Respectful Insolence

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A couple of Sundays ago (Easter, to be precise), my wife and I were sitting around yesterday reading the Sunday papers and perusing the Internet (as is frequently our wont on Sunday mornings), when I heard a contemptuous harrumph coming from her direction. She then pointed me to an article in our local newspaper entitled Gluten-free beauty products in demand among some customers. Now, I must admit that I haven’t been keeping up with the gluten-free trend, other than how easily it fits within the niche of “autism biomed” quackery, where, apparently, nearly every “biomed” protocol for autistic children demands that gluten be stripped completely from their diets, lest the evil molecule continue to infect them with the dreaded autism. I’ve kept an eye the literature, but haven’t really written about gluten. That’s why I could immediately tell why my wife had called my attention to the article:

Amy Soergel’s lip gloss was making her sick. The problem, she realized, was gluten — hydrologized wheat protein, to be exact. Then she went to the hairdresser who used a shampoo that made her neck burn. Again, it contained gluten.

“There’s hidden gluten in many places you may not consider,” including stamp and envelope glues, toothpaste and lip balms, said Soergel, who has a store, Naturally Soergel’s, near Pittsburgh that caters to people with allergies. Indeed, for people with celiac disease, a bit of gluten that might get swallowed from a lipstick or a stream of shampoo in the shower can be enough to cause illness.

A slew of gluten-free skin care products have come on the market, including items from well-known companies such as Murad, Dr. Hauschka, EO, MyChelle, Suntegrity, Acure and derma-e. Many are sold in Whole Foods and other health food stores. If they’ve been certified by a third-party agency, an icon usually appears on the packaging.

Whole Foods. Of course, it had to be Whole Foods (among others). Let’s take a look at the whole gluten-free movement and then at the end I’ll revisit the question of gluten-free cosmetics and skin products.

Gluten, of course, is nothing more than proteins found in wheat endosperm (a type of tissue produced in seeds and that is ground to produce flour) and can also be found in barley and rye. It consists of two proteins, gliadin (a prolamin protein) and glutenin (a glutelin protein). Gluten cannot be consumed by sufferers of celiac disease (CD), whose main manifestation is inflammation of the bowel lining when gluten is eaten. The end result of this chronic inflammatory process can be gastrointestinal scarring and atrophy of the villi (the finger-like protrusions of the lining of the bowel responsible for nutrient absorption, among other things). The most common symptoms are, of course, gastrointestinal, including diarrhea, nausea, abdominal pain, and bloating, but CD can also manifest itself in a number of other symptoms, including skin rashes, weight loss and fatigue, oral ulcers, joint pain, anemia, and depression. CD (or gluten-sensitive enteropathy) is not caused by gluten, but rather a genetic predisposition. If you’re unlucky enough to have this predisposition, gluten can do bad things to you.

There is no doubt that CD can cause real problems in the people who have true gluten sensitivity. Indeed, as this New York Times article describes, in the 1990s the general medical consensus was that in the US the prevalence of CD was around 1 in 10,000. More recent studies, such as this one from 2012, report a prevalence of around 1 in 100. Worse, the majority of CD goes undiagnosed. In actuality, what is happening appears to be a combination of more intensive screening due to better awareness of celiac disease as a potential cause of puzzling symptom constellations, plus what is arguably a real increase in prevalence since 1950, estimated by Mayo Clinic researchers to be approximately four-fold and continuing to increase over the last decade.

The definitive diagnosis of CD is made by:

  • Detection of anti-gluten antibodies in the blood (specifically, as Scott Gavura described, IgA antiendomysial antibody (EMA) and the IgA tTGA), a test that is 90-95% sensitive and 95% specific. This is suggestive of gluten-sensitive enteropathy but not fully diagnostic.
  • The gold standard test: Distal duodenal biopsy specimens demonstrating characteristic histologic changes in the small intestinal mucosa, changes that include: a spectrum from total to partial villous atrophy and crypt lengthening with an increase in lamina propria and intraepithelial lymphocytes. It is also important to take at least six biopsies, because changes can be patchy.

It’s also noted in multiple sources that these tests should in general be done before the patient is placed on a gluten-free diet, because otherwise the tests often produce a false-negative result. There is also a controversial condition known as “non-celiac gluten sensitivity” (NCGS). As both Steve Novella and Scott Gavura note, these are patients without definitive diagnostic criteria for CD who believe that gluten causes symptoms of bloating, fatigue, and irritable bowel syndrome, but do not have antibodies to gliadin. Indeed, Scott quite correctly speculated over whether non-celiac gluten sensitivity is becoming the new Candida; i.e., an all-purpose bogeyman responsible for all sorts of vague, chronic health complaints and thus a nice foundation upon which quacks can base all sorts of dubious therapies related to removing gluten from the diets of anyone with vague complaints but no evidence of CD on testing.

Scott also noted the dearth of good studies on NCGS, and a review of PubMed just yesterday found that, although there are about 27 more articles out there in PubMed than there were when Scott last wrote about NCGS, the quality of evidence supporting the existence of the entity of NCGS remains poor. For example, in 2013, Biesiekierski et al. reported a placebo-controlled, cross-over rechallenge study of 37 subjects, in which they found no evidence of specific or dose-dependent effects of gluten in patients with NCGS placed on diets low in fermentable, oligo-, di-, monosaccharides, and polyols (FODMAPs) in order to control other potential triggers of gut symptoms. No markers of intestinal injury were noted in any of the groups, although a high nocebo response was noted. It’s not surprising that a recent review article characterized NCGS as “an entity awaiting validation, better diagnostic criteria, and, if it does exist, pathogenic mechanisms.” It was also noted that the “reluctance to acknowledge other components of wheat, such as fructans, non-gluten proteins and WGA, as potential pathogenic factors has often hampered good interpretation of clinical observations.” In other words, people are so fixated on gluten that they ignore other potential components of wheat and grains that might be the real cause of symptoms noted. The authors of the review article even go so far as to propose reasonable rules for future rigorous clinical trials on the subject:

Essential rules for future studies should include the following. First, celiac disease has to be seriously excluded by HLA studies and/or strict histological and immunological criteria. The inclusion of patients with intraepithelial lymphocytosis will always raise the issue of whether they really have celiac disease with a milder intestinal lesion. Secondly, the use of blinded placebo-controlled food re-challenge methodology to prove gluten sensitivity is present is not reliable, especially in patients who believe they have NCGS. Perhaps the selection of patients for study should be those with IBS naïve to a GFD. Thirdly, the trap of assuming that response to a GFD or exacerbation of symptoms due to a gluten-containing diet reflects specific effects of gluten should be outlawed and credence be given to the other wheat-related food constituents that can also cause gastrointestinal symptoms. Perhaps if these rules were followed, we would now be a lot closer to defining mechanisms by which gluten might act, might have developed biomarkers to identify patients who truly do have NCGS and perhaps, most importantly, answered the question of whether NCGS does really exist. On current evidence the existence of the entity of NCGS remains unsubstantiated.

