it goes beyond the normal understanding based on immediate symptoms.
Then, FODMAPS can be blamed as well, but I think gluten should be avoided, ever, it’s not for mammalians.
I haven’t read all the comments about the subject of gluten free. I am gluten sensitive, meaning I can still eat some gluten stuff just as long as I don’t over do it. The FODMAPS doesn’t help my situation either. My GI tract lets me know when I had to much. But my other problem is I am lactose intolerant. How can the paleo diet help me eat a healthy lifestyle.
I didn’t even realize that I was sensitive to Gluten until I went off of it and miraculously all of my stomach issues, that I had accepted as normal, went away. In addition to that, I have not had an asthma attack in the three months I have been paleo and my iron levels are normal (no more signs of anemia). Anyone who does not believe that there is Gluten sensitivity should have been with me the day I ate soy sauce (I did not know that it contains wheat), I was very sick and will not be repeating that mistake. Although it is likely that I have Celiac Disease (my grandfather and two cousins have the disease), but now that I am Gluten free I have been told that I can not be tested. So for me, Gluten Sensitivity is all I can claim. Thank you for this article. I for one am tired of people telling me it is not a real issue. 😉
Kimmi,
Being gluten free does not stop you from getting a genetic test, which will tell you if you have the vulnerability to celiac disease or non-celiac gluten sensitivity. It won’t tell you if you are expressing either disease, but you can’t get celiac or NCGS if you don’t have the genes.
If you’ve done a 23andMe genetic test, you can look up which are the celiac genes and which are the NCGS genes. You need to be an informed consumer to interpret 23andMe test results yourself. Or you can do a genetic test through Enterolab.com. They will tell you if you do or don’t have celiac or NCGS and how to interpret those alleles.
I dont tolerate bread very well, not gluten free either. So I dont know what it is exactly in it, that I dont tolerate. To me it doesnt make much sense to just rid the food of the one thing you assume is the cause of the intolerance, and then eat the rest. If you dont tolerate the food in its whole form, then maybe you are not supposed to eat it at all.
Robb, Interesting that our own Monash University was at the forefront of developing a suitable diet.
A little story.
I developed problems with our bread some time ago. I have since discovered that there was a change in the type of wheat grown by our local farmers. This had something to do with making the bread “better for making pasta” (wtf?).
I thought this was BS until I noticed that I could tolerate the bread made by our local Indian restaurant (Roti, Naan, whatever).
I know these guys use flour that they import directly from the sub-continent (maybe it’s cheaper, I dunno).
So, given that my intolerance corresponds roughly (I can’t be precise) with a step-change in wheat variety, what is it in the new wheat variety that triggers my digestive system problems?
Actually, I don’t care because I avoid grains now and I’m okay with my health.
Like I said first-up; interesting though, isn’t it?
The 37 people selected for this study had self-reported NCGS and irritable bowel syndrome (based on Rome III criteria), but not celiac disease. The symptoms of NCGS are usually not intestinal and do not match the symptoms listed in the Rome III criteria for IBS. Which means people with NCGS were selected out of the study. I have genetically confirmed NCGS and I would have been excluded from this study.
The idea of a 2 week washout after exposure to gluten is absurd. The immune system reacts for months after even a one-time tiny exposure in those that are sensitive. Many NCGS people also cross-react to whey isolate, so using that as a control further invalidates the study.
I accept that some people with IBS are reacting to FODMAPS, which includes breads. But this study does not support the idea that NCGS is a nonexistent condition. The misleading study headline is partly to blame for all the trash journalism that has spewed forth from this study.
Dr. Alessio Fasano (on youtube) can offer further clarification
**Why is there no reference (I couldn’t see it) to water absorption in the large intestine caused by fructans in wheat. Rather than looking at gluten. The water drawn in causes a raft of issues!!
