When I work with patients on nutrition, I make a lot of the usual recommendations. Stop eating junk food (you’d be surprised how many people have doughnuts for breakfast), eat more veggies and drink more water and less soda. These suggestions are not a surprise to any of my patients.
But the advice that gets the biggest reaction — and the most resistance — is to stop eating wheat.
“It’s OK!” they exclaim. “It’s healthy whole wheat!” “It’s on the bottom of the USDA food pyramid!” “My doctor recommended I eat it at every meal!” “I need the fiber to keep me regular!” “Wheat is the staff of life!”
I understand all these objections, I gave them all myself when I was pronounced gluten sensitive several years ago. But the changes in my health when I went gluten free — and similar, amazing changes in my patient’s health — have led me to make this recommendation to every patient interested in improving their health through diet.
First let me explain the difference between celiac disease and gluten sensitivity. Celiac is an autoimmune reaction to gluten; celiac patients react to even the smallest amount of gluten, which is often added to foods to improve consistency. The reactions can be almost immediate, and usually consist of diarrhea and abdominal pain. There is no controversy about celiac disease, its cause, or the “treatment” of strict avoidance of any foods containing gluten.
Gluten sensitivity is less intense than celiac, at least initially. However, the symptoms vary wildly; they can range from heartburn, digestive pain and loose stools to chronic joint and muscle pain to sleep apnea to depression. Despite denials from some doctors that gluten sensitivity even exists, there is evidence to support it.
Personally, I am much more interested in how my patients respond to changing their diets than I am in the opinions of naysayers who claim gluten sensitivity is “all in your head” or a passing fad.
Grains that contain gluten include wheat in all its forms: bread wheat, spelt, einkorn and durum (used mostly for pasta) and products such as bulgur, semolina and couscous. Rye and barley also contain small amounts of gluten. Buckwheat is not really wheat, and is free of gluten, as are rice and oats. However, the older, less crossbred strains of wheat (such as einkorn) usually have less gluten than the newer forms. While they should be avoided by those with celiac, many with gluten sensitivity can tolerate them with little difficulty.
The first problem in dealing with gluten sensitivity is that it presents in so many forms, and often aggravates or underlies other problems. I have seen many patients with back or neck pain who only respond partially to our usual care and finally get complete relief when they stop eating gluten.
One patient had knee pain intense enough that her doctors recommended a total knee replacement. She is now both gluten- and pain-free, and still has her original knee. Another patient had the thickest chart in our office; she had constant chronic joint and muscle pain, which was only somewhat controlled with treatment or painkillers. After she was convinced to go gluten free a few years ago, her visits to the office grew less and less frequent. She hasn’t been in for more than a year now. Another patient had difficulty holding down a job due to depression and anxiety, and he didn’t find medications helpful. Eliminating gluten has allowed him to function much better, with a lot fewer missed workdays. (It has been estimated that 10-15 percent of all cases of gluten sensitivity appear as neurological symptoms, such as anxiety or depression, poor balance, difficulty walking and even mental illness.)
The same applies to other problems, including allergies and digestive problems such as gastroesophageal reflux disease, irritable bowel and Crohn’s. This makes it very difficult to diagnose; it is hard to know if any particular patient’s slow response to care might be due to gluten reactivity. Who doesn’t eat wheat products regularly?
The second hurdle in working with gluten problems is testing. I have seen too many patients with full-blown celiac disease “pass” the blood tests, where the problem was missed. I do not recommend relying on any of the available testing for gluten sensitivity, or even celiac, for this reason.
The only true test for gluten sensitivity is avoiding it for a minimum of three weeks. Of course, we love our medical tests; patients feel cheated when I tell them not to bother with them. There have been patients where this dietary change did not affect their symptoms at all, of course, but even if there is no gluten sensitivity, some nutritionists still recommend avoiding it. (More on that next week.)
If you are interested in reading more about the problems with eating wheat, and especially gluten, I suggest the book “Wheat Belly” by cardiologist William Davis. Since I can’t do this topic justice in one column, I will continue on it next week.
It’s OK to read the column while you’re eating breakfast, as long as you aren’t having doughnuts.
Dr. Michael Noonan practices chiropractic, acupuncture and other wellness therapies in Old Town.