Jump to content



Celiac.com Sponsor (A1):



Celiac.com Sponsor (A1-m):


  • You've found your Celiac Tribe! Join our like-minded, private community and share your story, get encouragement and connect with others.

    💬

    • Sign In
    • Sign Up
  • Dr. Ron Hoggan, Ed.D.
    Dr. Ron Hoggan, Ed.D.

    The Many Benefits of a Gluten-Free Diet

    Reviewed and edited by a celiac disease expert.

    Journal of Gluten Sensitivity Winter 2012 Issue

    The Many Benefits of a Gluten-Free Diet - Image: CC--Tim Evanson
    Caption: Image: CC--Tim Evanson

    Celiac.com 03/16/2018 - Celiac awareness has increased exponentially over the last decade among physicians and the general public alike. Increasing numbers of research publications and very active support groups and individuals have contributed to this growing awareness.  Knowledge of the many and varied manifestations is also growing rapidly although some individuals continue to cling to the notion that celiac disease is characterized by malabsorption and that nutrient deficiency is the dominant feature of this ailment. This misses the broader understanding of the many ways in which gluten grains negatively impact on human health. From toes to head, any and all of our human body systems may be harmed by ingesting gluten under some circumstances. Although the wide range of signs and symptoms of celiac disease is impressive, a similar, even broader range of impacts may be attributed to gluten in the context of non-celiac gluten sensitivity. Those with celiac disease only comprise a small portion of the population of people who are afflicted by non celiac gluten sensitivity. Dr. Rodney Ford has offered the all encompassing term of 'gluten syndrome' to identify everyone whose health is compromised by gluten consumption (1). 

    From Dr. Fasano's most conservative estimate that 6% of the population is afflicted by non-celiac gluten sensitivity (2), to Dr. Rodney Ford's estimate that 10% is afflicted (3), to Dr. Kenneth Fine's finding that IgG class anti-gliadin antibodies are found in about 11% of the population (4), to this writer's assertion that non-celiac gluten sensitivity includes well more than 20% of the population, the paucity of research in this area offers a wide range of estimates without a solid basis for refuting any of them. Nonetheless, it is clear that those with non-celiac gluten sensitivity outnumber those with celiac disease by a ratio of somewhere between 6 to 1 and more than 20 to 1. The gluten syndrome may therefore include from seven percent to more than twenty percent of the population. 



    Celiac.com Sponsor (A12):






    Celiac.com Sponsor (A12-m):




    The importance of these percentages and ratios is that we are seeing growth in the diagnosis of celiac disease, and in the number of people who have celiac disease (4). It has been argued that a similar trend may be seen across the spectrum of the gluten syndrome, attributing that trend to the genetic modifications that have been made to grains, and the increased consumption of these foods (5). 

    But this is just the tip of the iceberg. Dr. Fasano bases his estimate of non-celiac gluten sensitivity on those who mount an innate immune reaction to gluten grains. While there is likely some overlap between innate immune reactions and selective antibody reactions, most estimates of non-celiac gluten sensitivity are based on IgG class antibodies against one of the proteins of several protein families found in gluten. It makes eminent sense to me that when our bodies are mounting a measurable immune response against the most common food in our diets, whether the reaction is by the innate immune system or by creating selective antibodies, that food might be harmful to our health. I do not quarrel with the basis on which these sensitivities are identified. I simply argue that they are only identifying a sub-fraction of many more possible cases of non-celiac gluten sensitivity.  

    To put this issue into sharper focus, there are several protein families to be found in each of the gluten grains. In wheat, for instance, each family, glutelin, gliadin, and glutenin contains a number of individual proteins. The antibody test for gliadin ignores possible reactions to proteins in either of the other two families.  Further, IgG class antibodies are the most common and widespread class of selective antibody we produce.  But they form only one of five types of selective antibodies (known as immunoglobulins). Further, as is obvious from Dr. Fasano's conservative approach to identifying non-celiac gluten sensitivity, there are other facets of the immune system that do not involve selective antibodies, and can also be enlisted in a reaction against gluten grains.

    Thus, when we test for IgG anti-gliadin antibodies, the most common test for non-celiac gluten sensitivity, positive results are identifying reactions against only one of the several protein families found in gluten, and only one of the five possible selective antibody reactions against this single protein family. 

    It therefore seems wholly improbable that testing for reactions against a single protein family in only a single class of selective antibody would identify all or even most cases of gluten sensitivity. Admittedly, some researchers test for IgA antibodies but those investigators usually do not test for IgG antibodies. However, even with testing for both classes of selective antibodies, which most published reports on this issue have not done, it is clear that many possible immune reactions to any other protein fractions of gluten might well be overlooked, either in the form of other selective antibodies or as other immune reactions and various innate reactions against gluten grains.

     I'm sure that, by now, the reader will see that there are many possible immune reactions against this most common food, and that most of these reactions will go undetected, both in the context of standard medical testing and in most research conducted in this venue. On a more practical plane, when Dr. Curtis Dohan identified significant improvements among patients with schizophrenia patients eating a gluten-free, dairy-free diet (6), and Singh and Kay replicated their findings (7), many looked for celiac disease among patients with schizophrenia and found only a small increase.