So, in other words, CD is a real entity that is more common that diagnosed, but it is not even clear whether NCGS is a distinct clinical entity, despite the number of people who believe themselves to have it, the number of companies that cater to the belief that this entity exists, and the number of practitioners, particularly “integrative” practitioners and alternative practitioners, who have come up with all sorts of exclusionary diets and “biomedical” interventions to treat it. As yet, we do not have convincing, reproducible clinical evidence that the condition exists, which makes it premature to be speculating about mechanisms, no matter how much advocates of gluten-free diets as a cure-all for everything might “draw a line in the sand” and try to dismiss skeptics who don’t cite the biomarker studies they like as they promote dubious “paleo” diets. Does any of this mean that NCGS doesn’t exist or is bogus? No, not necessarily. What it means is that evidence is inconclusive and contradictory. Worse, because of relentless messaging in popular culture that gluten is bad for you, that many—who knows how many?—people have undiagnosed gluten sensitivities, and that most people would be better off without gluten in their diets, there’s a substantial nocebo effect. Meanwhile, confirmation bias, nocebo and placebo effects, regression to the mean, and the usual confounders that make individual experience so unreliable when determining if an intervention is effective in an individual explain the vast majority of glowing “testimonials” of people who “go gluten-free” and believe it made them so much healthier. Here’s a perfect example of An Open Letter to Gluten-Free Skeptics:

I gave up gluten in 2010. At the time I had no symptoms of gluten sensitivity – no digestive issues, no overt symptoms of problems. No diagnosis of celiac. I was, however, obese (and have been for most of my life), and prone to uncontrollable binge eating. I gave it up as an experiment – not sure that it would help me, just hoping.

And it did.

I’ve been leaner, and generally healthier, during the past 3 years than at any prior time in my life. And this hasn’t been an easy 3 years – it’s been very stressful (for reasons having nothing to do with food), yet despite lots of travel and lots of serious life changes, I’ve been able to lose most of my excess fat and keep it off, without very much effort.

This was not my first attempt at leaning out – I’ve tried many different eating strategies, from low fat to low carb to vegetarianism to intermittent fasting – over the years. None of them “stuck” until I went gluten free.

He continues:

Even if I DON”T have dozens of double blind studies published in peer reviewed journals showing that a GF intervention reduces inflammation, improves digestion, and leads to weight loss, I DO have evidence that it vastly improved MY life and health.

And:

But as much as YOUR argument that I don’t have science proving gluten is bad for everybody – nobody has any science showing that NOBODY benefits from a GF diet.

Let me reiterate: NOBODY has ever done even a single study that shows in any sense that NOBODY benefits from eliminating gluten from their diet.

None of which demonstrates that a gluten-free diet did anything for this man. These are, in fact, the same sorts of arguments, confusing correlation with causation riddled with confirmation bias that antivaccinationists use to “prove” that vaccines cause autism, that “autism biomed” can “recover” autistic children, and even that Stanislaw Burzynski or Robert O. Young cured their cancers. They prove little or nothing. Unfortunately, given the panoply of vague symptoms attributed to NCGS, it’s a condition, if it exists, that’s seemingly custom-made for all the confounders that make demonstrating the efficacy of a treatment so difficult. That’s why the rules suggested in the review article I cited above are so critical to future studies. Unfortunately, it’s also why gluten is likely to continue to be demonized beyond its health effects on people who have true CD.

Which brings us back to why on earth anyone thinks gluten-free cosmetics and beauty products are of any value. The answer is: They aren’t, with possibly one exception. The reason, of course, is that the gluten protein is too large to be absorbed through the skin. Now, it is known that it only takes a relatively small amount of gluten ingestion to result in gastrointestinal problems, as little as 50 mg (present in 1/80th of a slice of wheat bread) can cause damage to the intestinal villi. Consequently, there is a rationale for “going gluten-free” for any product that goes on the lips or in the mouth, such as lip balm, toothpaste, or lipstick, at least for people with severe CD. For people who think they have NCGS, where it hasn’t even been convincingly demonstrated that gluten is actually the component in wheat that causes symptoms, gluten-free cosmetics is nothing but marketing hype feeding into the same marketing hype behind the gluten-free products that are only really needed by people who have true CD and only debatably helpful to others. Remember, as I’ve seen pointed out, 93% of consumers purchasing gluten-free products are not diagnosed with CD, but rather do so because of an interest in “health and wellness,” ascetic-based practices of self-improvement, or the “flavor of the month” diet trend.

But what about gluten-free skin products? In general, these are an even bigger waste of money, again because gluten isn’t absorbed through the skin. Most of the reports, like this one, in which people attribute skin issues to gluten, do not constitute decent evidence that topical gluten causes their symptoms. The reason is simple. Those with CD not-infrequently suffer from dermatitis herpetiformis, a type of skin rash, as part of their symptoms, that is not caused by contact with gluten (indeed, a gluten skin patch test is notoriously poor in sensitivity for diagnosing CD) but by ingesting gluten. When they remove gluten from their diet, their dermatitis herpetiformis resolves with the rest of their symptoms. Such people, once they are made aware that they have CD, start wondering if gluten in skin products can be the cause. Not surprisingly, they switch to gluten-free skin products at the same time they are removing gluten from their diet, and, as usually happens, their skin symptoms recede along with their gastrointestinal symptoms.

