From Chapter Two – Carbs, Grains, and Gluten, pages 28-32
Addiction to wheat is biochemical
When wheat is digested in the body, certain compounds known as gluten exorphins (sometimes called gluteomorphins) are produced; interestingly, dairy products under certain conditions can also lead to the production of similar compounds known as casein exorphins. These chemicals cross the blood-brain barrier, enter the brain and bind to the same receptors that bind opiates like morphine and heroin, triggering a mild euphoria. Therefore, when my patients tell me that they are addicted to wheat, I know that there is a very real physiological mechanism behind this addiction. In fact, when someone eliminates gluten, they can sometimes go through an uncomfortable withdrawal period just like people with other addictions when they stop using what they are addicted to. The good news is that withdrawal from wheat addiction is less painful and shorter in duration then withdrawal from opiate drugs.
Celiac disease has become much more prevalent
In the last 50 years, there has been a dramatic increase in autoimmune disease in general, and celiac disease in particular; for example, comparison with old stored blood samples shows an alarming 500% increase in the incidence of celiac disease over the last 50 years.3 Certainly, there is an increased awareness of celiac disease and testing is much more common, although even today perhaps only 1/5 of people who have celiac disease actually know that they have it. However, there are two important factors that have contributed to a real rise in the prevalence of this condition.
Changes in the Microbiome Predispose to Gluten Sensitivity
The human microbiome, which consists of approximately 100 trillion bacteria per person, has been significantly changing over the past several decades. There is a growing body of research elucidating the vital roles of our gut bacteria in many aspects of health. Factors such as changing diets and the increased use of antibiotics have led to declines in gut bacteria that may be contributing to the increase in gluten sensitivity. The deterioration of our microbiota is potentially linked to the dramatic increase in the incidence of allergies and sensitivities to both foods and environmental triggers.
Taking antibiotics later on during our adult lives could possibly precipitate the development of celiac disease. A large Swedish study analyzing thousands of people diagnosed with celiac disease found that these individuals were more likely to have taken antibiotics within the preceding several months than healthy control subjects. Interestingly, the risk increased in proportion to the number of courses of antibiotics a person was prescribed; the drug metronidazole, which is a broad spectrum antibiotic that disrupts flora, had the highest association with celiac disease. This is only correlation and correlation does not imply causation– we cannot say that taking antibiotics caused the person to develop celiac disease. However, it is a provocative finding and it will be interesting to follow this research as it evolves.
Traditional populations that were healthy and tolerated wheat well differed from us in that they also had all of the factors that would contribute to a robust microbiome, such as regular consumption of fermented foods, exposure to a variety of microbes through farming and close contact with animals, lack of antibiotic use, etc. The microbiome is discussed in detail in Chapter 5.
Not your grandmother’s wheat
A secondary factor in the rise of gluten sensitivity has to do with the food supply. Genetic modification and selective breeding to increase crop yields over the years has dramatically changed the genetics and chemical composition of wheat.
The type of wheat that we currently consume is called dwarf wheat, named for its short stature relative to other varietals of wheat. Despite its diminutive size, dwarf wheat is highly prolific and produces a lot more grains per acre, which is an outstanding trait for productivity and profitability. However, its nutritional content has declined over the years – ancient grains such as einkorn wheat are 200-400% higher in Vitamin A, Vitamin E and the antioxidant lutein as well as certain minerals when compared to modern wheat.7 Dwarf wheat is also significantly higher in starch content, especially in a type of starch called amylopectin A that contributes to a higher glycemic index for wheat and has been associated with insulin resistance.
Unfortunately, it is much higher in gluten than older strains of wheat – modern wheat has up to forty times as much gluten as wheat from earlier this century.9 Moreover, the types of gluten present in the wheat also were transformed. Specifically, modern wheat contains high levels of an allergenic gluten protein known as glia-α9, which is notably absent in ancient grains; interestingly, most patients with celiac disease react negatively to glia-α9.