I’m not a scientist. I do not have celiac. I do not have a gluten ‘intolerance’. However…
Recently, I visited family and went waaaaay off my usual 95% gluten-free diet during the week I was with them. By this I mean wheat every day, sometimes more than once a day. The result? Pain, pain, pain. I ached all over, especially in my ‘issue’ areas. This wasn’t ‘discomfort’, this was PAIN. I was not a happy camper at all.
Following on this, I got food poisoning. I was out of commission for a few days. (And obviously eating almost nothing, given how my digestive system had been pulverized.)
I’ve been off gluten for six days now. The result?
Pain-free. Period. I’d have to go back to my teenage years to identify how long it’s been since I could say that.
So I guess I have what you’d call a gluten ‘sensitivity’.
This has been a huge slap upside the head for me; as a health practitioner once said, ‘The body WILL be heard.’ I’m finally listening. : )
I stopped eating wheat/gluten about 5 years ago. The most immediate change was that I stopped having horrible bloating and gas. (Seriously, before I went off wheat/gluten my husband would call me gassy lassie.) I later learned my paternal great grandfather used to have to lie on the couch with stomach pain due to carb sensitivities.
Even before learning about the paleo way of eating, I had been told not to eat wheat/gluten, dairy, or soy, by my functional medicine MD, based off tests related to my gut issues. It wasn’t a huge leap from there to further edit what carbs I eat and live mostly paleo.
It’s really irritating to deal with people who think you’re “following a fad” when you don’t eat wheat/gluten. I want to say, look, my MD sent my poop to a lab and it came back indicating I wasn’t digesting wheat/gluten, you happy now? But usually the comments and questions about why I don’t eat the stuff occur at mealtime.
I have hypothyroid and some metabolic issues (and likely adrenal issues from stress) and all I know is that if a dietary framework includes all the food groups (fats, proteins, veggies and fruits, and some degree of carbs many of which can come from veggies and fruits) it doesn’t require wheat/gluten related products to fulfill the nutritional checklist!
Wow, amazing that they’re thinking of prevention (being a little facetious here) rather than treating people already with diseases. But, that would save the health care system tons of money not to mention a ton of lives!
Regarding gluten-free low FODMAP diets, it’s interesting that not everything on that diet necessarily corresponds with Paleo because dairy is allowed. See here: Dairy and non-dairy alternatives: lactose-free dairy, small amounts of: cream cheese, half and half, hard cheeses (cheddar, Colby, Parmesan, Swiss), mozzarella, sherbet, (almond milk, rice milk, rice-milk ice-cream)
What I have observed with my clients is that going gluten-free is not enough and even just the Paleo diet is not enough for people suffering from autoimmune disorders or type 2 diabetes. They need a more specific protocol tailored to their needs.
So, one can view a low FODMAP gluten-free diet as one protocol for people with irritable bowel syndrome and its GI symptoms. The evidence from randomized trials indicates that a low FODMAP diet can help to treat irritable bowel syndrome in adults and children.
I’ve had a “wheat allergy” for over 30 years. It’s not celiac; I’ve been tested. And I don’t suffer from GI problems. Never have. My symptoms are sore throat and migraines. I doubt FODMAPs are my issue. Through a process of elimination way back when, when there was nobody to tell me what was wrong with me, I figured it out: wheat. I’m sticking with that diagnosis. It works for me.
Most of my symptoms were neurological (frequent spells of right-sided weakness and aphasia, poor balance and proprioception, cognitive and memory decline, headaches) as well as GI symptoms and chronic inflammation and pain. I’ve been gluten free for 3 1/2 years and am now moving to Paleo to get rid of the last of the inflammation (all the other symptoms disappeared when I went gluten free but still ate high FODMAP foods). I do think FODMAPs also contribute to the GI symptoms but I do not think the two – NCGS and FODMAP sensitivity are mutually exclusive. I think that it’s entirely possible to be sensitive to both. Maybe there is something else out there that is the root cause of sensitivity to those food groups. I don’t think it’s an either/or situation. Just sayin……..
