Tag: diabetes

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For several years now, gluten has been the subject of much debate, discussion, and disagreement.

Grocery stores and restaurants now offer a plethora of gluten-free products and meals.

You might have friends or family members who avoid gluten. Perhaps you follow a gluten-free diet, or have been paying closer attention to food labels and avoid it most of the time.

Maybe you aren’t even exactly sure what the heck gluten IS and are wondering why so many people avoid it like the plague.

So what is this all about, anyway?

Is “gluten-free” just another trendy health movement, or is there something to this way of eating?

Let’s start with the basics.

What IS gluten?

Gluten is a complex two-part protein found in grains such as wheat, rye, barley, and spelt. The two different proteins that comprise gluten are called glutelin and gliadin. Bread, cereals, and baked goods are obvious sources of gluten (unless they are labeled gluten-free), but they aren’t the only foods that contain the protein – it can be found in many items, even those you wouldn’t expect.

There ARE people who absolutely should avoid gluten entirely.

Let’s discuss the health conditions that make the consumption of gluten dangerous.

Celiac disease

People who have celiac disease, a chronic autoimmune/inflammatory disorder, must avoid the consumption of gluten. Celiac disease originates in the gut but affects the entire body when untreated. In people with celiac disease, the villi of the small intestine are damaged when gluten is consumed. When a person with celiac disease continues to eat gluten, serious health problems can develop.

Symptoms of celiac disease include (but are not limited to) abdominal pain, diarrhea, constipation, bloating, weight loss, fatigue, anemia, arthritis, and headaches. There are over 300 symptoms that are known to be caused by celiac disease…but some people with the condition have no symptoms at all.

But discomfort and pain aren’t the only problems celiac disease causes: the immune response that attacks the small intestine leads to damage to the villi, which are small finger-like projections that line the small intestine. The villi promote nutrient absorption, and when they become damaged, nutrients cannot be absorbed properly into the body. Undiagnosed or neglected celiac disease can lead to serious health problems, including osteoporosis, anemia, vitamin and mineral deficiencies, nervous system disorders, depression, dermatitis herpetiformis (blistering, intensely itchy skin), pancreatic insufficiency, intestinal lymphomas, GI cancers, and other autoimmune disorders.

There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA (Immunoglobulin A) test. If test results suggest celiac disease, the next step is usually a biopsy of the small intestine to confirm the diagnosis.

Currently, the only way to treat celiac disease is by strict adherence to a gluten-free diet.

Many people believe that gluten consumption is harmless in those who do not have celiac disease or an “allergy”, but studies suggest the issue is far more complicated than that. 

Non-Celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) 

Many people who lack the characteristic blood, tissue, or genetic markers of celiac disease experience celiac-like GI symptoms (as well as non-GI symptoms including fatigue, cognitive difficulties, and mood disturbances) after consuming foods that contain gluten.

Researchers call this condition non-celiac gluten sensitivity (NCGS) or non-celiac gluten or wheat sensitivity (NCWS).

There is no clear definition of non-celiac gluten sensitivity. The diagnosis is made when a patient reacts negatively to gluten, but celiac disease and allergies have been ruled out.

One explanation for NCWS is that exposure to the offending grains somehow triggers acute systemic immune activation, rather than a strictly localized intestinal immune response. Because there are no biomarkers for NCWS, accurate figures for its prevalence are not available, but it is estimated to affect about 1 percent of the population, or 3 million Americans, roughly the same prevalence as celiac disease.

A study led by researchers from the Columbia University Medical Center (CUMC) and published in the journal Gut in July 2016 examined 160 participants – 80 with NCWS, 40 with celiac disease, and 40 with neither condition. Here’s what they found:

While the NCWS group did not have the cytotoxic T cells found in those with celiac disease, they DID have markers of intestinal cellular damage related to a severe systemic immune activation.