    Dohan and Singh's publications were followed by several sloppy studies that ignored the guiding principles expressed in this pioneering work. These weak studies further undermined acceptance of the connection between gluten and schizophrenia. The net result was a growing belief that Dohan had erred and his heroic work was widely dismissed. Yet, more than twenty years after his death, one of Dohan's most vigorous critics is listed among the authors of a paper that reports an immune reaction against gluten that, while different from the reaction seen in celiac disease, is common among people with schizophrenia (8). 

    Similarly, I think that we can expect, sometime in the future, to see research that identifies immune reactions and damaging dynamics caused by gluten consumption among people with learning disabilities. There is, for instance, one newspaper report of an informal study conducted at the Nunnykirk School in Northumberland, a school that serves only children with dyslexia, a condition that is reported to afflict about 10% of children in the United Kingdom. After six months of eating a gluten free diet, more than 80% of these children improved their reading at a rate of at least twice that of normal children. Some leaped ahead, in their reading skills, by as much as 2.5 years over this six month period (9). 

    Relatedly, I had the privilege of working with Dr. Rodney Ford on a retrospective analysis of indicators of school readiness among children who had celiac disease, non-celiac gluten sensitivity (as measured by selective antibody testing) and children who showed no signs of either reaction to gluten. A large majority of those who reacted to gluten improved dramatically. There was a small but significant sub-group whose school readiness improved following a gluten free diet, and these improvements happened within 6 months of avoiding gluten (unpublished data).

    Autism, especially where normal development was curtailed after one or several years, is another condition in which excluding gluten seems to provide substantial improvements even in the absence of celiac disease. Some research in this area suggests that toxins (generated by bacteria resident in the intestines) are allowed access to the bloodstream and the brain (10). Perhaps exclusion of dietary gluten is the factor that limits access to the bloodstream through reducing zonulin production.   

    Similarly, although not as well supported, there is some evidence to suggest that gluten contributes to bi-polar disorder. Just how frequent and significant the contribution may be is still open to debate, but I have observed some evidence to support this hypothesis in my own family.  

    A range of types of epilepsy have been found in association with celiac disease, many of which are mitigated by the gluten free diet (11). 

    The manifestations of undetected non-celiac gluten sensitivity are not limited to brain function. We know that celiac disease is much more frequent in the context of other autoimmune diseases. We also know that antibody tests show even higher rates of non-celiac gluten sensitivity. Since we are only identifying a fraction of those who may be reacting to gluten, it seems reasonable to suggest that everyone with an autoimmune disease, or antibodies suggesting that an autoimmune disease is imminent, should begin a strict gluten free diet and follow it for at least one year. If there is any reduction of auto-antibodies or symptoms of autoimmunity, the diet should be continued. Although difficult in the early stages, it is an entirely benign intervention/treatment. There are no unwanted side effects or hazards. 

    There are more than 200 autoimmune and other medical conditions reported in association with gluten and are listed in Appendix D of Dangerous Grains (12). In each case, a lengthy trial of a gluten free diet would be well advised. Again, there are no negative side effects of the gluten free diet. It is an entirely benign intervention.

    A significant proportion of those who suffer from IBS, Crohn's or any of the various types of colitis have also been reported to benefit from a gluten free diet on various websites. Similarly, many people with MS and a host of other neurological diseases have been shown to benefit from a gluten free diet (13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23).  

    Even many AIDS patients are helped by a gluten free diet. It reduces their diarrhea and improves nutrient absorption (24). This is an important discovery that can be harnessed in conjunction with the improved treatments now available for this very serious illness. 

    Overweight, obesity, and weight loss are contentious issues with regard to the gluten free diet. Until quite recently, there were two reports of small studies of changes in body mass index in the USA and one report from Ireland, following institution of a gluten free diet. The two American studies showed weight loss among overweight subjects on a gluten free diet. The study from Ireland showed only weight gain among overweight subjects after following a gluten free diet. In November of 2011, another small study was published. Their conclusion states "The GFD (gluten free diet) has a beneficial effect upon the BMI (body mass index) of overweight children with celiac disease" (25), which is congruent with the earlier two American studies. I have previously suggested that the discrepancy between the findings may be due to the acceptance of wheat starch as part of the gluten free diet in the United Kingdom. However, regardless of the cause, the preponderance of evidence supports the notion that a gluten free diet can be used as an effective weight loss strategy in some cases of celiac disease. Other evidence suggests it may be a more broadly effective weight loss tool.

    Thus, my estimate of the prevalence of non-celiac gluten sensitivity includes the 6% who show signs of innate immune reactions to gluten, in addition to those who show IgG  antibodies against gluten, at about 11% of the population (although there may be some overlap between these 6% and 11% groups). My estimate also includes many of those with schizophrenia who number about 1% of the general population, and a portion of those with autism who are quickly approaching 1% of the population. I am also including 80% of the approximately 10% of the population with some degree of dyslexia. Because of overlaps between groups, and because gluten's impact is often only demonstrable through a gluten free diet, I only assert that non-celiac gluten sensitivity is a factor in more than 20% of the general population. However, I remain open to findings that will show a much greater negative impact from eating foods derived from gluten grains.  The portion of the human population that may be negatively impacted by gluten consumption can range as high as the 80% portion that produce haptaglobin 2, for which zonulin is the precursor. 

    The take away point here is that the gluten free diet may aid overall health for up to as much as 80% of the general population. In that context, my estimate that 20+% of the population is showing signs that they are variously mounting immune reactions against gluten or are otherwise harmed by gluten appears modest. The overlapping symptoms make it extremely difficult to narrow my estimate further. Nonetheless, gluten is one of the most harmful substances in our diet. Yet it is the most ubiquitous factor in our diets.    

