This blog is about the intersection between evolutionary biology and food. But also about practical applications, sustainable agriculture, and general tasty things.
Someone I know who follows a gluten-free diet said that he saw an ad for this product called GlutenCutter, an supplement that claims it helps people digest gluten, on Facebook. I would assume he "likes" many gluten-free/paleo/etc. blogs on Facebook that that is why he saw this ad. I looked at the product out of curiosity and it is a bit worrying, particularly the FAQ:
Q: Is Gluten Cutter intended for those with Celiac Disease?
A: It is recommended that those with Celiac Disease first consult with a doctor prior to using Gluten Cutter.
I would only hope they have a competent doctor who tells them the truth, which is that while some research is being done on using enzymes that would possibly allow a celiac to digest gluten, this is in very preliminary stages. There is currently no safe accepted dose of gluten for a person with celiac disease.
Furthermore with the state of our health care systems, I would worry that people with celiac symptoms would use this product. People who haven't had celiac ruled out. In the US I meet many people like this who cannot afford the diagnostic tests, particularly since the gold standard if it's not ruled out otherwise is biopsy that is performed as a surgical procedure. In places like the UK, it is often hard to obtain these tests as well, as it is not easy to see a specialist.
The supplement industry often thrives by filling in the gaps of the healthcare system, and sometimes in unsafe ways. I would not use this kind of product if it were possible that I might have celiac.
I have used Glutenease in the past, but celiac is ruled out in my own case. Glutenease mainly contains one of the enzymes under study, which is dipeptidyl peptidase IV (DPPIV). It seemed to help me transition out of a gluten-free diet, but I stopped taking it late last year and haven't had any problems. I think if i had continued to need it, it would have indicated the possibility of a more serious problem since low levels of it in the body are tied not just to celiac, but to other diseases that cause mucosal damage.
Compared to Glutenease, Glutencutter contains a host of other supplements which might have unintended side effects. One of the many reasons I think people experimenting with supplements should avoid bundled supplements and just supplement what they need in doses that are adjustable.
It just reminds me that gluten is probably a major public health issue in our time because
Not being gluten-free anymore has significantly broadened my ability to travel, eat-out, and go to social gatherings. And that's kind of a sad fact considering not everyone has that choice.
In developing countries, this problem is magnified:
Wheat and barley are major diet constituents with few acceptable alternatives, rendering the convincing of parents that bread is the cause of diarrhea very hard. Also, convincing patients with atypical CD to adhere to a GFD is difficult. Finally, lack of information about CD manifestations, lack of benefit from a GFD and lack of encouragement to adhere to such a diet may contribute. More than 10% of adults with CD do not adhere strictly to long term GFD and more than 30% who believe they are, are actually consuming grams of gluten daily.
Interestingly, some of the most at-risk populations come from the "Fertile Crescent" where wheat agriculture originated. Rather than poor adaptation to grains, celiac might be more of a legacy of more recent evolutionary trade-offs, an issue explored in Aaron Sam's dissertation (PDF). The crop that these early farmers so successful may also have ended up being a curse on their wide-ranging descendants.
It seems that celiac disease is on the rise and is becoming a major public health issues. I remember when I was a kid at summer camp we all ate at the same table. By the time I was a camp counselor there was a special "peanut-free table" and admission to it was enforced through inspection. I am imagine at my children's camps there will probably be a new gluten-free table.
But celiac incidence has risen and fallen in several cases, most notably in Sweden. In the 1980s, the incidence rate among children under two increased fourfold, then suddenly declined around 1995. Epidemiologists looked for what else had changed during this time and came up with two major factors
breastfeeding, the other was use of gluten-containing infant cereals. Further study into the matter produced a rather strong body of evidence that breast-feeding protects against celiac disease. A possible mechanism is the gut flora. I have written before about the unique properties of prebiotics in human breast milk and their role in establishment of gut flora. C-sections also interrupt establishment of gut flora, and not surprisingly they have also been connected to celiac.
One of my favorite quotes is by Joan Gussow: "I trust cows more than chemists."
I also trust millions of years of human evolution more than chemists. Breast milk is the perfect and most appropriate food for human infants. I become quite disappointed in continous misdirection in citing rare cases in which breast-feeding is literally impossible, such as adoption or after breast-cancer. In countries where breast-feeding is considered the default and formula is considered a last resort, such as Norway, breast-feeding rates are very high (around 99% of women breast feed in the first week) and many out of the remaining 20% receive donor milk. As long as formula is considered a good alternative, governments, employers, and hospitals will have an excuse not to provide support.
"This whole gluten intolerance thing is just a Western upper middle class fad. People are just orthorexic. Why would gluten intolerance increase all the sudden?"
Well, actually it's not a Western upper middle class fad. People in poor countries can be celiac, but they just die and people think it's from something else. When you are a refugee wasting away from chronic diarrhea, that's not so abnormal unfortunately. When you are in Central Illinois and suffering from the same, it is abnormal and you see a doctor and hopefully get a diagnosis.
