Sunday, 5 January 2020

Should folks with cancer avoid gluten?

Jo Lawrance cartoon
I’ve tried to avoid gluten since my diagnosis but keep hearing contradictory statements and views. It is time to try and unpick what is going on...What we do know, is that there is a link between gluten  and  inflammation; in someone sensitive or intolerant to gluten then eating it will cause an inflammatory response as the immune system attempts to fight it off. We also know that cancer thrives in an environment which is inflamed (i). However it is more complicated than that - I will start to look at  it in this blog. 

Gluten is a Latin word that means “glue,” and gluten is a group of proteins that hold together certain grains including wheat, barley and rye….celiac disease is an autoimmune disorder in which your immune system responds abnormally to gluten. Whereas non-celiac gluten sensitivity (NCGS) is a gluten-related condition that causes symptoms in people who don’t have celiac disease and are not allergic to wheat. The language of food allergy, food sensitivity or food intolerance is confusing. The Alliance for Natural Health (ii) shows how food allergies and sensitivities are immune mediated reactions to food and how they differ. There is not room to include the science in this blog but do check out the link to see how gluten impacts.

It has been estimated that one percent of the population has celiac disease and that this number is increasing. One study showed that between 1990 and 2011 the number of cases diagnosed went up four-fold; this is quite possibly due to better detection, more awareness or possibly eating more gluten products. The study worryingly also showed that only 0.25% of cases are actually diagnosed ie a shocking half a million people in the UK are missed (iii). Interestingly in both the Indian sub-continent and China, where diets are becoming more westernised, they are developing coeliac disease. 

Getting to love buckwheat in lots of ways
And what about NCGS? 

For years the scientific community, while clearly acknowledging celiac’s disease, did not accepted that gluten sensitivity or intolerance is a thing. The medical profession does have a bit of a history of dismissing diseases as being “just in the head”, take for example migraines, Parkinsons disease, multiple sclerosis, Lymes disease, post traumatic stress disorder and more. In contrast the internet is also full of unsubstantiated claims that gluten is the cause of many illnesses. Two controversial best-selling books have been key in fanning the debate and arguments about why gluten needs to be avoided; in 'Grain Brain’ by David Perlmutter, he calls gluten “this generation’s tobacco” while in ‘Wheat Belly' by William Davis he argues wheat has killed more people than all wars combined and is responsible for many health challenges including certain cancers, diabetes, obesity, Crohn’s disease and autoimmune disease (iv).

Evidence that gluten can have an impact on health is slowly growing. One small double-bind study in 2011 showed that gluten sensitivity is likely to exist; the study was hugely complicated by a large number of the participants believing themselves to be affected by gluten (ie the nocebo effect where they were negatively impacted when they thought they were eating gluten but weren't) (v). A 2012 Italian study also did a double-bind study and again found the nocebo effect, but in this case found evidence of non-celiac wheat sensitivity. This isn’t gluten; indeed the relevance of gluten to people's apparent intolerance to wheat remains an open question that deserves more research.

Another controversial figure to some, Dr. Alessio Fasano, who founded the Center for Celiac Research at the University of Maryland School of Medicine, indicates that between 5% and 10% of all people may suffer from a gluten sensitivity of some form. This was the guy that back in 2000 with his team discovered a protein they named zonulin. This regulates the opening of gateways in the gut wall so that what should stay in the gut stays there and what should go into the body goes into it. His work suggests that if you have a sensitivity and eat gluten regularly, perhaps 6 times each day, then this will cause a leaky gut and impact on your immune system. 

The Alliance for Natural Health say that then "Our gut is unable to breakdown gluten-containing grains fully, leaving behind another protein component, gliadin. This activates zonulin, which opens the doors in our gut (tight junctions), and stimulates our immune system to produce antigliadin antibodies leading to inflammation that then spreads through our body in the form of autoimmune illness. Research has found the autoimmune response is damped down if you take gluten out of the diet (vi)."

Some doctors like Amy Myers have described this as people 'fanning the flames of their inflammation without even knowing it’ (vii). She also agrees with Dr. Fasano’s research that a leaky gut is a precondition for developing an autoimmune disease. And, once you have an autoimmune disease, leaving the leaky gut untreated can cause your health and condition to get worse. Basically, the toxins, microbes, and bits of food particles including gluten get into the bloodstream where they shouldn’t be; this leads to your immune system seeing them as dangerous invaders and creates the inflammation to help remove them. See a video that explains this in some details here (viii).