    Sources:
    1. www.doctorgluten.com 
    2. Sapone A, Lammers KM, Casolaro V, Cammarota M, Giuliano MT, De Rosa M, Stefanile R, Mazzarella G, Tolone C, Russo MI, Esposito P, Ferraraccio F, Cartenì M, Riegler G, de Magistris L, Fasano A. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011 Mar 9;9:23.
    3. personal communication
    4. personal communication
    5. Wheat Belly
    6. Dohan FC, Grasberger JC. Relapsed schizophrenics: earlier discharge from the hospital after cereal-free, milk-free diet. Am J Psychiatry. 1973 Jun;130(6):685-8.
    7. Singh & Kay
    8. Samaroo D, Dickerson F, Kasarda DD, Green PH, Briani C, Yolken RH, Alaedini A. Novel immune response to gluten in individuals with schizophrenia. Schizophr Res. 2010 May;118(1-3):248-55.
    9. Blair, Alexandra. Wheat-free diet gives food for thought. http://www.timesonline.co.uk/tol/news/uk/article444290.ece
    10. Sandler RH, Finegold SM, Bolte ER, Buchanan CP, Maxwell AP, Väisänen ML, Nelson MN, Wexler HM. Short-term benefit from oral vancomycin treatment of regressive-onset autism. J Child Neurol. 2000 Jul;15(7):429-35.
    11. Ribaldone DG, Astegiano M, Fagoonee S, Rizzetto M, Pellicano R. Epilepsy and celiac disease: review of literature. Panminerva Med. 2011 Dec;53(4):213-6.
    12. Braly J, Hoggan R, Dangerous Grains. Avery, New York,  2002.
    13. Hadjivassiliou M, Sanders DS, Grünewald RA, Woodroofe N, Boscolo S, Aeschlimann D. Gluten sensitivity: from gut to brain. Lancet Neurol. 2010 Mar;9(3):318-30. 
    14. Turner MR, Chohan G, Quaghebeur G, Greenhall RC, Hadjivassiliou M, Talbot K. A case of celiac disease mimicking amyotrophic lateral scl Nat Clin Pract Neurol. 2007 Oct;3(10):581-4.
    15. Hadjivassiliou M, Chattopadhyay AK, Grünewald RA, Jarratt JA, Kandler RH, Rao DG, Sanders DS, Wharton SB, Davies-Jones GA. Myopathy associated with gluten sensitivity. Muscle Nerve. 2007 Apr;35(4):443-50.
    16. Hadjivassiliou M, Grünewald RA, Kandler RH, Chattopadhyay AK, Jarratt JA, Sanders DS, Sharrack B, Wharton SB, Davies-Jones GA. Neuropathy associated with gluten sensitivity. J Neurol Neurosurg Psychiatry. 2006 Nov;77(11):1262-6. Epub 2006 Jul 11.
    17. Hadjivassiliou M, Sanders DS, Grünewald RA. Multiple sclerosis and occult gluten sensitivity. Neurology. 2005 Mar 8;64(5):933-4; author reply 933-4. 
    18. Hadjivassiliou M, Williamson CA, Woodroofe N. The immunology of gluten sensitivity: beyond the gut. Trends Immunol. 2004 Nov;25(11):578-82. Review. 
    19. Hadjivassiliou M, Sanders DS, Grünewald RA, Akil M. Gluten sensitivity masquerading as systemic lupus erythematosus. Ann Rheum Dis. 2004 Nov;63(11):1501-3.
    20. Hadjivassiliou M, Grünewald RA, Davies-Jones GA. Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry. 2002 May;72(5):560-3. 
    21. Hadjivassiliou M, Grünewald RA, Lawden M, Davies-Jones GA, Powell T, Smith CM. Headache and CNS white matter abnormalities associated with gluten sensitivity. Neurology. 2001 Feb 13;56(3):385-8.
    22. Hadjivassiliou M, Grünewald RA, Davies-Jones GA.  Gluten sensitivity: a many headed hydra. BMJ. 1999 Jun 26;318(7200):1710-1. 
    23. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.
    24. Quiñones-Galvan A, Lifshitz-Guinzberg A, Ruíz-Arguelles GJ. Gluten-free diet for AIDS-associated enteropathy.  Ann Intern Med. 1990 Nov 15;113(10):806-7.
    25. Reilly NR, Aguilar K, Hassid BG, Cheng J, Defelice AR, Kazlow P, Bhagat G, Green PH. Celiac disease in normal-weight and overweight children: clinical features and growth outcomes following a gluten-free diet. J Pediatr Gastroenterol Nutr. 2011 Nov;53(5):528-31.
    26. Cheng J, Brar PS, Lee AR, Green PH. Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol. 2010 Apr;44(4):267-71.
    27. Murray JA, Watson T, Clearman B, Mitros F. Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. Am J Clin Nutr. 2004 Apr;79(4):669-73.



    User Feedback

    Recommended Comments

    There are no comments to display.



    Join the conversation

    You are posting as a guest. If you have an account, sign in now to post with your account.
    Note: Your post will require moderator approval before it will be visible.

    Guest
    Add a comment...

    ×   Pasted as rich text.   Restore formatting

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • About Me

    Dr. Ron Hoggan, Ed.D.