But what about the rest, who do not have CD but buy gluten-free skin products in order to avoid rashes? In my estimation, they’re wasting their money if they’re paying a premium for such products. If they’re not paying a premium, than it’s how well the product works for them that matters, not whether it has gluten in it or not. Again, there are many compounds and substances in skin products that can cause allergic reactions or simply contact dermatitis in some people, particularly fragrances. Because of all the publicity about gluten, it’s not surprising that so many people, whether they have CD or not, are quick to assume that a rash after using a skin product is due to gluten in the product. Without careful patch testing, assuming a reaction is due to gluten in a skin product is a leap.

It’s become clear that, up until the last decade or so, CD was severely underdiagnosed in the US. To some extent, it still is, although increased awareness and better-defined diagnostic criteria have alleviated that problem. Unfortunately, it is also a condition that appears to be increasing in prevalence, both due to an apparent increase due to greater awareness and, thus, diagnosis and, likely, to an increase in the actual frequency, as evidenced by studies suggesting that the prevalence of seropositivity for the appropriate IgA antibody in the population. In general, increased awareness is a good thing, as it allows for the appropriate diagnosis and treatment of a greater fraction of people with CD. So is the increased availability of gluten-free options for the approximately 1% of the population with CD, which allows them to alter their diet without suffering as grievous a hit to their quality of life.

Unfortunately, the known deleterious health effects of gluten in people with CD have been extrapolated into a much vaguer, as-yet scientifically unvalidated, clinical entity that supposedly a much larger percentage of the population suffers from. This has led to the unjustified demonization of gluten (which is really only harmful in a small minority of the population), overblown claims for “going gluten-free,” and ridiculous products such as gluten-free skin care products, deodorants, and shampoos.

Comments

  1. #1 Yerushalmi
    April 30, 2014

    Wow. Just wow. I didn’t expect this subject to appear here! I’ve actually encountered it before.

    A friend of mine once told me that her mother had celiac disease that was apparently so bad that she had to use gluten-free skin care products exactly like what you’re describing here. Not knowing about the absorption-through-the-skin problem, but knowing that celiac disease is a specific intestinal condition that has absolutely nothing to do with skin products, I told her that what she said doesn’t make sense and it sounds like she has an honest-to-God gluten allergy rather than celiac disease.

    My friend was furious that I would dare assume I knew more about her mom’s condition than she does, and this was the first of three or four arguments that ended up breaking off the friendship.

    I’ve seen people cling to stupid beliefs before, but her overreaction was far worse than anything I’ve seen before or since, and I’ve argued with anti-vaxxers!

  2. #2 Pris
    The Dark Side of the Force
    April 30, 2014

    Sometime I wonder if all those ‘sensitivities’ are nothing more than good old IBS.

    My mum has it, as well as properly diagnosed fructose and lactose intolerance, as well as properly diagnosed histamine sensitivity, and many of the symptoms described sound very much the same.

    I get the runs from certain food additives. They all are long chained poly saccharides that aren’t broken up by enzymes (like carrageenan). Some people have the bad luck to have gut flora that can break it up, leading to the same symptoms as for lactose intolerance.

    Also: for many of those ‘sensitivities’ I wonder if there might be a psychosomatic cause.
    My mum can track her stress level and mental health by her GI symptoms.

  3. #3 palindrom
    April 30, 2014

    Whole Foods parody rap video.

  4. #4 palindrom
    April 30, 2014

    Ach, the link may not have embedded correctly. The Whole Foods parody is at

    http://www.youtube.com/watch?v=2UFc1pr2yUU

  5. #5 Helianthus
    April 30, 2014

    I was, however, obese (and have been for most of my life), and prone to uncontrollable binge eating.

    I don’t know the details, but I would risk an hypothesis based on my own junk food cravings: in a gluten-free diet, you are forgoing regular pizza, cookies, pastries… You can find alternatives recipes, but GF food is still more difficult to come by (or was, before gluten-free became more mainstream). The extra effort to gather food may help a lot in cutting on binge eating.

    Someone on the Science-based medicine website once had an article comparing diets. He pointed out that, following a diet, any diet, was likely to make you food-conscious, and in itself it could be enough to make the diet successful,

    Then she went to the hairdresser who used a shampoo that made her neck burn.

    Re: gluten-free skin products. I can understand for lipsticks, or more generally if you prefer to avoid the risk of swallowing a bit of gluten-loaded soap or skin cream. But through the skin, as implied above?
    Even if you do not have celiac disease?

    Well, since there are already plenty of cosmetic products those vitamins and stuffs are supposed to flow through and nourish the dead layers of the skin, it’s just continuing on the same thread…

  6. #6 Dangerous Bacon
    April 30, 2014

    In focusing on gluten and non-gluten proteins, Orac evades the obvious cause of the surge in celiac disease diagnoses – vaccines! I read it on the Internet!

    Well, actually not.

    http://www.foxnews.com/health/2012/06/27/vaccinations-cleared-in-babies-celiac-epidemic/

    Even more disturbing for antivaxers – a vaccine _against_ celiac disease is moving closer to approval:

    http://www.fiercevaccines.com/story/immusant-waits-early-clinical-data-its-celiac-disease-vaccine/2014-03-13

  7. #7 Denice Walter
    April 30, 2014

    At any rate, I definitely have encounted wheat woo in my travels ( and -btw- one of my shampoos has wheat protein):

    – there are a few recent tomes ( “Wheat Belly”**) that proselytise weight issues associated with wheat and another ( “Grain Brain”**) that links grains to various mental problems.
    – other than autism woo, there is an entire anti-wheat faction of alt med: e.g. Null’s diet is vegan and gluten free for the past few decades because he is “allergic” to wheat and assumes that every one else is, too. It contributes to “brain fog” and many other woes.

    I was in the artsy sector of the city the other day and- lo and behold!- an entire restaurant located in a toney marketplace was gluten free and entirely overpriced for what it was.

    My distinct suspicion is that wheat woo is directly related to concerns about weight: avoiding carbs is a strategy that might help some people lose or control weight ; portraying this as a medical concern might make it seem less frivolous and vain.
    -btw-not that there’s anything wrong with being vain.

