In the last few days, there have been a number of stories on the IntarWebs claiming that a scientist has reexamined his findings and declared gluten intolerance to be a bunch of hokum. Some articles, like this one written by an Intelligent, Discerning, Investigative Organic Terrestrial make claims like it’s all “in your head”. Other, less journalistic articles, like this one written by a Broadly Inquisitive Gatherer Of Tales revel in holier-than-thou hatemongering in support of the writer’s blogging career.
This reveling is in particularly bad taste as they are making a big deal during Celiac Awareness Month about a study came out months ago. They seem to think that eating gluten-free is fun or conveys a special status. No, it’s humiliating, difficult, frustrating, and exhausting. I wonder if these same “journalists” would be jumping all over themselves during American Heart Month to promote the belief that heart disease is psychosomatic.
So, unlike the Deeply Investigative Clown of the Keyboard that spouted this headline, I decided to look at what was actually being said. I also thought that it would be informative to look at what else these scientists are up to.
First and foremost, let me be clear that I do not suspect that these scientists are doing anything wrong or sketchy. The doctors were absolutely right to attempt another experiment to see if the results could be replicated. This is critical to the Scientific Method and I applaud them for attempting to invalidate their own earlier work.
Second, I believe that this story is being hyped because a tiny group of smug, hateful people has run afoul of a tiny group of smug, snooty people who are eating gluten-free because somebody mentioned it in the latest issue of “Dilettante Health”. This has led to Artistic, Sarcastic, Self-righteous, Hatemongers Attracting Toadying by posting things like this picture. ->
Surprisingly, this particular piece of bigotry happens to include two different kinds of appropriate allegory, but I will come back to them later on.
So, what does Dr. Gibson’s study actually consist of? Thirty-seven subjects were fed a special diet that was low in other possible sources of irritation for nine days. These subjects were then given high-gluten, low-gluten, and gluten-free diets at random for a week, given awhile to detox, and then hit with a different diet for three days. This is important, because my reading suggests that Dr. Gibson and his colleagues were looking for an acute immune response. Something a bit like what Celiacs experience but on a much smaller scale. They didn’t find it. Which suggests that Non-Celian Gluten Sensitivity (NCGS) is not an allergy.
This makes sense. As the name indicates, it’s a sensitivity or intolerance, not necessarily an allergy. But allergies and similar acute responses needed to be ruled out. This is important research and had to be done. What the findings don’t say is “gluten sensitivity is bullshit”.
A particularly interesting facet of the study is that the subjects generally became more and more ill as the study progressed. There are a number of possible reasons for this. The one that the media likes to focus on is a possible “nocebo” effect, in which the subject’s thoughts are tricking their bodies into feeling bad. In other words, they are crazy or attention-seeking, not suffering actual physical symptoms.
If that were the case- if this study showed that NCGS was purely psychological and not physiological, we would expect these diligent scientists to farm further research over to the psych team and then wash their hands of the whole gluten “nonsense”. Did they?
No.
Since the study in question, they have published:
- Randomised clinical trial: gluten may cause depression in subjects with non-coeliac gluten sensitivity – an exploratory clinical study.
- Is gluten a cause of gastrointestinal symptoms in people without celiac disease?
- Characterization of Adults With a Self-Diagnosis of Nonceliac Gluten Sensitivity.
- Non-nutritional effects of food: an underutilized and understudied therapeutic tool in chronic gastrointestinal diseases.
- …
Well, okay, I gave up after listing the first few because there were enough to make the list look ridiculous. Drs. Gibson and Biesiekierski have been working on intestinal issues for a long time and are continuing to do so. They do work on Celiac, Irritable Bowel Syndrome, and a host of other things to do with our guts. Yet, if the study everyone is talking about (published in 2013) “debunked” NCGS, why are they still working on it?
Because the disease is real, even if the name is wrong. Medicine is filled with incorrect characterizations that were later replaced- “Hysteria“, for instance. The name “Hysteria” implies a problem with a woman’s uterus, yet the name stuck around in official diagnoses until 1980 or so. This might be the case with NCGS. Some scientists have suggested that the problem is “wheat sensivity“, not gluten specifically. This makes sense- even if we are talking about an immune response, the protein involved need not be gluten.
The authors of the study have themselves suggested that the issue, at least intestinally, could be “Fermentable, Oligo-, Di-, Mono-saccharides And Polyols” (FODMAPs) which are common in things like wheat bread. While they may be on to something, these hard-to-digest carbohydrates are found in a lot of things that NCGS people eat all the time. Things like fruit, beans, and vegetables. Of course, any specific FODMAP that could be the culprit might appear in a more restricted variety of foods, so this is a course of research worth pursuing.