    As co-author of "Dangerous Grains" and "Cereal Killers", the study of the impact of gluten continues to be a driving passion in my life. I am fascinated by the way that gluten induces illness and impedes learning while it alters mood, behavior, and a host of other facets of our existence. Sure, the impact of gluten on health is an important issue, but that is only the most obvious area of impact. Mood disturbances, learning disabilities, and the loss of quality of life due to psychiatric and neurological illness are even more tragic than the plethora of physical ailments that are caused or worsened by gluten. The further I go down this rabbit hole, the more I realize that grains are a good food for ruminants - not people. I am a retired school teacher. Over the last decade, I have done some college and university level teaching, but the bulk of my teaching career was spent working with high school students. My Web page is: www.DangerousGrains.com


  • Celiac.com Sponsor (A17):
    Celiac.com Sponsor (A17):





    Celiac.com Sponsors (A17-m):




  • Related Articles

    Diana Gitig Ph.D.
    Celiac.com 07/18/2011 - People with celiac disease are relatively lucky; a simple change in diet, without any drugs, can completely reverse all symptoms in most patients and causes no side effects. But maintaining a gluten free diet is, of course, far from simple. A number of treatment options are in varying stages of development, but no one has asked celiac patients what kind of treatment they would prefer to a gluten free diet, or if they would even prefer one at all. A recent study in the UK did just that. It found that over 40% of celiac patients are dissatisfied with the gluten free diet.
    Aziz et al. gave a questionnaire to 310 celiac patients and 477 controls. The first section measured their satisfaction with the gluten free diet; the second measured their use of complementary or alternative medicine by asking if they took popular oral supplements (multivitamins, kava, Echinacea, etc.); and the third assessed their views of novel therapies being developed to treat celiac disease. These include a vaccine that would be injected and would allow the consumption of unlimited gluten; peptidases or zonulin antagonists that would enzymatically degrade gluten or inhibit intestinal permeability, respectively, and would be taken orally in case of accidental or periodic ingestion of gluten; and genetic modification of wheat to reduce its toxicity.
    Although more than 40% of celiac patients were unhappy with the gluten free diet, they did not use complementary or alternative medicines with more frequently than controls. This suggests that they do not view these as viable alternative treatments to a gluten free diet. Most celiac patients - 42% - said that they would be interested in a vaccine that would allow them to eat unlimited gluten, while 35% said they would prefer anti-zonulin and 23% said they would like peptidases. Both of these latter therapies would not necessarily allow for healing of the small bowel mucosa like a gluten free diet does, but either could be taken as an adjuvant or to protect against minor or occasional ingestion of gluten. Of the potential novel treatments, all patients ranked genetic modification of wheat as their lowest preference.
    Adherence to dietary advice is among the lowest of all kinds of guidance given by doctors. Among celiac, strict adherence to a gluten free diet varies from 96% all the way down to 36% among different populations. As these British researchers demonstrated and noted in their conclusions, "patients with coeliac [sic] disease are keen to consider novel therapies."
    Source:

    Aziz I, Evans KE, Papageorgiou V, Sanders DS. Are patients with coeliac disease seeking alternative therapies to a gluten-free diet? J Gastrointestin Liver Dis 2011; 20(1) 27-31.


