brilliant account of the modern grain

And that’s exactly where we’re going next. But unlike Davis’s brilliant account of the modern grain and the battle of the bulge, we’re going to go one step further to see how it can inflict harm where we never imagined before: the brain. CHAPTER 2 The Sticky Protein Gluten’s Role in Brain Inflammation (It’s Not Just About Your Belly) Tell me what you eat, I’ll tell you who you are. —ANTHELME BRILLAT-SAVARIN (1755–1826) MOST EVERYONE HAS EXPERIENCED the throb of a headache and the agony of severe congestion. In many instances, we can point to a probable cause when symptoms descend on us, such as a long day in front of the computer in the case of a tension headache, or a passing cold bug when it hurts to swallow and the nose clogs up. For relief we can usually turn to over-the-counter remedies to manage our symptoms until the body returns to a normal, healthy state. But what do you do when the symptoms don’t go away and the culprit is much harder to pin down? What if, like so many patients I treat, you find yourself in an unending war with nagging pain and misery for years? For as long as she could remember, Fran struggled to chase the pulsating sensation out of her head. When I first examined her on a warm January day, Fran was as pleasant as could be for a sixty-threeyear-old who endured daily migraine headaches. Of course she had tried all the usual headache medications and was taking Imitrex (sumatriptan), a powerful migraine drug, several times a week. In reviewing her medical history, I noted that in her early twenties she’d undergone “intestinal exploratory surgery” because she was suffering from “severe intestinal discomfort.” As part of her evaluation, I tested her for gluten sensitivity and, not to my surprise, found that she was strongly positive in eight of the markers. I prescribed a gluten-free diet. Four months later, I received a letter from Fran stating: “My almost daily migraine symptoms have abated since removing gluten from my diet…. The two biggest changes in my body are the lack of a very hot head in the night with resulting migraines, and the huge increase in my energy levels. Today my level of daily accomplishment is enormous compared to my life before seeing you.” She went on to conclude: “Thank you, once again, for finding what seems to be the solution to my many years of migraine misery.” I wish she could have gotten the years back, but at least now I could give her a pain-free future. Another woman who came to me with a totally different set of symptoms but a similarly long history of suffering was Lauren. At just thirty years old, she told me squarely on our first meeting that she was “having some mental problems.” Lauren detailed the previous twelve years, which she described as a consistent downhill ride in terms of health. She told me how her early life was quite stressful once she lost both her mother and grandmother at a young age. When she started college she was hospitalized on several occasions for “mania.” During this time she would experience episodes of becoming highly talkative and overly grandiose about herself. She would then eat excessively, gain a lot of weight, and become severely depressed and suicidal. She had just started taking lithium, a medication used to treat bipolar disorder. Mental illness ran in her family; her sister had schizophrenia and her father was bipolar. Aside from Lauren’s dramatic account of her mental issues, the rest of her medical history was fairly unremarkable. She had no laments of bowel issues, food allergies, or any other of the standard types of complaints associated with gluten sensitivity. I went ahead and ordered a test for gluten sensitivity. We found profoundly elevated levels of six important markers for the condition. In fact, several of these markers were more than twice the normal range. Two months after starting a gluten-free diet, Lauren wrote a letter to me that echoed what I’d been hearing from so many patients who’d gone gluten-free and experienced striking results. She stated: Since being off gluten, my life has taken a complete 180. The first change that comes to mind, and the most important one, is my mood. When I was eating gluten, I would struggle with feeling depressed. I would always have to fight a “dark cloud over my head.” Now that I’m off gluten, I don’t feel depressed. The one time I ate some by mistake, I felt depressed again the next day. Other changes I’ve noticed include having more energy and being able to stay focused for longer periods. My thoughts are as sharp as ever. I can make a decision and come to a logical, confident conclusion like never before. I am also free of a lot of obsessivecompulsive behavior. Let me give you one more example of a case that’s emblematic of another set of symptoms linked to the same culprit. Kurt and his mother came to see me when he was a twenty-three-year-old young man suffering from abnormal movements. His mother stated that six months prior to their visit, he began “looking like he was shivering.” Initially his tremors were