Why is gluten-intolerance increasing? Doctors are more aware than ever of this condition and are doing more tests. More tests = more diagnosis. Symptoms that were dismissed as "IBS" or one of many other made-up symptom cluster illnesses are being re-diagnosed as gluten intolerance.
So what's the population with the highest level of celiac disease? Preschoolers on the Upper East Side? Nope, the Saharawi, an Arab-Berber refugee population. And maybe they aren't the highest since they were just unlucky enough to be refugees served by doctors interested in celiac research. Testing found that 5.6% of them have celiac. Unfortunately processed wheat flour is their staple food (I wonder when that started?). Before celiac was diagnosed, people thought their children were merely dying from a malnourishing diet or GI illness. Researchers are now finding celiac hotspots across the Middle East, India, and Africa.
This is interesting because so much government food aid contains gluten. How many of the children you see on those "save the children" campaign ads are really suffering from celiac like this child?? How many such starving children will be given gluten-containing food aid and will die as a result?
Another major question is why celiac disease incidence is so high in the region that gave birth to agriculture? The theory that CD was higher in populations that have adopted agriculture more recently like the Irish or the Finnish has not survived now that other populations have been examined more closely. The Finnish and Irish have high levels of CD because they have high DIAGNOSIS levels. Finnish children are tested at birth.
A few interesting things:
Really great conversation between John Hawks and Kathryn Clancy, both physical anthropologists. Apparently Clancy is gluten intolerant. She also studies fertility. I suggest reading her blog. Also tantalizing is that Hawks has a grad student studying autoimmune differences between farmers and foragers.
Some great posts by Dr. Clancy:
- Iron-deficiency is not something you get just for being a lady: EXACTLY why doctors need to start reading about evolutionary medicine. Almost all doctors seem to think that iron-deficiency is part of being a woman, but that doesn't make sense evolutionarily. Turns out, it's no normal and doctors who think it is often miss the true cause, which is internal bleeding.
When I was a freshman college I had iron issues. Just like in the post my doctor gave me iron pills, which absolutely destroyed my stomach. Finally a better doctor found out I had a GI bleed. Now why do so many people get GI bleeds? In my case it was from taking NSAIDs, which is a fairly common cause.
Great new post at Evolutionary Psychiatry about ADHD and diet. I need to post about "food allergy tests" some time, since I get so many questions about them. The unfortunate thing is that most are very inaccurate. Unethical doctors (usually naturopaths, which doesn't help their reputation) market them as accurate and I've gotten emails from people saying they are allergic to absurd combinations of food like kangaroo, banana, and cinaamon buns (just kidding). This causes people to avoid perfectly good foods. Dr. Deans mentions these tests in her post
There were a couple of interesting wrinkles. The kids were all tested for IgG antibodies to food, supposedly helping one sort out food intolerances. These tests are widely used by doctors and para-professionals alike to diagnose food allergies, but when you get down to it, there is not a lot of evidence these tests tell you much about what you might actually be allergic to. IgG antibodies simply mean that somewhere along the way your bloodstream was exposed to food allergens. To be honest, I think people with tons of positive IgG food allergies have leaky guts, that wheat and poor gut biome are reasonably likely culprits, and the foods that show up in the IgG test are a random sampling of what happened to make it through the leaky gut. In the INCA study, the kids were carefully rechallenged with their IgG + foods, and their symptoms of ADHD seemed to have nothing to do with the IgG test. So I'm right ;-) (maybe).
Facinating post on using infant closeness as an incubator. The fact that this had to be re-thought of speaks to the medical profession's disconnection with our evolutionary heritage. In foragers, a baby away from a female relative's body is a dead baby.
Reminds me of something I've been musing on for awhile. Evolutionary applications to modern social life sometime seem like they were invented by bros. Lots of papers on how promiscuous humans are, men are different from women, why men like attractive women blah blah blah. But what about the stuff that doesn't jive so easily with modern life? Like the importance of breastfeeding, the fact that optimal fertility occurs when a woman is relatively young, that that non-relatives don't do as good as job taking care of children as kin do? These are not ideas people want to accept because they are so against modern cultural norms.
I am excited to welcome our first ever guest blogger. Sarah Davies is a member of Eating Paleo in NYC and is a testament to the diverse appeal of our group. We have everyone from Crossfitters building muscle to celiacs interested in healthy healing grain-free eating. Sarah is an example of the latter. Last week she helped me teach the first NYC Paleo Skillshare making some delicious roasted vegetables, soup, salad, and mandarin chicken! She talked about how her cooking methods allow her to get through the week without stressing about food. That's very appealing to me, because as long as I've been doing this, I admittedly don't plan as much as I should. I often come home from work and realize that salmon filet that I was planning to eat was eaten three weeks ago and all my vegetables are spoiled! Inspired by Sarah, I'm planning to well...plan more! Hopefully you will be too!