    Dr. Ron Hoggan, Ed.D.
    Celiac.com 10/16/2015 - Y Net News, under their "Health & Science" banner, published an article titled "Israeli researchers propose link between gluten and ALS", on April 17, 2015 (1). ALS refers to amyotrophic lateral sclerosis, or Lou Gehrig's disease, also known as motor neuron disease. Authorship of this article is attributed to the news agency, Reuters. The article refers to a study in which the investigators identify an autoimmune dynamic in the brain (2). The Y Net News article quotes one of these investigators as warning ALS patients against experimenting with a gluten-free diet: "Patients should not be tempted to use a gluten-free diet without clear evidence for antibodies, because an unbalanced diet might harm"(1). This is the kind of advice that frequently appears in the popular media. There can be little doubt that a gluten-free can be unhealthy, just as gluten containing diets can be unhealthy. When contacted on this issue, Dr. Drory said that "Patients with ALS tend to lose weight due to symptoms of their disease and it is well known that weight loss has a negative influence on disease progression and survival. Therefore it is very important for these patients not to lose weight" (3). Although Dr. Drory did not mean to impugn the gluten-free diet for the general population, she is legitimately concerned about the longevity and health of ALS patients, so she believes that only those with positive antibody tests should try the diet, and then only under the supervision of a dietitian. Reuters, on the other hand, have not responded to my request, through Y Net News, to contact the author of this article.
    While Dr. Drory's concerns are reasonable, I think that she has missed an important feature of the gluten-free diet and she puts too much faith in the connection between TG6 and ALS [an abbreviation for a recently discovered enzyme named tissue transglutaminase six] apparently believing that it will identify all ALS patients who might benefit from avoiding gluten. However, if we can judge based on those who have celiac disease, it is a diet that is more likely to increase the body mass of someone who is underweight. Dr. Drory also seems to have missed the sentiment expressed in the abstract of her own report. It says: "The data from this study indicate that, in certain cases, an ALS syndrome might be associated with autoimmunity and gluten sensitivity. Although the data are preliminary and need replication, gluten sensitivity is potentially treatable; therefore, this diagnostic challenge should not be overlooked" (1). Thus, when dealing with an otherwise irreversible and unstoppable disease, patients are cautioned not to try the diet without these marker antibodies which the authors identify as "preliminary" findings.
    Dr. Drory's caution also assumes that dietitians will generally be competent to guide the ALS patient in their gluten-free diet. However, it is important to recognize that the neurological patient needs to be even more strict with the diet than a person with celiac disease, and there are many uncertainties and debates around this diet. The average dietitian may not be up to date with the application of the gluten-free diet for such conditions, or the relevant controversies, or their application. Also, the beneficial results of a gluten-free diet are widespread across so many ailments and much medical research currently lags well behind patients' positive experiences. This is what has led to the continuing debate about the frequency and importance of non-celiac gluten sensitivity. Until very recently, it was usually given no attention at all. Further, since "gluten sensitivity is potentially treatable," and the current life expectancy for an ALS patient is about 2 years, it seems irresponsible to warn patients to wait for further research results before trying a gluten-free diet.
    This latter sentiment captures the essence of my current view of the gluten-free diet. Until I was diagnosed with celiac disease, more than twenty years ago, I would have ignored Dr. Drory, and subscribed to the bias inherent in the Y Net News article. Sadly, I used to dismiss people who talked about diet in the same way that I responded to those who talked about "astro travel" and Astrology. I viewed them as foolish concepts that were popular fads among drug-crazed hippies of the 1960s and 1970s, and other similarly deranged individuals. I still question many other diets, astro travel, and Astrology, but hope I do not do so with the same arrogant certitude of my youth.
    You see, I experienced a startling change of perspective shortly after I was diagnosed with celiac disease. Just three days after beginning the gluten-free diet, I awoke to an altered state of consciousness. The closest I can get to describing it is that I felt somewhat like I remember feeling as a kid when I awoke on Christmas morning. I felt optimistic, hopeful, and I looked forward to the day ahead. That was a big change. I was used to waking up feeling tired, depressed, and usually with a sense of foreboding about the coming day. I also found, after about the first six months or so of avoiding gluten, that my mind was becoming sharper, I was more aware of my surroundings, and my memory seemed to improve. My reflexes also seemed quicker. My sense of balance got better and my reaction time was faster. When I looked at others, I saw that many people were similarly challenged and didn't seem to be aware of their limitations—or perhaps they had just become used to them. Thus, I now believe that many people unknowingly suffer from the myriad harms induced or facilitated by gluten consumption. I also see, given the many venues in which the diet made a difference for me, why others might be skeptical.
    But how did Dr. Drory get from the notion that since gluten sensitivity is treatable, and should therefore be investigated as a potential factor in some cases of ALS, to the notion that ALS patients should be cautioned against experimenting with a gluten-free diet because it can cause weight loss? The gluten-free diet can be an effective weight loss strategy for some people. As I have mentioned in previous columns, the gluten-free diet seems to reduce the appetites of overweight individuals with celiac disease by about 400 calories per day. Equally, underweight celiac patients usually gain weight. Dr. Drory's concern about weight loss for those with ALS might be well founded if it was a universally good weight loss strategy. But it isn't. The data regarding weight loss on a gluten-free diet are only available, to my knowledge, with regard to celiac patients, where underweight patients almost always gain weight and about half of overweight patients lose weight. She also thinks that experimentation without a positive antibody test and the oversight of a dietitian might be risky. So her concerns may not be as valid as they first appear. If those ALS patients are gluten sensitive, then they might behave similarly to those with celiac disease, at least with regard to weight gain and loss. Further, how can anyone say, without trying it, that a gluten-free diet would not benefit those ALS patients who do not show TG6 antibodies?
    The Reuters article goes on from there to state: "It’s also worth remembering that an association is not the same as a cause. At least one earlier study concluded that there was no association between TG6 antibodies and either neurological disease or gluten itself" (1). The preceding comment refers to a retrospective research report in which the records of patients, on a Swedish data-base, who had been diagnosed with celiac disease, were further examined for an additional diagnosis of ALS (4). This is more than a little strange, since the very study the Reuters journalist used to distinguish between associations and causality, seeks only evidence of an association between the ALS and celiac disease. The notion that correlation is not causation is valid. However, using a study that looks for a correlation between celiac disease and ALS is not a reasonable basis for differentiating between correlation and causation. Neither is it a valid example of a causal relationship.
    Further, it is difficult to imagine a study design that would be less likely to reveal an association between transglutaminase TG6 and any other ailment, than one based on recorded data from a large number of patients who were diagnosed with celiac disease between 1969 and 2008. All, or almost all of these patients were diagnosed prior to the first published report of the discovery and diagnostic utility of transglutaminase 6 (5). So if one looks through records that predate the discovery of TG6 to find evidence of a connection between TG6 and any other disease, one is highly unlikely to find it.
    The abstract of the study that asserts there is no association between these ailments is based on a very weak design. It also ends with the statement: "Earlier reports of a positive association may be due to surveillance bias just after celiac disease diagnosis or expedited diagnostic work-up of ALS" (4). They are so confident of their own findings that they suggest that contrary findings are either due to bias or fast, careless work. I will leave it to the reader to infer whether there is bias among the authors of this report. Additionally, the Y Net News article, by one or more journalists at the Reuters News Agency, reports that this study found no association between TG6 antibodies and ALS, even though the study in question examines data that predates the use of TG6 antibody testing. While the study in question does appear to claim that there is no connection between celiac disease and ALS, the mention of TG6 and whether there is a connection between these antibodies and ALS appears to be information added by Reuters.
    Regardless of this possibly 'added' information, it really is quite a stretch to warn the public or ALS patients of the dangers of a gluten-free diet in reporting about research that has found evidence of a possible connection between ALS and gluten consumption. In a balanced report, the Reuters journalist would have mentioned the seven other research publications that have reported associations, and/or cause to suspect such associations, between gluten and ALS (5-11). It really isn't rocket science. It is just ethical, balanced reporting, which should serve as a minimum standard for an organization that is engaged in reporting the news. Since there are always at least two sides to almost any argument, both sides should at least have been acknowledged. Thus, in addition to the weak study reporting that they didn't find an association, the seven other reports of possible associations really should have been mentioned.
