Gut feelings: gluten sensitivity is complicated
This morning Business Insider ran a short video: “Gluten Sensitivity Proven False,” which makes a few good points and some dubious ones. First off, a more accurate title for the video would be: “One Study Shows Gluten Not a Factor in IBS Symptoms,” but that’s got a lot less drama to it. (Here’s the video if you’re curious.)
Basically, according to the video only 1% of Americans have Celiac Disease but about 30% report wanting to eat less gluten. Is there such a thing as “non-celiac gluten sensitivity” and how many of that 30% might have it? The bottom line in the video is there isn’t such a thing. The actual title of the video on the page is “The Science is in — Why Gluten Sensitivity is Probably Fake.” I get cranky when people cite “Science” when they really mean one study or a small group of studies and then use emotionally loaded words like “fake.”
My bottom line is this: self-care trumps all. If you feel better eating gluten-free or grain free or only foods that don’t begin with the letter “g,” then that’s what you should eat. Everyone is an individual. Just like there aren’t two one-size-fits-all genders, there aren’t one or two diets for all humanity. Digestion is extremely complicated (at least from the western medicine viewpoint). What works for you doesn’t necessarily work for someone else so if you want to take good care of the people in your life, listen to them and support them if they’re trying different dietary options to be healthier.
Now if you’re curious to see me deconstruct the study and talk about some interesting trends in health and eating, read on:
The video’s data is based on a follow up study that Peter Gibson did to his 2011 study that suggested gluten can cause gastrointestinal distress in people who don’t have celiac disease. (Read the abstract and download the study here.) The new study involved 37 self-identified gluten sensitive patients with Irritable Bowel Syndrome (IBS). They did various diets with gluten and without. No matter what diet they were on, they had problems anyway — unless they eliminated the group of foods known as FODMAPs.
I’m not a doctor, I’m just a well-read health geek who’s had gastro symptoms pretty much from birth and has tried most of the tummy-friendly diets out there. I don’t know what’s best for you, but here’s my take on what’s wrong with this report and some things you can try if you have gastro distress:
#1 — FODMAPs are a common culprit.
They can create tremendous gastro distress (trust me!). If you’re suffering on a regular basis, look at the lists of FODMAPs and try eliminating all of them or go through one family at a time and remove them. You might find yourself feeling much better in a very short time.
Additionally, the FODMAP family that contains oligosaccharides includes wheat and rye, so if you eliminate those and feel better, this might be why. It’s not the gluten, it’s the oligosaccharides.
Here are some links about foods to avoid if you want to try eliminating FODMAPs:
Quick info: http://www.aboutibs.org/site/treatment/low-fodmap-diet/measuring
Dense PDF for food geeks: www.medicine.virginia.edu/clinical/…health/…/Parrish_Dec_12.pdf
#2 — The fact that Gibson used IBS patients is important.
Some percentage of IBS patients have a condition called Small Intestine Bacterial Overgrowth (SIBO). I’ve seen numbers ranging from 10% to 85%, so the jury’s still out on the total. With SIBO, your digestive distress is caused by a bunch of bacteria moving into your small intestine, where they shouldn’t be living, and setting up colonies complete with Walmarts and mini golf. While they party in your gut, they throw off gasses that mess with your digestion even more.
Why is that an issue in this study? If you have SIBO, carbohydrates and sugars feed the bacteria and make things worse for you. I looked at the report from Gibson’s study and they don’t say if they eliminated all grains and complex sugars from the IBS patients. If they didn’t, then this could explain why the symptoms remain whether or not gluten is in the diet.
It’s possible that for some people, eliminating gluten leads them to cut down on all grains and sugars — if they have SIBO, this will make them feel better. Of course if they replace gluten with a bunch of high-grain gluten free products, that’s not going to help with the SIBO. But this is one reason people might feel better gastrointestinally after they remove gluten from their diet.
To test if SIBO is an issue for you, you might try the Specific Carbohydrate Diet (SCD), which is designed to starve out your misplaced gut bacteria. It is not for the faint of heart — but after the elimination of key FODMAPs, the SCD diet has done more for me in terms of eliminating symptoms than anything else I’ve tried.
#3 — Blood sugar highs and lows might also be a factor.
I used to crash every afternoon around 2 p.m. and get super sleepy. At first I put it down to biorhythms. Then the gluten-free thing happened (and my doctor suggested I get off gluten because my mother has two of the three genetic markers for Celiac Disease). I stopped having sandwiches for lunch and I felt much more alert in the afternoon. This means I’m gluten-sensitive, right? Maybe not.
Maybe it’s an issue with blood sugar. In terms of glycemic load (how much a food raises your blood sugar), eating a piece of white or whole wheat bread actually creates more of a rise in blood sugar than eating a tablespoon of pure sugar. Depending on its contents (because more fiber will slow digestion and create less of a total glycemic load), that sandwich could be similar to eating more than two tablespoons of sugar with my lunch. About two hours later I crash and voila there’s the fatigue effect that I was attributing to gluten.
For members of the Gibson study who are also sugar sensitive, if they were eating moderate to high glycemic load foods they could still experience mental/emotional symptoms from their sugar crashes even without gluten being present.
Here are some common foods and their glycemic index and load numbers (the latter is a more accurate per serving measure than glycemic index) so you can see how grains have a higher glycemic load than you might expect.
Food———–Glycemic index —–Glycemic load per serving
White bread———– 71———- 10
Whole wheat bread—71———- 9
Oatmeal————– 53-58—– 12-13
White rice———– 64-89—– 33-43
Brown rice———– 50-55—— 16-23
Spaghetti———— 46———- 22
Apple—————– 39———– 6
Peach—————– 42———— 5
Carrot—————- 35———— 2
Sugar —————- 68———— 8
Honey ————— 55———— 9
Snickers bar——– 55———— 35
(The ranges of numbers are because I got them from two different sites and testing can vary somewhat. The sites are: http://nutritiondata.self.com/topics/glycemic-index and http://www.health.harvard.edu/newsweek/Glycemic_index_and_glycemic_load_for_100_foods.htm.)
#4 — Factors don’t operate in isolation
Gut issues can be really hard to figure out because there doesn’t have to be a single cause. Our guts are part of the emotional and thinking systems in our bodies. Studies are showing that our gut health influences our emotional state and we’ve long known that our emotional states impact our guts.
For more about how gut health influences moods, check out the NPR story: Gut Bacteria Might Guide The Workings of Our Minds or this story from the American Psychological Association.
If you’ve got three or four or five factors creating your gut distress, it can take a long time to figure out what’s what. Especially when western medicine tends to be less than helpful about holistic systems issues. You may have stress influencing how well your GI tract works, plus be eating foods that aggravate it, and then on top of that be feeling more stressed because you don’t feel well, which just compounds all of it. No one needs to add to this mix with articles or videos saying that “Science” says your food sensitivities are fake. Be patient and sweet with yourself or your friends/family members who are trying to have better gut health.
Kim AlbeeJuly 23, 2014 at 10:56 pm
I love the thinking and sensibility you’ve brought to the subject. I can say that I went on a diet that cut out wheat and grains. In about two weeks I noticed that the phlegm in my throat that I’ve had for a bulk of my life was gone. Wow! I’d never considered that it was something that wouldn’t be there.
So now, when I eat bread, I get that phlegm and if I eat gluten-free bread, I don’t. No scientific study, just my experience and there isn’t anything ‘fake’ about my experience.
I love your recommendation: do what works!