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Thursday, May 22, 2014

Gluten May Not Be Viable Option for New Method of Execution

We all know at least one of them. You know the person I’m talking about – the “I have the biggest gluten sensitivity and ever since I went gluten free, I feel SO much better” person.  They usually go on to share a delightful array of bathroom related anecdotes and narratives to support their newly discovered hatred for a loaf of Iron Kids.  Being the glutton for confrontation and gluten that I am (a gluten glutton…..that sounds nice), the first thing that flies out of my big mouth is, “Oh, so you’ve been diagnosed with celiac disease by your doctor? I’m sorry to hear that!”   Would you be shocked if they hadn’t in fact been diagnosed with Celiac disease, seen an allergist or gastroenterologist, or even mentioned something to their primary care physician about it?  I’m sure not.

It seems that in today’s society full of WebMD-self-diagnosing-hypochondriacs, gluten, a composite protein found predominantly in wheat, barley and rye, is all the rage. Celiac disease, a hereditary autoimmune condition of the small intestine triggered by eating gluten, makes the Top 50 most searched diseases on Google ….nestled right below gonorrhea and ovarian cancer.   Let’s be clear – Celiac disease is a very real problem for people unlucky enough to be affected by the disease and its symptoms (it appears that ≈ 50% are asymptomatic) which include bloating, pain, chronic diarrhea, vomiting, pale & foul smelling stools, fatigue, idiopathic iron-deficiency anemia, and arthritis, to name a few.

A recent article by Business Insider’s Jennifer Welsh points out that, although the true prevalence of Celiac disease in the US is around 1%, 18% of adults now buy gluten-free foods and 30% of people want to eat less gluten…and they’re willing to pay big for it; sales of gluten-free products are expected to reach $15 billion by 2016.

You can now buy sparkling water that has been genetically modified to remove the gluten. Thanks, R.W. Knudsen.

So, what’s the deal with all the bread boycotting? It turns out that a study was published in 2011 which provided seemingly sound evidence that gluten caused “gastrointestinal distress” in patients who did not suffer from true Celiac disease. This was termed non-celiac gluten sensitivity, aka gluten intolerance, and may have led to a large volume of self-diagnoses and diet modifications.

However, as any good researcher and true disciple of evidence based medicine knows, an experiment must be repeatable in order for one to make sound decisions based on the data which the experiment has produced.  The lead researcher, Professor Peter Gibson of the Alfred Hospital in Melbourne, Australia, decided to conduct another experiment. This time, he enrolled 37 patients who all reported that consuming a gluten-free diet relieved their gastrointestinal distress symptoms but were NOT suffers of the true autoimmune Celiac disease.  After enrollment, the patients were given a baseline diet that cycled through 3 different diets for a week in length and, most importantly, the patients had no knowledge of which diet they were consuming at any particular time (aka blinding).  Treatments consisted of one diet containing a large amount of added gluten, one containing a lower amount of gluten and whey protein, and one containing only whey protein. Each patient consumed all three diets over the course of the experiment to balance for the individual effect of each patient, regardless of which treatment diet they were consuming.  As a follow up, they also enrolled 22 of the original 37 patients on a similar study where they consumed another high gluten diet, whey protein only, or the original baseline diet in the same experimental design as the first, except for a period of only 3 days on each diet. 

The results of the 2 new trials?  “In contrast to our first study, we could find no specific response to gluten,” Gibson wrote.  Specifically, regardless of the diet the patients were on, they reported worsening GI symptoms (nausea, pain, bloating, and gas) and to relatively similar degrees.  The most interesting find came from the secondary trial in which patients reported worsening symptoms when the baseline diet was used as the control. Let’s put that in slightly less Big Bang Theory-esque terms: They reported that their symptoms worsened when absolutely nothing changed about their diet.  So, what gives?

Well, the researchers believe that the results were mostly a function of nothing but the good ol' human brain, in all its glory, and what is called a “nocebo” effect.  In other words, the patients thought they were going to feel bad, so they did. The researchers, however, did grant that there could be other factors that are yet to be elucidated at play in non-celiac gluten sensitivity, perhaps poorly absorbed short chain carbohydrates  (FODMAPs), but for now, it seems gluten is not a causative factor.  Might be time to rename that, eh?

As for the army of bread-bashing-bandwagon-hoppers out there, aside from the scientist in me who gets annoyed about every item you can buy at a grocery store that’s supposedly killing us all (unless the grocery store has the initials W.F., then you’re good), it upsets and perplexes me when I hear non-Celiac suffers brag about how their newly found life elixir is solely attributable to a wheat withdraw. The people I know who actually do have Celiac disease would like nothing more than to eat a non-cardboard crust pizza and wash it down with a frosty mug of Boulevard Wheat. 

For now, this data seems to support my hypothesis (and bias belief) that there is a large group of scone scorners out there that are full of a lot more than rice cakes, and personally, I think common sense goes a long way with most things at the intersection of food and health. If, for example, your daily habits include going Adam Richman on a baker’s dozen from the local hipster donut shop and you aren't an Ironman athlete, you’re going to have a bad time.  If something is really wrong, talk to your physician sooner rather than later and don’t rely on Bev, your dog walker’s, uncle’s, ex-wife whose only qualification is that she looks great in a cocktail dress at age 48, for life changing medical advice. For most people who would like to make a change of some sort, enlisting the help of our long lost friend, moderation, is likely a good place to start.


Gluten Glutton

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