Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
7 Apr

Dear Mark: Gluten

glutenDear Mark,

You talk a lot about the evils of grains. I follow your logic on why a grain free diet is best, and I have seen weight loss and just feel better overall since heeding your advice. But there is one thing (well, more than one) that I don’t understand but hear about often. Could you explain what gluten is and why it should be avoided?

Gluten is a large, water-soluble protein that creates the elasticity in dough. It’s found in grains such as wheat, rye, barley, triticale, and oats. These days it’s also found in additives like thickeners and fillers used in everything from lunch meat to soup to candy.

Gluten sensitivity or intolerance, once thought to be rare, is now believed to affect a third of the population. (Some believe this number is substantially higher.) It’s considered a genetically influenced, life-long autoimmune disease, but it sometimes doesn’t manifest itself until a person is in their thirties or even forties. When an affected person eats or drinks something containing gluten, the protein initiates a kind of allergic reaction in the body, resulting in some level of inflammatory reaction. The reaction can vary significantly from person to person and can manifest itself in a wide variety of initial symptoms that include: dermatitis, fatigue, joint pain, acid reflux, abnormal menses, and infertility. Some gluten sensitive people are asymptomatic, at least for a certain period of their lives.

In serious cases, gluten intolerance causes intestinal atrophy known as Celiac disease. The Gluten Intolerance Group of North America reports that 1 in 133 people have Celiac disease. Unfortunately, not everyone who develops Celiac disease will have recognizable symptoms before the condition has wreaked serious havoc in the intestinal system by flattening of the villus epithelium and subsequently decreasing the area for nutrient absorption. For these people, Celiac disease often isn’t diagnosed until after effects of malnutrition have set in (lack of growth in children, diarrhea, stomach pain and/or bloating, vomiting, behavioral changes, etc.). In these cases, biopsies are often taken to assess the extent of damage and to aid diagnosis. Even if biopsies are normal, there is still the chance that nutrient absorption is impaired.

Thankfully, methods for diagnosing gluten sensitivity and related Celiac disease have improved in recent years as awareness has increased and more research has been done. Blood tests for specific antibodies have allowed physicians to diagnose the disease in many cases before much if any damage has occurred. Researchers are also beginning to test for antibodies in the intestinal tract, which may promise an even earlier diagnosis in at-risk individuals.

Given my stance on grains, I obviously suggest avoiding gluten. As mentioned, gluten intolerance is a very common condition and may be underestimated still. Given the relatively recent introduction of gluten (and all grains) into the human diet, gluten intolerance and the related Celiac disease are very unfortunate but not very surprising conditions. In addition to omitting grains from your diet (especially those listed above), it’s important to avoid processed foods, which likely contain trace amounts in forms like hydrolyzed proteins, starch/modified starch, malt, binders, and natural flavorings. If anyone in your family has been diagnosed with Celiac disease or gluten intolerance, it’s a wise idea to talk to your doctor about testing options.

Whatshername? Flickr Photo (CC)

Further Reading:

Simple vs. Complex Carbs

Gluten-Free Girl

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You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. One thing I wish I’d known when I had the celiac antibody test – the test is useless if you haven’t actually been eating gluten recently. The doctor who ordered the test didn’t tell me that! I avoid gluten most of the time anyway – not religiously, but since I eat grains only very occasionally, and avoid processed foods, I hardly ever consume any gluten. But when I do, I suffer from GI distress.

    For our vegetarian friends, it’s also important to note that a lot of meat substitutes contain gluten – if gluten is a problem for you, read the labels! Or stick with whole foods.

    Migraineur wrote on April 7th, 2008
  2. 2 words anyone should know about when talking about grains and long term health…. Leaky Gut

    Mike OD - IF Life wrote on April 7th, 2008
  3. ok my fancy link didn’t work above…take 2…although less dramatic now….Leaky Gut

    http://projectfit.org/iflifeblog/2008/03/19/is-your-gut-leaking-what-to-do-about-it/

    Mike OD - IF Life wrote on April 7th, 2008
  4. So should we avoid bread all together? Or is there a healthy bread to eat?

