Friday, September 3, 2010

Woe is Wheat

(Shirt available at Cafe Press)
























I don't eat wheat as a general rule, and the reasons I don't are circumstantial, to be sure.  The most compelling reasons to me are all those healthy non-wheat eating cultures.  Read enough of Food and Western Disease: Health and nutrition from an evolutionary perspective, or The Primal Blueprint: Reprogram your genes for effortless weight loss, vibrant health, and boundless energy, or Dangerous Grains: Why Gluten Cereal Grains May Be Hazardous To Your Health, and wheat just doesn't seem tasty anymore.  If it ever did.  Well, maybe in a pizza.

However, the beautiful Ms. Minger has used the (admittedly fairly useless) China Study data to make the smokey fire around wheat flare up again.  The handsome Dr. Guyenet has a reasonable overview at his site.  (Hmmm... there seems to be a strong correlation between non-wheat eating blogging and good health and good looks.)

And, very recently, Dr. Rodney Ford published a paper where he makes an argument that there should be a medical condition labeled "The Gluten Syndrome,"  and that everyone with many common neurological and psychiatric conditions (such as ataxia, hypotonia, developmental delay, migraine, depression, anxiety, etc.) be tested for gluten sensitivity via the IgG anti-gliadin antibody.  His reasoning being that IgG antigliadin positive people can have negative intestinal biopsies (if they have latent disease or patchy involvement of the intestine), and they can also have negative IgA tTG testing (another pretty specific celiac antibody test) and still have improvement in symptoms on a gluten free diet.

While looking into the matter, I stumbled upon a very good paper called Neurological complications of coeliac disease: what is the evidence?  If you have institutional access, I highly recommend checking this one out.  It has some nice suggestions for teasing out biases and inaccuracies in research papers, and it has a good review of the pathophysiology of celiac disease.   Neurologists are one of my favorite species of doctor, as they tend to be brilliant and cranky*, and these authors point out very fairly that the evidence linking gluten exposure to ataxias, certain types of epilepsy, and peripheral neuropathy is often poor and contradictory.  Bless their clinical hearts, though, they end up recommending a trial of gluten-free diet for anyone who's game, educated about the type of data there is, and who has a positive celiac biopsy or positive celiac or gliadin antibody testing for those with certain neurologic conditions, recognizing that the harm of a gluten-free diet is minimal, and there are some case reports where going gluten-free improved ataxias, peripheral neuropathy, and seizures.


I have the same take with schizophrenia - the indirect evidence is damning, the direct not as much, but enough case studies and small studies to suggest that at least some (especially new onset) schizophrenics could really benefit from a gluten-free diet.  And seeing as how we are dealing with a progressive, devastating brain illness with no cure, it seems fair to give patients and families the option and explaining the data.  For most it won't make a difference, but for a few... I wouldn't hold off medication for a new onset psychosis to try a gluten-free diet, though. 

I'm not sure about testing everyone with depression and anxiety (or schizophrenia) for IgG or IgA ani-gliadin, or even IgA tTG.  I'd probably just recommend the gluten-free diet trial idea to anyone interested.  Mostly it's the schizophrenia data that puts me in this mindset.  All sorts of anti-wheat antibodies were found in the serum and urine of schizophrenics, after all, but most of them were entirely different than the celiac antibodies.  Until we know more about what to test for, I think you risk giving someone with a negative test a false sense of security about gluten.

No classical music link this week.  Nope.  It's a holiday weekend and there's a hurricane coming, and that calls for something a little more modern.

I'll still be blogging over the weekend, though.  Did you know that in a study of 52 patients with Huntington's disease (invariably fatal genetic autosomal dominant ataxia condition), 44% had a positive IgA or IgG (or both) anti-gliadin antibodies?  The general population is about 4.8% positive.  Wild, huh?  (No, don't jump on that and say OMG WHEAT causes HUNTINGTON's because that might not be what it means at all.  But still, pretty wild). This means a post on evolution, Iceland, genetics, anthropology, and even a mention of poor Dr. T. Colin Campbell. In the mean time, keep eating meat, fish, veggies, and a bit of fruit and nuts.

