Gluten, not fat, makes you fat!

A place to get your questions answered from McDougall staff dietitian, Jeff Novick, MS, RDN.

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Re: Gluten, not fat, makes you fat!

Postby JeffN » Sat Nov 12, 2016 6:24 am

Very interesting perspective on the wheat/gluten issue

In Health
Jeff

Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. The Journal of Experimental Medicine, 209(13), 2395–2408. http://doi.org/10.1084/jem.20102660

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526354/

Abstract
Ingestion of wheat, barley, or rye triggers small intestinal inflammation in patients with celiac disease. Specifically, the storage proteins of these cereals (gluten) elicit an adaptive Th1-mediated immune response in individuals carrying HLA-DQ2 or HLA-DQ8 as major genetic predisposition. This well-defined role of adaptive immunity contrasts with an ill-defined component of innate immunity in celiac disease. We identify the α-amylase/trypsin inhibitors (ATIs) CM3 and 0.19, pest resistance molecules in wheat, as strong activators of innate immune responses in monocytes, macrophages, and dendritic cells. ATIs engage the TLR4–MD2–CD14 complex and lead to up-regulation of maturation markers and elicit release of proinflammatory cytokines in cells from celiac and nonceliac patients and in celiac patients’ biopsies. Mice deficient in TLR4 or TLR4 signaling are protected from intestinal and systemic immune responses upon oral challenge with ATIs. These findings define cereal ATIs as novel contributors to celiac disease. Moreover, ATIs may fuel inflammation and immune reactions in other intestinal and nonintestinal immune disorders.


and from in the discussion:

"Importantly, ATIs are the primary resistance molecules of cereals to fend off pests and parasites such as the meal bug (Ryan, 1990; Cordain, 1999), and more recent breeding of high yielding and highly pest-resistant wheat (Ryan, 1990; Cordain, 1999; Sands et al., 2009) has led to a drastic increase of ATI content (Ryan, 1990). Our finding of ATI as a potent stimulator of TLR4 in the intestine might not only be relevant to celiac disease, but is likely to have implications for patients with so-called gluten sensitivity and possibly for patients with irritable bowel syndrome, inflammatory bowel disease, and even nonintestinal inflammation. Patients with gluten sensitivity do not have celiac disease, but their symptoms improve on a gluten-free (i.e., cereal and therefore ATI free) diet, and several case reports documented that other intestinal inflammatory conditions improved on a gluten-free diet (Verdu et al., 2009; Biesiekierski et al., 2011). Moreover, members of the ATI family have been previously characterized as allergens in baker’s asthma and gastrointestinal hypersensitivity to wheat (Tatham and Shewry, 2008). It is therefore tempting to speculate that their ability to stimulate TLR4 contributes to their allergenicity, as has been shown recently for the main house dust mite allergen Der p2 (Trompette et al., 2009). In conclusion, we identify ATIs, nutritional proteins from wheat and related cereals, as activators of TLR4 and inducers of innate immune responses in vitro and in vivo, with broad implications not only for the onset and course of celiac disease, but also for other intestinal and possibly nonintestinal inflammatory diseases."




Gluten may not be the culprit when it comes to wheat sensitivities
This article originally appeared on Medical Daily.

http://www.newsweek.com/sensitive-wheat ... ame-515503


Gluten may not be the culprit when it comes to wheat sensitivities, according to a new body of research presented at the United European Gastroenterology Week 2016. Instead, a team of scientists from Johannes Gutenberg University in Germany discovered a different protein in wheat known as amylase-trypsin inhibitors (ATIs), which may be what triggers stomach-sickening inflammation and other symptoms.

For the study, the team stopped focusing on gluten—a protein found in wheat, barley and rye —and shifted their attention to ATIs because it appears to cause inflammation and worsen other chronic health conditions. Although ATIs only make up 4 percent of proteins found in wheat, they are responsible for a lot of damage throughout the body. Not only is the stomach at risk for dangerous i

ATIs may also contribute to the development of non-celiac gluten sensitivity. Those who do not have celiac disease, which is a serious autoimmune disease that causes damage to the intestines, can still be negatively affected by gluten-containg foods, such as pastas, breads and baked goods. According to the Celiac Disease Foundation, one out of every 100 people suffer from celiac disease, but it is unclear how many suffer from general wheat sensitivity.

“We believe that ATIs can promote inflammation of other immune-related chronic conditions outside of the bowel,” said the findings’ presenter Dr. Detlef Schuppan, who is a professor at both Johannes Gutenberg University and Harvard Medical School, in a press release. “The type of gut inflammation seen in non-celiac gluten sensitivity differs from that caused by celiac disease, and we do not believe that this is triggered by gluten proteins. Instead, we demonstrated that ATIs activate specific types of immune cells in the gut, thereby worsening the symptoms of pre-existing inflammatory illnesses.”

Schuppan and his team’s research has shown that following an ATI-free diet, by reducing ATI-containing wheat products by 90 percent, should be enough to lessen symptoms. More research is needed before a regimen with medically backed recommendations can be given out to patients, but until then, all research is pointing to one conclusion—chronic diseases are worsened by ingestion of wheat ATIs.