We know that cancer thrives in an inflamed environment, but research on the connection between gluten and a risk of cancers is largely inconclusive with some studies seeming to contradict each other. However, there does seem to be evidence that a very small number of cancers are linked with gluten but only increases risk slightly if a person has celiac disease, or gluten intolerance (ix). The wider picture is confusing partly because cancer is often lumped into one outcome when there are many different types of cancer; indeed a Finnish study showed celiac disease increased the risk of non-Hodgkin lymphoma and small intestinal cancer but decreased the risk of another cancer. More research is needed.  

There are also others who come up with different reasons for avoiding gluten if you have cancer. For example Bill Henderson in ‘How to Cure Almost Any Cancer at Home for $5.15 a Day’ (2012) writes that "the main problem with gluten is its high glycemic index. That means it turns to glucose rapidly. If you want to feed your cancer cells, eat gluten. Otherwise, avoid it.” This seems to link to the idea of reducing carbohydrates generally but doesn’t seem to acknowledge that many gluten-free alternatives also have higher GI levels (x). Certainly there is evidence to show that cutting carbs would be good for those with some cancers; that is a whole different blog.

However many still don’t see NCGS as such a significant issue. For example a  2015 review of work in this area concluded "NCGS should be regarded as an independent disease outside of coeliac disease and wheat allergy, and that the number of patients affected is likely to be limited. Many questions remain unanswered and it needs to be verified whether the elimination of dietary gluten alone is sufficient for the control of symptoms, and to understand the overlap with other components of wheat” (xi).

Gluten-free dangers

Michael Gregor in his great short film (xii) and excellent book, “How Not To Die”, notes that there is "some evidence suggesting that a gluten-free diet may adversely affect gut health in people without celiac disease, wheat sensitivity, or wheat allergy”. A study showed that the very components wheat-sensitive people have problems with, like FODMAP (fermentable, oligo-, di-, monosaccharides and polyols) fructans, act as prebiotics and feed your gut with good bacteria. Furthermore the gluten itself may actually boost immune functions by increasing natural killer cell activity. This is confusing as low FODMAP consumption is recommended with Irritable Bowel Syndrome (IBS)(xiii). It is, of course, possible to get FODMAPs in your diet without wheat/gluten.

Another danger of gluten free diets are that they undermine our ability to diagnose celiac disease. Doctors diagnose celiacs by looking for inflammation but if folk have already stopped gluten they might miss the disease. Indeed if someone thinks they have a gluten intolerance, say because of irritable bowel symptoms, then the advice is not to go off gluten but to go to the doctor as you will need to be tested before coming off gluten.

It is also worth noting that this is all big business. I am wary if folk are making lots of money or there is an interest in pushing something. UK sales of gluten-free products are rocketing. In 2015 alone in the US nearly a quarter of all products launched had gluten-free claims. Furthermore there are considerable price hikes on gluten-free products. More worryingly two studies a couple of years ago, found that many people who had been diagnosed and were on a gluten free diet still had symptoms. It was found that the amount of gluten consumed on a supposedly gluten-free diet was significant. The study writes that this goes "a long way toward explaining the decades of reports showing that somewhere between 30% and 50% of patients with celiac disease and on a gluten-free diet still have damaged intestines that have not fully recovered” (xiia). This was shocking to hear that so many so called gluten-free products are not gluten free; I don’t see our standards agency checking to see if the products are as described. I think there needs to be louder calls for more effort to avoid cross-contamination and to educate food makers and handlers about gluten.

Love these pies!
Another aspect of gluten-free foods is that many of them have long lists of ingredients, can be high in fat and sugar and have loads of other additives, including starches and binding agents. Beware! Some of them are also quite frankly inedible!

Dead bread

White bread is dead. Well at least in terms of nutrition for alot of the bread sold in supermarkets. When whole wheat is refined to turn it into white flour it is effectively stripped of 25 naturally occurring nutrients and then has other nutrients, additives and preservatives to extend shelf life and fluff it up. It is also not great as white flour converts to sugar in our blood but does it differently to whole food carbohydrates in that it lacks the great antioxidants and phytonutrients. This effectively means that white flour is 'empty calories'. As Chris Wark in his book 'Chris Beat Cancer' writes, “a diet rich in empty calories will eventually make you fat and sick.”

