This week’s question comes from a cooking class I held in April. Two of the guests wanted to understand why all of my recipes are gluten-free. They both suspected they might be gluten intolerant but had received a negative biopsy for celiac’s disease. They both thought that definitively ruled out a problem with gluten. While many doctors still believe this, there is a growing body of evidence that shows that non-celiac gluten sensitivity (NCGS) is real and far more widespread than initially understood.
In fact, everyone may have it. Some specialists feel strongly that gluten – and the other proteins in wheat – are toxic to everyone. This is the premise behind this TedX talk by Dr. Rodney Ford, MB., BS., MD., FRACP, a pioneer in the field of pediatric food allergies. He shares a hypothesis he developed while working with sick children. He observed that all of the sick children improved substantially when gluten and wheat were removed from their diets.
There are other specialists that agree with this premise. You may have heard of them. William Davis, M.D., wrote Wheat Belly, in which he shares from decades of clinical studies removing gluten and wheat from the diets of thousands of patients. His observed and postulates that removing wheat causes:
- Weight loss of 20, 30, even 50 pounds in the first few months
- Alleviation of metabolic syndrome and type 2 diabetes
- Recovery from intestinal woes, like ulcerative colitis and celiac disease
- Marked improvement in overall cholesterol and LDL counts
- Improvement in bone density and reversal of osteoporosis
- Cessation of skin conditions from psoriasis to oral ulcers and hair loss
- Reduction of inflammation and rheumatoid arthritis pain
For a more complete understanding of Davis’ studies on wheat you can watch an excellent presentation here.
You may also have heard of Grain Brain, Dr. Perlmutter’s bestseller book about the devastating effects of gluten, sugar, and carbs on the brain and body. When it was released, this idea was novel and went against a lot of dogma, but in a recent blog post, Perlmutter references this 2017 study wherein non-celiac gluten sensitivity is validated and stated to be "common."
In Grain Brain, Perlmutter, M.D., describes how even “healthy” carbs like whole grains can cause dementia, ADHD, anxiety, chronic headaches, depression, and much more. He explains that our brains thrive on fat and cholesterol, and how you can spur the growth of new brain cells at any age by simply changing your eating habits.
For an excellent interview with Perlmutter on this issue go here. In it he shares shocking data that Alzheimer’s drugs actually speed the decline of the disease and proposes a healthier and safer option.
Some specialists say it shouldn’t necessarily be labeled non-celiac gluten sensitivity but also wheat sensitivity. For an excellent discussion on why, you can go here. In this talk, we learn that NCGS/NCWS is five times more prevalent in women than men, typically diagnosed in the 30s or 40s, and there’s a delay of hours to days between ingesting the gluten and experiencing the symptoms. (You may remember from last week’s article that means it’s a sensitivity, not a true allergy.) We also learn many of these patients already have known lactose sensitivity and/or an irritable bowel diagnosis. They usually suffer from intestinal symptoms like bloating or belly pain, nausea, diarrhea, constipation, reflux, vomiting, bowel habit problems, or unexplained weight loss. Sometimes, they also have a general lack of well being, headaches, brain fog, depression, hyperactivity, neurological symptoms, rashes, psychiatric disorders, numbness and tingling in extremities, bone and muscle and joint pain, horrible migraines, and fibromyalgia. Many of these people have families with a history of food allergies and/or eczema and/or asthma. We also learn NCGS/NCWS can be related to SIBO (an overgrowth of bacteria in the small intestine).
The doctor goes on to explain that not everyone who avoids gluten improves. Many do, but others improve more when they remove wheat altogether because of other proteins in wheat that are part of the sensitivity. Others need to remove all grains and go on a paleo or ketogenic diet to get amelioration of symptoms. This has been the bulk of my clinical experience. What is known for certain is that celiac’s disease and NCGS/NCWS over time result in leaky gut syndrome, which exponentially increases the foods we become sensitive to while simultaneously reducing the ability of the intestines to absorb nutrients from foods. This creates systemic inflammation and auto-immune conditions when left unchecked.
