Gluten: Should You Give It Up?

"Hi, I'm Wendy Zuckerman and Jealousening to Science Verses." Today on the show, we're putting facts against flour. Focaches. Fettuccini. That's right. It's Science Verses Gluten. "The years people have been worried about what gluten is doing to our body, but recently, it's like gluten has transformed into a dietary supervillain." "Gluten might be one of the biggest mistakes for your health and longevity." "This is not a food for which a little bit here and there can be okay." "But it's not just the wellness brigade on social media that's got this war against gluten." "Gluten?" "Gluten?" "Gluten." In the US, surveys show that nearly one in four people are avoiding gluten in some way, which seems like a lot, especially since only about one percent of the population has celiac disease. A condition where gluten can really scrub your gut and make you sick. So what's going on here? Well, people are saying that it's not just those with celiac disease that need to avoid this stuff. "Gluten is incredibly inflammatory for a lot of people." Some people say it can make you feel tired and brain-forked, while others reckon that going gluten-free is the secret to weight loss. "Now, without gluten in my life, I've lost fat." "So if you cut out gluten to 100%, you will lose weight easier." And you could just brush this aside as just another fat. But the thing is, a lot of people are going gluten-free and saying they feel better. So what is going on here? Is gluten really bad for all of us? Or is this just the placebo effect gone wild? When it comes to gluten, there's a lot of. "Gluten might be one of the biggest mistakes." But then there's science. Science versus gluten is coming up to stop to the break. Welcome back! Today we are talking all about gluten. This fat that just won't die. Or is it a fat? Produced at Michelle Dang is here to tell me all about it. "Hey, Michelle. Hey, Wendy." I really thought when gluten-free popped up, I don't know, five, ten years ago, it was just going to be a blip. I don't know. I feel like it emerged in the days of the paleo diet that you just don't hear that much about anymore. And yet this gluten-free thing has persisted, which does make me very curious. Yeah. I was curious too. So Michelle, first, can we start with a very basic question. What exactly is gluten? Yeah, so gluten is this group of proteins found in wheat, barley and rye. It's the stuff that gives food like bread and pasta their shape. And fun fact, the word gluten comes from the Latin word for glue. That is a fun fact. Okay, another fact I want to know, Michelle, is around one of the big claves about gluten-free, which is that gluten messes with your gut. So why would this protein that does this lovely thing to our bread muck up our gut? Yeah, so interestingly, we don't have the enzymes to fully digest gluten. We as in like everyone or just people with celiac disease. Yes, we as in everyone. And if you eat bread, the gluten in the bread basically does not fully break down. And then leaves these long chains of protein kind of hanging out in our gut. And so we know that for some of us, the immune system will find these bits and then start going haywire. That is people with celiac disease. Uh-huh. Yeah, so let me take you inside the gut of someone with celiac disease. What happens is that their bodies or gut finds these gluten bits that are left over and start to have this autoimmune reaction. And so the body starts attacking itself. Ground zero for this is in the small intestine where this immune response ends up destroying these tiny finger-like projections called the villi. I spoke to a scientist named Armin Aladini about this. He's an immunologist from Columbia University. Immune cells are being activated. They are attacking the villi. They are destroying them and therefore what you see in celiac disease patients, especially advanced cases of celiac disease. You see no villi. It's completely flat. So you don't see any of those finger-like projections. Wow. Okay. So this is for people who have this condition where there are immune system hates the breakdown products of gluten, celiac disease, which we mentioned is only around like 1% of the population, right? Yeah. Exactly. What is interesting to me is that recently there's been this like growing idea that it's not just people with celiac who need to be avoiding gluten, but like a whole bunch of astute, particularly people with what's sometimes called gluten sensitivity. What's going on here? Yeah. I was curious about that too because like the weird thing is that these people can have stuff like pain, bloating, and diarrhea, but they don't have anything obvious going on inside their guts. Like when doctors do biopsies and take a closer look at the guts, they pretty much see healthy little villi in there. Huh. What is happening with these people? Well, this was a question that Armin had as well. I mean, Armin had been skeptical himself that gluten sensitivity was a thing. And when he started wondering about this more than a decade ago, a lot of doctors were thinking that maybe these symptoms were just in people's heads. In fact, the patients were even stigmatized. You know, they would go to the clinician, they would say, I have, I think I have celiac disease, although they didn't have that. And then they, you know, there was nothing else to be done for them. So Armin decided to look into it. And you know, since they can't see obvious damage inside of the gut, he thought maybe the blood could tell us a bit more about what's happening in their bodies. So he found a group