Schuppan said, “We are hoping that this research can lead us toward being able to recommend an ATI-free diet to help treat a variety of potentially serious immunological disorders.”
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Re: Gluten, not fat, makes you fat!

Postby JeffN » Thu Dec 15, 2016 8:35 am

Article Abstract

Journal of Pediatric Gastroenterology and Nutrition
Published online ahead of print, DOI : 10.1097/MPG.0000000000001460
“Value of IgA tTG in Predicting Mucosal Recovery in Children with Celiac Disease on a Gluten Free Diet.”
Authors: M. Leonard, D. Weir, M. DeGroote, P. Mitchell, P. Singh, J. Silvester, A. Leichtner, A. Fasano

http://journals.lww.com/jpgn/pages/arti ... e=abstract

Abstract
Objective: Our objective was to determine the rate of mucosal recovery in pediatric patients with celiac disease on a gluten free diet. We also sought to determine whether IgA tissue transglutaminase (tTG) correlates with mucosal damage at the time of a repeat endoscopy with duodenal biopsy in these patients.

Methods: We performed a retrospective chart review of one-hundred and three pediatric patients, under 21 years of age, with a diagnosis of celiac disease defined as Marsh 3 histology, and who underwent a repeat endoscopy with duodenal biopsy at least twelve months after initiating a gluten free diet.

Results: We found that 19% of pediatric patients treated with a gluten free diet had persistent enteropathy. At the time of the repeat biopsy, tTG was elevated in 43% of cases with persistent enteropathy and 32% of cases in which there was mucosal recovery. Overall the positive predictive value of the autoantibody tissue transglutaminase was 25% and the negative predictive value was 83% in patients on a gluten free diet for a median of 2.4 years.

Conclusions: Nearly one in five children with celiac disease in our population had persistent enteropathy despite maintaining a gluten free diet and IgA tTG was not an accurate marker of mucosal recovery. Neither the presence of symptoms nor positive serology were predictive of a patient's histology at the time of repeat biopsy. These findings suggest a revisitation of monitoring and management criteria of celiac disease in childhood.



Mass Media Article

Gluten-free diet may not promote good intestinal health: Study
By Will Chu, 14-Dec-2016

Market analysts Mintel have found that 82% of US consumers who eat gluten-free foods, or used to eat them, have not been diagnosed.

Nearly one in five children with coeliac disease showed signs of continual intestinal damage, even with a strict regimen to a gluten-free diet.

http://www.foodnavigator-usa.com/R-D/Gl ... alth-Study

The findings were based on an analysis of 103 children with coeliac disease who had followed a gluten-free diet for at least a year. Repeat biopsies found persistent intestinal damage in 19% of them.

“The number of children who don't heal on the gluten-free diet was much higher than what I expected," said Dr Alessio Fasano, director of the MGHfC centre and co-senior author of the study.

“We assumed that healing would occur once a patient was put on the gluten-free diet. Now that we have learned that this is not the case for all coeliac patients.”

Similar results have been observed in adults and place both groups at an increased risk of lymphoma, low bone density and fracture.

The research team also commented that the malabsorption and inflammation in children may have negative repercussions on physical and cognitive development.

Researchers from the Mass General Hospital for Children (MGHfC) and Boston Children's Hospital (BCH) reviewed medical histories of these children, who had an average age of 10.6 years at the time of diagnosis.

The children, 60% of which were girls, also underwent a repeat endoscopy with duodenal biopsy at least 12 months after starting a gluten-free diet.

Gluten-free popularity

In 2014, a research team from the University of Nottingham found a fourfold increase in the diagnosis of coeliac disease in the UK since the 1990s.

While a gut biopsy is the only definitive way to test for coeliac disease, consumers often choose to self-diagnose, eliminating wheat products for a period of time to see if their health improves.

Food makers have responded with products free of gluten becoming a staple on supermarket shelves.

The gluten-free baby food market in particular is booming as a result of this precautionary approach.
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Re: Gluten, not fat, makes you fat!

Postby JeffN » Sat Feb 17, 2018 5:13 pm

Medscape Gastroenterology
COMMENTARY

Gluten-Free Diets: Healthy or Potentially Toxic?
David A. Johnson, MD
February 06, 2018
https://www.medscape.com/viewarticle/891920


"They looked at serologic testing and blood level testing of heavy metals. Patients following the gluten-free diet had significantly higher levels of cadmium, mercury, and, in particular, lead, which are all particularly related to heavy metal toxicity. These levels were not in the toxic range, though they were clearly different from the non–gluten-free-diet patients. They then assessed a randomly selected group (3901 not following a gluten-free diet and 32 who were) for urinary arsenic levels, which again were significantly higher. These were in the toxic range for patients following a gluten-free diet. Remember, arsenic goes back thousands of years as a component of traditional Chinese treatments and other types of medicines, but it is also well recognized as a poison. Arsenic level accumulation and heavy metal accumulation are potentially sequential."
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Re: Gluten, not fat, makes you fat!

