Thursday, July 9, 2015

The Myth of Big, Bad Gluten

update - added material about Grain Brain and  Wheat Belly at end

NY Times  As many as one in three Americans tries to avoid gluten, a protein found in wheat, barley and rye. Gluten-free menus, gluten-free labels and gluten-free guests at summer dinners have proliferated.

Some of the anti-glutenists argue that we haven’t eaten wheat for long enough to adapt to it as a species. Agriculture began just 12,000 years ago, not enough time for our bodies, which evolved over millions of years, primarily in Africa, to adjust. According to this theory, we’re intrinsically hunter-gatherers, not bread-eaters. If exposed to gluten, some of us will develop celiac disease or gluten intolerance, or we’ll simply feel lousy.

Most of these assertions, however, are contradicted by significant evidence, and distract us from our actual problem: an immune system that has become overly sensitive. [...]

Milk-producing animals were first domesticated about the same time as wheat in the Middle East. As the custom of dairying spread, so did lactase persistence. What surprises scientists today, though, is just how recently, and how completely, that trait has spread in some populations. Few Scandinavian hunter-gatherers living 5,400 years ago had lactase persistence genes, for example. Today, most Scandinavians do.

Here’s the lesson: Adaptation to a new food stuff can occur quickly — in a few millenniums in this case. So if it happened with milk, why not with wheat? [...]

Dr. Barreiro, who’s at the University of Montreal, has observed this pattern in many genes associated with autoimmune disorders. They’ve become more common in recent millenniums, not less. As population density increased with farming, and as settled living and animal domestication intensified exposure to pathogens, these genes, which amp up aspects of the immune response, helped people survive, he thinks.

In essence, humanity’s growing filth selected for genes that increase the risk of autoimmune disease, because those genes helped defend against deadly pathogens. Our own pestilence has shaped our genome.[...]

So the real mystery of celiac disease is what breaks that tolerance, and whatever that agent is, why has it become more common in recent decades?

An important clue comes from the fact that other disorders of immune dysfunction have also increased. We’re more sensitive to pollens (hay fever), our own microbes (inflammatory bowel disease) and our own tissues (multiple sclerosis).

Perhaps the sugary, greasy Western diet — increasingly recognized as pro-inflammatory — is partly responsible. Maybe shifts in our intestinal microbial communities, driven by antibiotics and hygiene, have contributed. Whatever the eventual answer, just-so stories about what we evolved eating, and what that means, blind us to this bigger, and really much more worrisome, problem: The modern immune system appears to have gone on the fritz.

Maybe we should stop asking what’s wrong with wheat, and begin asking what’s wrong with us.

Dr David Katz in The Atlantic
Dr. David Katz is the founding director of Yale University's Prevention Research Center. He is an epidemiologist who has published two editions of a nutrition textbook for healthcare professionals called Nutrition in Clinical Practice. The third edition, nearing publication, will have nearly 10,000 citations. He is also the author of the nutrition book Disease Proof: The remarkable truth about what makes us well. Like Perlmutter, he also cites this era as a gold-standard. Apart from that—and a first name and medical degree—the two have little else in common.
“I find the whole thing a little bit sad, to be honest with you,” Katz told me. “In several ways. Beginning with the fact that I actually like Dr. Perlmutter. He does some really interesting and innovative work in the area of neurodegenerative diseases. He’s cutting edge and is doing stuff that’s a little bit out there. But he generally does this carefully and has actually provided some useful guidance we’ve applied in my own clinic; and I have a longstanding relationship with him—or at least his clinic—and we’ve corresponded and I generally think very highly of him. So I find it sad to be in a position to say that I think so much of his book is a whole bunch of nonsense.”



Katz paused.

“Now, he’s absolutely right that we eat too much sugar and white bread. The rest of the story, though, is one just completely made up to support a hypothesis. And that’s not a good way to do science.”

This launches the discussion of what science is—the critical point that confronts every mainstream media health and science writer. Most recently and famously we have heard about it in criticism of the works of Malcolm Gladwell and Jonah Lehrer (outside of the latter’s self-plagiarism debacle). The law of good science is that you can’t say “I’ve got an idea and I’m going to fall in love with it and selectively cite evidence to support it.”

