Kurt Harris MD

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Entries in grains (3)

Monday
Dec282009

Avoid Poison or Neutralize It?

Let me be clear. Weston Price the man was a giant in nutrition and had many brilliant insights.

For some reason, though, some members of the Weston A. Price Foundation have a peculiar attachment to gluten grains. This attachment is strong enough that I frequently find myself admonished by them for recommending that all gluten grains be avoided as unfit for human consumption.

One reader, commenting off topic on another post, takes me to task at length for saying I don’t like the cavalier attitude towards gluten grains that I have found on the WAPF website.

Complainant’s comments in italics and indented, mine in standard font:

He says:

 The article by the WAPF that you referenced, written by Katherine Czapp can be found here:

http://www.westonaprice.org/Going-with-the-Grain.html

Perhaps you should take a second look at it.

I have.

There is no mention of re-introducing gluten grains as a part of the celiac healing protocol, as you claim, aside from the anecdotal bits about Czapp's father being able to eat sourdough bread seemingly without harm:

“... can those who have suffered from celiac disease enjoy genuine sourdough bread, properly prepared from rye or Kamut®? My father's experience suggests that the answer is yes, at least for some.”

Isn’t that anecdotal suggestion and the cheerful speculation that it may yet prove to be safe enough? It is enough for me to conclude that the writer is ignorant of the medical physiology of celiac disease.

If you're (sic) think that she's suggesting this for others to try, think again:

“While some critics may argue that long-rise sourdough breads could be doing silent damage beneath such apparent success, researchers are currently investigating the effects of long-term consumption of sourdough breads on recovered celiacs, and in coming years will be able to answer this question with enough certainty to satisfy the skeptics. For now, we know that properly prepared non-gluten grains can be safely introduced as wholesome additions to the diets of people who have recovered from celiac disease, and anecdotal experiences and preliminary research both indicate that breads traditionally prepared from gluten grains, even wheat, may also in time serve as wholesome additions to the diets of many people who have recovered from celiac disease.”

She says “anecdotal experiences and preliminary research both indicate that breads traditionally prepared from gluten grains, even wheat, may also in time serve as wholesome additions to the diets of many people who have recovered from celiac disease.”

That is not suggesting that it is possible for others? The descriptor for those who think eating gluten if you are celiac, by those who think it is possible is “skeptic”, yet the person doing the describing is not an advocate? I differ with your characterization of the author's stance.

By her own description, I am a skeptic and she is an advocate.

And regarding the breakdown of gliadin and glutenins, I didn't ask whether or not "soaking and cooking" wheat would accomplish this, as in your reply.  I specifically asked about sourdough bread being able to change the nature of these proteins.  Apparently this does happen through bacterial fermentation. 

It happens to a varying and incomplete degree in controlled laboratory experiments, and may or may not occur to the same degree in everyone's kitchen.

Czapp references research about this, as well as fermented wheat's effect on celiacs:

 “Their experiment included 17 subjects, all celiac patients who had been consuming gluten-free diets for at least two years and no longer exhibiting symptoms. The experimental bread was made from a combination of wheat (Triticum aestivum), oat, millet and buckwheat flours, 30 percent of which was wheat. The flour was mixed with a "broth" of four lab-obtained lactobacilli, a dose of baker's yeast and tap water in a continuous high-speed mixer. When the dough was allowed to ferment at about body temperature for 24 hours, almost all of the toxic peptide fractions in the wheat protein had been hydrolyzed. The bread was then baked and fed to the celiac volunteers (who also bravely ate breads made with plain baker's yeast as "controls"). After consuming the simple yeasted bread, analysis of the volunteers' gut permeability was made, which showed a change in permeability normally associated with celiac response. No such response was noted when the volunteers ate the 24-hour fermented sourdough bread.” 

The author is very clear throughout the article that sourdough bread may be okay for celiacs to consume.

Yes, she is and that is what I take issue with. That claim has an inadequate basis if you know anything about celiac disease.