*Neurologists are almost always right handed.  The field of psychiatry has more left handers (I have no source for this and it may be an urban medical myth).  There was a Nova episode last year about Oliver Sachs (famous neurologist) and music.  In it he admitted to preferring Bach to Beethoven.  I think that is the very definition of a neurologist.

16 comments:

  1. Yes, maybe in a pizza :)

    Thanks for the write up on Denise Minger's post!

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  2. Beethoven doesn't come close to Bach.

    If wheat causes anywhere near the amount of disease I read about on the 'net, it will be one of the most astounding medical advances of all time. In front of our noses for centuries, but unseen by the greatest minds in medicine, even William Osler.

    Earth-shaking. Even more so than learning that Helicobacter causes ulcers, and saturated fat doesn't cause heart disease.

    As a Christian, it would be hard for me to swallow the idea that bread is harmful to many of us, when he told us to remember him by eating bread and wine in the sacrament of Communion.

    [Now THAT'S going to be unpopular in an evolution-oriented blog. My sense is that most evolutionists are agnostic or atheist. BTW, I have an undergraduate degree in zoology, so was thoroughly indoctrinated in evolution theory, at least as of 1977. Anyway, I'm not convinced evolution and Christianity are mutually exclusive.]

    I'm enjoying your posts, Emily. I don't comment too often because you leave me speechless.

    -Steve

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  3. Steve - thanks! Glad you are enjoying my posts. You are so grounded and knowledgeable about metabolism that your critical eye is very valuable. The paleo crowd does tend to be a libertarian, questioning bunch that keeps me on my toes anyway, but they are much less likely to question an anti-wheat post, and I really don't want to go off the science rails as so many nutrition writers do sometimes. The case against wheat is circumstantial (for the population)! For certain individuals there are definite benefits for going without. What no one knows is how to best find those individuals (symptoms, blood tests, intestinal biopsy, which blood tests). Also, there are the long term smoldering issues (which may be the most important, but are the most controversial).

    As to the Bible and wheat, I'm not sure if you saw the posts on Heart Scan Blog a month ago or so. It was a little cheesy and showman-like but Dr. Davis and his friends made wheat from ancient grains (emmer and eikhorn, the Bible-times wheat) and found their blood glucose and reactions were very different than from modern whole wheat. (Here's a link to one of the posts, but there are several) http://heartscanblog.blogspot.com/2010/06/in-search-of-wheat-einkorn-and-blood.html

    Religion! I'm not going to share my own religious tradition, mostly because as a psychiatrist I want people of all religious (and non-religious) backgrounds to feel comfortable talking to me about what is important, and not to feel I am judgmental at all about it. Thank you for sharing yours. In this milieu I imagine you are right - there will be likely be an atheist or agnostic crowd. However, there are a surprising number of worldwide visits to my little blog, and I couldn't even imagine the number of different faiths represented out there.

    My feelings about Beethoven are best explained with this anecdote - Boston's Symphony Hall is (according to their literature) the third most acoustically perfect concert hall in the world. Built over 100 years ago, the designers left empty spaces above the stage so they could put up likenesses of famous composers. In the center is Beethoven, because everyone agreed he was number one. The rest remain blank, because no one could agree about who else to put up there!

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  4. Bach is best! And another excellent post--kudos!

    I particularly enjoy John Lewis' (from Modern Jazz Quartet) jazzy interpretations of Bach's Preludes and Fugues.

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  5. As to the Bible and wheat, I'm not sure if you saw the posts on Heart Scan Blog a month ago or so. It was a little cheesy and showman-like but Dr. Davis and his friends made wheat from ancient grains (emmer and eikhorn, the Bible-times wheat) and found their blood glucose and reactions were very different than from modern whole wheat. (Here's a link to one of the posts, but there are several) http://heartscanblog.blogspot.com/2010/06/in-search-of-wheat-einkorn-and-blood.html

    em, you rock!

    thanks again for another informative post.

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  6. After being recently diagnosed with Hashimotos, (auto-immune thyroid disease), going gluten free is the first nutritional change recommended by Dr Datis Kharazian. Anecdotally - many hashi's sufferers and finding they get big improvements cutting gluten.
    http://drknews.com/archives/280

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  7. When I get a moment (somewhere, someday) I definitely plan on checking out Kharazian's thyroid book. Though I anger enough PCPs prescribing cytomel as it is (honestly, old fashioned evidenced-based medicine in psychiatry! Check out STAR-D)

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  8. I'm also a Christian, and I'm almost certain that there was not a bakery in Eden.