    We’ve been taught as a society that wheat bread is the way to go, but that doesn’t seem to be the case from what I’ve learned lately.

    Jerry wrote on April 7th, 2008
  5. Celiac disease sounds like a very scary and serious thing. It is sad that these things can potentially go undetected and sometimes go undetected till it is to late.

    Eric wrote on April 7th, 2008
  6. Why would you tell people not to eat gluten?

    Why not suggest instead that they try not eating gluten for a few weeks and see if they feel any better?

    There is no reason to avoid it if you don’t have any problems digesting it.

    I don’t, and have enjoyed gluten based foods while dropping tons of fat, building muscle and improving my health as you can see when you visit my blog.

    This same advice applies to cow’s milk. Some people will cut dairy and feel great. Others will cut dairy and notice no difference. I drink lots of milk and feel fine.

    Any sort of absolutist dietary prescription should be taken with a big grain of salt and a healthy dose of skepticism.

    Barry wrote on April 7th, 2008
    • Barry:

      It is not about eating wheat and dairy and feeling good after.

      It is about what is in wheat and dairy that we have to worry about. Nobody should eat wheat or dairy if they want to stay healthy.

      Too many toxins in each.

      Cheryl wrote on May 13th, 2009
  7. Also, pointing out that this food or that food is “relatively new” to humans on the larger scale of evolutionary time is a little silly.

    Does anyone really think prehistoric man was eating broccoli? But I don’t see anyone warning of the dangers of broccoli. This whole paleolithic diet rhetoric has some merit but lots of people take it too far.

    Barry wrote on April 7th, 2008
  8. Barry,

    It’s helpful to think in terms of categories. We may not have eaten broccoli specifically, but we did eat a variety of wild vegetables and are adapted to them. We generally did not eat grains as hunter-gatherers and therefore we aren’t equipped to deal with gluten and a multitude of other grain toxins like phytic acid and protease inhibitors.

    Sasquatch wrote on April 7th, 2008
  9. Barry (& other gluten skeptics), you might want to check out this blog for some recent posts on glutens.

    Post #1
    http://wholehealthsource.blogspot.com/2008/04/leptin-and-lectins.html

    Post #2
    http://wholehealthsource.blogspot.com/2008/04/leptin-and-lectins-part-ii.html

    Anna wrote on April 8th, 2008
  10. Lots of folks feel great right up until they drop with a heart attack or receive a cancer diagnosis, too. Doesn’t mean just because one doesn’t perceive slowly accumulating damage from something, that damage isn’t occurring.

    Has anyone read the recent study on “normal weight obesity”, from the Mayo Clinic (Dr. Francisco Lopez-Jimenez). I just read the headline today and skimmed some press releases. Interesting stuff.

    Anna wrote on April 8th, 2008
  11. Right. Eating bread causes heart attacks and cancer. Great analogy.

    Barry wrote on April 8th, 2008
    • It probably does. Check out the research in Good Calories Bad Calories by Taubes.

      Sophie wrote on June 4th, 2010
  12. The bigger issue is also not only gluten…but a person’s whole body environment. A person living a stress free life, with a feeling of purpose, spending time with friends and family, being happy, and not surrounded by toxins….probably could easily deal with any issue associated with gluten. A person who is highly stressed, overweight, lowered immune system, surrounded by toxins….does not need anymore negative strains…as it only leads to more dangerous illness and diseases down the road. Health is a whole body equation…all the factors count, not one is responsible solely. Remove as many stressors (toxins, allergens, stess) as possible and let your body handle the things you can not control in your environment.

    Mike OD - IF Life wrote on April 8th, 2008
  13. Actually Barry, celiac disease IS linked to certain forms of cancer. No correlation to heart attacks that I am aware of though.

    Nancy S wrote on April 8th, 2008
  14. The proverbial “beer belly” is also known by another name – “wheat belly”.