WAPF does not recommend re-introducing gluten-grains after healing from celiac.  They merely suggest that sourdough might in the future, be discovered to be acceptable for people with such a condition.

I am aware of what they are saying and I maintain that it is irresponsible and pointless to say that it may be possible to eat small bits of gluten if you are known to have celiac. To say so reflects a lack of understanding of how hard it would be to prove lack of harm in celiacs, many of whom have clinically silent pathology that may not be manifest for many years

Again:

“anecdotal experiences and preliminary research both indicate that breads traditionally prepared from gluten grains, even wheat, may also in time serve as wholesome additions to the diets of many people who have recovered from celiac disease.”

I feel that this is important to bring to the table because one of your big contentions with the WAPF appears to be that they recommend eating gluten grains again after healing from celiac.  As far as I can tell, this simply is not true.

You have quoted an article by a non-physician, non-scientist with an anecdotal account of eating sourdough bread with no obvious recrudescence of Celiac disease with the contention that this might be safe to do for celiacs. Did her father have a jejunal biopsy or assays for TTG or IGA or IGG? Was he followed clinically for many years for autoimmune diseases?

Perhaps you should clean the slate and retract this particular argument against the organization ...

Show me where WAPF states that no one alive should eat gluten grains whether they have celiac disease or not and I will “clean the slate”. That is my position on gluten grains and it is one of the three pillars of my approach.

Until then, the slate will have to remain dirty.

The larger point is this - The whole exercise of finding a way to justify eating gluten grains is beyond pointless.

We have here a class of plant proteins derived from the seeds of plants that do not want to be eaten and that we did not evolve eating – cereal grains. These gliadin proteins (glutenins and gliadins) have known effects on gut permeability even in those without celiac disease via the innate immune response. These effects are in addition to those of wheat germ agglutinin (WGA), a secondary plant compound found in wheat germ that is elaborated solely to discourage consumption of seeds by animals.

The WAPF position is that, rather than simply avoiding eating things with gluten, we should soak, sprout and ferment these noxious plant seeds and eat them anyway, in hopes that our preparation has hydrolyzed enough of the gluten to make short enough peptides that the immunogenicity is diminished.

I suggest wheat advocates who worship tradition pay for access to this short report published in GUT – I did - and then explain why a celiac, or indeed anyone with a gut should expose themselves to even microgram amounts of incompletely hydrolysed gluten when 5 out of 6 people without evidence of CS (Celiac Sprue) have evidence of an abnormal innate immune response using a highly sensitive assay.

http://gut.bmj.com/content/56/6/889.extract

Here is a link to Peter's discussion of same.

Try to visualize this: 

The smallest circle in the Venn diagram contains ones with diagnosed clinically evident celiac disease – less than .01% of the population.

The next circle includes the first plus those with undiagnosed celiac disease, many of whom have vague or no symptoms (perhaps like the father in the anecdote above!) yet are at increased risk of cancers like lymphoma and various autoimmune diseases – this is about 1% of the population.

The next biggest circle is the 30% who have the HLA haplotypes that tend to get diagnosable celiac - a good portion of these will show evidence of an adaptive immune response if tested serologically.

The biggest circle in the Venn diagram encompasses 83% of the population –all the smaller circles plus those who might show evidence of an innate response but in whom testing for antibodies may show nothing, and who therefore would never be known to have been damaged by gluten consumption, even if they had MS, schizophrenia, Hashimoto’s thyroiditis, Grave’s disease. Lupus, Type I diabetes, Sjogren disease, etc. or any other of the many diseases that travel with celiac as a consequence of leaky gut and ensuing molecular mimicry that occurs when you damage your gut with wheat.

You are acknowledging that gluten damages so many people that you have only a 16% chance of being impervious to gluten yourself, but celiacs who are known to be affected by it to the point of villous atrophy on biopsy should not avoid bread, but eat sourdough because “most” of the gluten might be hydrolyzed?