The study found that NCWS is linked to a weakened intestinal barrier that allows the movement of microbial and dietary molecules from the intestines into the rest of the body. This, researchers suggest, ultimately results in the body-wide immune response that patients saw in response to gluten.

Study participants with NCWS who excluded wheat and related products from their diets for six months saw improvement in their symptoms and effects.

Study co-author Dr. Peter H. Green said of the findings:

“Our study shows that the symptoms reported by individuals with this condition are not imagined, as some people have suggested. It demonstrates that there is a biological basis for these symptoms in a significant number of these patients.”

Wheat allergy

While celiac disease and non-celiac gluten sensitivity have many symptoms in common, those of wheat allergy are usually distinct, as Gluten.org explains:

Wheat allergyis an immune reaction to any of the hundreds of proteins in wheat. When a person has a wheat allergy, one type of white blood cells, called B-cells, send out immunoglobulin E (IgE) antibodies to “attack” the wheat. At the same time, local tissues in the body send out natural chemical messengers to alert the rest of the body that there is a problem. This reaction happens very fast (within minutes to a few hours) and can involve a range of symptoms from nausea, abdominal pain, itching, swelling of the lips and tongue, to trouble breathing, or anaphylaxis (a life-threatening reaction). A person with a wheat allergy must avoid eating any form of wheat, but does not have trouble tolerating gluten from non-wheat sources. (It is possible for a person to be both allergic to wheat and have CD or NCGS.) In the United States, wheat is one of the eight most common foods to which people are allergic. Children who are allergic to wheat may out-grow the allergy, but adults with an allergy to wheat usually have it for life. The only treatment is a wheat-free diet.

It is important to understand that even if you are not allergic to wheat and don’t believe gluten causes problems for you, there are other components in wheat that can be very damaging to your health. For more on that, please check out this well-researched article from Paleo Leap: 11 Ways Gluten and Wheat Can Damage Your Health.

Gluten Ataxia

Sounds scary, doesn’t it?

It is. Thankfully, it is rare.

Gluten ataxia is a rare neurological autoimmune condition involving the body’s reaction to gluten. It can irreversibly damage the part of your brain called the cerebellum, according to practitioners who first identified the condition about a decade ago, explains Very Well:

This damage potentially can cause problems with your gait and with your gross motor skills, resulting in loss of coordination and possibly leading to significant, progressive disability in some cases.

However, because gluten ataxia is so relatively new, and not all physicians agree that it exists, there’s as of yet no accepted way to test for it or to diagnose it.

When a person has gluten ataxia, the antibodies the body produces in response to gluten ingestion mistakenly attack the cerebellum, the part of the brain responsible for balance, motor control, and muscle tone.

This autoimmune attack usually progresses slowly, but the resulting problems in balance and motor control eventually are irreversible due to brain damage.

Up to 60% of patients with gluten ataxia have evidence of cerebellar atrophy (shrinkage of that part of their brains) when examined with magnetic resonance imaging (MRI) technology. In some people, an MRI also will reveal bright white spots on the brain that indicate damage.

Gluten ataxia symptoms are indistinguishable from symptoms of other forms of ataxia and can include progressive balance difficulties, unsteadiness, problems swallowing, slurred speech, double vision, bladder control problems, and trouble with fine motor skills. Gastrointestinal problems are not often present in gluten ataxia cases, which can lead to delayed diagnosis.

Diagnosis is tricky, but if symptoms stabilize or improve after gluten is removed from the diet, it is likely that the ataxia was caused by gluten.

Other conditions linked with gluten, grain, and wheat consumption

Celiac disease is not the only autoimmune disorder that has been associated with the consumption of gluten (and other grains). So have others, including thyroid disorders, type 1 diabetes, rheumatoid arthritis, psoriatic arthritis, and psoriasis.

Gluten has been shown to trigger inflammation – and we know that inflammation is the likely cause of a multitude of health conditions, including arthritis, asthma, cancer, chronic pain, headaches, and heart disease.

Where is gluten found?

