Gluten-free January Participants: Take the Survey!

Matt Lentzner, Janine Jagger and I have designed a survey for participants of Gluten-free January, using the online application StatCrunch. Janine is an epidemiologist who studies healthcare worker safety at the University of Virginia; she has experience designing surveys for data collection so we're glad to have her on board. The survey will allow us to systematically gather and analyze data on the results of Gluten-free January. It will be 100 percent anonymous-- none of your answers will be connected to your identity in any way.

This survey has the potential to be really informative, but it will only work if you respond! The more people who take the survey, the more informative it will be, even if you didn't avoid gluten for a single day. If not very many people respond, it will be highly susceptible to "selection bias", where perhaps the only people who responded are people who improved the most, skewing the results.

Matt will be sending the survey out to everyone on his mailing list. Please complete it, even if you didn't end up avoiding gluten at all! There's no shame in it. The survey has responses built in for people who didn't avoid gluten. Your survey will still be useful!

We have potential data from over 500 people. After we crunch the numbers, I'll share them on the blog.

The Diabetes Epidemic

The CDC just released its latest estimate of diabetes prevalence in the US (1):

Diabetes affects 8.3 percent of Americans of all ages, and 11.3 percent of adults aged 20 and older, according to the National Diabetes Fact Sheet for 2011. About 27 percent of those with diabetes—7 million Americans—do not know they have the disease. Prediabetes affects 35 percent of adults aged 20 and older.

Wow-- this is a massive problem. The prevalence of diabetes has been increasing over time, due to more people developing the disorder, improvements in diabetes care leading to longer survival time, and changes in the way diabetes is diagnosed. Here's a graph I put together based on CDC data, showing the trend of diabetes prevalence (percent) from 1980 to 2008 in different age categories (2):

These data are self-reported, and do not correct for differences in diagnosis methods, so they should be viewed with caution-- but they still serve to illustrate the trend. There was an increase in diabetes incidence that began in the early 1990s. More than 90 percent of cases are type 2 diabetics. Disturbingly, the trend does not show any signs of slowing.

The diabetes epidemic has followed on the heels of the obesity epidemic with 10-20 years of lag time. Excess body fat is the number one risk factor for diabetes*. As far as I can tell, type 2 diabetes is caused by insulin resistance, which is probably due to energy intake exceeding energy needs (overnutrition), causing a state of cellular insulin resistance as a defense mechanism to protect against the damaging effects of too much glucose and fatty acids (3). In addition, type 2 diabetes requires a predisposition that prevents the pancreatic beta cells from keeping up with the greatly increased insulin needs of an insulin resistant person**. Both factors are required, and not all insulin resistant people will develop diabetes as some people's beta cells are able to compensate by hypersecreting insulin.

Why does energy intake exceed energy needs in modern America and in most affluent countries? Why has the typical person's calorie intake increased by 250 calories per day since 1970 (4)? I believe it's because the fat mass "setpoint" has been increased, typically but not always by industrial food. I've been developing some new thoughts on this lately, and potentially new solutions, which I'll reveal when they're ready.


* In other words, it's the best predictor of future diabetes risk.

** Most of the common gene variants (of known function) linked with type 2 diabetes are thought to impact beta cell function (5).

Two Wheat Challenge Ideas from Commenters

Some people have remarked that the blinded challenge method I posted is cumbersome.

Reader "Me" suggested:

You can buy wheat gluten in a grocery store. Why not simply have your friend add some wheat gluten to your normal protein shake.

Reader David suggested:

They sell empty gelatin capsules with carob content to opacify them. Why not fill a few capsules with whole wheat flour, and then a whole bunch with rice starch or other placebo. For two weeks take a set of, say, three capsules every day, with the set of wheat capsules in line to be taken on a random day selected by your friend. This would further reduce the chances that you would see through the blind, and it prevent the risk of not being able to choke the "smoothie" down. It would also keep it to wheat and nothing but wheat (except for the placebo starch).