    ** Has their creativity no limits?

  8. #8 Denice Walter
    April 30, 2014

    Addendum:
    Paleo diets limit carbohydrates because our ancient ancestors didn’t grow grains whilst they were still paleos.
    Mercola is amongst this crowd. Similarly blood type diets ( Adamo) restrict grains for type O’s who are paleo hunter-gatherers or suchlike.

  9. #9 enkidu
    April 30, 2014

    Pris: “Also: for many of those ‘sensitivities’ I wonder if there might be a psychosomatic cause. My mum can track her stress level and mental health by her GI symptoms”

    I have IBS, so bad that I couldn’t eat anything at all unless there was a bathroom nearby. After trying all sorts of elimination diets and anti-spasmatic drugs with no success, I was prescribed Effexor (it was obvious that stress made my symptoms a lot worse). Holy cow, my IBS disappeared within a few weeks of going on the medicine. I can now eat anything I want, anywhere I want, it is awesome.

  10. #10 jane
    April 30, 2014

    I personally don’t have a problem with modern high-gliadin wheat, but there are other controlled challenge studies that show effects in a higher percentage of putatively sensitive subjects than the 8% in the one study of 37 people you cited. I don’t understand the rage in parts of the scientism community towards people who say they have benefitted from cutting wheat, unless it is because wheat is so significant in European foodways. If someone says that his stomachaches went away after he gave up bread, why does a total stranger feel entitled to bellow that this can’t be true and he is stupid and irrational? Why should he feel obligated to go back to eating wheat and having stomachaches? Many fine cuisines did not historically include wheat.

  11. #11 Denice Walter
    April 30, 2014

    Come to think of it, there is a counter-trend amongst foodies and trendies- artisanal breads- which harken back to hippies days of yore- to create additive free, whole grain products which aspire to a certain mis-shapen elegance that loudly proclaims their non-factory origins.

  12. #12 Mu
    April 30, 2014

    I had a good friend misdiagnosed with gluten intolerance, so every meal with her had to be gluten free. I can see how you lose a lot of weight on that diet, it doesn’t give you many tasty alternatives unless you’re going heavy towards Atkins. I think 8 out of my 10 worst meals ever made come from that period. She was finally released from the torment when another doctor stated simply: If you have CD or similar, going gluten free helps within a couple months. If there’s nothing changing for 2 years you don’t have gluten problems. I think she spent 2 h at the French bakery on the way home.

  13. #13 Johanna
    April 30, 2014

    Like most folks, I have several chums with CD (diagnosed by MDs, not Google) and they’re rather conflicted about the current fad for GF living. On the one hand, grocery shopping has gotten a bit easier. On the othet, they’re facing increasing difficulty being taken seriously because of the speshul snowflakes – grads of Google U. – who have glommed on to the fad, but can actually tolerate gluten just fine. And then there are the “friends” who assume someone with CD is obviously a speshul snowflake and, gee, it’s just some soy sauce in the potluck bbq, get over yourself.

    (Those latter groups need a swift kick in the tuchus.)

  14. #14 Melissa
    April 30, 2014

    I really don’t understand the backlash against people who can’t consume gluten, or react topically to it. Those who make fun of people in this predicament have obviously never suffered an adverse reaction to a simple substance that manufacturers and the food industry seem to believe belongs everywhere.

    While the molecules may be too large to be absorbed through the skin to create classic intestinal damage, many people have an actual allergy to wheat products in addition to celiac disease or gluten intolerance. You fail to consider allergies in your pompous diatribe against gluten free products. Should those of us who need these products go without because gluten molecules are too large to be absorbed through the skin? What harm does the availability of these products do to you or your wife?

    Quite frankly, as someone who needs these products, I am quite irritated by people like you who endanger my health and happiness by suggesting that I don’t need to be able to buy lipstick, or shampoo like a “normal” person. Why should I be restricted to having to make my own lipstick out of beet powder and bees wax? And if someone without my restrictions would like to spend their money on gluten free moisturizer, what is it to you?

  15. #15 Mark Thorson
    April 30, 2014

    Don’t these people realize they have undiagnosed occult Lyme disease?

  16. #16 Pareidolius
    April 30, 2014

    Wheat is why the traffic on the European foodway flows so freely. But then again, my scientism is wholly informed by my biophobic worldview.

  17. #17 Krebiozen
    April 30, 2014

    Gluten sensitivity again? Time for an anecdote…

    Some 20 years ago, I was plagued by GI symptoms that eventually turned out to be a chronic giardia infection. Before I discovered this I tried a thousand and one things to try to alleviate my misery*, including several years trying to track down which foods in my diet might be responsible.

    I can state with some degree of confidence that trying to track down supposed food sensitivities is a marvelous way to chase red herrings. Despite a negative ant-gliadin antibody test I avoided wheat (and yeast, soy, sugar and various other foodstuffs) for varying lengths of time. For a long time I was convinced that this was helping, until the next flare-up of symptoms, which inevitably led me to a post-mortem, trying to figure out what I had eaten that contained something that didn’t agree with me – did I fail to read a label?

    Eventually I started a food diary – I actually wrote a little database using MS Access – and recorded everything I ate and my symptoms. After a couple of months I analyzed the data, exporting it to Excel and plotting graphs of wheat intake, say, and GI symptoms. I did find an association, but to my surprise my GI symptoms generally preceded my wheat intake. I concluded that when I had a flare-up of unpleasant symptoms I was more likely to comfort-eat pizza or other wheat-containing foods, in a fit of disgust at feeling unwell and having to avoid my favorite foods.

    These days I sometimes make gluten balls, as a meat substitute used in East Asian cooking. You make it by washing all the starch out of a ball of dough made with strong high-gluten flour, until the water runs clear, and you can make little balls out of the remaining gluten which are best fried before use in stews or stir-fries – it soaks up flavors a bit like tofu does. You can buy cans of the stuff, labeled as ‘mock duck’ in some food stores. If you are in any doubt, there is nothing quite like eating a plate of gluten with no negative effects whatsoever to convince yourself once and for all that you are not sensitive to the stuff.