The Celiac Disease Foundation notes that there are many food items that may contain gluten, often in hidden or unexpected ways.

Sources include but are not limited to the following:

Grains and their derivatives

  • wheat
  • wheatberries
  • durum
  • semolina
  • spelt
  • farina
  • farro
  • graham
  • KAMUT
  • einkorn wheat
  • rye
  • barley
  • triticale
  • malt (in various forms including malted barley flour, malted milk or milkshakes, malt extract, malt syrup, malt flavoring, malt vinegar)
  • brewer’s yeast

Special note about oats: While oats are naturally gluten-free, they may be contaminated. Therefore, it is safest to only consume oats with a gluten-free label.

Common foods that contain gluten

  • pasta
  • noodles
  • bread
  • pastries
  • cakes
  • donuts
  • crackers
  • baked goods
  • cereal
  • granola
  • sauces and gravies
  • flour tortillas
  • beer and malt beverages
  • anything that contains “flour” as an ingredient

For a full list of foods and other products that contain gluten, please see Sources of Gluten.

Could something other than gluten be causing these health problems?

While it is important to remember that people who have been diagnosed with celiac disease absolutely need to avoid gluten entirely, the issue isn’t as clear for those with NCWS. Science has demonstrated that gluten is poorly digested in all populations, but there may be other culprits that cause more severe and chronic symptoms in many people who do not have celiac disease.

FODMAPs

It is possible that FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides and Polyols), a group of poorly digested carbohydrates, are the actual cause of digestive troubles in some who believe gluten is the problem. FODMAPs are small, short-chain carbohydrates that are found in many foods – including those that contain wheat and other gluten-containing grains.

Here’s a list of common FODMAPs from Healthline:

  • Fructose: A simple sugar found in many fruits, vegetables, and added sugars.
  • Lactose: A carbohydrate found in dairy products like milk.
  • Fructans: Found in many foods, including gluten grains like wheat, spelt, rye and barley.
  • Galactans: Found in large amounts in legumes.
  • Polyols: Sugar alcohols like xylitol, sorbitol, maltitol, and mannitol. They are found in some fruits and vegetables, and often used as sweeteners.

Many people are unable to digest FODMAPs properly. Studies show strong links between FODMAPs and digestive problems including gas, bloating, stomach pain, diarrhea, constipation, and irritable bowel syndrome (IBS). An estimated 14% of people in the US have IBS (most of which are undiagnosed), so the implications of this are significant.

One study of 37 people with self-reported gluten sensitivity placed participants on a low-FODMAP diet, which reduced symptoms. The participants were then given isolated gluten, which did not affect their digestive symptoms.

This suggests that FODMAPs may be the true culprit for many people who think they react negatively to gluten. Because FODMAPs are found in so many foods, it is extremely difficult to entirely eliminate them from your diet. But, minimizing intake is often enough to help reduce symptoms of sensitivity.

If you follow a gluten-free diet and still experience unpleasant gastrointestinal symptoms, it may be worth trying a low-FODMAP diet to see if your symptoms improve.

Glyphosate

The herbicide glyphosate has been surrounded by controversy for years due to health dangers associated with the product. Created by multinational agrochemical and agricultural biotechnology giant Monsanto and sold under the trade name Roundup, it is the most widely used weedkiller in the world.

While an in-depth discussion about glyphosate is beyond the scope of this article, it is important to understand that the findings of some studies suggest that it may act as a selective antibiotic in the human gut, killing off beneficial bowel flora species, while encouraging the growth of pathogenic (disease-causing) species.

Some argue that gluten is not a problem at all as long as one consumes products that are organic and GMO-free (grown without exposure to glyphosate). However, if this were the case, all of the health problems associated with gluten (and wheat) would disappear in individuals who choose GMO-free options, and that isn’t always the case.

What does all of this mean for you?