The reason I chose the method in the last post is that it directly tests wheat in a form that a person would be likely to eat: bread. The limitation of the gluten shake method is that it would miss a sensitivity to components in wheat other than gluten. The limitation of the pill method is that raw flour is difficult to digest, so it would be difficult to extrapolate a sensitivity to cooked flour foods. You might be able to get around that by filling the pills with powdered bread crumbs. Those are two alternative ideas to consider if the one I posted seems too involved.

Blinded Wheat Challenge

Self-experimentation can be an effective way to improve one's health*. One of the problems with diet self-experimentation is that it's difficult to know which changes are the direct result of eating a food, and which are the result of preconceived ideas about a food. For example, are you more likely to notice the fact that you're grumpy after drinking milk if you think milk makes people grumpy? Maybe you're grumpy every other day regardless of diet? Placebo effects and conscious/unconscious bias can lead us to erroneous conclusions.

The beauty of the scientific method is that it offers us effective tools to minimize this kind of bias. This is probably its main advantage over more subjective forms of inquiry**. One of the most effective tools in the scientific method's toolbox is a control. This is a measurement that's used to establish a baseline for comparison with the intervention, which is what you're interested in. Without a control measurement, the intervention measurement is typically meaningless. For example, if we give 100 people pills that cure belly button lint, we have to give a different group placebo (sugar) pills. Only the comparison between drug and placebo groups can tell us if the drug worked, because maybe the changing seasons, regular doctor's visits, or having your belly button examined once a week affects the likelihood of lint.

Another tool is called blinding. This is where the patient, and often the doctor and investigators, don't know which pills are placebo and which are drug. This minimizes bias on the part of the patient, and sometimes the doctor and investigators. If the patient knew he were receiving drug rather than placebo, that could influence the outcome. Likewise, investigators who aren't blinded while they're collecting data can unconsciously (or consciously) influence it.

Back to diet. I want to know if I react to wheat. I've been gluten-free for about a month. But if I eat a slice of bread, how can I be sure I'm not experiencing symptoms because I think I should? How about blinding and a non-gluten control?

Procedure for a Blinded Wheat Challenge

1. Find a friend who can help you.

2. Buy a loaf of wheat bread and a loaf of gluten-free bread.

3. Have your friend choose one of the loaves without telling you which he/she chose.

4. Have your friend take 1-3 slices, blend them with water in a blender until smooth. This is to eliminate differences in consistency that could allow you to determine what you're eating. Don't watch your friend do this-- you might recognize the loaf.

5. Pinch your nose and drink the "bread smoothie" (yum!). This is so that you can't identify the bread by taste. Rinse your mouth with water before releasing your nose. Record how you feel in the next few hours and days.

6. Wait a week. This is called a "washout period". Repeat the experiment with the second loaf, attempting to keep everything else about the experiment as similar as possible.

7. Compare how you felt each time. Have your friend "unblind" you by telling you which bread you ate on each day. If you experienced symptoms during the wheat challenge but not the control challenge, you may be sensitive to wheat.

If you want to take this to the next level of scientific rigor, repeat the procedure several times to see if the result is consistent. The larger the effect, the fewer times you need to repeat it to be confident in the result.


* Although it can also be disastrous. People who get into the most trouble are "extreme thinkers" who have a tendency to take an idea too far, e.g., avoid all animal foods, avoid all carbohydrate, avoid all fat, run two marathons a week, etc.

** More subjective forms of inquiry have their own advantages.

Eating Wheat Gluten Causes Symptoms in Some People Who Don't Have Celiac Disease

Irritable bowel syndrome (IBS) is a condition characterized by the frequent occurrence of abdominal pain, diarrhea, constipation, bloating and/or gas. If that sounds like an extremely broad description, that's because it is. The word "syndrome" is medicalese for "we don't know what causes it." IBS seems to be a catch-all for various persistent digestive problems that aren't defined as separate disorders, and it has a very high prevalence: as high as 14 percent of people in the US, although the estimates depend on what diagnostic criteria are used (1). It can be brought on or exacerbated by several different types of stressors, including emotional stress and infection.