    * I was so desperate I even tried Hulda Clark’s quack anti-parasitic program of black walnut tincture, cloves and wormwood, which actually seemed to help a bit (for a while – placebo effect no doubt). After multiple scans, barium meals and enemas and a sigmoidoscopy I was told there was nothing physically wrong with me (apart from perhaps mild diverticular disease). I assumed I must have some deep-rooted unconscious conflict that was causing my symptoms, so I went to see a clinical psychologist and a hypnotherapist, and learned a lot about psychotherapy, relaxation and stress-management. Ultimately it was a week’s course of antiprotozoal drugs courtesy of Big Pharma that restored my GI function to normal.

  18. #18 JGC
    April 30, 2014

    I have friends with severe celiac disease, who are certainly grateful for the increasd availabilty of gluten free products. But having shared meals with them I have to say if I were limited to a completely gluten diet–gluten free crackers, flourless cakes, this past holiday gluten free matzoh ball’s in teh chicken soup (god help us).–I’d lose a lot of weight too, simply because it doesn’t taste good enough to go back for seconds.

  19. #19 erk
    space
    April 30, 2014

    You ought to look into the work of Dr. Alessio Fassano. His experience with the relevant research is more than, “I checked pubmed yesterday and…” He is quite convinced of the existence of NCGS. Also, I believe the diagnostic criteria for DC is different than what you have posted here. Fassano discusses the criteria here – https://www.youtube.com/watch?v=VvfTV57iPUY

    It is has been demonstrated that gliadin can increase intestinal permeability by its action on tight junctions. The long dismissed-as-woo “leaky gut” is indeed a thing. Without much more investigation, one ought not dismiss the possibility that it contributes to the the “syndromes”.

    Personally, removing gluten from my diet vastly reduced my suffering of seasonal allergies (I no longer require medication). Of course only anecdotal and only correlation but I did remove and reintroduce several times with the same affect each time.

    And thank you Jane, well said –>
    “If someone says that his stomachaches went away after he gave up bread, why does a total stranger feel entitled to bellow that this can’t be true and he is stupid and irrational [or a special snowflake, etc]?”

  20. #20 Denice Walter
    April 30, 2014

    @ Krebiozen

    Did you ever think that you might be partially feline?

    Believe it or not, there is an incredible amount of internet woo about cat IBD/IBS attributed to carbs in commercial cat foods. ( And which is actually often cured by anti-parasitics I was told by an experienced veterinarian).

    Anyway, the cat woo holds that cats are not built for digesting carbs being that they are little killling machines requiring mouse and bird- which contain litte carbs except that which is undigested meals in mouse or bird GI tracts.

    Thus, the internet woo prescribes home made diets of meat ( sometimes raw, sometimes consisting of exotic meats, like kangeroo and ostrich which are novel and helpful for the cat’s digestion) as well as store bought variants of carb-less meals all of which have names like ‘natural cat’, or suchlike.

    Like human woo, I take what I’ve read with a grain** of scepticism : probably it’s somewhat true for a few cats but I imagine that feral kittehs manage to survive quite well on a diet of raw mouse liberally mixed with an assortment of garbage usefully discarded by humans some of which is carb-laden. If you live near a restaurant you will know these things.

    ** I HAD to

  21. #21 Rich Woods
    April 30, 2014

    What Melissa said:

    You fail to consider allergies in your pompous diatribe against gluten free products.

    What Orac said:

    Again, there are many compounds and substances in skin products that can cause allergic reactions or simply contact dermatitis in some people, particularly fragrances. Because of all the publicity about gluten, it’s not surprising that so many people, whether they have CD or not, are quick to assume that a rash after using a skin product is due to gluten in the product. Without careful patch testing, assuming a reaction is due to gluten in a skin product is a leap.

  22. #22 Johanna
    April 30, 2014

    @Denice

    I’m a sucker for my two furritos, and they’re on a grain-free diet, because one of them, well, he’s called “Pixel”, but nicknamed “Megapixel” because he’s so big – 17lbs!

    The change of diet seems to have done them a lot of good – hairballs are a thing of a the past and their fur has become amazingly soft (all that fish oil, methinks). My chums nickname it the “Catkins Diet”

    But they do get *some* veggies in some of their canned food and Pixel loves red bell peppers, of all things…

  23. #23 Narad
    April 30, 2014

    I personally don’t have a problem with modern high-gliadin wheat

    Would you care to document this insidious, universal (and pointless, since gliadin-to-glutenin ratio determines dough behavior) increase in gliadin content? After all, it’s nothing new:

    “[W]e strongly recommend that coeliac patients should avoid consuming Graziella Ra® or Kamut®. In fact their α-gliadin not only is as toxic as one of the other wheat accessions, but also occurs in greater amount, which is in line with the higher level of proteins in ancient wheats when compared to modern varieties.”

    but there are other controlled challenge studies that show effects in a higher percentage of putatively sensitive subjects than the 8% in the one study of 37 people you cited.

    Mercifully, this is so vague that there’s no need to track it down.

    I don’t understand the rage in parts of the scientism community towards people who say they have benefitted from cutting wheat, unless it is because wheat is so significant in European foodways.

    Wheat had displaced millet in northern China by the T’ang
    period.

    Many fine cuisines did not historically include wheat.

    Which ones do you have in mind? Mesoamerican?

  24. #24 Narad
    April 30, 2014

    Pixel loves red bell peppers, of all things…

    I have to securely store tomatoes away from my youngest, or else they’ll disappear into other rooms.

  25. #25 Denice Walter
    April 30, 2014

    Mine adores canned pineapple.

  26. #26 Johanna
    April 30, 2014

    I once owned a Siamese cat who was MAD for sweet corn and my mother’s sweet-and-sour spare ribs. Then there was the time he tried to steal a pork chop off a guest’s plate, but that I could totally understand… ;)

  27. #27 The Grouchybeast
    April 30, 2014

    One of our cats goes crazy for cake and biscuits. She can smell a slice of lemon drizzle cake or a piece of flapjack from the other side of the house. I keep trying to explain to her that she’s an obligate canivore, but she just ignores me and begs for dessert.

    But then, one of my parents’ cats loved avocado pear. There’s no accounting for cats.

