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  • 4 new gluten myths that appeal to the healthy

    4 new gluten myths that appeal to the healthy

    The debate over gluten is certainly confusing. While there have been several high-profile articles warning against gluten-free diets for the average healthy person (see this article on today.com for an example), it’s also not hard to find a friend or someone in the office who has some sort of gluten-free success story. Who should you believe? Does gluten really do all of the bad things that people say it does?

    Gluten free diets are only medically needed by people who suffer from celiac disease, an immune disorder that attacks the small intestine. In contrast, the enormous popularity of going gluten free is not supported by medical need – instead, it’s bolstered by a number of medical-sounding gluten myths that speak to healthy people with common health concerns. In this article, we’ll pit these myths – which cover water weight, acne, rough skin, and hormonal problems – against established facts and learn why gluten is NOT behind them. We’ll also discuss the many benefits of wheat that you’d miss on a gluten-free diet.

    Myth 1: Gluten causes water weight gain.

    You may feel like you have less weight around the middle on a gluten-free diet, but carbs are actually behind this myth. Gluten is not a carbohydrate – it is a protein – and both carbs and protein are present in wheat. It naturally follows that if you avoid wheat bread, you are also avoiding the second largest source of carbs in the American diet (after soft drinks and next to cakes, cookies, pastries, and pies) [1].

    The factors that influence how much water weight you carry – like hormones, your water intake, and your salt intake – are dynamic, so your weight can fluctuate by a few pounds each day. Carbohydrate consumption is another such factor. The short-term energy reserves in your liver are made up of carbs that have been converted into glycogen. The glycogen is ‘hydrated’ so that you retain about 2.5 grams of water for each gram of stored glycogen. When you eat fewer carbs, you store less glycogen and you retain less water. Reverse the process and you can also see why you initially lose water weight on a low-carb diet. [2]

    The real question is, should you deliberately eat to avoid those few pounds of water, or is it healthier to invest in stretch denim? Losing water weight will only get you so far – eventually you need to further reduce calories to achieve sustainable weight loss, and a gluten-free diet is neither a good short-term nor a good long-term way to go about this. Gluten-free diets are not necessarily low in calories nor low in carbs if you eat processed foods or rice and potato flours, and, after a time, you are likely to become deficient in folate, calcium, iron, and zinc [3,4]. And if you’re thinking about adopting a typical low-carb diet instead, remember that while carb counting is important for diabetics, the benefit to others is unclear.

    Myth 2: Gluten causes acne.

    Carbs also seem to be responsible for this myth, too. After years of uncertainty as to whether sugar or chocolate really does cause acne, it is starting to look like refined carbohydrates and dairy aggravate or influence acne by way of insulin and insulin-like growth factor 1 (IGF-1). [5,6] IGF-1 is a growth hormone, but it continues to play a role in the body throughout adulthood.

    Just as we discussed for water weight, avoiding wheat in order to (unnecessarily) avoid gluten can come with the side benefit of lowering your consumption of refined carbohydrates and reducing your acne. Now, does this necessarily mean that you should switch to a low-carb diet instead? No. As registered dietitian Jennifer Burris points out [5], the research to establish dietary guidelines for acne has yet to be conducted, and the best approach for managing acne is for each individual to work with their doctor and a dietitian to develop a solution that fits their particular situation.

    Myth 3: Gluten causes “chicken skin” or keratosis pilaris.

    Keratosis pilaris (KP) is a benign skin condition that looks a bit like permanent goose bumps on the arms, thighs, and buttocks [7], although the bumps are much rougher than goose bumps. In KP, excess keratin – a key protein in our outer layer of skin and in our hair and nails – plugs the hair follicule, sometimes trapping a small hair inside. [7] Keratosis pilaris is quite common – it affects around 50% of adolescents (80% of females) and 40% of adults – and seems to have a strong hereditary component. [8]

    Keratosis pilaris is not caused by gluten-induced intestinal damage, as is claimed in this myth, and, in fact, keratosis pilaris is not common in celiac disease, the worst case scenario of gluten sensitivity. The only connection between KP and food seems to be a positive association with body mass index [9,10]. Less clear is a relationship between insulin resistance, IGF-1, and KP (also reported in the previous references), which is only speculation at this point.

