0:00

We

0:00

have a lot of choices to make about our diet,

0:03

add to that doing the right

0:05

thing when it comes to preventing or treating

0:07

a chronic disease, fighting a virus,

0:10

losing weight and suddenly our

0:12

nutrition choices can seem almost

0:14

overwhelming. Well, I'm

0:17

here to help. Welcome to the nutrition

0:19

facts podcast. I'm your host, doctor

0:21

Michael Greager. More than

0:23

ten thousand articles have been published

0:26

on gluten in medical journals, intimidating

0:28

even for me. Today, we have

0:30

a three part series summarizing the best available

0:33

signs on gluten. In

0:35

our first story, we look at how

0:37

we might prevent the inflammation that occurs

0:39

from gluten free diets.

0:42

Over the last decade or so, there's been a growing

0:44

interest in the medical that are shown plant

0:47

based eating beyond just exclusionary

0:49

terms like vegetarian or or

0:51

vegan. Previous such studies

0:54

were somewhat limited because they just split

0:56

people up in either vegetarian or

0:58

non vegetarian. Excluding some

1:00

or all animal foods, but without taking

1:03

into account the quality of plant

1:05

foods, vegans could be live out of

1:07

that. French fries, Oreos, and Coca

1:09

Cola. Enter changes

1:12

in plant based diet quality in total

1:14

and cause specific mortality. The

1:16

first study to investigate the associations

1:19

between changes in plant based diet quality

1:21

and subsequent risk of death. If

1:24

you look at overall plant based diet scores,

1:26

the more you increase your intake of any plant

1:28

foods and decrease your intake of any animal

1:30

foods, the lower your risk of death appears

1:33

to fall. But that's because people were

1:35

adding healthy plant foods like fruits and

1:37

vegetables. If you just look at people who

1:39

ate more processed sugary junk over

1:41

time, their mortality risk goes

1:44

up. The clinical implications

1:46

being the increasing intake of healthy plant

1:48

foods and decreasing intake not just animal

1:51

foods, but also animal crackers could

1:54

lower the future risk of premature death.

1:56

Whereas just reducing the intake of carbs

1:58

in general. Cutting down, not just refined

2:00

carbs and sugars, but healthy high carb foods

2:02

like fruits and whole grains is associated

2:05

with increased overall mortality. Which

2:08

could correspond to years of your life

2:10

being cut short, as well as the risk

2:12

of dying specifically from heart disease, stroke,

2:15

and cancer. Why

2:17

our whole plant food so good for us. Much

2:20

of the benefit may be mediated by

2:22

our microbiome. There are all

2:24

sorts of things threatening our good gut bugs,

2:26

like the over prescription of antibiotics. However,

2:29

the only factor that has been empirically shown

2:32

to be important is a diet

2:34

low in microbiome accessible carbohydrates.

2:37

In other words, prebiotics like

2:40

fibrin resistant starch only found

2:42

one place in abundance, whole

2:44

plant foods. We went

2:46

from high mac diets to big

2:49

mac diets and maybe

2:51

suffering the consequences. Indic

2:53

of dietary fiber, which is the main

2:55

source of macs in the diet, is

2:57

negligibly low compared

3:00

to how we evolved. Such a low fiber

3:02

die provides insufficient food

3:04

for our gut microbes, starving ourselves

3:06

of all the wonderful things they produce for us.

3:09

A low fiber diet is a key driver of microbiome

3:11

depletion, and this loss is implicated in

3:14

the rampant increase of chronic disease eases

3:16

that now plague the modern world.

3:18

We evolve getting perhaps a hundred

3:21

grams of fiber a day. Our

3:23

cut bugs must have been in heaven.

3:26

How do you even get close to that? A

3:28

couple of fruit may only have about three grams.

3:31

Couple vegetables, five grams. Why

3:33

so little? Because fruits and

3:35

vegetables are like eighty to ninety percent

3:37

water. One has to go to the

3:39

drier plant foods to really scale it up

3:41

like beans at fifteen grams

3:43

or intact grains like barley, over

3:46

thirty grams per cup. Many

3:48

people are avoiding common grains these days

3:50

like wheat barley and rye due to gluten,

3:53

but there's a dark side of gluten

3:55

free diets. Now

3:57

if you have a condition like celiac disease,

3:59

well then you absolutely have to avoid

4:01

GlutenFree. But if not, the downside

4:04

dives include the potential for nutritional deficiencies,

4:06

like not getting enough fiber, and toxic

4:09

compounds, for example, the accumulation of

4:11

heavy metals and people on gluten free diets.