Maelán Fontes Villalba at Lund University recently forwarded me an interesting new paper in the American Journal of Gastroenterology (2). Dr. Jessica R. Biesiekierski and colleagues recruited 34 IBS patients who did not have celiac disease, but who felt they had benefited from going gluten-free in their daily lives*. All patients continued on their pre-study gluten-free diet, however, all participants were provided with two slices of gluten-free bread and one gluten-free muffin per day. The investigators added isolated wheat gluten to the bread and muffins of half the study group.

During the six weeks of the intervention, patients receiving the gluten-free food fared considerably better on nearly every symptom of IBS measured. The most striking difference was in tiredness-- the gluten-free group was much less tired on average than the gluten group. Interestingly, they found that a negative reaction to gluten was not necessarily accompanied by the presence of anti-gluten antibodies in the blood, which is a test often used to diagnose gluten sensitivity.

Here's what I take away from this study:

1. Wheat gluten can cause symptoms in susceptible people who do not have celiac disease.
2. A lack of circulating antibodies against gluten does not necessarily indicate a lack of gluten sensitivity.
   
3. People with mysterious digestive problems may want to try avoiding gluten for a while to see if it improves their symptoms**.
4. People with mysterious fatigue may want to try avoiding gluten.
   

A previous study in 1981 showed that feeding volunteers a large dose of gluten every day for 6 weeks caused adverse gastrointestinal effects, including inflammatory changes, in relatives of people with celiac disease, who did not themselves have celiac (3). Together, these two studies are the most solid evidence that gluten can be damaging in people without celiac disease, a topic that has not received much interest in the biomedical research community.

I don't expect everyone to benefit from avoiding gluten. But for those who are really sensitive, it can make a huge difference. Digestive, autoimmune and neurological disorders associate most strongly with gluten sensitivity. Avoiding gluten can be a fruitful thing to try in cases of mysterious chronic illness. We're two-thirds of the way through Gluten-Free January. I've been fastidiously avoiding gluten, as annoying as it's been at times***. Has anyone noticed a change in their health?


* 56% of volunteers carried HLA-DQ2 or DQ8 alleles, which is slightly higher than the general population. Nearly all people with celiac disease carry one of these two alleles. 28% of volunteers were positive for anti-gliadin IgA, which is higher than the general population.

** Some people feel they are reacting to the fructans in wheat, rather than the gluten. If a modest amount of onion causes the same symptoms as eating wheat, then that may be true. If not, then it's probably the gluten.

*** I'm usually about 95% gluten-free anyway. But when I want a real beer, I want one brewed with barley. And when I want Thai food or sushi, I don't worry about a little bit of wheat in the soy sauce. If a friend makes me food with gluten in it, I'll eat it and enjoy it. This month I'm 100% gluten-free though, because I can't in good conscience encourage my blog readership to try it if I'm not doing it myself. At the end of the month, I'm going to do a blinded gluten challenge (with a gluten-free control challenge) to see once and for all if I react to it. Stay tuned for more on that.

Garlic, the sources of antiobiotic

Garlic is a broad spectrum antibiotic, killing a wide variety of bacteria. Many pharmaceutical antibiotics kill only a narrow range of these germs. Dr. Tariq Abdullah, a prominent garlic researcher stated in the August 1987 issue of Prevention: “Garlic has the broadest spectrum of any antimicrobial substance that we know of — it is antibacterial, antifungal, antiparasitic, antiprotozoan and antiviral.”  This property belongs to the garlic constituent allicin, which is released when you cut a garlic clove. This is the chemical that gives fresh garlic its strong biting flavor, and you need to use fresh garlic to get a reliable antibiotic effect. Commercial powders and other products will not work for direct applications. Garlic appears to have antibiotic activity whether taken internally or applied topically — researchers found that the urine and blood serum of human subjects taking garlic had activity against fungi

Some bacteria, viruses, fungi, mold, and parasites killed or inhibited by garlic or its constituents:

