This is the final version that was given at the Annual General Meeting of the Calgary Chapter of the Canadian Celiac Association, March 15, 1997.
Gluten is a Dubious Luxury of Non-Celiacs
by Ron Hoggan
Note: In this paper I use the term "gluten" and "cereals" generically, as we celiacs use it, to refer to all toxic proteins in wheat, rye, barley and oats.
One must wonder why, in spite of increasing life-spans in the advanced industrialized nations, modern medicine has failed to clearly identify the cause of many neurological, autoimmune and malignant disease. The gluten-free diet is only recommended where there is a clear indication of advanced, gluten-induced disease, but is this the best advice?
We may sometimes feel disadvantaged by the strict gluten-free diet we have to follow. It is costly and inconvenient. But perhaps it is those who continue to consume glutinous foods who should be concerned. Gluten, while dangerous to celiacs, has never been investigated for deleterious effects on the general population. Yet we have studies that show that hunter-gatherers following traditional life-ways do not develop the neurological, auto-immune and malignant diseases that people living in the industrialized world experience, and these people rarely eat gluten-rich foods (1,2). There is already compelling evidence connecting the advent of agriculture to bone and joint disease (3), and humankind has only been cultivating cereal grains for approximately 10,000 years (2,4), which is but a brief moment in evolutionary terms. Remember too, it is only a small population located in the Near East, that has had that length of exposure to cereal grains (4); most of the world has had agriculture for an even shorter period of time. Neurological and auto-immune diseases, as well as malignancies, are over-represented among celiacs (5), suggesting that glutens/gliadins may be a major environmental contributor to such diseases. Yet this area of investigation appears to have been avoided in research on these health problems. One must wonder at the cause of this neglect of such an important possibility.
There is abundant evidence connecting the advent of agriculture with retardation of long bone growth, dental enamel hypoplasia, iron deficiency anemia (indicated by porotic hyperostosis), juvenile osteoporosis, and joint disease (18). Do these conditions sound familiar? Many are the commonest signs of celiac disease, and they were apparently the rule, not the exception, in cultures adapting to agriculture.
We know, from palenotologists' study of human remains from the ancient past, that when a culture begins to cultivate cereal grains they experience substantial reductions in height, which is variously reported as 5" and 6"(2,4). Clearly, the reduction is substantial and significant. We know, too, that these remains demonstrate weaker bone structure (through reductions in peak bone-mass) and evidence of articular damage(3). Additionally, ancient Egyptians, who consumed a diet that would be considered very "heart-healthy" in our culture, have left behind mummies which clearly demonstrate atherosclerosis (7). While the evidence from the ancients is compelling, there can always be counter-arguments and debates when we are reaching back as far as 10,000 years into the past. Yet a few marginal pockets of scientific enquiry have explored a few elements of modern implications of this issue.
W.J.Lutz (4) has offered an alternative perspective on the "French Paradox." (The "French Paradox" is the unusually low rate of death by myocardial infarction among the French despite quite high per-capita rates of fat consumption.) Dr. Lutz has studied the spread of agriculture through Europe. He presents a picture whereby the spread of agriculture, and thus the period of time a culture has been exposed to cereal grains, is inversely related to the incidence of cardiovascular disease. The underlying assumption, of course, is that the longer the exposure, the greater the likelihood that those who were intolerant to these grains were trimmed from the gene pool of such cultures; it seems that the less time a culture has been exposed to gluten, the greater the portion of the population that continues to develop cancers and cardiovascular disease. (Lutz also provides similarly compelling data on the rates of breast cancer mortality.)
This work is confirmed by Simmoon's observation that there is a negative correlation between the frequency of antigen HLA-B8 and the length of time wheat farming has been practised in various parts of Europe (19).
Another interesting study done in China produced what the investigators found to be rather surprising results(8). In this investigation, the researchers plotted the diets of more than 3500 rural Chinese women, and measured their levels of SHBG (sex-hormone binding globulins). They were very surprised to find that wheat consumption, and perhaps, reduced fish consumption, were the strongest predictors of levels of SHBG, which would indicate an increased risk of cardiovascular disease.
Another study has connected gluten with neurological illness (9). This group of researchers tested 53 patients with neurological illness of unknown origin for antibodies against gliadin. More than half of them (30 people) demonstrated these antibodies. Nine of those folks proved to have celiac disease, but the other 21 only demonstrated an immune response to gluten, of a type that is often dismissed as meaningless. This study has some far-reaching implications for neurological research.
Yet another indication that celiacs are not the only segment of the population to suffer from the adverse effects of gluten is a study that was carried out on a very small group of siblings of celiacs(10). When subjected to rectal gluten challenge, half of the siblings showed an immune response to gluten, but these results did not correlate with the hereditary predictors of celiac disease.
As for the connection between autoimmunity and cereal grains, it is clear and compelling. The theoretical perspective of molecular mimicry suggests that gliadin-derived peptides, may activate the immune system against collagenous tissues, and since intestinal permeability (not celiac disease) is all that is required to allow the passage of these peptides into the bloodstream, a significant number of many types of autoimmune diseases seem likely to benefit from a gluten-free diet (11 ).
In total, then, there are several studies which demonstrate (often coincidentally) that a much larger group than those with celiac disease are mounting an immune response against gluten, and that this response is causing or contributing to serious illness. Phytic acid in whole cereal grains binds to minerals, including calcium. This chemical bond is not broken in the GI tract. The net result is the binding and wasting of much-needed dietary calcium, even among those whose immune systems can tolerate gluten, and these grains may be implicated in osteoporosis (12).
I would now like to draw your attention back to the issue of malignancy. _Medical Hypotheses_ will soon publish, a paper I have written which suggests (among other things) that gluten may be implicated in a great many cases of lymphoma (14). Gluten has been demonstrated to interfere with the celiac patient's ability to mount an immune response to malignancies (15,16,17). In my paper, I have postulated a dynamic whereby gluten may have a similar effect in others who are simply sensitive to gluten, or who have a sub-clinical form of this disease.
Ray Audette, a populist writer, has said that Stanislaw Tanchou "....gave the first formula for predicting cancer risk. It was based on grain consumption and was found to accurately calculate cancer rates in major European cities. The more grain consumed, the greater the rate of cancer." Tanchou's paper was delivered to the Paris Medical Society in 1843(20).
We hear all the time about pollution in the industrial world being the source for modern man's high incidence of cancer. It is the chemical additives, we are told, in the food we eat, that causes much of the problem. Perhaps.
I would like to suggest that the evidence from antiquity, the pattern of the spread of agriculture in Europe coinciding with the patterns of civilizatory illnesses, the levels of SBHG associated with wheat consumption, the high incidence of gliadin antibodies among those with neurological illnesses of unknown origin, the sensitivity to gluten among siblings of celiacs in spite of the absence of genetic indicators associated with celiac disease, and my own investigation of the literature regarding lymphoma, all point to the strong possibility that gluten is a dangerous substance to many more people than just celiacs.
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