A little while back I posted an article on non-celiac gluten sensitivity (NCGS) showing that it is a bona fide condition in the scientific literature. However, with evidence indicating that Celiac Disease (CD) and NCGS combined only occurs in 8 – 12% of the population, the question still remains as to whether gluten is bad for everyone.
In order to answer this question, we will venture into evidence linking gluten intake with chronic diseases such as diabetes, arthritis, obesity, metabolic syndrome, psoriasis, fibromyalgia, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), etc. However, much of the research focuses simply on a gluten free diet without consideration for any other dietary factors. Why is that a problem? Well, for those of you who read my blog or are knowledgeable about ancestral nutrition know that “gluten free” does not equate to a healthy diet all on its own. You can get just as many refined/processed gluten free products full of artificial additives and refined sugar/carbohydrates as you can in non-gluten free products. Case and point, soda pop and jujubes are gluten free. Even with this in mind, there are some interesting results from studies comparing standard and gluten free diets, so let’s have a look.
Metabolic Syndrome, Obesity and Diabetes
Metabolic Syndrome, which includes obesity, insulin resistance, and altered cholesterol levels, as well as overt type II diabetes are major risk factors for increased lifetime morbidity (ie. other chronic diseases) and all-cause mortality (ie. death). Experimental animal models show that a gluten free diet can stop, and possibly reverse, fat gain as well as improve insulin secretion and insulin resistance in non-celiac/NCGS mice (1). In fact, epidemiological studies in healthy human populations reflect some of these findings with gluten free diets relating to lower BMIs, improved insulin secretion, and improved HDL levels (considered the “good” cholesterol) (2, 3). While there may be many confounding factors in the results of such epidemiological studies, the results are nonetheless interesting. Furthermore, animal models of type II diabetes show improved glucose tolerance and pancreatic function (ex. more insulin producing cells) when on a long term gluten free diet (4).
Aside from celiac disease, which is an autoimmune disease directly tied to gluten intake, gluten has also been associated with a number of other autoimmune diseases including type 1 diabetes, rheumatoid arthritis, psoriasis, fibromyalgia, sjogren’s syndrome, inflammatory bowel disease, and multiple sclerosis (5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16).
An opioid is any substance that acts on opioid receptors and can produce morphine-like effects. The breakdown of gluten has been shown to produce natural opioids that can act on these receptors (17, 18). This can cause a number of effects such as addiction, withdrawal symptoms, increased hunger, and possibly mask any pain related symptoms (ex. gastrointestinal symptoms) of gluten intake due to opioid pain reducing qualities (18). This means that some people may have gluten related issues but don’t notice them due to gluten’s opioid effects.
If you haven’t heard about the negative health effects of chronic inflammation, you must be living under a rock. It has been tied to virtually all chronic diseases (see below), and there is growing evidence in both animals and humans that dietary gluten promotes inflammation by altering the anti/pro-inflammatory balance, possibly in a dose dependant manner (19, 20, 21, 22).
Intestinal Permeability and Inflammation
You may ask what intestinal permeability is, but unless you have been living on another planet for the last few years, you’ll definitely recognize its alternate name…leaky gut. Simply put. Leaky gut is when your intestinal lining does not function properly and allows particles and molecules from your intestines to pass into your body. Normally your intestines allow digested nutrients and other beneficial molecules into your body, this is its normal function; however, when it malfunctions it allows things into the body that are not supposed to be there such as pathogens, undigested food particles, toxins, etc. When this happens, it triggers an inflammatory response in the body. Now if this happens only once for a short period of time, the inflammatory response resolves the threat and all is good. However, there are a large number of things that can promote leaky gut, most of them being common in our modern world. This means that leaky gut may be chronic in many cases and cause a chronic elevation in the immune system, otherwise known as chronic low grade inflammation. Because of this, we would expect leaky gut to be linked to many chronic inflammatory diseases, and indeed this is the case. Leaky gut has been connected with metabolic syndrome (insulin resistance, obesity, and dyslipidemia), diabetes, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), autoimmune disease, neurodegenerative disease, dementia, non-alcoholic fatty liver disease, etc.
So, what does this have to do with eating gluten? Well, as mentioned, there are many elements in this modern world that can cause leaky gut, lots of them being dietary, and you guessed it, wheat and/or gluten is one of them. Evidence from animal models suggests that gluten can induce intestinal permeability via its impact on a molecule called zonulin, which regulates intestinal permeability. (23, 24)
Chronic Disease and the Inflammatory Connection
So now we know that gluten may be linked to a number of chronic diseases as well as elevated inflammation and leaky gut. But, this may not be enough for everyone. Therefore, to further strengthen the connection between gluten and disease, we need to understand the link between chronic low-grade inflammation and chronic disease. Such a connection is not difficult to show as there is multiple lines of evidence indicating that chronic low grade inflammation may be a connecting cause of virtually all chronic diseases of our modern world including: metabolic syndrome (insulin resistance, obesity, and dyslipidemia), diabetes, IBD, IBS, autoimmune diseases, neurodegenerative diseases, dementia, caner, physiological changes from ageing, etc. (25, 26, 27, 28, 29, 30, 31, 32, 33, 34)
Whole Food vs Whole Food Gluten Free Diets
As mentioned before, a simple gluten free diet is not always a healthy diet and even though many studies show benefits of a gluten free diet, they do not always consider other dietary factors such as amount of refined/processed foods, industrial seed oil, Omega 3, Omega 6, dairy, glycemic index or load of gluten free or control diets. In fact, epidemiological studies do not even have a control diet and rely on diet questionnaires where there is lots of room for error. So, how then do we get even closer to determining if gluten really is bad or good for us? One way is to look at clinical trials of diets that are considered “whole food” based (little to no refined/packaged food), where one diet is gluten free and the other is not. Luckily, there is a type of diet that is a whole food, gluten free diet and receiving a large amount of attention, that’s right, the Paleolithic diet.