If you believe you may have celiac disease, it is important to consult with your healthcare provider because of the seriousness of the disorder. If you don’t think you have celiac disease, but believe you might benefit from avoiding gluten, it couldn’t hurt to eliminate it from your diet for a few weeks to see how you feel.

A few more points:

Going gluten-free does NOT guarantee weight loss – in fact, it wouldn’t be hard to GAIN weight while following a gluten-free diet if you consume gluten-free junk foods like cookies, cakes, crackers, and bread. No substitutions for gluten-containing products are necessary, as those foods are usually highly processed anyway. Beware of the “gluten-free” labels that are popping up on products all over stores – many of those products are junk foods, loaded with sugar and other things you don’t need in your diet.

You might be wondering about fiber – what about all those cereals and bread that boast of high fiber content? Companies that make those products want you to believe you need grains in your diet because they contain fiber…completely neglecting the fact that fruits, vegetables, nuts, and seeds are all excellent sources of fiber (and are all naturally gluten-free). In addition, they all naturally contain far more nutrients than cereal or other grain-based foods (especially the processed ones).

In fact, the majority of the research supporting the benefits of dietary fiber comes from epidemiological studies that link the consumption of fiber-rich fruits and vegetables with a lowered risk of certain diseases such as obesity, heart disease, and cancer (particularly colon cancer). And, when tested in the lab, controlled intervention trials that simply add fiber supplements to an otherwise consistent diet have not shown these protective effects.

In conclusion…

Ultimately, the choice is yours. If you want to continue eating foods that contain gluten, by all means – please do. I’m not here to tell you what to do with your body.

But the main point I want to emphasize here is this – humans don’t NEED to consume gluten, and many people report feeling better after going gluten-free. If you are concerned about the possible health risks associated with gluten, there’s absolutely no harm in removing it from your diet to see how you feel. It could make a huge difference in your health – you won’t know until you try. Often, we get used feeling less-than-great – it becomes our “normal” – and don’t realize our health was suffering until we make changes to improve it.

For those who are still skeptical (or want inspiration), please read my dear friend Melissa’s personal story about her battle with NCWS and the amazing health transformation she experienced when she removed gluten from her diet.

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Want to join our online communities? Check them out here: All About Habits group for motivation and inspiration and Plant-Based for 30


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Obesity Can Significantly Shorten Your Life, and You Really Can’t be “Fat But Fit”

Two recent studies on obesity yielded some concerning findings regarding its impacts on life expectancy and heart disease.

Let’s take a look at each.

Obesity and Longevity

In April, researchers from the Cleveland Clinic and New York University School of Medicine found that obesity resulted in as much as 47 percent more life-years lost than tobacco, and tobacco caused similar life-years lost as high blood pressure.

The research team found the greatest number of preventable life-years lost were due to (in order from greatest to least) obesity, diabetes, tobacco use, high blood pressure, and high cholesterol.

Of the five top causes of death, three (diabetes, hypertension, and high cholesterol) are treatable with medications and lifestyle changes. Obesity and tobacco use are more challenging issues to resolve: both involve complex psychological factors.

From the press release:

To estimate the number of life-years lost to each modifiable risk factor, researchers examined the change in mortality for a series of hypothetical U.S. populations that each eliminated a single risk factor. They compared the results with the change in life-years lost for an “optimal” population that eliminated all modifiable risk factors. Recognizing that some less common factors might place substantial burden on small population subgroups, they also estimated life expectancy gained in individuals with each modifiable risk factor.

The reality is, while we may know the proximate cause of a patient’s death, for example, breast cancer or heart attack, we don’t always know the contributing factor(s), such as tobacco use, obesity, alcohol and family history. For each major cause of death, we identified a root cause to understand whether there was a way a person could have lived longer.

Glen Taksler, Ph.D., internal medicine researcher from Cleveland Clinic and lead author of the study, said of the findings,

“Modifiable behavioral risk factors pose a substantial mortality burden in the U.S. These preliminary results continue to highlight the importance of weight loss, diabetes management and healthy eating in the U.S. population.”