    Myth 4: Gluten causes hormone imbalances.

    According to this myth, gluten produces intestinal inflammation that places stress on the adrenal glands, which in turn interferes with the sex hormones. Symptoms include water retention, acne, moodiness, extra body fat, migraines, fatigue, and many others – a little something for both younger and older women, and men, too. This myth is actually a new variant of an old idea from alternative medicine known as adrenal fatigue. In adrenal fatigue, the adrenal glands are called on to produce more and more of the stress hormone cortisol and eventually become exhausted. However, adrenal fatigue wasn’t true before gluten sensitivity came along, and it still isn’t true now.

    But isn’t avoiding gluten just good sense?

    To some, gluten-free dieting has its own sort of logic: since humans cannot fully digest gluten, and since modern wheat has been bred to have a high gluten content, then eating less wheat brings us back to the way things should be. But while longing for a low-gluten past may be a lovely bit of nostalgia, that’s all it is. Most people have no medical reason to avoid gluten, and no one has actually shown that the hybridization of modern wheat has led to a rise in any illness.

    In fact, it is even wrong to think that the gluten content of wheat has been deliberately altered over the past several thousand years. [11] And true, many products today like supermarket breads contain an added gluten powder called vital gluten, and our consumption of vital gluten has tripled since 1977; however, this added gluten is still less than one-tenth of the overall gluten intake for most people. [11]

    Despite wheat getting a bad rap today because of gluten (and earlier this century because of the high glycemic index of many foods based on white flour), there are actually health benefits to eating wheat – and possibly even gluten! Before you go gluten free by choice, take a look at some of wheat’s virtues:

    • Wheat contains a type of carb known as fructans, and one of these is the inulin that you’ll see listed in the ingredients of high fiber or prebiotic processed foods. Fructans help to support certain beneficial bacteria in the gut, which may in turn protect us against some cancers, some inflammatory conditions, and cardiovascular disease. [12] On the down side, fructans can make you gassy and bloated, but remember not to blame gluten for this.
    • Whole grains lower blood pressure, reduce the risk of type 2 diabetes, lower total and LDL cholesterol levels, and decrease the serum concentration of C-reactive protein, a marker of low grade inflammation. [13-15] Whole grains contain fiber, vitamins, minerals, and phytochemicals, but we don’t know which of these (or which combination) is responsible for their protective effects [14]; this makes it difficult to come up with a good substitute for whole grains, and whole wheat figures prominently into many whole grain foods.
    • Gluten itself may indirectly help boost the immune system and lower blood pressure. [12]

    All things considered, a gluten-free diet is not really necessary for healthy people and may actually be detrimental.

    Conclusion

    Gluten myths seem to persist because of gluten’s association with carbohydrates – avoiding wheat to avoid gluten can also alleviate certain problems that are aggravated by carbs, giving the false impression that gluten is to blame. Don’t throw the baby out with the bathwater: for otherwise healthy individuals, a healthy, balanced diet will always be better than one that eliminates a staple food or an entire food group. If you do have health concerns, don’t go it alone. Speak with a doctor or a registered dietitian.

    Last updated July 9, 2015

    © 2014 Anna (Laurie) Laforest. All rights reserved.
    Photo © Can Stock Photo Inc.
    FoodConnections.org – Food intolerance resource with a scientific twist

    References

    1. O’Neil C, Keast D, Fulgoni V, Nicklas T. Food Sources of Energy and Nutrients among Adults in the US: NHANES 2003–2006. Nutrients. 2012 Dec 19;4(12):2097–120. http://dx.doi.org/10.3390/nu4122097

    2. Blackburn GL, Phillips JC, Morreale S. Physician’s guide to popular low-carbohydrate weight-loss diets. Cleveland Clinic journal of medicine. 2001;68(9):761–761.