Conversing with the converted here. You guys have really nailed the gluten sensitivity argument.
As for FODMAPS, the big push now is for high,… higher fibre.
It is, all about the gut microbiome.
Low FODMAP smacks of the sugar industry presenting fat as the culprit & forcing the low fat/high carb recommendations way back when a low carb diet was the recommendation of the day. Is the wheat industry fighting back now?
If low carb hadn’t been designated to the back burner we wouldn’t have Paleo now. Everyone would have cut back on bread and gluten sensitivity would not have become an issue for another couple generations.
Sugar & fructose replacing fat in manufactured food are the obvious culprits now.
We all know GF products are a fad. They contain rice, soy, corn, sugar, & the rest of the junk. They are HIGH CARB.
But, come on guys, 90% paleo & soy sauce made with wheat. Soy is not Paleo. Tolerating a cheat cookie or sushi role is not healthful.
FODMAPS are a red herring. The sooner you go low carb/higher fat without those sneaky gliadins, the sooner [5 days… remember those miracle 5 day diets] you will be able to eat those FODMAPS for your gut’s sake.
Then the obesity epidemic can be treated for what it is; a diabetes epidemic.
Most of the symptoms above can be associated with high blood sugar. Fasting blood sugar levels of 7.0 mmol/l or more 126 mg/dl or more [ Aust. is 8] for a diagnosis of diabetes in a population eating wheat. On a low carb diet protein can send you way over that.
All I can say is get a blood glucose monitor and isolate those symptoms, aside from obvious gut [gliadin/dairy] for what they are.
This was really interesting to read. I’m just starting to learn about the Paleo diet and have been gluten free for a year.
My take on this is that what’s most important is understanding that there is something going on and eliminating that from the individual’s diet. It doesn’t really seem to matter if it’s the gluten or the FODMAP causing the issue.
It will be interesting if we see FODMAP free foods in the stores 5 years from now.
Our family doctor suggested FODMAPS when a gluten free diet helped my husband, who was tested for celiac (neg). The reason that I see this can be important to know is that many of the foods used to keep the flavour and interest in a paleo diet are fodmap foods (onions, garlic etc). It seems to me you could say that a fodmaps diet is potentially more restrictive than a gluten free diet. Or at least different. My two cents
YES! spot on!
Placebo effect aside, I know I feel 1000 times better cutting gluten out. I hear so many conflicting views on this, but I also know what works for me. I’ve heard of a correlation between lactose intolerance being triggered by gluten. I am lactose intolerant. I know when I cut both out, I am a totally different person.
OK, so I’m 7 years late to this party but here’s my 2 cents worth.
Every time I see these docs saying gluten sensitivity is all in our heads I’m reminded about the joke about the woman who walks in on her husband having sex with another woman. The husband angrily denies he’s unfaithful, saying “Who’re you going to believe – me or your own lying eyes?” Similarly the docs are saying to us “Who’re you going to believe – us or your own lying bodies”.
After treatment with antibiotics for Lyme Disease had resolved most of the symptoms I was still left with the GI issues. I also found myself scratching my itchy forearms, a classic sign of an allergic reaction – I had previously had these same itchy forearms after having a severe allergic reaction to a penicillin injection – but I hadn’t linked it to gluten. After trying various things my GP ordered a blood test for anti-gliadin antibodies – they came back 3 times normal! I cut out products made of wheat and my GI symptoms and itchy forearms vanished immediately!
I’ve discovered that gluten is in all sorts of products you wouldn’t suspect, usually due to a reoccurrence of my gluten symptoms when I unsuspectingly consumed the stuff. For instance, here in Australia we don’t have HFCS because maize is not a major crop. Instead we have “glucose from wheat” which I suspect is the same high-fructose garbage as HFCS only using wheat as feedstock. I discovered this after having symptoms following eating icecream which on reading the contents label included the wheat-based “glucose”. So tell me Doc – how can I be imagining my symptoms when I didn’t even know I was consuming it?