4:14

Those following a gluten free diet had significantly

4:16

increased blood mercury levels more arsenic

4:19

flowing through their systems. The arsenic

4:21

is likely due to increased rice consumption

4:24

because rice is major ingredient in

4:26

gluten free foods, but you can certainly choose

4:28

other grains like sore gum. That's my favorite

4:30

rice substitute. And the higher mercury

4:32

may just be because people eating gluten free

4:34

diets were tending to eat more fish for

4:36

some reason. But the reason that ten

4:39

out of ten of those without celiac

4:41

disease or recognized gluten sensitivity

4:44

following a gluten free diet experienced

4:46

a proinflammatory gastrointestinal

4:48

environment is likely due

4:50

to starving your microbial self

4:53

not getting enough prebuyer not

4:55

getting enough fiber because you're avoiding

4:57

grains like wheat. So whatever

4:59

diet you choose for whatever reason, make sure

5:02

you're getting enough

5:03

fiber. In

5:04

our next story, we look at how the effects of gluten

5:07

on our health have been debated for more

5:09

than thirty years.

5:11

In nineteen eighty, researchers in England

5:13

reported a series of women suffered from chronic

5:15

diarrhea that resolved on a gluten free

5:18

diet yet did not have evidence

5:20

of celiac disease, the autoimmune

5:22

disorder associated with gluten intolerance.

5:25

The medical profession was skeptical at

5:28

the time. And even

5:30

thirty years later. So

5:33

much so that much like

5:35

patients who had irritable bowel syndrome Patients

5:37

claiming non cilia gluten sensitivity

5:40

were commonly referred to psychiatrists

5:42

because they were believed to have an underlying mental

5:45

illness. Psychological testing

5:48

of such

5:48

patients, however, found no evidence as they were

5:50

suffering from some kind of psychosomatic hysteria.

5:54

The medical profession has a history of

5:57

dismissing diseases as all

5:59

in people's heads, PTSD, ulcer

6:02

of clients, migraines, ulcer, asthma, Parkinson's,

6:05

MS, despite

6:08

resist from the prevailing medical community

6:10

at the time these health problems have subsequently

6:12

been confirmed to be credible,

6:15

physiologically based disorders

6:17

rather than psychologically based confabulations.

6:21

On the flip side, the Internet

6:23

is right with unsubstantiated claims

6:25

about gluten free diet, which

6:28

has spilled over into the popular press

6:31

to make gluten free diet villain

6:33

du jour with claims

6:35

like seventeen million Americans are

6:37

gluten sensitive. However, it must

6:40

be remembered that this is also

6:42

big business. When

6:45

literally billions of dollars

6:47

or at stake, it's hard to trust

6:50

anybody. So is always

6:52

best to stick to the science.

6:54

What sort of evidence do we have for the existence

6:57

of a condition presumed to be so widespread?

7:01

Not much. The evidence base

7:03

for such claims was unfortunately very

7:06

thin because we didn't have randomized controlled

7:08

trials demonstrating that the entity

7:11

even exists. The

7:13

gold standard for confirming non

7:15

cilia sensitivity requires

7:18

a diet followed by a double

7:20

blind randomized placebo controlled food

7:22

challenge, like you give someone

7:24

a muffin. And they're not

7:27

told if it's a gluten free muffin or

7:29

gluten filled muffin to control

7:31

for placebo effects and see what happens.

7:34

The reason this is necessary is

7:36

because when you actually do this, a number

7:38

of quote unquote gluten sensitive patients

7:41

don't react at all. To

7:43

disguise GlutenFree instead react

7:45

to the gluten free placebo. So

7:47

it truly was in their heads. But

7:50

we never had that kind of level of evidence

7:52

until two thousand eleven

7:55

when a double blind randomized placebo

7:57

controlled trial was published which tested

8:00

to see if patients complaining veritable bowel

8:02

type symptoms who claimed they felt better on

8:04

a gluten free diet despite not having

8:06

celiac disease actually could tell.

8:08

If they were given gluten free bread

8:11

and muffins or gluten containing bread

8:13

and muffins. They started

8:15

out gluten free and symptom

8:18

free for two weeks, and then they were challenged

8:20

with the bread and muffins. Here's what

8:22

happened to the fifteen patients who got

8:24

the placebo. Meaning they started on a gluten

8:26

free diet and continued on a

8:28

gluten free diet, they got

8:31

worse. Just a thought

8:33

that they may be eating something that was bad for

8:35

them made them feel all crampy and bloated.

8:38

This is what's called a no seaboe effect.

8:40

The placebo effect is when you give someone

8:42

something useless and they feel better. The

8:45

no placebo effect is when you give someone

8:47

something harmless and they feel worse.