    3. Thompson T. Folate, iron, and dietary fiber contents of the gluten-free diet. J Am Diet Assoc. 2000 Nov;100(11):1389–96. http://dx.doi.org/10.1016/S0002-8223(00)00386-2

    4. Shepherd SJ, Gibson PR. Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet. 2013 Aug;26(4):349–58. http://dx.doi.org/10.1111/jhn.12018

    5. Burris J, Rietkerk W, Woolf K. Acne: The Role of Medical Nutrition Therapy. Journal of the Academy of Nutrition and Dietetics. 2013 Mar;113(3):416–30. http://dx.doi.org/10.1016/j.jand.2012.11.016

    6. Melnik BC, Schmitz G. Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Experimental Dermatology. 2009 Oct;18(10):833–41. http://dx.doi.org/10.1111/j.1600-0625.2009.00924.x

    7. Hwang S, Schwartz RA. Keratosis pilaris: A common follicular hyperkeratosis. Cutis. 2008;82(3):177–80.

    8. Alai AN, Elston DM. Keratosis Pilaris Treatment & Management [Internet]. Medscape. [cited 2014 Jun 12]. Available from: http://emedicine.medscape.com/article/1070651-overview

    9. Yosipovitch G, Mevorah B, Mashiach J, Chan YH, David M. High body mass index, dry scaly leg skin and atopic conditions are highly associated with keratosis pilaris. Dermatology (Basel). 2000;201(1):34–6.

    10. Yosipovitch G, Hodak E, Vardi P, Shraga I, Karp M, Sprecher E, et al. The prevalence of cutaneous manifestations in IDDM patients and their association with diabetes risk factors and microvascular complications. Diabetes care. 1998;21(4):506–9.

    11. Kasarda DD. Can an Increase in Celiac Disease Be Attributed to an Increase in the Gluten Content of Wheat as a Consequence of Wheat Breeding? Journal of Agricultural and Food Chemistry. 2013 Feb 13;61(6):1155–9. http://dx.doi.org/10.1021/jf305122s

    12. Gaesser GA, Angadi SS. Gluten-Free Diet: Imprudent Dietary Advice for the General Population? Journal of the Academy of Nutrition and Dietetics. 2012 Sep;112(9):1330–3. http://dx.doi.org/10.1016/j.jand.2012.06.009

    13. Brouns FJPH, van Buul VJ, Shewry PR. Does wheat make us fat and sick? Journal of Cereal Science. 2013 Sep;58(2):209–15. http://dx.doi.org/10.1016/j.jcs.2013.06.002

    14. Belobrajdic DP, Bird AR. The potential role of phytochemicals in wholegrain cereals for the prevention of type-2 diabetes. Nutr J. 2013 May 16;12:62. http://dx.doi.org/10.1186/1475-2891-12-62

    15. Hauner H, Bechthold A, Boeing H, Brönstrup A, Buyken A, Leschik-Bonnet E, et al. Evidence-Based Guideline of the German Nutrition Society: Carbohydrate Intake and Prevention of Nutrition-Related Diseases. Annals of Nutrition and Metabolism. 2012;60(s1):1–58. http://dx.doi.org/10.1159/000335326

    Anna L. Laforest

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  • Beware of elimination diet instructions (Part 1) – Don’t mess with the Big 8!

    Beware of elimination diet instructions (Part 1) – Don’t mess with the Big 8!

    I have mixed emotions whenever I see an article on the Internet that instructs people on using an elimination diet to discover their food sensitivities. Of course, it’s not the idea of an elimination diet that bothers me – I have said many times that a properly done elimination diet and food challenges are the only way to diagnose food intolerance. These articles worry me when they suggest testing for sensitivities to foods that are on the list of Big 8 allergens. Simply put, don’t mess with these foods without consulting your doctor.

