Gluten Sensitivity

In some of my earlier posts on subjects such as ivermectin and fluoride, I talked about ways that reasonably intelligent non-scientists can evaluate research. I think being able to do this is important for several reasons. Science denial and willful ignorance seem to be all around us these days, and while the right and MAGA are leading the charge, you can see it coming from the left as well (I’m lookin’ at you, progressives and New Age woo-woo). But it can be difficult to know if a specific claim is for real or just so much chin music.

So let’s take a concrete example. For whatever reason, you pick up a copy of Gwyneth Paltrow’s cookbook, “It’s All Good,” and read this:

“Every single nutritionist, doctor and health-conscious person I have ever come across… seems to concur that (gluten) is tough on the system and many of us are at best intolerant of it and at worst allergic to it.

That’s alarming to hear. Maybe you follow up on what else Gwyneth has to say about gluten and find this:

The 40-year old actor explained how giving up gluten has changed her life for the better. For one thing, she says, she feels lighter and more relaxed. Before going gluten-free, Paltrow says she had “a lot of unexpressed anger. I made everyone else’s feelings more important than my own. I’d suck it up and then be alone in my car yelling at traffic or fighting with hangers in my closet when they got stuck together.”

Let me say up front that I have nothing against Gwyneth Paltrow. She seems like a well-intentioned person. I thought she was pretty good in the Iron Man and Avengers movies, and I don’t think Shakespeare in Love was overrated at all. But should you cut gluten out of your diet based on what she says? How can you know?

Well, you probably should if you have Celiac disease. Celiac disease is an autoimmune disorder. When people talk about autoimmune disorders, they’re referring to what happens when your immune system—your body’s defense against bacteria, viruses, and even cancer mistakenly starts attacking healthy cells instead. It’s a biological case of mistaken identity, and it can trigger all sorts of problems: inflammation, tissue damage, and a laundry list of symptoms that depend on what part of the body is under fire.

We’re not talking about rare medical curiosities, either. More than 80 different autoimmune diseases are recognized, including well-known names like celiac disease, type 1 diabetes, rheumatoid arthritis, and lupus. No one’s pinned down an exact cause, but it’s probably some unpredictable mix of genetics and environmental bad luck.

These conditions don’t just fade away. They’re chronic and managing them usually requires ongoing treatment to keep flares and complications in check. Bottom line: autoimmune disorders show what can go wrong when the body’s defenses become a little too enthusiastic and start fighting the very tissues they’re meant to protect.

For people with celiac disease, the body reacts to gluten by attacking the lining of the small intestine, which impairs nutrient absorption and leads to symptoms like diarrhea, abdominal pain, bloating, fatigue, and sometimes weight loss or malnutrition.​

Both children and adults can be affected; untreated celiac disease may cause growth problems in children or other health issues such as anemia, osteoporosis, neurological symptoms, and skin rashes. The only treatment is a strict lifelong gluten-free diet, which allows the intestine to heal and symptoms to resolve. So celiac, if you have it, is no joke. 

But how likely are you to have celiac disease? Most research puts the prevalence at about 1% of the population. That’s low, but if you are having any of the symptoms listed above, you should see a doctor and get tested. But what about the idea that gluten is just bad for you even if you don’t have celiac? Let’s return to Ms. Paltrow.

If I decided to embark on an acting career at this point in my life, I might be interested in what she had to say. But does it make sense to get your health advice from an actress? I checked, and Ms. Paltrow went to UC Santa Barbara for a couple of years to study art history but didn’t finish her degree. Again, that’s no sin; I’m sure she has made more money as an actress than she would have doing whatever art historians do. But it doesn’t make her an authority on autoimmune diseases. By the same token, she might be right; the statement “Gwyneth Paltrow says gluten is bad, but she didn’t even finish her art history degree” is an ad hominem attack; her level of education has no bearing on whether she is right or wrong about gluten. Maybe she has a famous gastroenterologist in the family and got the information from them. But I wouldn’t assume she has any special knowledge of gluten-related diseases.