8:50

But the small group that got the

8:53

actual gluten felt

8:55

worse still. So

8:58

they concluded this non cilia gluten

9:00

intolerance may actually exist.

9:03

It was a small study, though, when even though

9:05

they claim the gluten free bread muffins

9:07

were indistinguishable. Maybe at

9:09

some level the patients could tell, which

9:11

is which. So in two

9:13

thousand twelve, researchers in Italy

9:16

took nine twenty patients that

9:18

had been diagnosed with non celiac immune sensitivity

9:21

and put them to the test. With

9:23

a double blinded wheat challenge by giving

9:25

them not bread and muffins, but

9:27

capsules filled with wheat flour

9:29

or filled with placebo flour. Or

9:32

kind of placebo powder. No flour

9:34

at all. And more than two

9:36

thirds failed the

9:38

test. Like they got worse

9:41

on the placebo or better on the wheat.

9:44

But of those that passed,

9:46

there was a clear benefit to

9:48

staying on the wheat free diet confirming

9:51

the existence of a non celiac

9:54

wheat sensitivity. Now,

9:57

Note, they said wheat sensitivity, not

10:00

gluten sensitivity. itself

10:03

may not be causing gut symptoms

10:06

at all. See, most people with wheat

10:08

sensitivity have a variety of

10:10

other food sensitivities. Two

10:12

thirds are sensitive to cow's milk protein

10:14

as well, then eggs were the most

10:17

common culprit after that. So

10:20

if you put people on a diet

10:22

low in common triggers and irritable bowel

10:24

symptoms, and then challenge them

10:26

with gluten, there's no effect.

10:29

Same increase in symptoms with high gluten, low

10:31

gluten, or no gluten. Right?

10:33

Calling into question the very existence

10:36

of non celiac gluten sensitivity.

10:40

Interesting. Despite being

10:42

informed that avoiding gluten wasn't apparently

10:45

doing a thing for their gut symptoms, many

10:48

participants opted to continue following

10:50

a gluten free diet as they just subjectively

10:53

described feeling better. So

10:55

the researchers wondered if avoiding

10:57

gluten might be improving the

10:59

mood of those with wheat sensitivity and

11:02

indeed. Short term exposure

11:04

to gluten appeared to induce feelings of depression

11:06

in these patients. But

11:09

whether non c lactagloon sensitivity is

11:11

a disease of the mind or the gut,

11:14

it is no longer a condition that

11:16

can be dismissed.

11:19

Finally today, how common is

11:21

gluten sensitivity? Are there benefits

11:24

to does the medical profession

11:26

explicitly advise against people who

11:28

might suspect they may be gluten intolerant from

11:31

just going on a gluten free diet?

11:33

Let's find out. Until

11:36

only a few years ago, almost

11:38

a whole the scientific world maintained that

11:40

the wheat protein gluten would provoke

11:43

negative effects only in people with rare conditions

11:45

such as celiac disease or wheat

11:47

allergies. But by the early part

11:49

of two thousand thirteen, it was largely

11:51

becoming accepted that some

11:53

non celiac

11:54

patients could suffer from gluten or

11:56

wheat sensitivity. And

11:58

indeed a consensus panel of experts

12:00

now officially recognizes three gluten

12:02

related conditions, wheat allergy, celiac disease,

12:05

and gluten sensitivity. So

12:07

what percent of the population should

12:09

avoid wheat? About

12:12

one in a thousand may have a wheat allergy,

12:14

nearly one in hundred may have celiac

12:17

disease. And

12:19

it appears to be on the rise, though

12:22

there's still less than about

12:24

one in ten thousand chance Americans

12:27

will get diagnosed with celiac in any

12:29

given year. How

12:31

common is wheat or gluten sensitivity? Our

12:33

best estimate point is that in

12:36

that same kind of general range,

12:38

slightly higher than one percent, but

12:40

still that's potentially millions

12:42

of people who may have been suffering for

12:45

years, who could have been cured by

12:47

simple dietary means, yet

12:49

went unrecognized and unhelped. By

12:52

the medical profession. Although

12:55

sensitivity continues to gain medical credibility,

12:58

we still don't know how it works or how much gluten

13:00

can be tolerated if it's reversible

13:02

or not and with the long term complications

13:04

might be of not sticking to the diet.

