Slam-dunked and Wheat Belly

All right.  Work has been really, well, working me lately, so I've barely had time to sleep, much less to review papers, keep up with the blogosphere, and write.

I do like this song, though (right click to open in new tab):  Days are Forgotten (and it is getting very difficult to find songs on youtube that will play without ads upfront - sorry if there is an ad on this one!  It had a glitch and skipped the ad but might not work for everyone :()

Despite the time crunch, I did manage to squeeze in Wheat Belly over the weekend (most of it), and read the rest last night.

No, I don't like it.

No, I don't eat wheat as a rule, and I am not a grain industry shill.

But I don't feel I have to put my name out in support of a shoddy, sloppy book just because the overall message "wheat sux" agrees with my thoughts that wheat gluten and other wheat proteins likely are inflammatory in many people and cause problems for more than just those with celiac disease.  I think most physicians and researchers with critical thinking skills will find this book useless and full of hyperbole.  For those not taken in by the confident tone, it may do more harm than good.

Why don't I like Wheat Belly?  In short, it is the carelessness and simplicity of the message.  Hyperbole and poorly supported, confident claims.  Obesity and chronic illness is a complicated subject.  It doesn't come down to wheat.  Wheat isn't responsible (entirely) for "moobs" or the other too-cute phrases Dr. Davis churns out ad nauseum throughout the book.

An example?  In chapter 4, Dr. Davis spends a bit of time discussing the evidence linking wheat to schizophrenia and addiction.  I've discussed this issue at some length and noted the obvious circumstantiality of the evidence and the need for more research.  (see Wheat and Schizophrenia and Wheat and Serious Mental Illness).  And while Dr. Dohan (who was the major researcher who championed the wheat causes schizophrenia meme) felt he had evidence that schizophrenia has increased incidence in wheat-eating populations, most modern schizophrenia researchers make note that schizophrenia is pretty consistent in incidence across many populations - around 1%-1.3% incidence, in the developing world and in the Western world, in rice eating Chinese areas and the wheat-eating American Midwest.

Dr. Davis says:  "while it seems unlikely that wheat exposure caused schizophrenia in the first place, the observations of Dr. Dohan and others suggest that wheat is associated with measurable worsening of symptoms."  I don't get that quote at all.  Is the incidence of schizophrenia higher in non-wheat eating countries or not?  Do exorphins cause psychotic symptoms or not?  Schizophrenia, after all, is defined by the symptoms.  Something that "worsens" schizophrenia will cause schizophrenia, a symptomatically defined illness, as I've discussed earlier in my posts on cannabis.

But where I find the book to be critically annoying is in the discussion of addiction and opiates.  Wheat, as we know, has break-down components that are exorphins, which activate the opiate receptors in the brain and nervous system (the same receptors that are activated by our natural endorphins, opium, morphine, heroin, percocet, and other opiate painkillers).  The opiate pathway is part of the reward pathway in the brain, and is actually activated by anything "rewarding" - such as sex, exercise, drugs, gambling, and rock and roll.

Where I agree with Dr. Davis is that I have seen clinical evidence that some people seem to be "addicted" to wheat.  Particularly night bread binge-eaters.  They talk about bread much like one of my opiate addict patients would talk about oxycontin.  They can't stop eating it even after they are full, and even when they desperately want to lose weight.  They will leave their cozy house and pick up crackers, pretzels, fast food with fluffy bread, or a fresh loaf to eat at night. Critically, in certain cases (where more evidence-based methods have been tried), I've managed to stop these cravings and binge behaviors with naltrexone, which blocks the opiate receptors and short-circuits reward.  The problem is, ALL reward is mediated through opiate and dopamine, so using naltrexone doesn't tell you that you've blocked specific wheat exorphins - maybe the person has a real jones for fresh steaming lovely bread for simple reward sake - like some people love chocolate, Pringles, or cocaine.

It's a good message, though, and something that should be researched.  But then Dr. Davis comes up with this sentence (and also states he has seen the withdrawal and "brain fog" from wheat in "thousands of people"then later "I've personally witnessed hundreds of people…"), which is incredibly jarring and ruins the credibility of the message: "Let's pretend you're an inner-city heroin addict.  You get knifed during a drug deal gone sour and get carted to the nearest trauma emergency room.  Because you're high on heroin, you kick and scream at the ER staff trying to help you.  So these nice people strap you down and inject you with a drug called naloxone, and you are instantly not high."

Naloxone (and it's orally administered cousin, naltrexone), is an opiate blocker, or "opiate antagonist."  It will immediately knock opiates off the opiate receptor and put someone high on opiates into instant withdrawal.  This is not only extremely unpleasant, it tends to make people very agitated, unhappy, and even violent.  If you have to do it to save someone's life, you do it.  If someone is overdosing on opiates and loses the chemical signal to breathe, it will be lifesaving. If someone is alert and active and still high on heroin, injecting someone with naloxone would be a galactically stupid thing to do, particularly if you were just injured in a knife fight and needed some painkilling.  Injecting someone with naloxone will mean that the strong painkillers will not work in someone who will have a high tolerance to hospital painkillers.

Any emergency room physician, nurse, or doctor with a shred of ER experiecne will read that sentence in "Wheat Belly" and go, "huh?  What is this guy talking about, and is he galactically stupid?"

Honestly, I think it is a throwaway line that was carelessly written and carelessly published.  And other "paleo" books like  "The Vegetarian Myth" are full of lines like that.  But you know what, I have a much higher standard for a cardiologist than I do for a non-scientist like Lierre Keith.  I want real science, real risks, real data.  Not hyperbole and nonsense.

So no, I don't recommend Wheat Belly. And I don't recommend eating wheat either.

(Nor am I saying that Dr. Davis is stupid - far from it - just careless in his phrasing.  If you are going to take on Conventional Wisdom of Healthy Whole Wheat, you really have to "bring it."  It was not brought.)