subtle, but then they increased with time. He had been to two neurologists and received two different diagnoses: one for what’s called “essential tremor,” and another for “dystonia.” The doctors had offered him a blood pressure medication, propranolol, which is used to treat some types of tremor disorders. The other recommendation was to have the various muscles in his arms and neck injected with Botox, the botulinum toxin that would temporarily paralyze the spastic muscles. Both he and his mother had elected not to use either the pills or the injections. What was interesting about his history were two things. First, he was diagnosed as having a learning disability in the fourth grade; his mother said that “he could not handle excessive stimulation.” And second, for several years he had complaints of stomach pain with loose bowel movements to the extent that he had to see a gastroenterologist, who took a biopsy of his small intestine to test for celiac disease. It proved negative. When I examined Kurt, his excessive movement problem was very evident. He could not control the shaking of his arms and neck and appeared to be suffering mightily. I reviewed his laboratory studies, which, for the most part, were unrevealing. He had been checked for Huntington’s disease, an inherited disorder known to cause a similar movement abnormality in young people, as well as Wilson’s disease, a disorder of copper metabolism also associated with a movement abnormality. All of these tests were negative. Blood work for gluten sensitivity did, however, show some elevated levels of certain antibodies indicative of vulnerability. I explained to Kurt and his mother that it was important to make sure gluten sensitivity wasn’t the cause of his movement disorder, and I provided them information on how to pursue a gluten-free diet. After several weeks I received a phone call from Kurt’s mother indicating that without question his movements had calmed down. Because of his improvement he elected to stay on a gluten-free diet, and after approximately six months, the abnormal movements had all but disappeared completely. The changes that occurred in this young man are breathtaking, especially when you consider that a simple dietary change had such a life-transforming impact. We are just beginning to see medical literature documenting a connection between movement disorders and gluten sensitivity, and physicians like me have now identified and treated a handful of individuals whose movement disorders have completely abated with a gluten-free program and for whom no other cause was identified. But unfortunately, most mainstream doctors are not on the lookout for the dietary explanation for such movement disorders and they are not aware of the latest reports. These cases are not outliers. They reflect patterns that I’ve witnessed in so many patients. They all might come to me with vastly different medical complaints, but they share a common thread: gluten sensitivity. It’s my belief that gluten is a modern poison, and that the research is compelling doctors like me to notice and re-examine the bigger picture when it comes to brain disorders and disease. The good news is that knowing this common denominator now means we can treat and, in some cases, cure a wide spectrum of ailments with a single prescription: the eviction of gluten from the diet. Walk into any health food store, and now even a regular grocery store, and you’re sure to be amazed at the selection of “gluten-free” products. In the past couple of years, the volume of glutenfree products sold has exploded; at last count, the industry clocked in at $6.3 billion in 2011 and continues to grow. 1 Spin-offs of everything from breakfast cereals to salad dressing are now positioned to take advantage of the ever-increasing number of individuals who are choosing foods without gluten. Why all the hype? No doubt media attention may be playing a role. A 2011 Yahoo! Sports article asking “Is Novak Djokovic’s new, gluten-free diet behind his winning streak?” goes on to say, “A simple allergy test could have led to one of the most dominant stretches in tennis history.” 2 But beyond this one athlete’s epiphany, what does the scientific community have to say about gluten sensitivity? What does it mean to be “gluten sensitive”? How does it differ from celiac disease? What’s so bad about gluten? Hasn’t it always been around? And just what exactly do I mean by “modern grains”? Let’s take a tour. THE GLUE OF GLUTEN Gluten—which is Latin for “glue”—is a protein composite that acts as an adhesive material, holding flour together to make bread products, including crackers, baked goods, and pizza dough. When you bite into a fluffy muffin or roll and stretch pizza dough prior to cooking, you have gluten to thank. In fact, most of the soft, chewy bread products available today owe their gumminess to gluten. Gluten plays a key role in the leavening process, letting bread “rise” when wheat mixes with yeast. To hold a ball of what is essentially gluten in your hands, just mix water and wheat flour, create a