Acinetobacter calcoaceticus

Aspergillus flavus

Aspergillus fumigatus

Aspergillus parasiticus

Aspergillus niger

Bacillus cereus

Candida albicans

Candida lipolytica

Cryptococcus neoformans

Cryptosporidium

Debaryomyces hansenii

Escherichia coli

Hansenula anomala

Herpes simplex virus type 1

Herpes simplex virus type 2

Histoplasma capsulatum

Human cytomegalovirus (HCMV)

Human immunodeficiency virus (HIV)

Human rhinovirus type 2

Influenza B

Kloeckera apiculata

Lodderomyces elongisporus

Parainfluenza virus type 3

Vaccinia virus

Vesicular stomatitis virus

Micrococcus luteus

Mycobacterium phlei

Mycobacterium tuberculosis

Paracoccidioides brasiliensis

Pneumocystis carinii

Proteus vulgaris

Pseudomonas aeruginosa

Rhodotorula rubra

Saccharomyces cerevisiae

Salmonella typhimurium

Salmonella typhimurium

Shigella dysenteriae

Shigella flexneri

Staphylococcus aureus

Streptococcus faecalis

Torulopsis glabrata

Toxoplasma gondii

Vibrio parahaemolyticus

(Sources: Adetumbi et al 1983, 1986; Anesini and Perez 1993; Appleton and Tansey 1975; Borukh et al 1974, 1975; Chen et al 1985; Conner and Beuchat 1984; Dankert et al 1979; Didry et al 1987; Fletcher et al 1974; Fliermans 1973; Fromtling and Bulmer 1978; Ghannoum 1990; Gonzales-Fandos et al 1994; Johnson and Vaughn 1969; Kabelik 1970; Kumar and Sharma 1982; Mahajan 1983; Moore and Atkins 1977; Sandhu et al 1980; Sharma et al 1977;Shashikanth et al 1984; Tynecka and Gos 1973, 1975)

 

Resistant bacteria

A major problem with pharmaceutical antibiotics is that they can promote the development of resistant strains of bacteria. Initially the antibiotic kills most of the bacteria being attacked. With repeated exposure, however, those few bacteria that by chance are genetically resistant to the antibiotic begin to multiply. Eventually a recurring infection becomes completely resistant to that antibiotic. After a half century of the massive use of antibiotics, and the indiscriminate over-prescription of them in North America, potentially serious medical problems exist from resistant strains of bacteria. Garlic does not seem to produce such resistant strains, and may be effective against strains that have become resistant to pharmaceutical antibiotics. European researchers in the late 1970s tested garlic juice against a group of ten different bacteria and yeasts (Moore and Atkins 1977). They found that garlic was effective against all of them, and also found a “complete absence of development of resistance.” In an Indian study of garlic for dysentery, the researchers specifically selected four bacterial strains that were resistant to multiple antibiotics (Chowdhury et al 1991).

Garlic is effective against specific bacteria that are notorious for developing resistant strains, such as staphylococcus, mycobacterium, salmonella, and species of Proteus.

 

Antiviral activity

A weakness of conventional antibiotics is that they are not effective against viral infections. That’s why they won’t work against the common cold or flu. They also won’t work against some serious viral infections like viral meningitis, viral pneumonia, or herpes infections. Garlic or its constituents will directly kill influenza, herpes, vaccinia (cowpox), vesicular stomatitis virus (responsible for cold sores), and human cytomegalovirus (a common source of secondary infection in AIDS.) Garlic will also cure or improve the symptoms of a variety of viral diseases in humans or animals. In one animal study, researchers first fed a garlic extract to mice. They then introduced the flu virus into the nasal passages of the animals. Those animals that had received the garlic were protected from the flu, while the untreated animals all got sick. The researchers postulated that garlic’s effect was due in part to direct antiviral effects of garlic, and in part to stimulation of the immune system (Adetumbi and Lau, 1983)

Parasites and fungi

The medical missionary Albert Schweitzer brought some fame to garlic earlier this century when he used it successfully to treat amoebic dysentery in his patients in equatorial Africa. Subsequent experiments have shown garlic to be effective not only against the parasitic amoebas that cause dysentery, but against other organisms such as toxoplasma, cryptosporidia, and pneumocystis, all of which cause disease in humans.