I just don’t get it.

You can live fine with zero gluten grains in your diet. Wheat flour is vitamin poor, has no nutritious fat that isn’t rancid, and the proteins in it are incomplete in their amino acid complement. There is absolutely no upside to eating wheat if you are not starving

So why engineer some convoluted preparation ritual in order to eat it? Why not just avoid it?

Weston Price studied traditional cultures, many of whom were healthier than those on the SAD, and none of whom were pre-neolithic cultures. That they were healthier than modern folks eating biscuits and sugar does not mean that every foodway these traditional cultures practiced is by definition healthy or desirable for everyone or even anyone. That is just one giant non sequiter, and for reasons I can’t fathom I see that all the time when I argue with some WAPF members.

WAP the man was cool.

You could do worse than to follow some of the advice on the WAPF website, but not when it’s about eating grains. I don’t care if the Swiss got away with it just like I don’t care if the Kitavans get 70% of calories from tubers.

Tolerated is not optimal. Why is that hard to understand?

Someday eating corn oil and soy protein will be a “tradition”, too. Then what will you do? Say that only sugar is bad because it’s the most obvious?

Pick the traditional practices that have a good foundation in modern medical science and that comport with evolutionary reasoning and toss the rest.

Don’t practice blind empiricism.

Tuesday
Jun232009

The Argument Against Cereal Grains

What is a cereal grain?

Cereal grains are seeds of monocot grasses that have been artificially selected by humans to serve as food. The ones that cause the most trouble, and constitute the biggest part of European and North American diets, are the gluten grains Wheat, Barley and Rye. I use the term gluten grains to signify primarily wheat barley and rye, but spelt, triticale and other less common grains, and some argue, oats are also gluten containing. One factor complicating gluten grain avoidance is the fact that non- gluten grains can often be contaminated by being processed on the same equipment as gluten grains.

How about other grains? Corn, rice and other non-gluten grains are carbohydrate heavy have antinutrients that interfere with mineral absorption and offer no nutritional advantages over animal products and non-seed vegetables in a food-abundant (non-subsistence) environment. As these non-gluten grains were also not consumed in important amounts in the Paleolithic period, the healthiest strategy is just complete grain avoidance.

That’s what I do generally. I have a little corn or white rice now and then, but no wheat, barley or rye if I can help it.

Here is the argument against gluten grains.

In a paleolithic non-food-abundant environment, omnivorous humans would at least occasionally eat anything that had caloric value that would not kill them. Natural selection favors propagation of the gene, even if the organism is not made "healthy" or does not live as long. It does not follow that any particular thing eaten was or is healthy, particularly if it were a type of plant that uses poisons in its seeds to discourage consumption by wild animals.

We need to apply the PaNu methodology to see if there evolutionary discordance. This has two parts. First, we look at evidence from modern medical sciences like biochemistry and epidemiology. Then, we look to the past with paleoanthropology to see if that supports our argument.

All plants tend to be in a contest with predators who might consume them. When we contemplate the chief difference between plants and animals, it makes sense that animal sources in general may be healthier for us.  Animals are mobile, and can avoid predation by running away from us. Plants use a variety of strategies to avoid predation, but one of them is to discourage consumption by elaborating toxic substances. Hence there is a contest of co-evolution over generations between plants “trying” to avoid consumption and animals evolving adaptations (or not) to the plant’s defenses.

Nuts are seeds that have a physical hard shell to discourage consumption. Relying more on this physical barrier than poisons, nuts like walnuts or pecans are seeds but safer to eat than grass seeds.

Gluten grains are grasses that use wind to disperse their seeds. The seeds contain carbohydrate and protein meant to help the seed germinate and grow. The seed has lectins and physical structure designed to discourage consumption by predators, whether single cell, fungus, insects or vertebrates. Some creatures, like birds, are clearly adapted to overcome the defenses of gluten cereal grains and use them as a primary food source. Most animals, including most mammals and our closest relatives the omnivorous fruit and insect-eating chimpanzees, are not adapted to grains and don’t eat them in substantial quantities. The question is, are humans adapted?