Postby JeffN » Sat Oct 20, 2018 10:09 am

One-third of ‘gluten-free’ restaurant food contains gluten

Using crowd-sourced data from users of Nima (Nima Labs), a portable gluten detection device

Of 4,732 tested items with a gluten-free label, 32.2% contained gluten, slightly higher than the percentage of all tested foods that contained gluten (32%). Compared with other foods, gluten-free labeled pasta and pizza were the most likely kinds of foods to be contaminated with 53.2% (OR = 2.5; 95% CI, 2–3.2) and 50.8% (OR = 2.1; 95% CI, 1.5–3.1) of tests detecting gluten, respectively.

Researchers found that gluten was most likely to be detected during dinner (34%) compared with a low during breakfast (27.2%). Gluten-free labeled food from restaurants in the western region of the United States were less likely to contain gluten than foods from restaurants in the northeast (OR = 0.8; 95% CI, 0.67–0.95).

Lerner BA, et al. Abstract 8. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

https://www.healio.com/gastroenterology ... ins-gluten
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Re: Gluten, not fat, makes you fat!

Postby JeffN » Thu Jun 06, 2019 3:24 pm

A Population Survey of Dietary Attitudes towards Gluten
Nutrients 2019, 11(6), 1276; https://doi.org/10.3390/nu11061276

https://www.mdpi.com/2072-6643/11/6/1276/htm

Abstract: It is unclear how the prevalence of people who believe the gluten-free diet (GFD) to be generally healthy (“Lifestylers”) is impacting the overall rates of self-reported gluten sensitivity (GS). We repeated a population survey from 2012 in order to examine how attitudes towards GS have changed over time. Our survey (N = 1004) was administered in Sheffield (UK) in 2015, replicating the 2012 experiment. The questionnaire included a food frequency survey and assessed self-reported GS as well as associated variables (prevalence, current diet, pre-existing conditions, etc.). The overall rates of key variables and chi-squared analysis in comparison to the previous survey were as follows: self-reported GS was 32.8% (previously 12.9%, p < 0.001), pre-existing coeliac disease (CD) was 1.2% (previously 0.8%, p = 0.370), following a GFD was 3.7% (previously 3.7%, p = 0.997). Self-reported GS was positively associated with some pre-existing conditions, including anxiety, depression, chronic fatigue, headaches, and other food allergies/intolerances (including irritable bowel syndrome (IBS); chi-squared analyses, all p < 0.001). Over a 3-year period, the fraction of people who self-reported GS increased by over 250%. Despite this, arguably more meaningful indications of underlying physiological GS remained comparable. This research suggests that the public perception of gluten is causing a marked increase in the number of people who erroneously believe they are sensitive to it.
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Re: Gluten, not fat, makes you fat!

Postby JeffN » Thu Sep 03, 2020 10:58 am

Detection of Gluten in Gluten-Free Labeled Restaurant Food: Analysis of Crowd-Sourced Data
Am J Gastroenterol 2019 May;114(5):792-797.
doi: 10.14309/ajg.0000000000000202.

Abstract

Introduction: Adherence to a gluten-free (GF) diet is the mainstay of therapy for celiac disease. Until now, those wishing to avoid gluten in restaurants had to rely on menu labels, word of mouth, intuition, and restaurant workers' advice, with a relative dearth of supporting data. We used crowd-sourced data from users of a portable gluten detection device to estimate rates of, and identify risk factors for, gluten contamination of supposed GF restaurant foods.

Methods: We analyzed data from a portable gluten detection device (Nima), collected across the United States during an 18-month period by users who opted to share the results of their point-of-care tests. Data were sorted by region, time of day, median household income in the restaurant's vicinity, restaurant genre, and food items. We used the χ test for bivariate analysis and multiple logistic regression for multivariate analysis to identify predictors of gluten detection in restaurant food.

Results: There were 5,624 tests, performed by 804 users, in the examined period. Gluten was detected in 32% of GF labeled foods. Rates of gluten detection differed by meal, with 27.2% at breakfast and 34.0% at dinner (P = 0.0008). GF labeled pizza and pasta were most likely to test positive for gluten, with gluten detected in 53.2% of pizza and 50.8% of pasta samples. On multivariate analysis, GF labeled food was less likely to test positive for gluten in the West than in the Northeast United States (odds ratio 0.80; 95% confidence interval 0.67-0.95).

Conclusions: This study of crowd-sourced data suggests that a substantial fraction of GF labeled restaurant foods contain detectable gluten. Although the highly sensitive Nima device may detect gluten at levels <20 parts per million (ppm), leading to gluten exposure of unknown clinical significance, our findings raise a potential concern. In addition, our findings of higher rates of gluten detection in pizza and pasta provide practical data when providing dining strategies for patients with celiac disease.



Open Article

Gluten-free menu items often not so gluten-free
https://examine.com/nerd/article/gluten ... uten-free/

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