Parasitic infections are a common problem in AIDS patients. Dr. Subhuti Dharmananda, Director of the Immune Enhancement Project in Portland, Oregon, regularly treats AIDS patients with such opportunistic infections. The main antibiotic therapy he uses in garlic, at about nine cloves a day for active infections, and he finds it effective to prevent or treat these infections, even when conventional antibiotics have failed to do so. Note that he started out trying to use an encapsulated form of garlic standardized for its allicin content — one of the better products. He found, however, that even doses of twenty-seven capsules a day had no effect on the infections. When he switched to raw garlic at the same dose, he got the desired result (Dharmananda 1995). Recent research supports use for intestinal parasites in AIDS (AIDS Research Alliance 1996; Deshpande et al 1993).

 

Yeast infections

If you’ve ever had athlete’s foot, you know how stubborn a yeast or fungal infection can be. A garlic wash can be very effective against fungi externally, but garlic can also treat systemic fungal infections. Researchers from the University of New Mexico demonstrated that garlic was effective both in the test tube and in animals against infection with the fungus Cryptococcus neoformans. Chinese researchers also have shown that garlic as a intravenous extract can be effective against cryptococcal meningitis. The blood and cerebrospinal fluid of the patients in that trial was twice as effective against the fungus as before treatment with garlic.

How to use garlic

To use garlic as an antibiotic take it internally and, if appropriate, apply it directly to an infection. For internal use, try one of the following forms:

Garlic infused wine. Chop or crush garlic, cover with wine, and let it sit overnight.

Garlic vinegar. Same as above, but use vinegar instead of water.

Garlic honey. Same as above, but with honey. No added water is needed. This makes a great antibiotic cough syrup.

Garlic/carrot juice. Blend three cloves of garlic up in six ounces of carrot juice. Let it sit for four to six hours.

For external application, use caution putting crushed garlic directly against the skin, because it can cause burns. Here are some forms you can use for direct application of garlic as an antibiotic:

Blend up three cloves of garlic in a quart of water and apply as a wash. Make a larger amount of this mixture and use it as a sitz bath or foot bath for infections of the feet or pelvic area.

Crush garlic, and dilute the juice with ten part of water. Use it as nose drops or a gargle.

 

Garlic and the immune system

Although garlic attacks bacteria, viruses, and other microorganisms directly, it also stimulates the body’s natural defenses against these invaders. Garlic’s remarkable and legendary power against infectious diseases is due to a combination of both these properties.

Garlic or its constituents activate phagocytes, B-Cells, and T-cells — all three levels of the cellular immune system. For instance, diallyl trisulfide, a constituent of garlic, was found to activate natural killer cells and macrophages directly, and indirectly to increase B-cell activity to make antibodies. It did this in lab experiments at concentrations of as low as one microgram per ml — the equivalent of a tiny pinch of salt in about 30 gallons of water. The macrophages in this trial were then tested for their activity against cancer cells, and the diallyl-trisulfide-treated cells were more active than regular macrophages, indicating that not only their number but their activity was increased (Feng et al 1994). This same effect has been reproduced in other experiments.

This effect is not limited to trials in a test tube. Dr. Abdullah experimented with garlic in AIDS, giving the equivalent of two cloves a day of garlic to ten patients for six weeks, and the equivalent of four cloves for another six weeks. Three of the patients could not complete the trial, but of the seven who did, all showed normal natural killer cell activity by the end of the trial — activity which had been depressed at the start of the trial. The patients’ opportunistic infections — chronic diarrhea, candida infection, genital herpes, and a chronic sinus infection — all improved. The patient with the chronic sinus infection had gained no relief from antibiotics during more than a year of treatment before the garlic trial (Abdullah 1989).