    Anna wrote on April 8th, 2008
    • Other than my extremely round and often bloated belly I am happy with my body. As I read up on Celiac disease I realize I need to get diagnosed asap. Can you tell me more about the “wheat belly”?

      VW wrote on November 6th, 2009
  15. Barry,

    I’m thrilled for you that you can eat gluten and thrive. I sure did for 45 years. Or so I thought.

    My research has led me to a point where I now suggest that, based on our common evolution and the fact that our genes haven’t changed much in 10,000 years, we are all prediabetic, prearthritic, precancerous and preatherosclerotic if we send the wrong signals to genes. It’s just that some of us are much more “pre-disposed” than others. Maybe based on minor gene variants, maybe on stress as Mike suggests – whatever. The fact that some of us react almost immediately to gluten or casein and others don’t does not mean that a daily intake of those “foreign substances” isn’t having some long-term effect, however minor. Furthermore, since I am a big fan of reducing insulin secretion and increasing insulin sensitivity, I am in favor of eliminating unnecessary carbs, which all grains are anyway.

    Ironically, if you have read any of (and agreed with) the latest science on carbohydrate metabolism, you’d realize you aren’t far off on your “eating bread causes xyz” statement.

    Mark Sisson wrote on April 8th, 2008
    • Hi Mark – I’m new to this and just read lesson #2 about avoiding grains. Would you suggest gluten free bread/pasta if I were to eat some carbs? Thanks

      Scat wrote on October 11th, 2012
  16. Jerry asked, “Or is there a healthy bread to eat?”

    Good question. I don’t know if there is a definitive answer. I do think most of the breads touted as “healthy” aren’t really.

    For me, the answer is definitely no, because my glucose metabolism no longer works properly. The miniscule amount of bread I can eat without raising BG just isn’t worth it, I really like good bread, and used to bake it all the time, but that’s probably how “a predisposition” into a reality. As time goes on, I see bread more as a transportation vehicle, a way to eat food without utensils. I’m fairly coordinated, so I forgo the bread and use a knife & fork. I really can taste the food without the bread getting in the way. I also find many bread tastes too sweet now.

    For people with a healthy glucose metabolism and no known gluten issues, I don’t know, but the research I’ve been reading over the past few years is leaning me towards it not being a good idea for anyone. So much of bread eating is habitual or for convenience, anyway. Better to err on the side of caution and save it for really special breads rather than all the time, like good sourdough while visiting SF or freshly baked for a special occasion.

    I’m having a harder time with the bread issue with my 9 yo. he’s the only one at home who eats bread regularly. He loves to have a sandwich lunch at school and he loves to fix PB toast snacks at home. We’ve reduced the amount of bread he eats generally, but we haven’t eliminated it (but he goes through it slowly enough that I have to freeze it to prevent molding).

    I’m hoping to at the very least minimize problems by getting a bread made by a local company that has fewer “red flags”. The ingredients are simple: sprouted whole multi-grain (no soy and flourless), water, yeast, honey (to feed the yeast), salt. It’s amazing how hard it is to find bread, even in the “whole foods” store that doesn’t have several “red flags” : made with flour (ground whole grain is practically like refined flour in terms of glucose hitting the system), soy, lots of added sugars/fructose/honey, added wheat gluten, plus lack of soaking or sprouting.

    Anna wrote on April 8th, 2008
  17. Hi Mark
    GREAT post about Gluten.

    My 8 year old little girl (who is a Type 1 Diabetic) has Celiac Disease. To those who want to try and eliminate Gluten to see if they “feel better,” don’t be fooled! My daughter was not symptomatic at all, but flagged the Celiac Antibody. She just returned to being Gluten Free after being on a “Gluten-ous” diet to confirm the diagnosis completely. She is for sure Celiac.

    I have made the commitment to her to remain Gluten Free as well. Not always easy, especially out at restaurants… but I want her to feel like I am with her on this.