So what’s next? Well, you could go to a reputable website; the one run by the Mayo Clinic comes to mind. What does the Mayo Clinic say about gluten-free diets? Here’s what their expert says:

As gluten-free food options increase, it can be difficult to decide whether to include gluten in your diet or not. For most people, there is no need to completely eliminate foods containing gluten and no proven benefit from doing so, says Sarmed Sami, MBChB, a gastroenterologist at Mayo Clinic Healthcare in London. In this expert alert, Dr. Sami explains why and the difference between two gluten-related medical conditions: celiac disease and gluten intolerance.

“There’s no evidence that a gluten-free diet by itself is healthier,” Dr. Sami says. “It’s not about the gluten. Take a biscuit, for example: It’s more about the fat and the sugar in the biscuit than the gluten.”  

That seems like better advice than something you’d get off a celebrity’s website. But maybe you are the inquisitive type and really want to know the facts; good for you. But your degree is in English literature, and you didn’t get much scientific training. What’s the next step?

If you are feeling ambitious, you could look at the references supplied by the Mayo Clinic or Cleveland Clinic websites. Another possibility is using PubMed, Google Scholar, or the Cochrane Library and researching the subject. Let’s try Google Scholar. You just Google it.

OK, I’ve opened Google and typed in “gluten-free diets.” Here’s an article that came up from the journal “Foods,” which is a reputable, peer-reviewed publication on food science: 

Wheat/Gluten-Related Disorders and Gluten-Free Diet Misconceptions: A Review

The abstract of the article is a short summary that appears at the top of the publication. Here’s what it says:

Abstract

In the last 10,000 years, wheat has become one of the most important cereals in the human diet and today, it is widely consumed in many processed food products. Mostly considered a source of energy, wheat also contains other essential nutrients, including fiber, proteins, and minor components, such as phytochemicals, vitamins, lipids, and minerals, that together promote a healthy diet. Apart from its nutritional properties, wheat has a set of proteins, the gluten, which confer key technical properties but also trigger severe immune-mediated diseases, such as celiac disease. We are currently witnessing a rise in the number of people adhering to gluten-free diets unwarranted by any medical need. In this dynamic context, this review aims to critically discuss the nutritional components of wheat, highlighting both the health benefits and wheat/gluten-related disorders, in order to address common misconceptions associated with wheat consumption.

You can scroll down to the “conclusions” section of the article and see the authors’ bottom line. Here are some excerpts: 

Wheat is the widest cultivated crop on Earth and has been consumed for 10,000 years by humans from its most primitive form to the current species. Wheat is a nutritious cereal, rich in dietary fiber. The nutritional recommendations of many countries emphasize cereals as the basis of a balanced diet. This is particularly true in low and medium-income countries where grain-based food is the main source of energy, carbohydrates, fibers, proteins, B vitamins, and minerals essential for human survival. The exclusive properties of dough made from wheat flour derive from the gluten protein complex and allow it to be processed into bread, pasta and noodles, and other diverse forms of food feeding most of the world population.

Only a tiny percentage of the worldwide population is affected by these wheat/gluten-related disorders. Opting or promoting a GFD to improve well-being unwarranted by any medical suggestion is an unhealthy alternative since the consumption of wheat is more beneficial than its non-consumption. Thus, to answer the question “How healthy is to eat wheat?” and the take-home message is that wheat is an excellent food for people without any associated medical conditions because it is a very nutritious cereal, rich in macro and micronutrients that only beneficiate our health. The problem is that people are removing wheat from the diet without any medical indication or health/nutritional condition with a proven relationship and consequently are not consuming the necessary nutrients. This is a mistake that results from a growing number of misconceptions related to this cereal that should be avoided and clarified, as they end up harming these people’s health. 

For the majority of patients diagnosed with celiac disease, eliminating gluten keeps it under control, Dr. Sami says. But without a celiac diagnosis, there is no reason to eliminate gluten.

