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Dear Doc: Wheat, gluten, inflammation — baffling!

Dear Doc: Wheat, gluten, inflammation — baffling!

Dear Dr. K: I’ve had a blood test for gluten sensitivity, allergy tests for wheat and even an intestinal biopsy for celiac. All the tests are negative, but I still feel better when I avoid wheat. What gives?

What gives is that wheat is not good for you. No medical test is perfect. Even “gold standard” tests such as chest X-ray for pneumonia or cardiac catheterization for coronary blockage sometimes fail to demonstrate an existing abnormality. The bottom line is to listen to your body – it almost always gives reliable feedback.

I suspect you feel better wheat-free for one of two reasons: 1.) You are wheat-allergic or gluten sensitive, despite negative tests or, 2.) You are feeling metabolic and inflammatory buffeting from wheat.

Regarding the first possibility, the Mayo Clinic published research data from their GI department. They found that 15 percent of their patients with chronic GI problems improved on a wheat-free diet, despite negative tests for gluten sensitivity. They posited that perhaps a better test for gluten sensitivity needs to be invented.

With respect to the second possibility of metabolic and/or inflammatory problems, this case was probably best summed up by Dr. Daniel Lieberman, a Harvard social anthropologist, in his book, The Story of the Human Body. He maintains that the cultivation of wheat, starting 10,000 years ago, was both the best and worst step for humans. He contends the ability to farm allowed humans to move from sparsely populated hunter-gatherers to the burgeoning population of civilized humans who have covered the globe.

The trade-off, he says, is a dramatic increase in the “civilized” diseases of metabolism and inflammation. Ghrelin, leptin, adiponectin and insulin are crucial to proper metabolism and weight management, and all four are adversely affected by wheat. He points out the phytic acid (phytate) in wheat severely reduces absorption of essential micronutrients and vitamins.

With respect to inflammation, gluten is pro-inflammation; in addition, wheat contains the lectin WGA (wheat germ antibody). Lectins are proteins that bind to the glycoproteins and glycolipids found in many cells in the body. These include: skin, respiratory system, GI tract, nerves, cartilage, connective tissues, prostate, kidneys, pancreas, liver, uterus and thyroid. This binding serves as a promoter of inflammation in these tissues. Lieberman draws a direct parallel between the increased consumption of wheat and the appearance of “modern” diseases such as diabetes, heart disease, autoimmune diseases, allergy and cancer.

Gluten Avoidance & Celiac Disease

Gluten Avoidance & Celiac Disease

Dear Dr. K: I tested negative for celiac disease and I’m not allergic to wheat, but I feel better when I avoid gluten. Why?

Your question is a good one in a specific sense and in a global one.

It is reliable maxim that the feedback your body gives you is a more sensitive crucible for problems than any medical test. If your body tells you to avoid gluten, then you should do so. 

In an effort to explore your conundrum there are several possibilities.

First of all, it is possible that you do have celiac disease and your test is falsely negative. This could be due to lack of sensitivity of the test. It could also be due to the fact that a once-positive test can become negative as a person avoids gluten, and therefore avoids the stimulus that causes a positive test.

Another possibility is that your gut flora is altered and the ingestion of gluten leads to fermentation in the gut with resultant cramps, gas and diarrhea. The most common reason for this would be an overgrowth of yeast due to antibiotics, steroids, hormones or immunosuppressive drugs.

Lastly it may be that you fall into a category of people recently reported in the American Journal of Gastroenterology. The scientists who did this research project found a moderately large group of patients who have been labeled IBS (Irritable Bowel Syndrome) who simply felt better on a gluten-free diet. The scientists concluded that gluten can cause GI symptoms by a mechanism as yet not understood.

Celiac disease and gluten may not be good combo

Celiac disease and gluten may not be good combo

A recent article in the Journal of Pediatric Medicine has this interesting title:  “The Complexity of Celiac Disease”.

The reason for the title surfaced when the researchers were testing the validity of the standard approach to diagnosing celiac disease.  The current gold standard for diagnosis consists of having a positive blood test and having an intestinal biopsy that shows villous atrophy (shortening of the absorptive “cilia” in the gut).

This study was conducted in Finland where this disease is quite common.  In the study group of patients who had a positive blood test but a normal biopsy, half went on a gluten-free diet, and half continued to eat gluten.

After a year the gluten avoiders not only felt better, but their blood tests had become negative.  The group that ate gluten continued to have symptoms and most of them developed a positive result on a repeat biopsy.

Their editorial conclusion was that a positive blood test warrants at least a trial of gluten-free diet.