    The Big 8 foods account for 90% of the food allergies in the US. (Interestingly, the most common food allergens vary by country.) The Big 8 foods are milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soybean. Other notable allergens include buckwheat, sesame, celery, mustard, and even corn. Fruits can also cause allergic reactions, and, quite frankly, it is possible to be allergic to any food, even if it isn’t commonly thought of as an allergen. Deadly anaphylactic reactions in adults are most often caused by peanuts, but any allergen can lead to a life-threatening reaction, even when your previous reactions were mild.

    Adult-onset allergies

    Did you know that it is possible for adults to develop food allergies after a lifetime of being able to eat anything? Allergies can start at any age, and adult-onset food allergies come with an increased risk for severe reactions.

    Recently, doctors from Northwestern University [1] wanted to learn more about adult-onset food allergies, so they looked at the medical records of 1,111 patients from their allergy clinics. Fifteen percent of these patients were newly diagnosed as adults. In this group, the average age of onset was 31 years old, and 64% of patients were women. Shellfish and fish were the most common allergens, but all of the major allergens were represented.

    If you think that you may have experienced an allergic reaction to a food in the past – even something as small as tingling in the mouth or a delayed reaction – ask your doctor for help in ruling out food allergies. For each person, the minimum amount of allergen required to produce a reaction is different. While the minimum amount for some foods is generally small (think peanuts), others often require larger amounts. When you ‘challenge’ yourself with a food to see whether you have a reaction, you don’t want to get into trouble by eating a large amount of something you wouldn’t normally eat. Even if your doctor allows you to do the food challenges on your own, it’s better to have asked than to be sorry later.

    You might wonder why certain Internet MDs and nutritionists are giving out bad advice on testing for sensitivities to these allergenic foods. Unfortunately, they are basing their advice on misinformation from the alternative medicine community. Alternative medicine will have you believe that there is a lower grade of allergic reaction – originally referred to as food intolerance but now most often called a ‘sensitivity’ – that occurs when your IgG antibodies try to protect you from harmful foods. (A different antibody, IgE, is responsible for true allergic reactions.) As the story goes, IgG-based symptoms are delayed but never deadly. The truth is, these reactions don’t exist, and IgG antibodies are present in all of us as a sign that we can tolerate the foods that we commonly eat, like wheat, milk, eggs, soy, etc. Don’t mistake your mild but true allergic reactions for one of these ‘sensitivities.’ Even though food allergies often diminish over time, they will never cross over into a food sensitivity.

    For more information on the common foods that produce allergic reactions (and for some interesting reading, too), check out these websites:

    Stay tuned for a second article on this topic, where I will discuss the other conditions associated with these food allergens that you should talk to your doctor about.

    Last updated September 25, 2015

    © 2014 Anna (Laurie) Laforest. All rights reserved.
    Photo © Can Stock Photo Inc.
    FoodConnections.org – The skeptic’s guide to food intolerance

    References

    1. Kamdar TA, Peterson S, Lau CH, Saltoun CA, Gupta RS, Bryce PJ. Prevalence and characteristics of adult-onset food allergy. The Journal of Allergy and Clinical Immunology: In Practice. 2015 Jan;3(1):114–115.e1.

    Anna L. Laforest

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  • Doctors’ positions on food intolerance blood tests

    Doctors’ positions on food intolerance blood tests

    Food intolerance blood tests measure a person’s levels of IgG antibodies to a wide variety of foods, but IgG antibodies do not have any proven link to illness. At best, these blood tests are a waste of money; at worst, they can lead to poor or even dangerous health decisions.

    More information: Myths used to justify food intolerance blood tests

    Despite their inherent ineffectiveness, IgG food intolerance tests have spread to the pharmacy and the doctor’s office, making it hard for the average patient to know where to turn for reliable information. To protect the public, professional medical associations in many countries asked the best minds in immunology to prepare position statements warning against these tests. Let’s take a look at some of the main points from these warnings in plain English.