dough by kneading the ball with your hands, and then rinse the glob under running water to eliminate the starches and fiber. What you’re left with is a glutinous protein mixture. Most Americans consume gluten through wheat, but gluten is found in a variety of grains including rye, barley, spelt, kamut, and bulgur. It’s one of the most common food additives on the planet and is used not only in processed foods, but also in personal care products. As a trusty stabilizing agent, it helps cheese spreads and margarines retain their smooth texture, and it prevents sauces and gravies from curdling. Thickening hair conditioners and volumizing mascaras have gluten to thank, too. People can be as allergic to it as they can be to any protein. But let’s get a better look at the scope of the problem. Gluten is not a single molecule; it’s actually made up of two main groups of proteins, the glutenins and the gliadins. A person may be sensitive to either of these proteins or to one of the twelve different smaller units that make up gliadin. Any of these could cause a sensitivity reaction leading to inflammation. When I speak with patients about gluten sensitivity, one of the first things they say is something like, “Well, I don’t have celiac disease. I’ve been tested!” I do my best to explain that there’s a huge difference between celiac disease and gluten sensitivity. My aim is to convey the idea that celiac disease, also known as sprue, is an extreme manifestation of gluten sensitivity. Celiac disease is what happens when an allergic reaction to gluten causes damage specifically to the small intestine. It’s one of the most severe reactions one can have to gluten. Although many experts estimate that 1 in every 200 people has celiac disease, this is a conservative calculation; the number is probably closer to 1 in 30, since so many individuals remain undiagnosed. As many as one in four people are vulnerable to the disease due to genetics alone; people of northern European ancestry are particularly susceptible. What’s more, people can carry genes that code for mild versions of gluten intolerance, giving rise to a wide spectrum of gluten sensitivity. Celiac disease doesn’t just harm the gut. Once the genes for this disease are triggered, sensitivity to gluten is a lifelong condition that can affect the skin and mucous membranes, as well as cause blisters in the mouth. 3 Extreme reactions that trigger an autoimmune condition such as celiac aside, the key to understanding gluten sensitivity is that it can involve any organ in the body, even if the small intestine is completely spared. So while a person may not have celiac disease by definition, the rest of the body —including the brain—is at great risk if that individual is gluten sensitive. It helps to understand that food sensitivities in general are usually a response from the immune system. They can also occur if the body lacks the right enzymes to digest ingredients in foods. In the case of gluten, its “sticky” attribute interferes with the breakdown and absorption of nutrients. As you can imagine, poorly digested food leads to a pasty residue in your gut, which alerts the immune system to leap into action, eventually resulting in an assault on the lining of the small intestine. Those who experience symptoms complain of abdominal pain, nausea, diarrhea, constipation, and intestinal distress. Some people, however, don’t experience obvious signs of gastrointestinal trouble, but they could nevertheless be experiencing a silent attack elsewhere in their body, such as in their nervous system. Remember that when a body negatively reacts to food, it attempts to control the damage by sending out inflammatory messenger molecules to label the food particles as enemies. This leads the immune system to keep sending out inflammatory chemicals, killer cells among them, in a bid to wipe out the enemies. The process often damages our tissue, leaving the walls of our intestine compromised, a condition known as “leaky gut.” Once you have a leaky gut, you’re highly susceptible to additional food sensitivities in the future. And the onslaught of inflammation can also put you at risk for developing autoimmune disease. 4 Inflammation, which you know by now is the cornerstone of many brain disorders, can be initiated when the immune system reacts to a substance in a person’s body. When antibodies of the immune system come into contact with a protein or antigen to which a person is allergic, the inflammatory cascade is provoked, releasing a whole host of damaging chemicals known as cytokines. Gluten sensitivity in particular is caused by elevated levels of antibodies against the gliadin component of gluten. When the antibody combines with this protein (creating an anti-gliadin antibody), specific genes are turned on in a special type of immune cell in the body. Once these genes are activated, inflammatory cytokine chemicals collect and can attack the brain. Cytokines are highly antagonistic to the brain, damaging tissue and leaving the brain vulnerable to dysfunction and disease—especially if