13:07

Considering the lack of knowledge, maybe people with

13:09

gluten sensitivity should be trying

13:11

to reintroduce gluten back into their diet

13:13

every year or so to see if it's still causing

13:15

problems. The reason

13:18

health professionals don't want to see people on

13:20

gluten free diet unless absolutely necessary

13:23

is that for the ninety eight percent of people

13:25

that don't have gluten issues, whole

13:27

grains, including the gluten grains wheat,

13:29

barley and rye, are health promoting

13:32

linked to reduced risk of

13:34

coronary heart disease, cancer, diabetes, obesity,

13:36

and other chronic disease. You know, just like

13:39

because some people have a peanut allergy

13:41

doesn't mean that everyone should avoid

13:43

peanuts. There's

13:45

no evidence to suggest that following a

13:48

gluten free diet has any significant benefits

13:50

in the general population. Indeed,

13:53

there is some evidence to suggest that gluten free

13:55

diet may adversely affect gut

13:57

health in those without celiac disease or

13:59

gluten sensitivity urology. They're

14:01

talking about this study. They found that

14:04

a month of gluten free diet may hurt

14:06

our gut flora and immune function.

14:08

Potentially setting those on gluten free

14:10

diets up for an overgrowth of harmful

14:13

bacteria in their intestines. Why?

14:16

Because ironically of the beneficial effects

14:18

of the very components we'd send that people

14:21

have problems with, like the FOD map

14:23

fructose that act as probiotics and

14:25

feed are good bacteria, or the

14:27

gluten itself, which may boost immune

14:29

function, less than a week of added gluten

14:31

protein significantly increases

14:34

natural killer cell activity, which

14:36

could be expected to improve our body's ability

14:39

to fight cancer and viral infections. High

14:42

gluten bread improves triglyceride

14:44

levels better than regular gluten

14:46

bread as another example. Ironically,

14:50

one of the greatest threats of gluten free

14:53

diets may be the

14:55

gluten itself. Self

14:57

prescription of a gluten free diet may

14:59

undermine our ability to pick up celiac

15:02

disease, the much more serious form of gluten

15:04

intolerance. The way we diagnose

15:06

celiacs by looking for the inflammation caused by

15:08

GlutenFree celiacs sufferers. But if

15:10

they haven't been eating a lot of gluten, we might miss

15:12

the disease Hence rather

15:14

than being on a gluten free diet, we want celiac

15:17

suspects to be on a gluten

15:19

loaded diet. We're talking four to six

15:21

slices of gluten packed bread a day, every

15:24

day, for at least a month, so we can definitively

15:26

diagnose the disease. Why does

15:28

it matter so much to get a formal diagnosis

15:31

if you're already on gluten free diet?

15:33

Well, it's a genetic disease, so

15:36

you'll know to test the family. But most

15:38

importantly, Many people on

15:40

gluten free diets are not actually

15:43

on gluten free diets. Even

15:45

twenty parts per million can be toxic

15:47

to someone with celiac. Many

15:50

on so called gluten free diets inadvertently

15:52

still eat gluten.

15:55

Sometimes there's contamination in gluten free

15:57

products. So even foods labeled quote

15:59

unquote GlutenFree may still

16:01

not be safe for celiac sufferers.

16:05

That's why we need to

16:07

know. The

16:09

irony editorialized in a

16:11

prominent medical journal of

16:13

many celiac patients not knowing the diagnosis,

16:15

while millions of non sufferers first banished

16:18

gluten from their diets can be considered

16:20

a public health force.

16:23

We would love it if you could share with us your stories

16:26

about reinventing your through evidence based

16:28

nutrition. Go to nutrition facts dot org

16:30

slash testimonials, we may be able to

16:32

share it on social media to help

16:34

inspire others. To see

16:36

any graphs, charts, graphics, images, or

16:38

studies mentioned here, please go to the nutrition

16:41

facts podcast landing page. There

16:43

you'll find all the detailed information you need

16:45

plus linked to all the sources we cite

16:47

for each of these topics. For

16:49

a vital timely text on the pathogens that

16:51

cause pandemics, you can order the ebook,

16:54

audiobook, or a hard copy of my latest book

16:56

how to survive a pandemic or go to

16:58

your local bubble library for that matter.

17:01

For recipes, check out my new how not to

17:03

diet is cookbook. It's beautifully designed

17:05

with more than a hundred recipes for delicious

17:07

and nutritious meals. And of course, all the

17:09

proceeds I received from all the sales of my books

17:11

go to charity. NutritionVax

17:14

dot org is a nonprofit science based public

17:16

service where you can sign up for free daily updates

17:18

on the latest nutrition research via bite

17:20

sized videos and articles, everything

17:22

on the website is free. There are no

17:24

ads, no corporate sponsorships, no

17:26

kickbacks, strictly non commercial,

17:28

not selling in