The answer is no.

First, see 6s and 3s and the logic of grain avoidance, for what happens when bovines that are adapted to eating grasses, eat too many grass seeds (grains) to which they are not adapted.

Now consider humans:

1) Fully 1% of the population has celiac disease, with 97% of these currently undiagnosed. 30% of the population has the genetic HLA haplotype that is susceptible to celiac disease -we can only know which of these 30% have it by testing. Celiac disease is caused by gluten grain consumption, with the offending gliadin proteins heat stable and not destroyed by cooking. Nearly every common autoimmune disease described is associated with at least an order of magnitude increased risk of celiac disease. Conversely, celiac patients have increased cancer, osteoporosis, and autoimmune diseases like DM I, autoimmune thyroid disease, Multiple Sclerosis, Sjogren disease, Rheumatoid arthritis, neuropathies, and even neurological disorders like schizophrenia. We don't know how big the iceberg is with these diseases, but the tip seems very large. 

2) Gluten grains are grass seeds that are employing a biologic strategy to avoid consumption, including elaborating the heat stable lectin WGA, which is known to damage the human gut. The nutritive value of gluten grains is inferior to the vast majority of non-gluten plant sources of carbohydrate and protein that have lesser adverse biological effects, and there is no evidence they provide anything uniquely essential. In addition to wheat germ agglutinin and gliadin proteins, there are a variety of other antinutrients in cereal grains, including phytates that bind essential minerals, and enzyme inhibitors that inhibit digestion. These are known to have their own dose-related adverse effects when included in the human diet. Inclusion of gluten grains and the oils extracted from grains in the diet also skews the ratio of n-6 to n-3 fatty acids in an unhealthy direction that adversely affects immune function.

3) The paleoanthropological record shows that humans and their hominid progenitors would eat nearly anything that had calories that would not immediately kill them, including occasional grass seeds. Nevertheless, the evidence also tells us that monocot grass seeds in general and gluten cereal grains in particular were inconsistent and trivial food sources prior to agriculture. The evidence is that cereal grains and legumes have antinutrients with clinically significant effects, and the evidence that these are an evolutionarily recent food source supports our observation that we are poorly adapted to them.

Note that the PaNu method does not ask solely if a food was or could have been eaten in Paleolithic times.  A history of being a paleolithic food source is neither necessary nor sufficient to establish it as concordant or discordant. There must be evidence that it is discordant both in the present and in the past under the PaNu method.

Dairy products are evolutionarily novel, but I believe in the context of a modern food abundant environment, and given what we really know about their health effects in the present, they are healthy for most people if your gut is not made leaky by grain consumption. Although dairy products are historically neolithic food, there is evidence of traditional cultures doing very well with them.

So when I call something a neolithic agent of disease, that really has two parts: 1) We have current evidence that is is noxious and 2) It is somehow outside of our evolutionary experience

Conversely, wild honey is a preferred food source for its caloric value among modern hunter gatherers and has probably been a hominid food source for millions of years. Wild honey is just fructose and glucose with dirt and pollen in it. Would there be negative health effects with 100% elimination of sucrose (a disaccharide of glucose and fructose) from your diet ? Honey can keep you from starving if food is scarce, but is there some magic ingredient in there with the sugar? I have convinced you, I hope, that in a food abundant environment, excess sucrose or its chemical equivalent is not healthy, as anything you eat is necessarily displacing something else you could be eating. Clearly the argument in favor of a food must rest on more than simply whether it was ever exploited.

I am now making the same elimination argument for gluten grains we have made for refined sugar and white flour, even though the specific biological argument is different. In a food abundant environment where anything you eat displaces something else in a roughly isocaloric diet, eating gluten grains is not optimal for your health. What is in wheat that you cannot better get from a green salad with egg on it - without the lectins and the gliadin proteins?