of scientists in Italy who were working already with a crop ton of people who felt yucky after eating gluten-rich foods like wheat, rye, and barley, but they didn't have celiac disease. And Armin asked the scientists if they could do a study together. So then they took the blood from 80 different patients and shipped it off to Armin by plane across the ocean. And you know, he went to the airport to pick it up and was super excited. But the package got stuck clearing customs at the airport. And the dry ice keeping the blood frozen had basically disappeared. So the package was sitting there and all the samples got spoiled. Oh no. So we were talking about, you know, 200 samples that were at this had happened to. And so we were extremely disappointed. And I said, we have to see if we can get these samples again. Luckily, the Italian doctors had more samples and he got another package. And this time the samples were okay. It was like Christmas. I was just ecstatic. I was just ecstatic. So Armin got these blood samples to the lab and started poking around. And he was looking to see if there were any markers of the immune system going haywire in these people of gluten sensitivity. And the results of this were truly what changed my mind entirely about what was happening in these patients. What did he find? So what he found was like a host of immune cell activity in the blood. We were detecting such a huge inflammatory response. The battle was raging. So we were extremely surprised. We were really, really surprised and excited at the finding. He also found little traces of gut cells in the blood, which suggested there actually was a bit of damage to the gut lining. And when Armin looked at blood from the healthy controls in the study, he didn't find these signs of inflammation and damage. The levels of these markers, this inflammation that we were seeing was so much higher than unhealthy individuals. Oh, wow. And we know inflammation when you're got can trigger things like pain and bloating. So do we know what's causing this? Because people with celiac disease, it's an autoimmune reaction, but what could be going on in these gluten sensitive people? Well, Armin has a theory about what's happening. You know how our guts have a ton of bacteria and stuff inside? Yes, yes, yes. Yeah. Well, one of the jobs of the gut is to keep that bacteria from getting out. Because you don't want this huge population of microbial organisms to get to the rest of the body, right? Because they'll trigger at a very strong immune response. Yes, I want them to stay where they are in the gut. Yeah. And one idea is that this bacteria is escaping, getting into the blood and causing the inflammation markers that Armin saw. Huh. But like so many things can cause inflammation. Why does he think it's the bacteria escaping? Yeah, so he basically found antibody responses to bacteria that we do know often are in the gut. And like we said earlier, he didn't find this inflammation in the healthy controls. Their blood looked totally fine. I mean, that is very curious. I just remember there being so much skepticism about this idea that you could be sensitive to gluten, have a reaction to it when you weren't testing positive for celiac disease. And was this like one of the first times that scientists were able to say no, no, no, look, we can point to something here? Yeah, this is one of the first studies that helped show that there's actually something going on. And you know, Armin's still working out what all this means. But the bottom line for Armin was that people with the sensitivity are experiencing something real. And all of these things really convinced me that we are dealing with a real condition here with a biological mechanism behind it, that this is not something in the patient's heads. This is really something that involves the immune system at a major level. So does everyone who, like, not including people have celiac disease, but people who are saying their gluten-sensitive, who is saying when I eat gluten, I get bloating and these yucky symptoms, like all those people on TikTok, do they all have that battle going on in their blood? Well, there's a couple other things that might be going on. The first is placebo, right? I talked to Carolyn Newberry about this. She's a gastrointologist from Wile Cornell Medicine. They've tried to isolate and do like real placebo-controlled trials where they give people, you know, gluten and capsules and capsules without gluten in them and sort of try to isolate whether it's actually the gluten that is causing their symptoms or other components of the foods that they're eating. I love these kinds of studies because they really get to the heart of this question. Is I, you really sensitive to gluten or something else? So what exactly do they do in these trials? Scientists will collect people who report being gluten-sensitive and then they will give them either pills with gluten in it, like pure gluten or pills without or, you know, sometimes they'll give them foods like muffins with gluten and without and then they'll see what happens. So what do they find, like can people with gluten sensitivity tell which is the real thing? Yeah, what they find is that some people are actually reacting to gluten, but it's not everybody. One metanalysis rounded up around 200 people from these studies that had the gluten sensitivity and took the placebo or the real thing and they found that on average when they tested them only 16% reacted to pure gluten, 16% interesting. So one in six could actually tell the difference, wow, and maybe some of those are