    From the Australasian Society of Clinical Immunology and Allergy [1]:

    “IgG antibodies to food are commonly detectable in healthy adult patients and children, independent of the presence or absence of food-related symptoms. There is no credible evidence that measuring IgG antibodies is useful for diagnosing food allergy or intolerance, nor that IgG antibodies cause symptoms. In fact, IgG antibodies reflect exposure to allergen but not the presence of disease.” (full text)

    What it means:

    The most important thing to remember is that everyone produces IgG antibodies to food. The concentration of IgG antibodies in your blood depends on your genes, your diet, and maybe even on how you were fed as an infant [2]. There is simply no ‘correct’ IgG level. This means that a healthy person could get the same diet recommendations from an IgG blood test as a person with symptoms.

    Looking at the entire body of available evidence, there is no correlation, let alone a causal link, between IgG antibodies and symptoms. In fact, using IgG test results to identify problem foods is no more successful than flipping a coin.

    From the European Academy of Allergy and Clinical Immunology [2]:

    “Food-specific IgG4 does not indicate (imminent) food allergy or intolerance, but rather a physiological response of the immune system after exposition to food components. Therefore, testing of IgG4 to foods is considered as irrelevant for the laboratory work-up of food allergy or intolerance and should not be performed in case of food-related complaints.” (full text)

    What it means:

    You might think that not being allergic to a food – in other words, being “tolerant” to that food – means that your immune system ignores it. Sometimes that happens, but tolerance is often an active process. Regulatory T cells keep the immune system from reacting to potential food allergens, and it is these cells that call in the IgG antibodies by secreting an anti-inflammatory messenger chemical known as IL-10. IgG antibodies are not the sign or cause of anything bad, but rather a sign that a person has eaten and has tolerated a certain food. IgG antibodies have nothing to do with food intolerance.

    From the Canadian Society of Allergy and Clinical Immunology [3]

    “The test is also being marketed to concerned parents, and may lead to exclusion diets which carry risks of poor growth and malnutrition for their children: for example, the elimination of dairy products, wheat, eggs, and/or other foods found in healthy balanced diets.” (full text)

    What it means:

    IgG blood tests often identify between 5 and 20 suspect foods, so the risk of nutritional deficiencies in children is real if too many foods are eliminated without proper medical support. The bigger issue is whether these tests are actually related to the conditions they are purported to treat, namely ADHD and autism spectrum disorder (ASD); let’s take a look at that.

    ADHD. Some artificial colors have been shown to affect behavior in children with ADHD, but this reaction does not involve the immune system, so IgG blood tests are irrelevant for identifying which children might be affected. Other foods have also been shown to aggravate ADHD, but IgG levels could not accurately predict which foods. [4]

    Autism spectrum disorder. Since IgG blood tests do not really detect adverse reactions to foods, it is unlikely that these tests would apply specifically to autism. While there is speculation that a ‘leaky gut’ increases the likelihood that IgG antibodies to wheat and milk proteins will be found in the blood of children with ASD, a much-touted paper on the topic actually showed that IgG levels did not correlate with intestinal permeability [5].

    This doesn’t mean, though, that someone with autism couldn’t also suffer from food intolerance independent of IgG test results. For parents thinking about dietary interventions for autism, it might be helpful to consider the opinion of registered dietitian Zoe Connor, chair of the Dietitians in Autism group within the British Dietetic Association [6]:

    “…[A]lthough there is insufficient evidence to recommend the use of any diet as a treatment for ASD, dietitians and other health professionals should provide support when an individual or their parents choose to try dietary changes. There are too many reports of children with ASD improving in behaviour and/or bowel habits after eliminating some foods for them to be discounted. However, the mechanism for this (until proven otherwise) is likely to be the same as for any general food intolerance, rather than any specific disorder that is particular to ASD, and so each case should be considered individually. For example, bowel problems such as diarrhoea or constipation can sometimes be caused by food intolerances, so individuals suffering from these might benefit from trying different food exclusions (medical causes should first be investigated by a doctor).” (p. 66)

    From the American Academy of Allergy Asthma and Immunology [7]

    “Additionally, and perhaps of greater potential concern, a person with a true immunoglobulin E (IgE)-mediated food allergy, who is at significant risk for life-threatening anaphylaxis, may very well not have elevated levels of specific IgG to their particular allergen, and may be inappropriately advised to reintroduce this potentially deadly item into their diet.” (full text)

    What it means:

    In true food allergies, IgE antibodies bind with allergen proteins to cause chemicals, like histamine, to be released in the body and trigger symptoms. IgG antibodies are not interchangable with IgE antibodies, and IgG blood tests do not detect food allergies.