I have never had anyone able to tell me exactly what evil would befall a person without wheat, barley or rye in their diet. I have scores of non-celiacs that say that it made a huge change for the better, and some say it did much more than the sugar elimination.

Our cultural veneration of grains literally amounts to making a virtue of necessity, as 55% of world calories consumed is from grains. A paradigm shift is possible, though, if you are willing to read some more and adopt a radical skepticism of current government, mainstream media and industry supported nutritional dogma. I was initially as skeptical as you might be, and only came to my conclusions through investigation. 

Again I ask, rhetorically, what possible negative health consequence could there be to eliminating wheat, barley and rye from your diet? 

Ditch the grains. Don't be a wheat-eater.

Read Part II Here.

Saturday
Jun132009

Using Dairy to substitute Fats for Carbohydrates

Why do I advocate whole milk and cream but in later steps suggest eliminating dairy?

The 12-step list assumes we are starting with the standard american diet. I have found that step one is very difficult without the immediate introduction of fats to substitute for the excess of sugar and wheat flour. Following an "eat what they ate" paleolithic diet has the flaw of eliminating dairy as not “orthodox paleolithic”. This is a mistake as the best weapons you have to replace unhealthy carb intake with fat in a convenient fashion (without eating brains, liver and marrow of wild game every day) are butter and milkfat. Remember, the paradigm is about paleolithic metabolism, not paleolithic food re-enactment!

Step one is enabled by taking the milk most people are already drinking and ramping up the fat content. Skim milk is less than 0.5% fat by weight and so is mostly water with milk sugar or lactose, and milk protein, including casein. Whole milk is 3.2% fat by weight and has 50% calories from fat, half-and-half is about 12% fat by weight and most of the calories are therefore coming from fat. (Cream of course avoids most of the lactose and casein because it's nearly all fat.) The satiety you get from the increased fat will make the step one elimination of sugar, HFCS and white flour possible. Step one and two really need to be simultaneous to be effective. My “diet” is more a high-fat prescription than a low-carb one. I believe that not only is saturated fat not harmful, but it is actually may be a key component to EM2 in a food-abundant environment.

Cream, butter, and cheese have little to no lactose as it has been either skimmed off or consumed by fermentation.

In addition to lactose intolerance, which is very common, there can be an immunologic reaction to casein (edit - and whey as well), the protein in milk.

Cream and butter are mostly fat of course, but both milk and cheese have casein. I do not think dairy is nearly as significant on a population basis as grain lectins, but it may be an issue. So I generally view butter and heavy cream as excellent and cheese and milk as less so. Most who have difficulty with dairy are just sensitive to the lactose, but there can be immune system issues with casein found in milk and cheeses. I believe casein serving as a molecular mimic to self antigens, and therefore causing autoimmune diseases, mainly occurs in the context of an already leaky gut. So if you do not have Wheat Germ Agglutinin and other grain lectins in your diet, the casein is not likely to leak into your blood stream. Multiple sclerosis may be linked to both gluten grain consumption and milk casein in this way. That is why I believe eliminating gluten grains minimizes the threat of dairy for most people. I believe getting to step 3 makes the milk prescription in step 2 safer in this way.

The advice to move milk up the list if you are sensitive just acknowledges that some are lactose intolerant and some may (theoretically) not tolerate the casein even after gluten grain elimination. (although some may be lactose intolerant and just think it's "normal")

I myself consume copious amounts of butter and cream, half and half and occasionally whole milk - but, no surprise, I consume zero gluten grains.

Again, the last two steps of dairy elimination are more for theoretical completeness as I find much less scientific evidence indicting dairy than grains. Dairy is not paleolithic historically, but as a relatively ubiquitous food class, definitely helps in acheiving the EM2 - the evolutionary metabolic milieu of low insulin levels and mimimal toxins from modern cereal grains.

The PaNu EM2 is not a diet composed of prehistoric food items, it is a metabolic state that we are trying to live in while eating foods that exist now.