    It would also have been informative to their readers to mention Stephen Hawking, the longest living patient who was diagnosed with ALS. Dr. Hawking is still alive and has been on a gluten-free diet for the last 40+ years (12). He had already lived well beyond the two year life expectancy predicted by his doctors when, in 1963, Hawking's ALS had progressed to the point where he had begun to choke on his food. That is when he eliminated gluten, sugar, and plant oils from his diet. He has continued to avoid gluten for all these years and has also added several vitamins and supplements to his diet. Whether any or all of these measures have made "the" life extending difference, or if it is all of these measures combined that have allowed him to continue for so long, we can't know. Nonetheless, it may be that the gluten-free diet has been a determining factor in Dr. Hawking's longevity in the context of ALS. We also don't know if he would have tested positive for TG6 back when he was first diagnosed. However, he might not still be with us if he had opted to wait for this research to emerge and be confirmed.
    Since Hawking began his self-directed dietary experiment, researchers at the Royal Hallamshire Hospital in Sheffield, UK, have shown that the TG6 antibodies, while present in some celiac patients, are also found in some patients with non celiac gluten sensitivity and either neurological disease or an increased risk of developing one (5).
    Others, reporting a case study, had diagnosed ALS, then identified, diagnosed, and treated co-existing celiac disease with a gluten-free diet. They then retracted their ALS diagnosis saying: "Ultimately, improvement in the patient’s symptoms following treatment for celiac disease rendered the diagnosis of ALS untenable" (6). It would appear that any improvement in ALS symptoms obviates a diagnosis of ALS. It also raises the possibility that some cases of ALS can be effectively treated with a gluten-free diet.
    Similarly, in another case study report, the authors state: "ALS is a condition with relentless progression; for this reason, the simple observation of an improvement in symptoms is most pertinent in rendering the diagnosis of ALS untenable" (7). Again, the patient's ALS symptoms regressed following institution of a gluten-free diet.
    Yet another report that connects ALS with autoimmunity in general states: "The significance of increased premorbid celiac disease in those with ALS, and in family members of patients with MMN [multifocal motor neuropathy] remains unclear at present."(9). Still others have offered genetic evidence of connections between gluten sensitivity and ALS (10).
    Thus, the Reuters article raises an important question. Why are we seeing so many media attacks on those who are taking responsibility for their own health and experimenting with a gluten-free diet? It might come as a surprise to the Reuters journalist to learn that we humans had evolved and spread into most habitable areas of the world long before a few farmers began cultivating grains in regions of what are now known as Iraq and Iran. She/he might also be surprised to learn that we have known, for decades, that variants of wheat, rye, and barley have a deleterious impact on human neurological tissues (13, 14, 15) and that a variety of neurological ailments arise both in the context of celiac disease and non-celiac gluten sensitivity (14).
    The conclusion in the abstract of the 'no relationship' study dismisses reports of opposing findings as either due to "surveillance bias" or "expedited diagnostic work-up" (4). (This latter is a euphemistic statement suggesting that the work that led to these other reports was conducted too quickly and errors resulted.) Whatever your personal view of the attitude expressed there, the greater concern may be that the media continue to identify the gluten-free diet as potentially harmful (1) while researchers and individuals experimenting with a gluten-free diet have found evidence connecting gluten sensitivity with, at least, some cases of ALS (2).
    Over the years, I have heard many reasons for resisting this diet, but the one that is probably the least defensible is the assertion that it is potentially harmful. Almost any dietary regimen can be hazardous, of course, but the assertion that it might cause a harmful dietary imbalance fails to recognize that gluten has only been part of the Human experience for a very short time, in evolutionary terms. The simple fact is that we humans have spent far more of our evolutionary past eating a gluten-free diet than we have spent eating gluten. Some populations have only been eating these grains since European incursions over the last several hundred years. Some of these populations have only been eating it for less than one hundred years. Still others have been eating gluten for a few thousand years. In Israel, where Dr. Drory's study originated, grains were probably incorporated into the diet much earlier than in most of the rest of Europe, probably sometime between 15,000 and 10,000 years ago. It is difficult to imagine that after hundreds of thousands of years of eating a gluten-free diet, that avoiding gluten can pose a health hazard. The Reuters journalist appears to have another axe to grind, but I continue to wonder why we are seeing so many journalists on the attack against the gluten-free lifestyle?
    The driving force behind these journalists' attacks may well be similar to the perspective that I experienced before my diagnosis with celiac disease. Perhaps they suspect, whatever their reasons, that the gluten-free diet has little or no merit, and their only concession is to grudgingly allow that it may be helpful to those with celiac disease. My suspicion is that this attitude is driven by an insecurity. We want to believe conventional wisdom that gluten grains are healthy and that our medical professionals, and the institutions in which they serve, are above reproach. Nobel Laureate, Kary Mullis, is one highly vaunted physician's voice, among many, who dismiss most diets as fads, arguing that we are omnivores whose secret of successful adaptation to a wide variety of environments is the result of our flexibility in sources of nourishment (18). Many of us want to be able to rely on our physicians. We don't want the insecurity of knowing that our medical establishment is a flawed, human institution. The self-directed experimentation with a gluten-free diet poses a threat to that credibility, and hence, our sense of security, especially when it results in improved health. We don't want to feel the resulting uncertainty that comes from doubting the medical cornerstone of our civilization.
    It is not long ago that Don Wiss, myself, and others, argued extensively with physicians and researchers who insisted that the rate of celiac disease in the USA was variously one in 12,000 persons or one in 25,000 people. Sometimes these discussions became quite heated. Some of the people posting to these newsgroups were asking for suggestions for how they might proceed with various health complaints. When Don or I saw a post asking about symptoms that had been reported in the peer reviewed literature, in association with untreated celiac disease, we suggested a trial of a gluten-free diet. Some of the physicians and researchers contacted these individuals privately, saying things to discredit us. It seems doubtful that they would not have said such things where they were likely to be held accountable for what they said. Their reactions, I suspect, were driven by a sense of feeling threatened. As soon as controlled testing was done, it became clear that the rate of celiac disease, among Americans, is at least 1 in 133 Americans, and many of those individuals we advised to try a gluten-free diet might well have had celiac disease. Yet many journalists, physicians, and researchers have a great deal invested in the current status quo. Any threat to the established order is likely to incite the ire of many members of these groups.
    Thus, while others may consider it prudent to await the end of the current debate about ALS and a gluten-free diet, the ALS patient might be better advised to take dietary steps to ensure against weight loss, while trying a strict gluten-free diet. I know what I would do if were diagnosed with ALS...on second thought, since I've been gluten-free for more than twenty years, maybe I won't ever be diagnosed with ALS. I will continue to hope. In the meantime, Thomas Kuhn clearly outlined this stage of acceptance of new ideas in science (19). We appear to be in the "denial" stage, which is the last one before we can expect the emergence of widespread claims that 'we knew it all along'. If so, then broad acceptance is in the offing, and these nay-saying journalists will move on to some other controversial new discovery, and we can be spared the condescending remarks suggesting that the gluten-free diet is a mere placebo and a 'fad diet' for most of those who follow it.
    Sources:
    http://www.ynetnews.com/articles/0,7340,L-4647994,00.html Gadoth A, Nefussy B, Bleiberg M, Klein T, Artman I, Drory VE. Transglutaminase 6 Antibodies in the Serum of Patients With Amyotrophic Lateral Sclerosis. JAMA Neurol. 2015 Apr 13. Drory V. Personal communication via email Ludvigsson JF, Mariosa D, Lebwohl B, Fang F. No association between biopsy-verified celiac disease and subsequent amyotrophic lateral sclerosis--a population-based cohort study. Eur J Neurol. 2014 Jul;21(7):976-82. Hadjivassiliou M, Aeschlimann P, Strigun A, Sanders D, Woodroofe N, Aeschlimann D. Autoantibodies in gluten ataxia recognize a novel neuronal transglutaminase. Ann Neurol 2008;64:332-343 Brown KJ, Jewells V, Herfarth H, Castillo M. White matter lesions suggestive of amyotrophic lateral sclerosis attributed to celiac disease. AJNR Am J Neuroradiol. 2010 May;31(5):880-1. Turner MR, Chohan G, Quaghebeur G, Greenhall RC, Hadjivassiliou M, Talbot K. A case of celiac disease mimicking amyotrophic lateral sclerosis. Nat Clin Pract Neurol. 2007 Oct;3(10):581-4. Ihara M, Makino F, Sawada H, Mezaki T, Mizutani K, Nakase H, Matsui M, Tomimoto H, Shimohama S. Gluten sensitivity in Japanese patients with adult-onset cerebellar ataxia. Intern Med. 2006;45(3):135-40. Turner MR, Goldacre R, Ramagopalan S, Talbot K, Goldacre MJ. Autoimmune disease preceding amyotrophic lateral sclerosis: an epidemiologic study. Neurology. 2013 Oct 1;81(14):1222-5. Auburger G, Gispert S, Lahut S, Omür O, Damrath E, Heck M, BaÅŸak N. 12q24 locus association with type 1 diabetes: SH2B3 or ATXN2? World J Diabetes. 2014 Jun 15;5(3):316-27. Bersano E, Stecco A, D'Alfonso S, Corrado L, Sarnelli MF, Solara V, Cantello R, Mazzini L. Coeliac disease mimicking Amyotrophic Lateral Sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2015 Feb 3:1-3. Hawking J. Travelling to Infinity: My Life with Stephen. Alma Books, Richmond, UK. 2014.