How did we get to this point? In the 1960s there was an ever-increasing development of high-yielding varieties of wheat. We saw widespread use of artificial fertilisers, pesticides and fungicides. Andrew Whitley, author of Bread Matters and co-founder of the Real Bread campaign (ivx), says: "That changed  the nature of the grain and only in the last 10 or 15 years has it become clear that some of the protein structure – and gluten is a combination of wheat proteins – has changed. Essentially there are bits of protein that have appeared because of the intensive breeding of grains for yield.” This has given rise to many, like author William Davis, mentioned above, claiming that modern wheat is a “Frankengrain” or ”Frankenwheat” because it contains a super starch and super gluten which is much more likely to create inflammation in the body. Again this has been challenged by many other doctors and some studies(vx), but, whether or not this is key, the wheat we eat now is different.

Another big issue is industrialised breadmaking. As my bread making friend said, for much of humankind history we have been making bread similar to sourdough. Then in 1961 along comes the cheaper, quicker 'Chorleywood process’; high-speed machinery plus additives such as extra yeast, hard fats and enzymes. Some 80% of our bread is made like this without the fermentation process - and even where the fermentation process is still being used say in some supermarkets it is often much shorter than in the past - Whitley has labelled those breads ‘pseudough’ (xvi). The fermentation process digests some of the proteins but now we have them in the bread. Whitley comments "My contention is that is also contributing to an excess of undigested gluten in the diet. Bread is not the only source of gluten, but it is the predominant way in which we consume it.”

I’ve already mentioned concerns about what gets added to our food. In terms of bread, the wonderful food journalist Joanna Blythman has noted that for the past 20 to 30 years, industrial bakeries have added extra gluten to their products, known as ‘vital gluten’ in the trade, but often labeled innocuously as ‘wheat protein.’ This means that people today consume more gluten than ever. In her book ’Shopped’ (2004) she noted that the Federation of Bakers say: “Advances in enzyme technology allow bread to stay fresher for longer…In the UK this has resulted in the shelf life of sliced bread and wrapped bread, which normally stays fresh for only 2-3 days, doubling to one week.” Amazingly these enzymes do not need to be declared on the label because they are conveniently classed as processing aids and not ingredients.

In Joanna Blythman's recent book, 'Swallow This’ (2015) she uncovers much more about the food industry - I thought I knew lots but this was a revelation and I highly recommend it! Among the stories are vitamin E tablets made from petrol, cooking oil extracted with a toxic solvent and fruit salads bathed in acids. I’m not sure we need to wait for chlorinated chicken to come from the States, we seem to already have many shocking and very widespread food practices. But hey, I digress a little, in terms of bread, Blythman notes it has one of the highest levels of phthalates in it - this is so not good for health! A UK study published in 2012 found that 31% of food products sampled were non-compliant with EU regulations (xvii). We really would all be better off with the fewer processed foods the better!

Role of glysophate?

Conventionally grown wheat is sprayed with glysophate to control weed, but is also used a week or so before harvest; by exposing wheat to glyphosate it kills off the wheat so that there is less to clear after harvest and it releases more seed as it dies and farmers get higher yields. We know from studies that glysophate-based herbicides are endocrine disrupters in trace amounts. The WHO International Research on Cancer classifies it as ‘probably carcinogenic to humans.’ Chris Wark notes that in a 2013 article in ‘Interdisciplinary Toxicology’ gluten intolerance, celiac disease and IBS had risen in direct proportion to the increase in spraying of glysophate on grains. 

The authors of that article, Dr. Anthony Samsel and Dr. Stephanie Seneff, suggest that “gut dysbiosis, brought on by exposure to glyphosate, plays a crucial role in the development of celiac disease. Many CYP enzymes are impaired in association with celiac disease, and we show that glyphosate’s known suppression of CYP enzyme activity in plants and animals plausibly explains this effect in humans (xviii).” Again all this is contested by other scientists.

Oats; should we avoid them as well?

A quick mention of oats, as a very experienced local bodyworker has suggested that it is best to avoid oats as well as gluten. It seems that people who are sensitive to gluten may also react negatively to oats. There is no consensus on whether or not oats should be part of a gluten-free diet, and I read that some suggest that as many as 1 in 10 American celiacs have negative reactions even to oats that are labeled gluten-free. Others say it is much more rare.

Oats do not contain gluten but are often grown and processed alongside wheat, rye, and other stuff that does contain gluten. Oat allergies can be life-threatening, so need to be taken seriously. Where it does occur, an immune system reaction is caused to avenin, a protein found in oats. Apparently this avenin is not the same in all oat cultivars; some kinds of oats cause no sensitivity, whereas others trigger an autoimmune response according to a University of Seville study published in 2011 by "GUT, An International Journal of Gastroenterology and Hepatology (xix).” That study is welcomed, as it showed the avenin in at least three varieties of oats received little negative immune response. Even the three most troublesome oat varieties, which presented the strongest evidence of immune-system problems, attracted an attack of antibodies 40 to 400 times less powerful than that of wheat gliadin.