    Mark — do you have a link to somewhere on your site with ‘diet guidelines?’ I really need to dial in my eating, have cranked my training back to lower HRs (ala Maffetone/Kearns) and want to really make the commitment along with being Gluten Free to putting HEALTH over FITNESS and taking my training and living to the next level.

    Thanks for your site!

    Ken

    Ken Wilkens wrote on April 9th, 2008
  18. Ken,

    Great that you looked into all this with your daughter and nipped it in the bud. Of course, you will be better off yourself for eliminating gluten. And it’s not that difficult, given enough time to readjust.

    I don’t have a real specific link to diet guidelines yet (other than the many posts we have done over the past 18 months). I will have a very detailed set of guidelines in my forthcoming book “The Primal Blueprint”. Glad to hear you have adopted the “Kearns Method” in your training. BK knows his stuff.

    Mark Sisson wrote on April 9th, 2008
  19. Kearns had a good teacher!… look forward to the book, and will pick through the posts and put together some sensible eating guidelines in the meantime. Seems like much of it is in line with “Paleo Diet for Athletes…” and at the most basic level — lean proteins, fruits and vegetables… and of course the right carbs for training…

    Thanks!

    Oh, some additional information — Type 1 Diabetics are very prone to Celiac, so both my Diabetic kids (yes, 2 of my 3 kids have Type 1 Diabetes!) get screened every Quarter for Celiac. It’s amazing that 1 in 133 people have Celiac, but I think something like 1 in 10,000 are diagnosed. All of the others are walking around with a silent timebomb inside of them, ticking away with every bite. Scary and eye opening. The great thing about this disease, though, is that by eliminating Gluten you put the disease in remission. Great stuff!

    Ken Wilkens wrote on April 9th, 2008
  20. “Type 1 Diabetics are very prone to Celiac.” Wow. Why have I never heard this?

    Migraineur wrote on April 10th, 2008
  21. Hi Migraineur
    Not sure if your comment was serious or tongue-in-cheek. Either way, both diseases are Auto-Immune and there is a definite link. If you Google “Celiac and Type 1 Diabetes,” you will see plenty of info.

    Ken Wilkens wrote on April 10th, 2008
  22. I was told that tempeh is cultivated with a mold called Rhizopus Ogliosporous. Isn’t that against everything we believe?? It is like eating blue cheese. The manufacturers claim it is a good mold to eat.

    Any comments on such???

    Cheryl Diamond wrote on April 10th, 2008
  23. Everything we believe? Don’t know about that, Cheryl. Although one of our mutual friends might disagree with me here (DK), some fungus is definitely edible while some is deadly toxic. It helps to know the difference :-) RO is both edible and has been shown to remove neurotoxins from certain legumes. A number of studies indicate that its use in making tempeh is quite safe.

    Mark Sisson wrote on April 10th, 2008
  24. I very frequently get a throbbing pain that extends from 1.5″ above my navel to about 2″ below the navel. This does occur within 3-6 hours of eating but eating wheat bread or drinking a beer actually makes me feel better! The doctors can’t find anything wrong other than to say I have a “redundant colon” (extra length of colon) which may cause constipation. Is it possible I am gluten intolerant or would I know by having a reaction to wheat or beer?

    Lisa wrote on June 28th, 2008
  25. Lisa,

    Sounds like you have some kind of sensitivity. I wouldn’t be surprised if were to gluten. Have you tried going a few months with no grains?

    Mark Sisson wrote on June 30th, 2008
  26. I recently was diagnosed with stage III form of celiac disease and also have diabetes mellitus since early childhood. Personally, I have suffered for many years with complications associated with celiac disease, but was never diagnosed or tested for the disease.

    On a positive note, I began the diet almost three months ago and now feeling much better and experiencing an increased level of energy and stamina. The diet has dramatically changed my abilities to control my blood sugar levels. Thanks to everyone in the celiac support group, the wonderful doctors and nurses who have been the utmost supportive.

    Shannon wrote on July 15th, 2008
  27. We found a bread that is gluten free,and yeast free. It contains millet and flax seed with a little baking soda. Is this bread ok to eat??