“You’re only being a good scientist,” Katz said, “if you say, ‘I’m going to try to read the literature in as unbiased a manner as I possibly can, see where it leads me, and then offer the advice that I have based on that view from an altitude.’ I don’t see that going on here, and again, I think it’s kind of sad because I think the public is being misled.”

“I also find it sad that because his book is filled with a whole bunch of nonsense, that’s why it’s a bestseller; that’s why we’re talking. Because that’s how you get on the bestseller list. You promise the moon and stars, you say everything you heard before was wrong, and you blame everything on one thing. You get a scapegoat; it’s classic. Atkins made a fortune with that formula. We’ve got Rob Lustig saying it’s all fructose; we’ve got T. Colin Campbell [author of The China Study, a formerly bestselling book] saying it’s all animal food; we now have Perlmutter saying it’s all grain. There’s either a scapegoat or a silver bullet in almost every bestselling diet book.”

The recurring formula is apparent: Tell readers it’s not their fault. Blame an agency; typically the pharmaceutical industry or U.S. government, but also possibly the medical establishment. Alluding to the conspiracy vaguely will suffice. Offer a simple solution. Cite science and mainstream research when applicable; demonize it when it is not.

“It makes me sad that somebody like you is going to reach out to me, so you can get what I’d like to think are sensible comments about a silly book. If you write a sensible book, which I did—it’s called Disease Proof , and it’s about what it really takes to be healthy, brain and body—nobody wants to talk about that. It has much less sex appeal. The whole thing is sad.”

Negative reviews of Grain Brain and Wheat Belly -
http://www.forksoverknives.com/the-smoke-and-mirrors-behind-wheat-belly-and-grain-brain/ 

http://www.foodnavigator-usa.com/Regulation/Misleading-and-sensationalist-Grain-Brain-book-distorts-science-and-confuses-public-with-advice-to-avoid-grains-say-critics 

http://www.theatlantic.com/health/archive/2013/12/this-is-your-brain-on-gluten/282550/

http://www.salon.com/2015/05/03/diet_fads_are_destroying_us_paleo_gluten_free_and_the_lies_we_tell_ourselves_partner/

10 comments:

  1. It's clear that the Torah does not hold of a gluten free diet. Lechem is the main food and it general it's a straight wheat bread. If this is the primary food, gluten can't be bad.

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  2. what is the minhag of not drinking water today between 2-3 pm? I take it is not in the Rambam?

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  3. check out the fascinating article this morning in Haaretz with the claim that 75% of Askenazi Jews are lactose intolerant.

    http://www.haaretz.com/life/science-medicine/.premium-1.664967

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  4. According to this, you have it almost right: "Lechem" is "main food," just not davka from grain.


    http://www.balashon.com/2006_03_01_archive.html

    “Man cannot live on bread alone” - כי לא על הלחם לבדו יחיה האדם (Devarim 8:3)

    While it is clear from the verse that there are more important things in life than lechem (orlehem/lekhem) לחם bread, by its placement it is also clear that lechem is of very high significance. What is the meaning of this staple word?

    Well, first of all, it's not clear that it originally meant only bread. In Arabic lahm means meat, and as Ruth Almagor-Ramon points out here: http://msradio.huji.ac.il/wwwroot/INST/rega.doc
    lechem meant "the main food". When flour was the basis of the main food, then lechem meant bread; for those who relied mainly on meat, then the same root took on that meaning.

    Stahl explains the term similarly. He points out that Hebrew also preserves some of the non-bread meaning of lechem, as in the verse from Tzefania 1:17: וְשֻׁפַּךְ דָּמָם כֶּעָפָר, וּלְחֻמָם כַּגְּלָלִים - "their blood will be poured out like dust, and their flesh like dung". Here l'chum refers to flesh, to meat.

    In Hebrew, Bethlehem derives from Beit Lechem - the House of Bread. In Arabic, they call it Beit Lahm - House of Meat. (The English word bedlam derives from a London mental hospital called "Hospital of Saint Mary of Bethlehem".)