So who is pushing the idea that wheat generally and gluten specifically are harmful? There are the influencers, of course. And food companies have gotten onto the bandwagon; I chortle to myself when I buy a jar of dill pickles that proclaims, “A naturally gluten-free food!” I wasn’t expecting to find a great deal of wheat protein in pickled cukes in the first place, or in a pack of chicken wings either, come to that. But this kind of marketing does boost sales. But there are also the “medical authorities” who push this idea. Back in 2011, the book “Wheat Belly” by William Davis, MD, was an NYT bestseller and sold millions of copies. Among his more questionable claims regarding wheat consumption include the following examples: I’ve added what the scientific community thinks about these claims:

Claim	Scientific Support
Wheat consumption is a primary cause of obesity and weight gain in the U.S., more so than sugar or calories alone.	Not scientifically supported—Rigorous studies show obesity is multifactorial, with no evidence that wheat is uniquely responsible for population-level weight gain
Eating modern wheat triggers addictive responses in the brain, similar to opioid drugs, due to “exorphins.”	Not scientifically supported—Claims about opioid-like “addiction” from wheat proteins are based on limited lab studies and not demonstrated in humans.
Modern wheat is a genetically modified “Frankenwheat” that is far more harmful than wheat of the past.	Not scientifically supported—Today’s wheat is not genetically engineered; changes through hybridization have not made it uniquely harmful, according to genetic and clinical analyses
Eliminating wheat can reverse chronic diseases such as heart disease, arthritis, diabetes, and many autoimmune disorders.	Not scientifically supported—No direct clinical evidence shows that removing wheat alone reverses these conditions in the general population.
Wheat is the root cause of most cases of irritable bowel syndrome, inflammation, and many neurological or psychiatric disorders, even in people without celiac disease or wheat allergy.	Not scientifically supported—Research does not support wheat as the primary cause of these disorders in the general population
Wheat is the root cause of most cases of irritable bowel syndrome, inflammation, and many neurological or psychiatric disorders, even in people without celiac disease or wheat allergy.	Not scientifically supported—Research does not support wheat as the primary cause of these disorders in the general population
Everyone should avoid wheat and gluten for better health, not just those with celiac disease or gluten sensitivity.	Not scientifically supported—Medical consensus is that wheat and gluten are harmless for the vast majority, with only a small percentage needing to avoid them
Whole wheat bread raises blood sugar more than table sugar, making it especially harmful to metabolic health.	Partially misleading and exaggerated—Some wheat products can have a high glycemic index, but context (dietary pattern, fiber, portion size) matters, and wheat is not inherently more “harmful” than other carbohydrate sources.

Clearly, it’s probably not a good idea to stuff yourself with Wonder Bread. As my sister Vivian put so succinctly, “A calorie is a calorie is a calorie,” and if you eat too many of them, you will gain weight, with all the problems that go along with that. And it’s probably not a good idea to eat large amounts of processed foods. The best science-based advice about diet is out there: emphasize fruits and vegetables, whole grains, and lean protein; limit sugar, salt, and alcohol; and avoid over-processed foods. That said, an occasional cheeseburger won’t kill you; you can have a little of everything if you don’t overdo it.

So why all this interest in gluten? I think there are a couple of reasons. I already mentioned that food fads sell and make money for food companies. Then there is our old friend the nocebo effect. The nocebo effect is what happens when your expectations alone make you feel sick with no actual cause required. Think of it as the evil twin of the placebo effect. If you believe that a pill, food, or even an experience is going to give you side effects or make you sick, your brain sometimes happily obliges, serving up real symptoms out of thin air. We’re talking headaches, nausea, pain, gut issues—you name it—all triggered by negative expectations, not by chemistry or physiology.

This isn’t some fringe idea: there’s plenty of research showing that if you expect a bad reaction, there’s a good chance you’ll get one, even if what you just took was harmless. Here are some examples:

Back when they were doing trials of the Covid-19 vaccines, 35% of people who received a placebo (with no vaccine at all) rather than the actual vaccine reported headache, fatigue and other negative effects. Six months later, 36% of the original group who tested negative for Covid were still reporting at least one symptom.

In November 1998, a teacher noticed a “gasoline-like” smell in her classroom, and soon thereafter she had a headache, nausea, shortness of breath, and dizziness. They cleared the school and 80 students and 19 staff members went to the emergency room at the local hospital. Five days later, after the school had reopened, another 71 persons went to the emergency room. Doctors and health officials scoured the school for toxins or anything that would explain all the sudden illnesses, but none were found.