 

In one trial, immune parameters of the blood were measured after subjects — elderly patients — took a garlic powder preparation for three months (Brosche and Platt, 1993, 1994). The dose was only 600 mg of the powder per day, the equivalent of less than one-third of a garlic clove. Blood tests showed an increase in phagocytosis of the white blood cells, and also increased numbers of lymphocytes, responsible for cell-mediated immunity. Other trials have shown that garlic can increase the activity of natural-killer cells in healthy volunteers

Soy milk, a Source of Healthy Diet

 

According to the recent researches, cow's milk is not better in nutritional value than soy milk. Either cheaper than cow's milk, soy milk is not fattening and can be consumed by those who can not drink cow's milk because lactose intolerant reason. Soy milk is also an excellent source of phytoestrogens, the essential enzim for women.

In fact, the nutritional value of soy milk is not less than cow milk. As prices soar cow's milk, many people who prefer to stop the consumption of milk rather than replace them with alternatives such as soy milk.
Drinking milk must be a habit. At least a day we should consume a glass of milk.

Soy milk can be a solution for those who can not consume cow's milk with a variety of reasons, such as allergies, lactose intolerance, or because of economic factors. Soy milk can also be a substitute for cow's milk variety menu to avoid saturation.

Not Ordinary Drink
Soy milk is highly nutritious beverage which was originally developed in China. This drink is known in the 2nd century AD From China, soy milk and then evolved into Japan. After World War II, soybean milk became popular in Southeast Asia, including Indonesia.

In Hong Kong, soy milk is better known by the name vitasoy. In Singapore and Malaysia, soy milk is familiar with vitabean. In both countries, soy milk has been cultivated commercially since 1952. In the Philippines, popularly known as philsoy. In Indonesia, soy milk was originally sold on the roadside flora. In recent years, soy milk in cardboard boxes or bottles, many in the market.

Viewed from the nutritional value, soy milk is not less than cow milk. Therefore, soy milk can be used as a substitute for cow's milk. Two glasses of soy milk consumption has been able to meet 30 percent of the daily protein requirement. In 100 grams of liquid soybean milk contained 3.5 gram of protein, whereas in cow's milk is only 3.2 grams per 100 gram.

Quality protein, soy milk no less than cow milk. Quality protein, soy milk in the form of a single food is 80 percent of cow's milk protein quality. This can be seen from the PER (protein eficiency ratio) of soy milk that is not much different from cow's milk.

PER value of 2.3 soy milk, whereas cow's milk 2.5. PER value of 2.3 means that from every gram of protein consumed will result in weight gain of 2.3 grams in standard experimental conditions (usually done with the animal experiments). That the higher the PER value indicates the better quality protein.

Essential amino acids in soy milk contained in the composition is almost complete and harmonious. Compared with cow's milk, the composition of amino acids in protein, soy milk with less in terms of methionine and cysteine. The main advantage of soy milk has the amino acid lysine is high enough. Thus, soy milk can be used to improve the nutritional value of protein from rice and other cereal foods.

Not to Make Fat
Soy milk good for those who want to diet, but still supplying the needs of protein in sufficient quantities. One of the advantages of soy milk compared to cow's milk is low fat content.

Fat in soy milk can not cause obesity because most are in the form of unsaturated fatty acids. Meanwhile, the fat in cow's milk is a potential animal fats cause the body to be elastic because they contain saturated fatty acids is quite high. Another advantage, soy milk contains no cholesterol.

Although soy milk contains carbohydrates are good enough, only 12-14 percent that can be used in a biological body. Carbohydrate group consisting of oligosaccharides and polysaccharides class. Class consisting of oligosaccharides and raffinosa stakiosa soluble in water, whereas erabinogalaktan group consisting of polysaccharides and cellulosic materials are not soluble in water, and can not be digested.

Generally, soy milk has a good content of vitamins, especially A and B complex, except for vitamin B12. Other vitamins contained in considerable amounts is vitamin E and K. No wrong when during the many people who argue that drinking soy milk to make the body younger. Vitamin E and A is an antioxidant that can prevent premature aging.