    Tina Turbin
    Celiac.com 12/29/2015 - I discussed the possibility of a Low Glycemic Paleo Diet as an entertaining idea as a beneficial diet for celiac in the last issue, Winter 2015. In closing, I stated I would reveal more about this topic in the coming issue. So, let's dive in and open our eyes to some facts and even some revealing possibilities that may very well help improve our health and quality of life.
    As a celiac myself, (2 of my three kids have celiac disease and my grandfather died from undiagnosed celiac disease) I was more than happy to follow the gluten-free diet diligently once finally diagnosed after many years of distress, bone loss, declining health not to mention non-stop bone aches, bowel inconsistency and severe lack of muscle tone. I will spare you further details but there was no doubt a major beneficial change that occurred once I eliminated all gluten from sources of wheat, rye and barley and all its "relatives" or any possible cross contamination. Eventually I was thrilled to be able to eat baked good substitutes that did not hurt my belly, cause my joints and bones to ache and were absolutely delicious and healthy, as they were gluten-free!
    Soon after I became an active advocate (and for many years) I was thrilled to be able to speak broadly to help raise awareness about celiac disease and the NEED for the gluten-free diet. I was also soon working closely with many gluten-free companies (as a tester, consultant and promoter) becoming blind to the fact that the boxes that were arriving to my door by the truckload were all desserts, loaded with carbohydrates and sugars.
    At the time I wrote and spoke often (in interviews and on radio) about Type 2 diabetes and celiac disease but never put two and two together. If lifestyle and diet change can address Type 2 permanently, what were these diet changes that were so effective? Also, even more to the point, why was Type 2 diabetes so common as a diagnosis after being diagnosed with celiac disease and going on the gluten-free diet?
    Research suggests an association between Type 1 diabetes and celiac disease, but there does not appear to be a link between celiac disease and type 2 diabetes. Type 2 is not an autoimmune disorder and doesn't share genes with celiac disease. According to the Celiac Sprue Association, individuals can be genetically predisposed to Type 2 diabetes, but those genes don't increase the risk of celiac disease.
    Let's look at the immense increased ingestion of glucose, sugars and carbohydrates and fiber while one is on the gluten-free diet by indulging in baked goods, desserts and grains! Gluten-free foods and grains are typically made with rice starch (or brown rice starch), tapioca starch, cornstarch and potato starch. All of which have virtually no fiber. Hence straight into the blood stream spiking the blood sugar bite after bite and quickly.
    The latest attempt is many companies and cooks trying to improve nutrients by baking with higher fiber gluten-free grains with higher nutrient value. Such as teff, millet, buckwheat etc. These are all still VERY HIGH in carbohydrates and very little fiber to slow the glycemic entrance into the blood system, still resulting in spiking the blood sugar rapidly. I must mention that most people do not just eat 2-3 bites of millet or a ¼ cup of cooked buckwheat. This would be easier on the body, but it seldom occurs.
    Carbohydrates are a type of nutrient in foods and some feel we need this to survive physically and some MD's are saying we need far less than we ever thought. The three basic forms are sugars, starches and fiber. Different types of carbohydrates have properties that affect how quickly your body digests them and how quickly glucose enters your bloodstream. When we eat or drink anything with carbs, the body breaks down the sugars and starches into a type of sugar called glucose. Glucose is the main source of energy for cells in the body. Fiber passes through your body undigested. The unused glucose for energy is quickly taken out of the blood stream by the insulin and "stocked" away in the cells for future energy as fat. It is the body's amazing way of survival.
    To elaborate a bit more, the two main hormones from the pancreas help regulate glucose in the bloodstream. Insulin moves glucose from the blood into the cells. Glucagon helps release glucose stored in your liver when the blood sugar (blood glucose) level is low.
    I suggest to anyone to take a look at the nutritional value on all packages and foods and get familiar with the amount of carbohydrates you are ingesting through your meals, snack and drinks. Get familiar with the carbohydrate, sugar and fiber levels in the food you buy and have in your home. Getting educated is the first step to learning and then you can make changes to suit your health and body goals.
    A healthy paleo or gluten-free diet is a low glycemic one at the very least. A low glycemic diet can improve all manner of current health situations. By statistics and more than abundant research, it will deter diseases quiet commonly associated with a high glycemic diet.
    We will expand on this topic next time.
    At this point I would like to refer you to some highly respected professionals and allow you to do further research and come to your own conclusions. Please look further into DrPerlmutter.com, Mercola.com, WheatBellyBlog.com, BulletProofExec.com, ChrisKresser.com, MarksDailyApple.com.
    As always, wishing you the best in your life and health!