    Cheryl wrote on July 15th, 2008
  28. Cheryl, if you must eat bread, that’s probably your best alternative. We’d call it a sensible vice.

    Mark Sisson wrote on July 16th, 2008
  29. Hi,

    Interesting post. I learn more and more informations on almost every type of food we consume that is unhealthy in one way or the other. Eventually I suppose everything would come under this category and I wonder if there would be anything left out to eat without having to worry.

    Gowri wrote on May 13th, 2009
  30. Ummm, Yeah Gowri..Clean meat,eggs, natural fats, veggies, nuts, seeds and some fruit…organic of course! (fermented ,too!)

    Julie Aguiar wrote on December 6th, 2009
  31. I am surprised at the link to Gluten Free Girl…sll her recipes seem to me to be ‘worse’ than the gluten full recipes!
    tapioca? potato flour? rice flour???

    Krista wrote on June 4th, 2010
    • The link to Gluten Free Girl is included not because of her un-primal recipes but because Shauna Ahern (lady behind GFree Girl) has a lot to say about Celiac disease/going gluten free, and what it means for health.

      Debbie wrote on June 4th, 2010
  32. It is unfortunate, but my mother buys a lot of vegan products… the main ingredietns are soy and gluten for the protein…

    But, since I have been primal (2 months ago) my family has eaten more primal foods and less of the “other stuff”. So, I am doing my part!

    Primal Toad wrote on June 10th, 2010
  33. Hey Mark, I think I’m a stumbler. I was at the gym recently and a guy suggested your site. Now recently (over the summer) I’ve swapped my normal breakfast of porrige oats for fruit (melon, grapefruit etc) and I began to notice my belly get smaller. Now I’m a large man (6″2′, 22.36st) and I know when my belly changes shape.

    When the guy at the gym mentioned genes, fat / sugar burning I was interested. Maybe I’ve stumbled upon why my belly has shrunk a little. So I’m going ot stat looking at gluten free meals.

    My question would be one of energy, where could I get enough of that from?

    Adv(thanks)ance

    Ben

    Ben Thom-Wood wrote on September 12th, 2011
  34. Thanks for this post Mark! Only question remains, what does gluten DO to cause these various symptomps? I mean HOW does it flatten the villus etc. I know this might be too much to explain for average Joe/Jane, but if you’d please try :)

    Johanna wrote on December 21st, 2011
  35. I have to admit, I recently am cutting grains out of my diet (which is so hard to do) and I have noticed my stomach flattening in a week. I have been eating some grains still, but just cutting back made a difference. I can’t help but to agree with the adaptation to fruits, vegetables and protein sources. In all honesty, I don’t think many animals were even meant to eat grains. Look at animals like fowls, cows and pigs that are often fed corn and other grains. Higher incidence of hyperlipidemia so that fat is literally marbled throughout the muscle tissue. Sure it tastes good, but when muscle tissue is actually replaced with fat, you know something is wrong! Animals that aren’t eating human made “feed” tend to have much higher muscle tissue and little fat. Also less health conditions. Humans are not immune to it either. I am not looking down on anyone who still loves their bread, cereals and alcohol (yes grain based alcohol is included in this) I mean I still eat some, but I do at least try to eat little of it. I have weak moments, but I am human after all xD Anyway, everyone just make the choice you feel is best for you and live with what ever consequences come (good and bad) that is all we can do at that point. Good luck to all of you in any goals you may have with diets, weight loss and general healthy living! <3

    Anna D wrote on September 16th, 2012
  36. I have been gluten free since September and at the end of January I added a low carb wrap in. I had only eaten maybe 5 all together through out the months. By March I had a rash on my tummy and was in a lot of pain Sunday night. When I got out of bed I was dizzy and felt like I had the flu. I got tested Friday for celiac and my results 381 for immunoglobulin expected is 81-463 but I no longer eat those wraps and my rash is gone. But I’m waiting to understand better since my dr was no help on this.

    Candy wrote on April 5th, 2014

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