like the people in almond study, like that's where, that's where those people live. Yeah, yeah. Okay, but that still suggests that of the people out there listening to this show talking on TikTok who say they have a gluten sensitivity. If we can extrapolate from these studies, actually only one in six may have a gluten sensitivity. So what else could be going on with those like, with those five out of six people? I mean, immediately, just because I've done this show for too long, I swear I don't mean to be mean, but like, I'm immediately thinking of the Nessibot effect, like that, like that some of these people have just like manifested a fad and they're like, this is, I don't want to say all in their head, but this is a psychological thing. Is that doing from these studies, do we have any idea whether that could be going on? Yeah, it could be. So that metanalysis, I mentioned also found that 40% of people who went through these trials said they felt crappy after they got the placebo. So no gluten at all. Oh, they said they had like bloating and stuff like that, even though they were just taking the placebo pill, 40%. Yeah. But the scientists also said that it could be something in the facemos that could have been causing that reaction because often they're, you know, these pills, but they're sometimes also muffins or bars that they use as the vehicle. Oh, okay. Okay. So then zooming out away from that metanalysis, what else in food might be causing these symptoms then? There are a couple other big culprits. So here's Carolyn. Gluten often is an innocent bystander of foods that cause bloat. There's other proteins found in wheat. In fact, in armen study, his subjects had gone through these placebo trials already for their belly aches, but the tests they used wasn't specific enough to tell if their bodies were reacting to chris gluten or maybe something else in wheat. Now one of the interesting suspects here is this particular group of sugar chains with a much less sexy name. It's called FODMAPS. It's an acronym and it stands for fermentable illegal saccharides, dyesaccharides, monosaccharides and polyol. Oh, I wonder why they came up with the acronym, you could, that's just so catchy. These are different groups of sugar chains, like big sugar chains, but the key to take away is that they're fermentable, which means that the bacteria in our gut really like to get at it and start fermenting it and produce a lot of gas. So I have another fun way to put this is wind causing sugars. I like fat causing food. Fat causing food? That is another way to put it. Wind is a waste but like such a weed euphemism for farts. Don't you think? It doesn't feel like wind to me. Okay, we can say FODMAPS, the FART causing foods. So FODMAPS are in wheat, and so they're going to end up in a lot of the foods that gluten's associated with too, your breads, your croissants, your, you know, all those things. Oh, all that good stuff. Yeah, they're also in a bunch of other foods too, like apple, mango, milk, garlic, onion, so many FODD causing foods. I mean, that doesn't make sense to me. Yeah. I mean, we've heard a lot. Now, there's this one FODMAPS study that I want to talk about that really tried to work out how many people who thought they were gluten sensitive might actually be sensitive to FODMAPS. Wow. Amazing. What did they do? Okay. So researchers recruited around 60 people who said they had gluten sensitivity and had gone gluten-free. Then, they gave them three types of bars. Uh-huh. All the bars looked and tasted the same and the people and the study ate each type of bar for one week. So here's what they found. On average, all the bars called some symptoms, maybe people were a bit bloated or farty, but the FODMAPS bar made people feel the worst. Right. To put some numbers on it, the FODMAPS bar made people feel 25% more bloated than the gluten bar. Wow. Wow, wow, wow. And another thing that was sort of surprising here is that the bar with gluten, it didn't make people feel any worse than the control bar. Ha, so what really could be these FODMAPS is fructane stuff rather than just blaming gluten because that's the buzzy word right now. And other studies have found this sort of thing too. It's funny because the FODMAPS is not a new thing. Right. Like, it's been in the science world for a while. Yeah. They've particularly been looking into it for IBS. It seems to help that group a lot. Interesting. So it is funny. Maybe they need like a better acronym, you know, maybe FODMAPS not doing it for the kids. Maybe farty sugars. So then my next question Michelle is, if we're all eating these FODMAPS, these farty sugars and the bacteria in our gut are breaking them down and producing gas, like that's just part of how the human body with our friendly bacteria digest these products, then why is it that some people feel like bloating and pain as a result of eating them and not others? Yeah. So, you know, because we all have those, you know, we all get wind from those farty sugars, it could be that some people just have a more sensitive gut to that gas. And so here's Carolinix winning a bit more about how scientists figure that out. And so they've done these really fascinating studies that I would never volunteer for. But they've like blown balloons up in people's like intestines and they've found that, you know, some people are like, you know, I'm really uncomfortable with this balloon, just blowing up a tiny tiny bit and other people don't feel it at all. And you get a sense that some people have a lot more higher threshold and when they actually feel bloated, just