Because of its growing popularity, the paleo diet has been the topic of a number of clinical trials where it has been compared to standardly recommend whole food diets. In fact, the evidence indicates that a paleo diet is more effective for improving multiple health markers (obesity, insulin resistance, cholesterol levels, inflammation, oxidative stress, cardiovascular risk, colon cancer, fatty liver, etc.) than whole food diets containing gluten such as a diabetes diet, a hearth healthy diet, the Mediterranean diet and the Australian, Nordic and Dutch government food guides, which are similar to our North American food guides (35, 36, 37, 38, 39, 40, 41, 42, 43, 44). Once again, these are not perfect comparisons as gluten is not the only difference between the paleo diet and these other diets. Paleo is not only gluten free, it is grain free, dairy free, legume free, industrial seed oil free as well as typically being lower in carbohydrate, and higher in fat and protein than the other mentioned diets. While all of these factors certainly play a role in the effectiveness of the paleo diet, it does not take away the possibility that gluten also plays a large role.
So, Gluten is Bad for Everyone Right?
For those with celiac disease or non-celiac gluten sensitivity, gluten is most definitely terrible for you and you should avoid it at all costs! Evidence as to whether gluten is bad for everyone is not as clear; however, evidence is continuing to grow that gluten may not be a healthy choice for anyone with it being linked to multiple chronic diseases and gluten free, whole foods diets showing very positive health results. Therefore, my conclusion is that the majority of people would do better to avoid gluten as much as reasonably possible without pulling your hair out doing it. Healthy individuals may not notice an immediate difference in their health by removing gluten from the diet; however, for these individuals the positive impact is gained over time by reducing the risk of many chronic diseases later in life. Chronic low grade inflammation doesn’t cause immediate disease; it is an accumulation over time, that’s why these things are called chronic diseases of lifestyle.
For those who cannot totally remove gluten for whatever reason, try and ensure gluten is eaten only on an occasional basis (1-2 times per week or less) and is eaten in sprouted, fermented, and heirloom forms. Sprouting and fermenting wheat can reduce many of the problematic molecules, including gluten, while heirloom varieties of wheat contain less gluten and gluten that does not impart the level of negative immune effects as modern wheat strains (45, 46, 47).
Gluten is Not a Necessary Food
For those who are now convinced that gluten is bad for everyone, you may be wondering about all the wonderful things people say about whole grains and all the necessary nutrients that wheat, rye and barley contain. Well, the truth may surprise you as there is nothing in wheat (or other grains for that matter) that cannot be obtained through other foods, and in higher amounts. Generally speaking, grains are not nutrient dense foods, hence the reason that many grain based products are enriched with vitamins and minerals. Vegetables, fruits, organs meats, seafood, free range meats, and grass fed dairy products are more nutrient dense than grains and can supply more than the required amount of micronutrients.
Wait, what about fibre? Once again, the truth is that more than sufficient fibre can be obtained through vegetables, while at the same time getting more micronutrients than getting fibre from grains.
OK, but what about all the evidence that says eating more whole grains improves health and reduces the risk of disease. There is real evidence of this so it is a very good question. However, we must keep in mind that “better” is not always equivalent to “best”. In this sense, whole grains are a “better” choice than refined grains, but that does not mean they are a better choice than vegetables for instance. Another confounding factor is that the information showing health benefits of whole grains come mainly from epidemiological studies where questionnaires are used for information gathering. The problem here is that there are many confounding factors that can impact any given outcome, in this case health. For instance, most people who choose whole grain foods are more likely to make many other healthy choices like exercising, eating lots of vegetables, etc. than those who don’t eat whole grains. While well designed studies attempt to control for these variables, it is never perfect. In cases like this, results are skewed by what is called the healthy user bias (what I described above). Epidemiological studies with red meat and vegetarianism/veganism fall victim to this same problem. In fact, the proposed benefits of whole grain consumption are not always seen in results of clinical intervention trials with some evidence indicating they may have a negative effect on immune function (48, 49).
Arguably, Gluten is Bad for Everyone
Ultimately, it is likely that gluten is bad for everyone either in the short or long term with regards to the overall risk of disease for a number of reasons:
- Gluten has been linked to multiple chronic diseases
- Gluten has opioid activity
- Gluten is linked to chronic low grade inflammation (arguably the cause of most chronic disease)
- Gluten is linked to leaky gut (a big cause of chronic low grade inflammation)
- A gluten free whole food diet appears to be better for health than a gluten containing whole food diet
- Gluten containing foods are not necessary as part of a healthy diet (ie. they are nutrient poor) as all nutrients can be obtained more efficiently through fruit vegetable and animal foods.
The Barefoot Golfer