    What about two other words that share the same root with lechem - מלחמה milchama - war, and הלחמה halchama - welding? Both Stahl and Almagor explain that they are all connected. Welding brings things closer, and in war in ancient times, the combatants were very close to one another. And what about lechem? Almagor claims that man feels very close to lechem (food), whereas Stahl says that the flesh association is earlier, and explains that lechem (flesh) is very close to the bone.

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  5. I notice that this type of allergies (gluten, polen, nuts etc.) that are so common in North America, are almost inexistent in South America. I agree with the author that maybe there's something wrong with our lifestyle in general, from excess of processed foods to lack of sun.

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  6. I don't care what the dictionaries say or any comparison to Arabic implies.

    It is clear in the laws of challa that the main form of bread is from חטה which is wheat and throughout the Talmud lechem means pure wheat bread. Food is called lechem because the main meal of people used to be bread and many laws of blessings and the structure of a meal are based on the main food being bread and other things just amplify the bread. Whenever bread is made of the other 4 grains of the 5 grains, the bread is specified to be of the other type.

    Since this is clear and the main food that G-d has provided us and G-d does everything for the good, it makes no sense that a vast swath of humanity could not eat this food.

    If the grains have been tampered with to the point that it becomes harmful that might cause the gluten problems that appear today but it's hard to believe that basic wheat has been so denatured that its essential benefits are lost.

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  7. First, In the USA, about 1/3 of the population carries genes that make them vulnerable to gluten/gliadin immune damage once gut barrier integrity is lost, which is an increasing problem.

    As to wheat having been denatured, believe it.

    Wheat has been genetically engineered (NOT genetically modified, BTW, though that is in the works) to make it more easily harvestable by machines and to increase the protein, in particular gliadin, content. (Increasing the gliadin content also increases the amount of addictive gliadomorphins formed from the partial digestion of wheat; when the gut barrier integrity is impaired, the brain is exposed to these compounds.)

    The structure of the wheat proteins was also altered; in that way too the wheat our ancestors were given is not our wheat. In addition, modern farming practice often involves storage of grain surplus for several years (to sell when market conditions are more favorable) under conditions that denature the proteins and render them more antigenic.

    So there is a perfect storm: multiple factors operating to compromise gut integrity, which exposes a vulnerable population to increased levels of antigenic substances, which have in addition been made more highly reactive.

    There is no question that the domestication of the grains that gave rise to modern wheat (in Asia it was rice) was a pivotal event in the rise of civilization in the Middle East in general and is mirrored in our people's movement from a small pastoral clan that ate Egyptian bread-beer in its paradigmatic exile to a nation that gave ma'aser of grains grown on Promised soil to support the Beit HaMikdash and the Kohanim and Levi'im.

    But for better (higher yields and protein content and more reliable production) and for worse (see above) the grains they gave are not the grains we have today.

    For an interesting and informative introduction to the subject, see neurologist David Perlmutter's Grain Brain.

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  8. Permultter's Grain Brain is widely condemned by the medical profession as being based on half truths and faulty logic

    http://www.forksoverknives.com/the-smoke-and-mirrors-behind-wheat-belly-and-grain-brain/

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  9. @ontheleftcoast - bottom line the global claim of causation by Permlutter is not accepted in the medical field. What he is doing is not acceptable as Science.

    Another helpful book that I am reading now is Grain of Truth by Stephen Yafa

    http://www.amazon.com/Grain-Truth-Against-Wheat-Gluten/dp/1594632499

    I also just finished

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  10. Yes, wheat built civilization. But civilization built a different wheat, and a lot of the rest of civilization has compromised many people's ability to tolerate the wheat we now have.

    I will say that when clinicians venture into public policy it can be problematic. That said, if Perlmutter can get more people to lower their hemoglobin A1cs and restore their barrier systems, more power to him. I think there are multiple constitutional types; some people do REALLY well with a ketogenic diet long term; others less so.

    Bottom line, I think Perlmutter is more right than McDougall.

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