send it uncomfortable than another person. And some of my patients get very frustrated because they happen to be on the spectrum where they really sensitive nerves. So even a tiny bit of extra gas makes them very uncomfortable. Oh, that is fascinating. Yeah, I had never thought about that and also doing that kind of study. I really appreciate the volunteers who were up for putting balloons in their cars. So here is where we're at, Michelle, is this right? There are people who have celiac disease, audience knows this. Then there are people who report being gluten sensitive. What could be happening here is that, yes, indeed, their immune system might be responding in some way to the gluten. It could also be that gluten is an innocent bystander here and their body is reacting nastily to FODMAPs. Yeah, yeah. And for some people, it could be something else altogether. Right. Yeah, the unfortunate thing about all of this is that there's no test to figure out what's actually bothering you. Oh, that is frustrating. What is up next, Michelle? It's gluten been blamed for this time. Okay, so a lot of people on TikTok are saying that they lost a ton of weight when they went gluten free. So can going gluten free help you lose weight coming up. Look back today, we're talking all about going gluten free. Yes, gluten, the internet's most wanted dietary criminal producer, Michelle, dag so far. I reckon I'm still going to eat croissants at this point. Unless have you got a reason I shouldn't? Well, there are people on the internet and on TikTok that say gluten is addictive because it breaks down into a structure that's similar to endorphins in our body. So, you know, like natural opioids or feel good chemicals. And is that true? Does it do that? Well, it's true. Yeah. And the idea is that the gluten bits then get absorbed into our blood, go to our brain and cause that. I want to keep eating, I want to keep eating more of this feeling. Uh-huh. And like, that's why, you know, that piece of bread, that whole loaf of bread is so irresistible. Scientists in the 70s did start looking into this and you know, propose the idea that gluten could be like morphine. Really? Yeah, but you know, more recent research has found that no, it's very unlikely that these bits actually pass through and do something to our brain. Right. Okay. So, in our gut, when gluten gets broken down, it kinda looks a bit like an adorffin, but you're just going to crap it out. It doesn't get up into your brain, it's like high jacket. Right. Right. And it turns out like, a lot of foods do this as well, breaking to these similar structures. Even spinach has a lot of these. And no one's saying that they're addicted to spinach. Don't. They are not. Well, I mean, except of course, everyone's favorite spinach eating sailor. Papa, who seems to have been vindicated here, but gluten, it's not addictive, very good to hear. Another thing we are hearing all over TikTok and the internet though, is that going gluten-free can help you lose weight. What is the science here? I want to talk to Natalie Reniger about this. She's an nutrition epidemiologist from the University of Manitoba, and she had this huge data set from the Canadian government that had surveyed over 20,000 people on their diet, and so the- It's a lot of poutine, is that that? Poutine. Poutine. A lot of poutine. And they wanted people's houses and had people sit down with one person from the household and had them remember everything they ate in the past 24 hours. And this went really, really detailed. So if somebody says they had a Tim Hortons sandwich, it can go into the drop-down list. It'll search, you know, like you've typed in Tim Hortons, and also it'll come up and they can click it. So it'll link to all the nutrient information. Wow. This sounds really fancy. And so in this study, they had also asked whether people were avoiding gluten or not. And so Natalie was able to pull out the people who were avoiding gluten. And there were about 500 people. And so one of the things she wanted to find out was like, did the BMI was a different between this group of people who were avoiding gluten from the rest of the lot? And what she found, there was no difference between Canadians' body mass index who avoid gluten compared to those who don't avoid gluten. Yeah, it didn't matter if they were eating gluten-free Tim Hortons or regular Tim Hortons. The group of people avoiding weren't any significantly thinner. And other big studies have found the same thing. Like one researchers look at the weight of people who eat gluten versus people who don't eat gluten. They just don't see a difference here. And so, you know, when people say they went gluten-free and they lost a bunch of weight, is it just because they're restricting certain foods from their diet? Like, it's not as if they're replacing a muffin with a gluten-free muffin. They're just not eating muffins anymore. Is that what's happening? Exactly. So we know that avoiding carby stuff like bread and pasta, which is where you might find a lot of gluten, can help people lose weight at least for a while. And so the reason is likely that they're replacing bread with stuff that's just more filling, that lower in calories. Yes, of course, of course. Gluten-villanized here when it's really just our old friend calorie. Yes. Yes. And so overall, Natalie says when you look at all the evidence that exists out there, does going gluten-free lead to weight loss? I'm sure there's somebody who avoids gluten who's like, "I lost weight. I don't dispute that." But there's no evidence that avoiding it contributes