Genetically Engineered Wheat
The genetic engineering performed to create dwarf wheat also resulted in a plant with extra sets of chromosomes encoding new proteins with unpredictable effects in humans. Dwarf wheat has forty-two chromosomes (known as hexaploid), unlike einkorn wheat, possibly the oldest form of cultivated wheat, which has a simple genetic structure of fourteen chromosomes (known as diploid). The significance of this is that modern wheat has a lot more genes encoding more proteins than what our bodies are used to seeing and processing. Interestingly, one study showed that unmodified ancient grains such as einkorn wheat may be better tolerated by people with celiac disease (although of course I recommend that patients with celiac disease do not consume any type of wheat). Suffice it to say that the wheat that’s available today is very different from the wheat that your grandmother may have used to bake bread.
There may be differences from country to country in terms of wheat varietals, processing techniques, etc. Some of my patients report that they tolerate wheat in other parts of the world, e.g. the Middle East and, to a lesser degree Europe, much better than they tolerate wheat in the United States – in fact, some of them cannot have wheat at all in the US but can have it with impunity in certain other countries. It is not clear what is responsible for these differences. Perhaps it has something do with different species of wheat, genetic modification, method of processing within the food industry, variations in pesticides applied to wheat, or other factors.
To summarize, modern wheat has much more gluten, different types of gluten that people are more sensitive to, far more new genetic material, higher starch content and lower levels of vitamins, minerals and antioxidants when compared to ancient wheat. During the last half- century, our human DNA has not experienced major changes commensurate with this radical transformation of wheat, and many people’s bodies simply may not be capable of processing modern wheat effectively. Add to this the unprecedented alteration of the human microbiota and you have a perfect storm of criteria that have contributed to striking increases in celiac disease and gluten sensitivity.
Certain people can eat wheat and be healthy
This is not to say that there aren’t certain people who could eat ancient strains of wheat under certain conditions and be healthy. There have been healthy traditional cultures that consumed wheat. For example, Weston Price noted certain populations such as people in Switzerland who regularly ate wheat and had excellent health overall. I should reiterate that traditional populations that were healthy and consumed wheat also had the often undervalued characteristics that would contribute to a healthy microbiome, such as consumption of fermented foods, exposure to a variety of microbes through farming and close contact with animals, paucity of antibiotic use, etc. The robustness and strength of their microbiome made a significant difference in being able to tolerate wheat.
In addition, traditional populations used older, unmodified strains of wheat and utilized stone-ground whole wheat berries rather than refined white flour. They also fermented their wheat before consumption. Of note, wheat that is prepared in such a traditional manner, such as sourdough bread that has undergone a long fermentation, has been found to contain much less gluten than traditional wheat. Moreover, one study that had patients with celiac disease consume properly fermented sourdough bread (which was found to contain <10 ppm of gluten) for 60 days found that there was no adverse effect on clinical symptoms or intestinal pathology.
Many modern sourdough breads are prepared using faster-acting chemical methods or leavening agents that require only a few hours and do not utilize the extended fermentation of wheat flour by sourdough bacteria. As a result, there is not enough time for the microbes in the dough to process and break down the gluten to low levels, like in traditionally prepared sourdough. This is another example of how traditional food preparation can have health advantages that are lost when foods are prepared using modern, time-saving methods. To be clear, I’m not recommending that patients with celiac disease or gluten sensitivity consume sourdough bread (or einkorn wheat) – reactions vary and wheat in any form may not be tolerated. Instead, transitioning from wheat bread to sourdough bread may be a good in him and initial step for people who are trying to reduce the amount of gluten in their diet.
What about if you don’t have celiac disease or any known gluten sensitivity? Should you still eliminate gluten? This question must be individualized. One way to test this would be to do an elimination diet. Eliminate gluten for at least 3 months and then reintroduce it and observe the effects of that on your body. If you want to proceed through functional medicine testing, several laboratories offer quantitative tests for gluten sensitivity, utilizing blood, saliva or stool samples, which go beyond the traditional blood test for celiac disease. Determining which lab and which test is right for you is a clinical decision best made in conjunction with a functional medicine practitioner.
If you have autoimmune disease of any kind, inflammatory bowel disease or hypothyroidism, it is likely that a gluten-free diet would be beneficial for you. There is evidence also that the gluten-free diet can be helpful for patients with a variety of neurological disorders including chronic migraine, epilepsy and Parkinson’s disease. In my clinic, I also find that the gluten-free diet is beneficial for patients with imbalances in their gut bacteria, as part of a comprehensive program to optimize and restore the health of their microbiome.