  28. #28 Science Student
    April 30, 2014

    Gluten free is more than just the latest fad… there are multiple studies showing that gluten can cause harmful effects. We all know Gluten is a protein composite found in several types of grains, including wheat, spelt, rye and barley. When flour is mixed with water, gluten forms a sticky cross-linked network of proteins, giving elastic properties to dough and allowing bread to rise when baked.

    When gluten reaches the digestive tract and is exposed to the cells of the immune system, they mistakenly believe that it is coming from some sort of invader, like bacteria and in certain people who are sensitive to gluten, this causes the immune system to mount an attack against it. In celiac disease (the most severe form of gluten sensitivity), the immune system attacks the gluten proteins, but it also attacks an enzyme in the cells of the digestive tract called tissue tansglutaminase.

    Therefore, gluten exposure in celiacs causes the immune system to attack both the gluten as well as the intestinal wall itself. For this reason, celiac disease is classified as an autoimmune disease. Therefore you can make a very obvious conclusion that gluten is only harmful to people with celiac disease if they consume it. On mayoclinic.org Micheal F. Picco, MD answers the question if gluten can be absorbed through the skin. The answer… :

    “No. Gluten-containing skin care products and cosmetics aren’t a problem unless you accidentally swallow them. For this reason, avoid using such products on your lips or around your mouth. Also, avoid using gluten-containing dental products, such as certain mouthwashes and toothpastes. If you’re uncertain about whether a product contains gluten, check the ingredient list on the product label or contact the manufacturer.
    Some people develop a form of celiac disease called dermatitis herpetiformis (DH), which causes an itchy, blistering rash. This skin disorder is also linked to gluten intolerance. But although it involves the skin, DH is caused by ingesting gluten, not by skin contact with gluten. So, eliminating gluten from your diet will help clear up DH as well.
    If you use a cosmetic or skin care product that contains gluten and you develop a skin reaction, see your doctor or dermatologist to identify the cause. It is possible to have an allergy to wheat or another grain that could cause a skin reaction.”

    I hope this information delivered some insight on the topic and that some will find it helpful.

  29. #29 herr doktor bimler
    April 30, 2014

    I had a Siamese who shared the avocado love. Avocados do a good job of appealing to feline tastes. IIRC from reading “Ghosts of Evolution”, jaguars are partial to them.

    Whatever large central-American herbivore used to eat the fruit and spread the seeds is now extinct.

  30. #30 herr doktor bimler
    April 30, 2014

    Red peppers? Tomatos? Pineapples? Clearly the cats are collecting ingredients for pizza.

  31. #31 M
    United States
    April 30, 2014

    All I can say is thank you. As someone who is married to a celiac, gluten free is no joke. this is not a lifestyle we choose (though i am not gluten-free). my husband (45) was diagnosed in 20 years ago – by endoscopy as the blood tests weren’t developed yet. While the gluten-free fad has made life easier for us in some ways, it’s is also incredibly annoying. this is not a lifestyle we choose. i have 2 sons who have been genetically screened. both have tested positive for the same gene. It’s hard to stomach the people who are ‘gluten free’ but enjoy the occasional NY bagel or piece of pizza.

  32. #32 Chris,
    April 30, 2014

    palindrom: “Whole Foods parody rap video.”

    Due to confirmation bias in regards to news about the guy who pushed Cliven Bundy off the “most racist cad” pedestal: I mostly noticed the guys Clippers cap.

    I very seldom go into Whole Foods, and never ever enter its parking lot. I typically park over a block away and just run in to see if it has the one particular ingredient I am trying to find. Especially because it is across the street from major transit tunnel project.

    Melissa, you might try reading the articles more closely. I hope you can employ some sensitivity to those of us with nickel allergies when we refuse to try on jewelry or are very particular about sewing needles.

    I first thought it was the shoddy soap in the washrooms at work, but it turned out to be my wedding set.

    I have actually had people tell me to just use a specific kind of cream.

  33. #33 Jerry A
    April 30, 2014

    jane: “scientism”?? Oh please, spare me. Science is not a religion, no matter how badly you mis-spell it or misunderstand it.

    Now for the important part of my comment: I have one cat who steals lettuce and sometimes shredded cabbage. We also have a short video clip of him eating roasted seaweed. My wife could not stop laughing about it.

  34. #34 Lurker
    May 1, 2014

    Interesting.

    Re. CD, wheat woo, and products: On balance I’d say that it’s a good thing if there’s a wider range of products available for people with real CD (or real wheat allergies, or other medical issues). It’s similar to accessible design: it helps some people and causes no difficulties for others.

    Even if one of the reasons for the wider availability is an increase in woo and snowflakes (‘fashion med’?): It’s better than if people with the real conditions had to go searching all over town for a limited range of products that tasted nasty none the less, and couldn’t go on holiday without bringing a large trunk full of ‘provisions’ to be sure they had what they needed.

  35. #35 The Grouchybeast
    May 1, 2014

    Lurker: Increased availability of ‘gluten free’ can be a two-edged sword. Celiacs now have to negotiate a world full of supposedly gluten free food that is really catering to the faddish or orthorexic who won’t actually suffer any ill effects from cross-contamination. Some people honestly just don’t understand how serious it can be. It’s easy to stick ‘gluten free’ on a menu, but much harder to implement it properly. It’s the difference between having, say, gluten-free fish and chips where the batter is made from gluten-free flour but fried in the same fryer, and keeping a separate fryer for the gluten-free.

  36. #36 palindrom
    May 1, 2014

    Chris @32 — Hey –

    “That’s how we LIVE
    On the West Side of LA.”

  37. #37 cakesphere
    May 1, 2014

    With regards to cats, my big white kitty won’t eat “people food” except for grains. While the other cats will gather round the fish/pork/beef/chicken and cry for a taste, he’s across the room, chewing open the cellophane-wrapped baguette.

    Guess I shouldn’t have named him Wheatley ;)

  38. #38 Denice Walter
    May 1, 2014

    @ cakesphere:

    Are you sure he isn’t craving the cellophane itself? It is often a delicacy for them.
    Bread and cellophane- what a treat!

  39. #39 Johanna
    May 1, 2014

    Pixel will try to eat cellophane, too. I think it’s the crinkly sound it makes. He seems fascinated by it.