Other people question whether the problem is not the wheat but how the wheat is grown today. The list of chemicals that are dumped on wheat crops are frightening indeed. To better understand this issue, I suggest watching this great TedX talk by nutritionist Cyndi O’Meara.
These disorders (CD, NCGS/NCWS) can develop at any point in our life. For a list of the over 200 symptoms known to be related to Celiac’s Disease, go here.
Some studies now suggest 30 per cent of us may be gluten reactive and all of us may have some degree of sensitivity to gluten. According to Perlmutter, “It is likely that 100 per cent of humans activate zonulin when exposed to gluten, and this increases gut permeability. This is thought to play an important role in autoimmunity.”
I’ve seen many people fail the celiac test, yet develop symptoms when they consume foods that contain gluten. They may or may not be better on a gluten-free diet, as there are often other sensitivities at play. In such a case, removing the wheat/ gluten would improve their state mildly, but inconsistently, because other foods are still triggering them. This often happens when processed ‘"gluten-free" foods are used for removing gluten from the diet. They are full of low quality fats and refined starches that often will also trigger the inflammatory symptoms. The person mistakenly concludes the work to remove the gluten isn’t worth it and often stops there.
When recommending a gluten-free protocol, I never recommend "gluten-free" processed foods. Stay away from this cardboard dressed as food! These are highly processed grain/ lentil/ potato/ corn based substitutes – all of which are high glycemic, often inflammatory, and not particularly nutritive. In the gluten intolerant person, the body needs to be super saturated with easily absorbed nutrients to heal damaged tissues, and that can’t happen with such subpar foods. I recommend a whole food, low carbohydrate, ancestral diet, rich in probiotic foods, as I do for almost all ailments. It’s not glamorous and requires cooking your food at home, but this is again and again what I find to work.
But what if the problem is all the proteins in wheat, not just gluten? Removing gluten would not stop the symptoms. What if the problem is a sensitivity to a combination of gluten, sugar, and dairy or a leaky gut that has created multiple food sensitivities? In that case removing gluten would not make the condition much better. Only removing all of the offending foods would bring amelioration.
This is why it’s essential to see a professional nutritionist for guidance to remove all possible sources of wheat and gluten and to do a full assessment and screening for other intolerances. A nutritionist is also the best person to help you address the likely underlying gut biome issues.
The gold standard to determining this sort of sensitivity is to remove the foods entirely while also removing the foods that are known to be common co-sensitivities like dairy. For some, only a grain free, ketogenic diet really works. It’s important to note that typical allergy skin prick/scratch testing is not effective at determining food intolerances, in my clinical experience. Hair testing and strict elimination diets are effective, with one being obviously much more time and energy consuming than the other.
Just to recap, some of the symptoms non-celiac gluten/wheat sensitivity include:
- Headaches and migraines
- Fatigue and sleep problems
- Irritability and mood swings
- Psychosis and thinking problems, including schizophrenia and bipolar disorder
- Chronic inflammation of the joints
- Autoimmune disorders
- Thyroid disorders
So to summarize, I believe gluten intolerance is far more prevalent than we have been led to believe and many people who have not been diagnosed as having celiac improve greatly when put on a professionally managed gluten-free/wheat-free/grain-free diet. I think it’s an epidemic problem and most people benefit from removing grains from their diet because grains are full of innately inflammatory proteins, so even if a person isn’t intolerant per se, these anti-nutrients are not an optimal food for human consumption.
The internet has an abundance of great recipe sites dedicated to grain and gluten free eating, so it’s actually really easy to find great recipes. One of my favourite sites is Against All Grain by Danielle Walker. She has many great, free recipes listed there and her cookbooks are wonderful!
I hope this is helpful! As always, if readers have their own health questions, I welcome them. Just send me an email at firstname.lastname@example.org. If you want to read more of my articles, you can do so at Ask the Nutritionist.