to weight loss when you take in all other factors into account. I love how Natalie knows the internet so well. I'm not saying, you know, I'm not saying that you've lied on your TikTok. I'm just saying the science. Right, right. And just one more thing that comes up that I want to mention, there's this idea that going gluten-free can help with cognition. Well, there is some evidence that this might be the case for people with C-Lac disease. There's not great evidence that it will help those with gluten sensitivity. And just generally, there was this one study that looked at data falling over 13,000 women without C-Lac disease. And they looked to see if there were any cognitive differences between low and high gluten-eaters. Well, they didn't find any. Okay. All right. So then, I think Michelle, my last question is. If you personally feel like cutting out gluten is good for you and your body, are there any downsides to cutting it out? I mean, other than missing out on yummy food? Yeah. There have been a lot of big red flags from studies in the past that found that gluten-free diets were like overall lacking certain vitamins and nutrients. So in Natalie's study, the computer system had all the micronutrients broken down. Amazing. Natalie was able to then analyze that. And she found that when people skipped gluten, they got less folic acid, vitamin D, and calcium. Huh. Why? Why is that? So, folic acid, it's added to wheat flour to prevent neural tube defects and fetuses. You know, important for pregnant people. And if you go gluten-free or likely to get less of it because you're just not eating as much, you're not eating wheat. Of course. When it comes to vitamin D and calcium, that might not be related to gluten itself. Because a lot of people who avoid gluten also avoid dairy. So it's possible that could be a reason. Here's Natalie. I don't think it's, you know, a nutritional disaster. It just requires a bit more thought, perhaps. So bottom line, gluten is not the big villain in our diets. No, Andy, actually let's spend a moment just to appreciate gluten foods. Yes. I feel like gluten just gets so much crap. Let's have this moment, Michelle. What should we love about gluten-filled foods? Well, gluten-rich foods like wheat, barley, and rye have a ton of fiber. And I know fiber does not sound sexy, but it's so important. Eating a bunch of it lowers the risk for stuff like heart disease and type 2 diabetes, possibly because your gut can't chew out food with a lot of fiber easily, which helps keep your blood sugar from spiking. Oh, interesting. And one big review found that people who eat high fiber foods are about 20% less likely to die of cardiovascular disease. 20%? Yeah. Also, fiber can help you pass poo faster, which may lower your risk for colon cancer. Well, thank you, fiber, for your services. I know you can get fiber from non-gluten-rich foods, which people with celiac disease are very grateful for, but that is wonderful. So Michelle is we're capping off here, as we're sorting out the wheat from the chaff. It feels like the new evidence is telling us that there is this thing called gluten sensitivity that we don't have a test for, but some people, their guts and immune systems don't like gluten, even though they don't have celiacs disease. But then the internet has taken that fact and blown it up to say that we should all be avoiding gluten. And there's really no good evidence for that. Yeah, even our men who did that study, but found all those information markers and people's blood, doesn't think everyone should be avoiding it. Most people do not have a sensitivity to it. So to make that blanket statement that everybody should go off of it, I think we don't have the evidence for that. We really don't. And you know, I think Adely said it best here. I believe everybody knows their body best in terms of if that makes you feel better, then do it. But for individuals who have no medical reason for avoiding gluten, there's no evidence to suggest that gluten harms your health in any way. I love gluten. Yeah, I have no medical reason to avoid it, so I enjoy it. Well, this is great news. Natalie and I will be choosing with croissants to this side's news. Yes, I'll join you. That side's best is. And so how many citations in this week's episode? There are 99 citations this week. 99, that's so many gluten, non-gluten filled citations, if people want to find the where should they go. They can head over to our show notes and check out the transcript. Yes. And we talked a lot in this episode about how TikTok is kind of full of bull. So if you are on TikTok and don't want to hear about bull, come find me because I now am making videos on TikTok. I have @weddyzookamid, that's zookamid with no say. Next week, our episode on affordable housing, Michelle, are you excited? Oh, well, my ranch ever go down. That's where we're going to find out. Awesome. Why is red so expensive? Why is buying a house so expensive? It's a super fun episode. Thanks, Michelle. Thanks, Wendy. This episode was produced by Michelle Dang, with help from me, Wendy Zookamid, Merrill Horn, Raine Nattabitch, Joel Werner and Rose Rimla. We're edited by Black Terrell, fact checking by Diane Kelly, mix and sound design by Boomi Hiddaka, music written by Bobby Lorde, Peter Leonard, Emma Munga and Boomi Hiddaka. Thanks to everyone we reached out to for this episode, including Dr. Sachin Ruskey, Dr. Robert Anderson, Dr. Johnnish and Gomez, Dr. Jessica Beersgurkey and Zoe Shire, special thanks to the Zookamid family and Joseph Lovalle Wilson. I'm Wendy Zookamidne, fact you next time.