People who are told that a medical procedure is likely to cause discomfort report higher levels of pain and discomfort than people who had the same procedure and were not told to expect discomfort.

The bottom line is that what you believe can shape how you feel—sometimes with no real-world trigger needed. And there is pretty good evidence that this is the case with gluten. There have been a series of studies that have shown that almost 50% of people who believe they have gluten sensitivity (not celiac) developed symptoms even when they were given foods with no gluten but were told that the gluten was there. This doesn’t surprise me, since unlike celiac disease, there is no medical test for gluten sensitivity. It’s a clinical diagnosis usually made by eliminating and reintroducing certain foods and seeing what happens.

There’s also the problem of somatization. Somatization occurs when emotional distress is experienced and expressed as physical symptoms, including pain, fatigue, or gastrointestinal problems, often leading people to seek medical help even when no clear medical cause is found. It is not a single diagnosis but a general term for a mind–body pattern in which emotions, stress, or conflict are “translated” into bodily complaints that feel very real and distressing to the person. Somatization exists on a continuum: many people occasionally get a stress headache or upset stomach under pressure, while for others it becomes chronic and disabling and may be part of conditions like somatic symptom disorder, where health-related worry and preoccupation significantly interfere with daily. This comes up all the time in my practice, but I’ll save that for another post. But if you tend to have this problem, you’ll look for a medical cause for your malaise, and gluten intolerence fits the bill perfectly.

This brings us back to how people should decide whether to go gluten-free. You can listen to Gwyneth Paltrow and Kim Kardashian for your health advice, but I wouldn’t leave it at that. These days it’s easy to do a little research online and make a more informed decision. Luckily, deciding not to eat bread and crackers probably won’t have any ill effects, and if cutting out gluten makes you feel better, more power to you. The only real negative effect I can see is that gluten-free food substitutes are about 140% more expensive, but it’s your money. Just remember that some medical decisions are serious; vaccinating your children comes to mind. And you probably shouldn’t base your decisions on what a bunch of folks on social media are saying. Going back to Ms. Paltrow, as I mentioned, she seems like an intelligent, well-intentioned person. But personally, I’d take her advice about gluten in the context of other health-related claims she has made:

• She suggested that it was a good idea for women to insert jade eggs into their vaginas, and sold them off her website, “The Goop.” Why, I hear you ask? She claimed that these eggs could regulate menstrual cycles, prevent uterine prolapse, and balance your hormones. In 2018, the consumer protection agency of California brought suit against Ms. Paltrow’s company, which was selling these eggs; the suit was settled for upwards of $100,000 along with a promise to stop making such claims.
• She stated that she would rather die than let her kids eat Cup-o-Soup.

• In the same vein, she indicated she would rather smoke crack than eat cheese from a can (I think she was talking about pressurized Cheese Whiz. Mmmm…Cheese Whiz. )

My general point here is not to bash Ms. Paltrow. But she’s an actress, not a physician or scientist. How to put this…  The world is full of things most of us don’t know much about. Take me for example. You want a psychological evaluation? I’m your man. Want advice on fixing your car, investing in the market, or writing code for a computer program? You’d do about as well with me as you would with a capuchin monkey. For any of these issues, I’d go to someone with a proven track record of knowing something about the subject in question. And you can be very good at some things and know nothing about others. So if you are trying to decide about something complicated like dietary choices and autoimmune diseases and you aren’t a rheumatologist, where should you get your information? Pop quiz time:

You are at home watching football, and you have an ache in your left bicep. The pain becomes more intense, and you feel pressure on the left side of your chest. You feel short of breath, and you are sweating profusely. You have a deep sense of dread as well. Should you seek the services of:

1. An auto mechanic
2. An emergency room physician
3. Joe Rogan
4. RFK Jr.
5. A naturopathic physician
6. Gwyneth Paltrow

If you chose any answer besides B, I wish you luck, because you are going to need it.