Oats (labelled gluten-free where possible) are part of my diet, despite the warnings; they are wonderfully healthy on many other levels. And while they may well act like gluten on the gut it would appear that those impacts are much less than gluten.

Where does this leave us?

A 2016 study reported in Nature estimates that as many as 70 to 90% of cancers are caused by diet, lifestyle and environmental factors. So the food we eat is pretty important!  But I think this blog has not added much light to the discussion! I am still confused. It seems some see the culprit as being gluten while others suggest it could be other wheat proteins, FODMAPs, yeast or pesticides. The list of foods that cause a reaction in some people is growing. Interestingly there are 8 legally recognised food allergens in the US but in the UK and EU, there are 14 (xx).  Some see gluten as a big, big problem, others think it has all been blown out of proportion. More studies are needed especially as existing research into gluten and wheat has been impacted by both placebo and nocebo effects.

Benjamin Lebwohl, a gastroenterologist with the Celiac Disease Center at Columbia University notes an important difference between saying that there’s no proof that gluten has health effects in the general population and saying that there is proof that gluten has no health effects in the general population (xxi). Clearly the distinction is huge.

In the end it comes down to each of us weighing up the arguments and taking a view. Clearly if you have symptoms like diarrhoea, stomach pains and lethargy then seeking medical advice is critical. The Coeliac UK website gives great info on symptoms and what to do; critically don’t stop eating gluten before being tested (xxii). Michael Gregor points out that many feel better on a gluten-free diet as they stop eating so many processed foods; if you eat a deep fried Mars bar and your stomach hurts then it may not be gluten. Of course if you are diagnosed with celiacs, then follow the diet but if not and you still have symptoms then looking to a healthier diet makes sense. There are quite a number of reasons for symptoms which need ruling out before a gluten free diet is considered.

Of course there are some of us, me included, that don’t have symptoms listed for NCGS - or at least I don’t have symptoms unless I eat a lot of gluten products - and it may not even be the gluten that causes some mild discomfort in those cases. In previous kinesiology tests it showed I did have some gluten insensitivity. I won’t go into kinesiology here or for that matter all the other allergy/sensitivity tests available; that is more than a minefield of what much of the medical establishment would call hocus pocus. Perhaps another blog?

I see the science is still very much up in the air around some aspects of gluten, but I do respect some of those folk who take a more, what I see as a precautionary principle (ie a strategy to cope with possible risks where scientific understanding is yet incomplete). Rob Verkerk, who spoke at Trew Fields last year, is one of those people; he founded the Alliance for Natural Health in 2002, which he has headed since. The ANH devised Food4Health guidelines by looking not only at the most relevant published science, but also at clinical experience, which led them to take the unprecedented step of offering a plate-based guideline back in January 2015 that was 100% gluten free (xxiii).

The Alliance for Natural Health’s advice (xxiv) is that "Daily consumption of wheat and wheat products, as well as other cereal grains is not advised as its contribution to chronic inflammation and autoimmune disease manifestation is both well documented and common. Even more importantly, most people have little idea as to where they sit in terms of their overall risk to gluten especially given that some effects, including serious ones, may not manifest clinically for years (e.g. silent coeliac disease).” They also recommend Dr Fasano's book 'Gluten Freedom’ (2014).

Having said that, while I am persuaded to avoid gluten, if there is only a choice between supermarket gluten-free bread and long fermented sourdough, then I will go for the latter. I do recognise that some nutitionists argue that even a slight bit of gluten can cause inflammation and should be avoided completely. I also note that exploring replacements for the grains I used to eat before my diagnosis two and a half years ago, has been a wonderful adventure. Maybe this approach will help me maximise wellbeing? It seems more than worth the risk!

Research so far in Stroud has revealed my top places for bread and cakes

Pecan Pie by Jack Bakes
Best gluten free breads in Stroud

Amazing bread at this cafe - so good we also make it at home:
Artisan baker in the Farmers Market, using psyllium husks:
Hobbs is pricey and has oats but is consistently good:

Best gluten free cakes in Stroud (that are also refined sugar free)

Plus Stroud Farmers Market stalls:

Lastly there was a gluten-free group that met in Nailsworth last year that I think is still going (contact via the Natural HealthClinic) plus a very inactive gluten free Stroud Facebook group:

As always your thoughts, corrections and additions wlecomed!


1 comment:

  1. Chris Woollams from Canceractive about how gluten makes things worse:


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