    Jefferson Adams
    Celiac.com 05/26/2016 - An Australian dietary organization has published a study showing the high and hidden costs of a gluten-free diet, and is calling for a subsidy program to help offset those extra costs.
    A newly published study quantifying the cost of gluten-free foods shows a family with two children can pay nearly 20% more for gluten-free food. The costs are even greater for single men on welfare.
    The study is the first of its kind to prove "that a gluten-free diet is a significant financial burden for many Australian family types," say University of Wollongong researchers Kelly Lambert and Caitlin Ficken, the study's authors.
    The study was supported by the Dieticians Association (DAA) of Australia, and the results appear in its scientific journal Nutrition and Dietetics. For their study, Lambert and Ficken compared gluten-free diet groceries with a standard non-gluten-free shopping basket using data from supermarkets in five varying suburbs in the Illawarra region south of Sydney.
    They found that flour actually showed the highest cost differential, with gluten-free flour costing 570 per cent more than plain flour, "so even making things from scratch is exorbitantly more expensive," said Ms Lambert, who is also a dietician at Wollongong Hospital.
    The study showed that wholemeal gluten-free bread was nearly five times more expensive than comparable non-gluten-free bread.
    In the face of these results, the DAA is calling for gluten-free diets to be subsidized for those with medical need.
    What do you think? Is a gluten-free diet for people in medical need something that deserves to be subsidized?
    Read the more at: Dietitians Association of Australia


  • Popular Now

×
×
  • Create New...