    We most often think of food allergies as beginning in childhood, but adults can also develop allergies at any time. Perhaps an old allergy returns, perhaps a mild allergy was there in the background all along, or perhaps the allergy is completely new. New allergies to pollen can also bring on food-related symptoms in the form of oral allergy syndrome. Adult food allergies must be taken seriously, because the risk for severe reactions becomes greater the later they develop [8].

    Approaching food sensitivities the right way

    The EAACI position statement [1] mentions another vulnerable market for food intolerance blood tests – people who see their doctor for a suspected food sensitivity that turns out not to be an allergy but cannot be explained. The doctor dismisses their symptoms, but not their suspicions of food. Feeling let down, they go outside the medical community for care or advice – which is understandable, but never the wise thing to do.

    In a case like this, the safest thing is to get a doctor’s referral to see a registered dietitian and discuss doing a diet investigation. Alternative medicine may use rhetoric about ‘hidden food intolerances,’ but a knowledgable dietitian can use your personal history and diet log to guide you through the elimination diet and food challenges that check for food intolerance. In actuality, there is nothing ‘hidden’ about food intolerance, and there is no need to resort to blood tests to find your food sensitivities.

    Last updated September 25, 2015

    © 2014 Anna (Laurie) Laforest. All rights reserved.
    Photo © Can Stock Photo Inc.
    FoodConnections.org – The skeptic’s guide to food intolerance

    References

    1. Australasian Society of Clinical Immunology and Allergy. Unorthodox Techniques for the Diagnosis and Treatment of allergy, Asthma and Immune Disorders – ASCIA Position Statement [Internet]. 2007 [cited 2014 Mar 10]. Available from: http://www.allergy.org.au/health-professionals/papers/unorthodox-techniques-for-diagnosis-and-treatment (Archived by WebCite® at http://www.webcitation.org/6OjZpQGNt).

    2. Stapel SO, Asero R, Ballmer-Weber BK, Knol EF, Strobel S, Vieths S, et al. Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report. Allergy. 2008;63(7):793–6. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2008.01705.x/abstract (Archived by WebCite® at http://www.webcitation.org/6OjZbB9va).

    3. Carr S, Chan E, Lavine E, Moote W. CSACI Position statement on the testing of food-specific IgG. Allergy Asthma Clin Immunol. 2012 Jul 26;8(1):12. Available from: http://www.aacijournal.com/content/8/1/12 (Archived by WebCite® at http://www.webcitation.org/6OjZmUPVA).

    4. Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Dubois AE, Pereira RR, et al. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. The Lancet. 2011;377(9764):494–503.

    5. De Magistris L, Picardi A, Siniscalco D, Riccio MP, Sapone A, Cariello R, et al. Antibodies against Food Antigens in Patients with Autistic Spectrum Disorders. BioMed Research International. 2013;2013:1–11.

    6. Connor Z, Autism and autistic spectrum disorders. In: Skypala I, Venter C, editors. Food Hypersensitivity: Diagnosing and Managing Food Allergies and Intolerance. John Wiley & Sons; 2009. p. 63-68.

    7. Bock SA. AAAAI support of the EAACI Position Paper on IgG4. Journal of Allergy and Clinical Immunology. 2010 Jun;125(6):1410. Available from: http://www.jacionline.org/article/S0091-6749(10)00512-9/fulltext (Archived by WebCite® at http://www.webcitation.org/6OjZkm9m9).