***

Busting the “Fat but Fit” Myth

Storing too much fat in the body is associated with a number of metabolic changes, including increased blood pressure, high blood sugar, and altered cholesterol levels, which have been linked to numerous health problems and diseases.

However, some studies have revealed a subset of overweight people who appear to lack the adverse health effects of excess weight, leading to them being classified as “metabolically healthy obese” in the medical literature (referred to “fat but fit” in the media).

In August, researchers from Imperial College London, University College London, and other institutions across Europe found that being overweight or obese increases a person’s risk of coronary heart disease (CHD) by up to 28 percent compared to those with a healthy bodyweight – even if they have healthy blood pressure, blood sugar, and cholesterol levels.

For this study – the largest of its kind to date – scientists used data from more than half a million people in 10 European countries – taken from the European Prospective Investigation into Cancer and Nutrition (EPIC). They found that excess weight is linked with an increased risk of heart disease, even when people have a healthy metabolic profile. Researchers focused on weight and signs of heart disease. Then, they looked at more than 7,637 people who had cardiovascular events such as death from heart attack, and compared them to more than 10,000 people who didn’t have heart problems.

Being metabolically unhealthy or having metabolic syndrome was defined as having three or more of the following at baseline:

  • high blood pressure, use of blood pressure medications, or self-reported history
  • high triglycerides (a type of fat) or use of lipid-lowering medication like statins
  • low HDL (good) cholesterol
  • high blood sugar, use of diabetes medications, or self-reported history
  • high waist circumference

Researchers looked for the new development of heart disease during follow-up, either self-reported or through data from GP and hospital registers and mortality records. The last follow-up ranged from 2003- 2010, with an average of 12.2 years.

They looked at the link between body fat, metabolic markers, and developing heart disease, adjusting for baseline variables of country, gender, age, education, smoking status, alcohol intake, diet, and physical activity.

After those adjustments and considerations, the scientists found that people with three or more heart risk factors like high blood pressure, high cholesterol, or large waist sizes (more than 37 inches for men and 31 inches for women) were more than twice as likely to have heart disease, regardless of whether their weight was normal or above normal.

But those who were considered overweight yet healthy were still 26 percent more likely to develop heart disease than their normal-weight peers. Those considered healthy but obese had a 28 percent higher risk, the study found.

The findings, which were published in the European Heart Journal, add to a growing body of evidence that suggests being “fat but fit” is a myth, and that people should aim to maintain a body weight within a healthy range.

The excess weight itself may not be increasing the risk of heart disease directly, but rather indirectly through mechanisms such as increased blood pressure and high glucose, the researchers said.

Lead author Dr. Camille Lassale explained,

“Our findings suggest that if a patient is overweight or obese, all efforts should be made to help them get back to a healthy weight, regardless of other factors. Even if their blood pressure, blood sugar and cholesterol appear within the normal range, excess weight is still a risk factor.”

Dr. Ioanna Tzoulaki, from Imperial’s School of Public Health, added,

“I think there is no longer this concept of healthy obese. If anything, our study shows that people with excess weight who might be classed as ‘healthy’ haven’t yet developed an unhealthy metabolic profile. That comes later in the timeline, then they have an event, such as a heart attack.”

***

Additional Resources:

Secrets from the Eating Lab: The Science of Weight Loss, the Myth of Willpower, and Why You Should Never Diet Again by Traci Mann, PhD

Diet Anarchy: Are You Sabotaging Yourself?

Diet Anarchy: The More Things Are Forbidden…

Why You Should Ditch Your Scale

Diet Anarchy: Are You Eating Enough?

Diet Anarchy: Should You Count Calories or Eat Intuitively?

***

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Do You Need a Reason to Stop Drinking Soda? Here It Is.

Drinking sugar-sweetened beverages every day is associated with an increase in a particularly nasty type of body fat that has been linked with diabetes, heart disease risk, and a multitude of other health issues.

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