    But there were cattle. Created by verse 24 of Genesis.

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  9. Hi Emily,
    Thanks for your entertaining musings. Talking about Cytomel... I have a low T3 and fT3 for at least a year (not checked before) and the endo I've seen recently doesn't want to prescribe t3 replacement therapy. I'm trying to convince her to do a trial that goes against her usual conventional views. Her point is that LDL is sky high and I need Lipitor. My point is that my LDL might be sky high because I have a thyroid hormone defficiency that incidentally aggravates depression too (hence my question to you)
    What do you think?
    Please, don't say I need citalopram. Have you read R. Whitaker's book about the consequences of taking anti-depressants? Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker. I did take them once and I wonder if I screwed up my serotonin receptors for good.
    Thanks.

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  10. There is a long history of literature for the use of T3 in psychiatry, right up to the STAR-D trial. My own clinical experience? It is a great option for a few months, but people inevitably become hyperthyroid, which shouldn't surprise anyone. Except I've had a few patients who are hypothyroid and already on T4 who have resistant depression that really perk up when I add a bit of T3, and if you wiggle the T4 down a bit, they don't become hyperthyroid. My heretical belief is that I'm treating some inefficiency of the ability to convert T4 to T3 - though as far as I know there is not a foundation of endo literature to support this belief. There is huge resistance to the use of T3, even the very small amounts we use in psychiatry.

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  11. So none the wiser again.
    I keep coming back to the conversion myself, but euthyroid sick syndrome is said to exist in the presence of another NTI (non thyroid related illness) which is why the endo would say starvation causes it as she can't see anything else, so she considers it temporary, would return to normal once I stop restricting calories. I haven't lost any weight in the last 9 months, though.

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  12. I'm going to punt on this one because an evolutionary medicine approach to thyroid is not something I've investigated in enough detail to know which side I fall on yet in a situation like yours. Heart Scan Blogger would likely say use Armour or add T3. But I'm not sure if euthyroid sick syndrome isn't your body trying to cool itself off for a bit, so better to leave well enough alone. There are too many variables and I can't, obviously, treat specific medical problems over the internet. However, here are some blog posts from others that may be of interest to you:

    http://thehealthyskeptic.org/5-thyroid-patterns-that-wont-show-up-on-standard-lab-tests

    (there are a bunch of other related posts there too)

    http://thyroid.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=thyroid&cdn=health&tm=18&f=10&su=p284.9.336.ip_p726.8.336.ip_&tt=2&bt=1&bts=1&zu=http%3A//www.thyroid-info.com/articles/shamestsh.htm

    http://www.marksdailyapple.com/hypothyroid/

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  13. I haven't read Whitaker's book, by the way. I can tell it is going to piss me off, and I'm debating whether I am going to spend money on it. I've seen many of the relevant studies, and many relevant other studies. I'm not in the mood to go into it now, but maybe, one day...

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  14. Thank you for your response and those links, I have seen them (as I am avidly reading the paleo blogosphere hoping to see something that might help me).

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  15. I thought that it would be worth mentioning that some Ancient Hebrew sources, including the Talmud (bBer 40a) and the Midrash (GenR 15:7) regard the forbidden fruit as wheat- wheat is “khitah” in Hebrew and therefore is a pun on khet, “sin.” The Talmud also says that "a baby does not know to call for it's father and mother until it experiences the taste of wheat" (Talmud Bavli Sanhedrin 72).

    An interesting aspect about Communion is that wheat (bread) is the body of Christ and wine is the blood- both of these substances are a product of agriculture and unknown to previous hunter-gatherers. According to Wikipedia, “in the philosophical novel Ishmael, the story of eating the forbidden fruit is described as a metaphor for the loss of quality of life caused by the change from a hunter-gatherer culture to an agriculturally based society."

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  16. I have been taking bovine thyroid about 6 weeks. I have noticed I am not nearly as foggy brained and my fingernails are growing. I also seem to have a bit more energy but just started taking 2 in the morning. At this point I wouldn't say its a great supplement but I would say that it definitely helps.

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