    8. Kamdar TA, Peterson S, Lau CH, Saltoun CA, Gupta RS, Bryce PJ. Prevalence and characteristics of adult-onset food allergy. The Journal of Allergy and Clinical Immunology: In Practice. 2015 Jan;3(1):114–115.e1.

    Anna L. Laforest

    , , , , ,

  • Dr. Oz and how not to investigate your diet

    Dr. Oz and how not to investigate your diet

    Non-celiac gluten sensitivity is not the same as food intolerance: gluten sensitivity may turn out to be a type of immune system reaction, while food intolerance is a non-allergic sensitivity to food chemicals. They do share one thing, though: the only proper way to diagnose them is through an elimination diet and food challenges.

    Elimination diets and food challenges are not rocket science, but they do need to be done right. Here, I’d like to give you an example of how to do them WRONG. This comes from an episode of The Dr. Oz Show, in a segment titled “The New Warning Signs for Gluten Sensitivity.” Let’s look at why Dr. Oz’s advice is not a good way to go about investigating your diet.

    “The New Warning Signs for Gluten Sensitivity”

    In this episode, Dr. Oz warns that anyone who experiences migraine, brain fog, depression, joint pain, arthritis, or skin rashes could actually be suffering from gluten sensitivity (1).  His guest, Dr. Amy Myers, agrees.

    Dr. Myers is introduced as a specialist in functional medicine, which means that she is a licensed MD who practices alternative medicine. This is far from the first time that “America’s doctor” has promoted alternative medicine on his show; there are many good articles out there on his mixture of scientific and non-scientific beliefs – search on his name at Science-Based Medicine for more than a few – so I’m not going to get into that here. But I will say that much of what is said on his show should be taken with a grain of salt, including Dr. Myers’ thoughts on the prevalence of gluten sensitivity.

    Dr. Myers first states that gluten sensitivity affects 18 million people in the US. She doesn’t explain this, but this figure corresponds to 6% of the US population, which is what some quote as the maximum possible prevalence for non-celiac gluten sensitivity (2). She then states that her personal suspicion is that 1 out of 2 people have gluten sensitivity, but this goes directly against what the researchers who originated the disorder think. She and Dr. Oz then tell us that people who suspect gluten sensitivity can do a gluten-free trial at home.

    What’s wrong here?

    The first problem with Dr. Oz’s advice is a matter of motivation. How likely is it that someone has gluten sensitivity? If the prevalence is 6%, then gluten sensitivity is a problem of similar size to food intolerance, but it’s not that likely for people who suffer from migraine, brain fog, depression, joint pain, or rashes – which are fairly common problems – to have gluten sensitivity. If the prevalence is 50%, as is presented on the show, then it’s quite a different story – you’d be crazy not to go gluten-free, right? And you might think, “Well, it’s only a two week diet. It won’t hurt and it might help.” But it could hurt, and it’s important to get it right.

    Even for people who do have a deep suspicion that their symptoms are related to food, it is hard to know exactly which food or foods are causing the problem because we don’t eat single ingredients all day long. This leads me to the second problem with Dr. Oz’s advice – he doesn’t explain that an elimination diet and food challenges must be done in a systematic way.

    More information: Diagnosing food intolerance

    Theoretically, you could just remove one food from your diet and keep the rest of your diet entirely the same. But this is difficult, if not impossible, to do in reality, especially with a foundation food like wheat. For example, if you stop eating pasta, you will probably also stop eating tomato sauce, and if you stop eating bread, you might also stop eating jam. You might still eat tomatoes and you might eat fruit, but tomato sauce and jam are concentrated versions of these foods and more likely to cause food intolerance. (3) Or you might inadvertently cut down on sugar and carbs or dairy or some other common trigger. (In fact, there is an idea floating around that high-sugar diets can lead to the same health effects as described by Dr. Oz.) So, if you started a two week gluten-free diet and felt better, could you really blame gluten for your symptoms? No.