There is, however, another piece of the puzzle- two, actually. Remember that sign I ridiculed earlier? The one about lead and cocaine? Well, NCGS is sometimes compared to both, based on differing hypotheses of what it actually is. The study making the news was testing a gluten allergy hypothesis (very specifically).
There is also a systemic chemical sensitivity hypothesis, suggesting that problems like swelling and joint pain may be the result of a slow build-up of gluten, wheat, or agricultural chemicals that cause issues in some people. As with lead, the symptoms are unnoticeable at first, and get progressively worse over time. The study in question only lasted a few weeks, so it would be hard to test long-term effects of exposure. I don’t blame the scientists for not testing this- it wasn’t what that experiment was designed to look for. Besides, long-term dietary studies are hard to keep precise because people are more likely to cheat or get accidentally exposed.
The second- and more important hypothesis regarding NCGS (more important than allergy, even) is the exorphin or “leaky gut” hypothesis. Compounds like gluten and casein (each actually a family of proteins) turn into some pretty interesting things when we digest them. Both of them release opioid peptides (“exorphins”) similar to the endorphins your brain produces to block pain. These chemicals are OPIOIDS- meaning they affect your brain in a fashion similar to opium and its derivatives- morphine, heroin, oxycodone, etc. In most people, these stay in the intestines, but some people are hypothesized to have a “leaky” intestine that allows the drugs to get into the bloodstream.
How or why the intestine might become “leaky” is still debated, as well as how common such a thing might be. However, what would be the effect on someone who was exposed to a nearly constant low-level dosage of an opioid pain-blocker?
First of all, they would experience desensitization or drug tolerance. The more that someone was exposed to, the higher their doses would need to be in order to block pain. As these compounds bind to the receptors that govern your own body’s internal pain blockers (endorphins), over time you would be less and less able to shut out little pains. These little pains would begin to become a constant state of dysfunction, weakness, and suffering.
The second major effect would be dependence. Opioids are addictive and affected persons would develop a craving for food products that could give them a fix. Even so, the dosages are small enough that unlike a heroin addict, the person would generally be in control of their choices. The subject would likely try to fight the cravings, leading to a high-low oscillation in their opioid levels. Such a thing would play havoc with their emotional state. Remember that study linking gluten and depression that these scientists published after the “gluten sensitivity is bullshit” study?
Now, let’s get back to the “nocebo” effect in the “no effect” study. Remember, that study was looking for allergy responses, especially in the intestines, feces, and urine. It was not looking for opiods in the bloodstream.
In that study, many of the subjects were given a diet for one week, then a “washout” period of two weeks followed by three days of a different diet. By the end, all of the groups had similar levels of intestinal discomfort. Which would make sense if they were experiencing reexposure and/or withdrawal.
It’s clear that these scientists knew, on some level, that this was a possibility because they followed the allergy study with the depression study. A study that DID find a link between gluten exposure and increased levels of depression:
Short-term exposure to gluten specifically induced current feelings of depression with no effect on other indices or on emotional disposition. Gluten-specific induction of gastrointestinal symptoms was not identified. Such findings might explain why patients with non-coeliac gluten sensitivity feel better on a gluten-free diet despite the continuation of gastrointestinal symptoms.
Will they try that test again? Hopefully. That’s how science should work.
To sum it up, let’s hear from one of the scientists being quoted in the original story that sparked a thousand gloatings:
Biesiekierski recognizes that gluten may very well be the stomach irritant we’ve been looking for. “There is definitely something going on,” she told RCS, “but true NCGS may only affect a very small number of people and may affect more extraintestinal symptoms than first thought. This will only be confirmed with an understanding of its mechanism.”
So, what’s the lesson? The scientists found no allergic link between gluten and NCGS; but they did find a brain chemistry link. This suggests (as do many other studies) that Non-Celiac Gluten Sensitivity is a real, physiological (not psychological) condition- it just may not be what we think it is.
TL;DR – The people who keep trying to convince you that gluten sensitivity is bullshit are IDIOTs, BIGOTs, ASSHATs, and/or DICKs who didn’t actually do their homework and just wanted to laugh at their friend who is off anti-depressants for the first time in years after going gluten-free. If you are that friend, you should feel justified in belittling their tiny, tiny egos. Let’s see them eat crappy $6 fake bread for months on end.