    He doesn’t understand why his big mean Mama won’t let him have it.

  40. #40 Politicalguineapig
    May 1, 2014

    I have a cat who used to run her teeth down packages of sesame bagels. She also tried to make off with a potato a couple of times.

  41. #41 Johnny
    127.0.0.1
    May 1, 2014

    Clearly the cats are collecting ingredients for pizza.

    No, that can’t be right. You included pineapple.

  42. #42 cakesphere
    May 1, 2014

    @Denice:
    He likes the cellophane, too, for sure. He also enjoys chewing on plastic bags. Something about the noise it makes, or the texture, perhaps. But I’m pretty sure he enjoys the bread also since he takes whole chunks of it out with his little kitty teeth!

  43. #43 Renate
    May 1, 2014

    We had a Siamese cat, who loved to chew on packages with paper handkerchifs. At the end the contents of the package was soaking wet.

  44. #44 sarahjaneb
    May 1, 2014

    Gluten is not absorbed through the skin; however, as I learned the hard way, anything that’s on your skin or your hair is likely to end up in your mouth at some point. For example, if it’s on my face or my hair, then it gets on my pillowcase, then when I turn over my mouth is on the gluteny spot on the pillowcase. Or I wipe sweat off my lip with my glutenated arm, or something like that. This should only be an issue for people with actual celiac disease who are very sensitive, but it is indeed a real issue.

  45. #45 brewandferment
    May 1, 2014

    One of our 3 cats has a thing for cardboard boxes–she rips off little chunks and flings them about. Once I left a medium sized box alone and I kid you not, she chewed it down to its nubs–all that was left was about an inch of the sides and the base. Doesn’t swallow, just tosses pieces around. She also redistributes small Lego parts around the house…you’d think we’d learn not to go barefoot inside…

  46. #46 Kultakutri
    May 1, 2014

    I’m one of those who exhibit symptoms after eating a lot of wheat. (These days, I’m miserable because comfort food plus some self-punishing thing… whatevs.) I’m glad for the gluten-free fad, one gets more and cheaper stuff to eat.

    And, I’m allergic to every other thing. Or sensitive some other way, should some nitpicker want to nitpick, it’s not really important as the outcome is that I can’t really wear makeup. So… I skip it, it’s not worth the hassle. However, should someone feel the need to use certified gluten-free cosmetics, then that’s free market economy in action, someone gets the certification, earns money, buyers of gluten-free lipsticks are happy, nothing wrong about it. However, I certainly do feel that the anti-gluten hype is overdone.

    In here, the latest health fad is depression and “sorta lighter form of autism” that stands for I feel down and I don’t always get on well with people. Another source of immense fun.

    Speaking of kittehs, my furry beast has chronic pancreatitis or some such (I didn’t shell out $1000ish for the specific tests so there is only circumnstantial evidence) and the diabetic kibble contains quite some wheat and dietary fibre. Not sure what it does to feline digestion but this specimen went from lethargic, visibly sick, with greasy stinky diarrhoea to the good old self within a month. Apparently, gluten doesn’t matter.

  47. #47 Adam
    May 2, 2014

    My kids are coeliac. A few soaps and shampoos have flecks of oat, bran or wheat germ in them as a mild abrasive and I would avoid them simply because bits could detach in the bath. Otherwise any old soap / shampoo would do them. I see no reason to pay a premium for a “gluten free” product when they already are.

    As for Wholefoods, I see it as a double edged sword. It sells products that run the spectrum from ethically sourced, organic, dietary – no problem with that, but dear god it goes completely off the walls – aromatherapy, crystal healing, tarot, communing with spirits etc. Medical necessity and woo are conflated into a single experience.

    It’s depressing to be lumped in with new age flakes but at the same time it’s very to avoid doing so. These stores do carry a large GF selection of breads, biscuits, cereals, mixes, frozen and fresh foods and provide one thing that many coeliacs miss the most – choice.

  48. #48 Dangerous Bacon
    May 2, 2014

    It’ll be interesting to see what reaction the gluten-intolerant (real and imagined) will have to the introduction of genetically modified wheat that is essentially free of the Bad proteins. There’s probably quite a bit of overlap between anti-glutenites and anti-GMOers, so many will be conflicted (see the comments after this article):

    http://www.celiac.com/articles/23353/1/Gluten-free-Wheat-Can-New-Wheat-Hybrids-Help-Celiac-Sufferers/Page1.html

  49. #49 Helianthus
    May 2, 2014

    @ Denice Walter #20

    the cat woo holds that cats are not built for digesting carbs being that they are little killling machines requiring mouse and bird- which contain litte carbs except that which is undigested meals in mouse or bird GI tracts.

    It’s funny, a few years back this argument was made about dogs, with the logically following advice on giving dogs only raw meat.
    Which may or may not lead to an improvement to the dog’s health, but it certainly is not improving the dog’s smell, front and back.

    As for cats not digesting carbs: maybe their only source of carbs is the guts of their preys, but from what I remember of a few NatGeo documentaries and my own cats’ leftovers, the guts are often what they eat first. It’s how big cats get their greens…

  50. #50 Adam
    May 2, 2014

    @Dangerous Bacon if there were a reasonably priced GM wheat which was gluten free yet possessed the properties of wheat which make it good for baking then I’d be all over that for my kids.

    The problem I suspect is once you take the gluten out, it’s little better than most of the other flours out there. Without it, it will have no elasticity and it’ll fall apart. It might taste a little bit better (some GF flours have very weird tastes). I should note that some GF breads already contain wheat starch which has the gluten washed out.

    A more promising idea is a gluten “vaccine” (http://www.immusant.com/news/) which is in trials. The idea is to acclimatize the body to the presence of gluten proteins through a series of injections so that the immune system eventually ignores them. I guess the success will depend on if this is a course of injections, a continuous series of injections, the intervals between each booster. and whether people will be happy about sticking with it or any potential effects.