    All you can conclude from a poorly-done elimination diet is that your symptoms might be caused by something in your usual diet. Food challenges are the necessary second step to determine whether a specific food is causing your symptoms. After your symptoms subside, you must try eating that food again (the ‘challenge’) – if your symptoms return, then you can blame that food. But the food challenge is not as simple as it sounds, and you should be working with a doctor or dietitian on this. First, you should challenge with every food or trigger chemical that you excluded during the elimination diet phase – which, as I said, will probably include more substances than just gluten. Second, you should not only test yourself with the foods in question but also with a placebo. In an informal setting, a placebo could be any meal for which you do not know the ingredients (of course, you need to be working with someone else to pull this off). As you can see, coming up with the right foods or meals to challenge with does take some research and planning.

    More information: Common food triggers

    The placebo test is important to make sure that you find the truth and not just what you expect to find. In some cases, a doctor or dietitian might omit this step, especially in open challenges where it is obvious which food is being tested; however, the placebo effect could be significant for someone who goes into the process believing that they have a 50/50 chance of being sensitive to gluten. On top of this, specialists think that for patients with subjective symptoms (symptoms that can’t be measured by a third-party, like headache, brain fog, etc.), the food challenge and placebo tests should be repeated three times each, with a sufficient ‘wash out’ or break period in between, in order to get the best results.

    So far I have been talking about avoiding results that are false positives – that is, thinking that you have gluten sensitivity when you don’t. It is also conceivable that you could get a false negative result, where you really are sensitive to gluten but your symptoms didn’t go away during the elimination diet. One way this could happen is if you also have a food intolerance – either you kept eating other foods that contributed to your symptoms or you added more of them to your diet through gluten substitutes. For example, sweet potato flour, sesame seeds, coconut flour, fava bean flour (and ‘garfava flour’), and almond flour are reported to be high in salicylate and/or amines. Most other grains and substitutes are not. Something similar could happen if you also suffer from a food allergy that you don’t know about (many gluten sensitive people also report food allergies). In order to avoid false negatives, the elimination diet should remove as many possible allergens or trigger chemicals as possible.

    The price for getting it wrong

    Those who suffer from celiac disease must to be extremely careful to avoid even trace amounts of gluten or else risk serious complications. This is a hard life to lead, to say the least, and not something to get into unnecessarily just because we are in the middle of a gluten-free fad. People on gluten-free diets also have problems meeting certain nutritional requirements, such as for folate and fiber. Doctors do not yet know whether gluten-sensitive people would need to follow the same level of adherence to a gluten-free diet as celiac suffers do.

    Health problems should be approached more carefully than a 10 minute TV segment can convey. Doctors diagnose people with gluten sensitivity by ruling out all other causes and by looking at several different gastrointestinal test results that are easiest to interpret before you go gluten free. Self-diagnosis is dangerous because you can miss a serious medical problem; you also do yourself a disservice if you do have gluten sensitivity, because a doctor could provide you with ongoing advice as new risk factors, diagnostics, and treatments are discovered in this active area of research. You’ve waited long enough to sort out your symptoms – find a medical professional to help you get it right the first time.

    Last updated March 4, 2015

    © 2013-15 Anna (Laurie) Laforest. All rights reserved.
    Photo © Can Stock Photo Inc.
    FoodConnections.org – Food intolerance resource with a scientific twist

    References

    1. The New Warning Signs for Gluten Sensitivity [Internet]. The Dr. Oz Show. 2013 [cited 2013 Dec 27]. Available from: http://www.doctoroz.com/episode/gluten-warning-signs-next-epidemic (Archived by WebCite® at http://www.webcitation.org/6OjaH1MXG).

    2. Catassi C, Bai J, Bonaz B, Bouma G, Calabrò A, Carroccio A, et al. Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders. Nutrients. 2013 Sep 26;5(10):3839–53.

    3. Swain A. The role of natural salicylates in food intolerance [PhD Dissertation]. University of Sydney; 1988. Available from: http://www.sswahs.nsw.gov.au/rpa/allergy/research/students/1988/AnneSwainPhDThesis.pdf

    Anna L. Laforest

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