  51. […] Gluten-free skin and beauty products? More like thought-free <b>…</b> […]

  52. #52 JustaTech
    May 2, 2014

    The thing about branding products as “whatever the thing is this week” – free is that so often it’s just jumping on a bandwagon. Like when Jolly Ranchers are labeled “fat free”. Yes, a factual statement, but that doesn’t change that they are 100% sugar. OTHO, if slapping a new label on your product (or creating a new line entierly) without having to change the product opens up a new customer base, I can’t really blame a company for making money.

    Cat: the only human food my cat likes is white cheddar cheese powder, like on box mac’n’cheese or cheese puffs. Doesn’t like cheese, just cheese powder.

  53. #53 Narad
    May 2, 2014

    from what I remember of a few NatGeo documentaries and my own cats’ leftovers, the guts are often what they eat first

    Mine have generally started at the head with rodents and stopped at the hindquarters. They don’t actually eat the birds.

    IIRC, eating bones is one of the few decent dentifrices for housecats.

  54. #54 Michele
    United States
    May 3, 2014

    I just had to comment on this terrific comments section. I love jumping from celiac to giardia to speshul wooflakes to cellophane-eating cats and then right back to celiac. I wish that all comments sections included random side-threads about cellophane-eating cats! Much more entertaining.

    Less tangentially – last year I put my youngest on a GF diet – her main symptom were obviously not feeling well (she’s young and can’t verbalize it well yet) and persistent diarrhea. The diet helped immediately, but was a huge pain and she felt stigmatized because she couldn’t enjoy treats that her friends (and sister) could eat. So, I’ve tried reintroducing gluten. So far no diarrhea! I’m still keeping a journal though, and she’s finally almost old enough for proper allergy testing. I’m glad we tried it but I’d love to not have to do it any more. I’m so over being GF.

    I myself had an incidental duodenal biopsy a few years ago (it was unrelated to symptoms of CD but they were all up in my duodenum so they checked anyway). I do not have it, which I rejoice at every opportunity.

    Final tangential thought – I just had a gluten-free conversation with a relative during which she proclaimed that “Nobody needs to be eating gluten!” and turns out she thought it was a chemical additive. I wonder how common that is – people hear it’s bad, without knowing why, or maybe equate it with whatever additive Subway just took out of their bread, and don’t understand that it’s just a regular old naturally-occurring plant protein.

    P.S. I once had a cat who craved coffee grounds, spaghetti sauce, peanut butter and rum. Best. Cat. Ever.

  55. #55 Denice Walter
    May 3, 2014

    @ Michele:

    Well, we are thrilled that you enjoy the comments section. Believe it or not, the apparent randomness usually makes a salient point related to science….. eventually: in science ( or in long term memory) nothing is entirely tangential and I venture that no correlations are truly zero.

    Cellophane eating cats are of course a topic dearly beloved by feline gastroenterologists only surpassed by tinsel eating cats- which exemplifies the LOI syndrome ( i.e. linear object ingestion) a/k/a string eating.

    Usually our *quasi* tangential meanderings discuss food preparation and -if I have any say- fashion and occasionally, ancient festivals and mythology as well as long term memory. We just got through Beltaine/ May Day -btw- it was lovely: flowers, food, dancing and divers activities.

    But all roads lead back to Woo.

  56. #56 Brook
    May 3, 2014

    Eat or don’t eat gluten, it’s all the same to me. My only request is that if it’s a necessity you let me know when I invite you to dinner and if it’s a choice you act like my favorite daughter. She’s been gluten free for a year but most of her co-workers, relatives, friends don’t know it. If she showed up and you were serving lasagna, she’d take a tiny serving, a large helping of salad and be the life of the party. She even shows up with homemade ice cream sandwiches or carrot cake. (she definitely didn’t get her willpower from me. I can’t imagine not licking bowls.) As for taste, you haven’t had my pain d’epice, flourless chocolate cake or lemon mousse. Or my cornbread.

  57. #57 Brook
    May 3, 2014

    As for cats, mine have always been pretty standard eaters but I had one that was willing to take baths with the toddler boys.

  58. #58 herr doktor bimler
    May 3, 2014

    Mine have generally started at the head with rodents and stopped at the hindquarters.

    Our Siamese and the big fluffy one like to leave rat butts lying around for us to find. They may be intended as some kind of insult.

  59. #59 Politicalguineapig
    May 3, 2014

    The most recent rodent remains was the head of the mouse that was intended for the snake. (Snake went off it’s feed, we bought something to encourage its appetite, but it decided it’d rather hunt it’s own.)

  60. #60 LW
    May 3, 2014

    I had a ferret that ate spiders. I knew because she liked the chewy centers but not the crunchy legs, which she left for me.

  61. #61 NumberWang
    May 3, 2014

    I can’t compete with the cat facts but…..my OH did once show our staffie a dead baby bird she found in the garden. After a thoughtful pause she ate it, leaving my OH holding two tiny drumsticks. Tragic……but hilarious at the same time.

  62. #62 brewandferment
    May 3, 2014

    your…staffie?? are you talking a person or getting mixed up with the notion that cats regard the two-legged persons in their house as staff>>

  63. #64 NumberWang
    May 4, 2014

    The British staffie is smaller and more compact than the American version, but yes. Reminds me of this http://static.fjcdn.com/pictures/cats_22eb1c_4172563.jpg

  64. #65 Dangerous Bacon
    May 9, 2014

    There is a squib in the current issue of Consumer Reports making fun of Seventh Generation toilet bowl cleaner, for having a “gluten-free” label on the bottle.

    Apparently some toilets are gluten-sensitive, and we don’t want them to get the runs.

  65. […] he’s even piled onto the dubious “gluten-free” craze with today’s show. If there’s one thing that Dr. Oz is probably most known for, if […]

  66. #67 Jaryn Finch
    Cambridge, MA
    June 13, 2014

    It may be ridiculous for some people but as someone who actually has to actively avoid soy, gluten and dairy in products for fear of even accidental ingestion causing a reaction, I’m pretty thankful that they number of these products is increasing, even if it’s ‘silly.” I’m a scientist, I know the things at play, but for the small subset of the population that has to deal with these problems other scientists trying to debunk and make fun of it just undermeans the issues we have to deal with daily. Not everyone reads the article, way too many people read the headlines and assume and that puts the few of us at great risk by the undermining of peoples respect for the words ‘gluten allergy.’

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