Saturday, April 2, 2011

Is Gluten Making My Gut Leaky? (A Shorter Post!)

by Chris Masterjohn

While some people really liked my last blog post, one commenter asked me to writer a shorter post next time.  So here's a shorter post.

A commenter on Paul Jaminet's blog recently suggested that the reason I developed some arthritic symptoms including a limp during a brief stint eating two to three sweet potatoes per day was not because they are extremely high in oxalates, which was my guess, but because wheat is giving me leaky gut, allowing the lectins in sweet potatoes (and all other plant foods, he suggests) to cause an autoimmune reaction.

I actually don't consume a whole lot of wheat and most of my gluten comes from rye that has been soured for 24 hours, which is likely to be pretty low in gluten. 

However, I believe I had been gluten-free for over a year before the sweet potato incident.  In looking back at past emails and posts on various lists, I find that I went gluten-free and casein-free back in July of 2005 and that the sweet potato incident happened mid-October, 2006.  Although I do not have any record of the exact date I reintroduced the 24-hour soured rye bread, the earliest record I can find is a post I wrote on November 23, 2006 saying I reintroduced it "recently."

Although my memory of what I ate four to five years ago is not perfect, I believe the reason I was eating so many sweet potatoes to begin with was because I was trying to do the FAILSAFE diet while also remaining gluten-free and casein-free, and I was finding it difficult to obtain sufficient calories without using lots of vegetables or starches as a vehicle for fat.  So I feel pretty confident I was gluten-free at the time.

In any case, given the two recent studies showing that gluten and wheat do not cause leaky gut in people without celiac, I'm not sure why anyone would propose that I would have a leaky gut from eating wheat, even if I were actually eating a substantial amount of wheat.

As I pointed out in my last gluten post, a recent paper by gluten researcher Dr. Allesio Fasano and colleagues found that intestinal permeability was even lower in people they judged as having non-celiac gluten sensitivity who had been eating gluten under supervision for four months when they compared them to control subjects, whereas those with active celiac disease had greater intestinal permeability.

Likewise, the recent double-blind, placebo-controlled gluten trial  found that six weeks of gluten consumption did not cause any change in intestinal permeability in subjects the authors judged as having non-celiac gluten sensitivity.

I realize these studies are new and these findings may not be well known, but it seems that it is time to stop assuming that gluten causes intestinal permeability in anyone except people with celiac, unless some contrary information emerges.  It is, of course, possible that some subset of people without celiac exists in whom this occurs, but one would think that if it occurs in anyone without celiac, it would be in people considered to be gluten-sensitive.

If anyone knows of clear evidence that gluten alters intestinal permeability in humans without celiac, please post a link to the study in the comments.

Read more about the author, Chris Masterjohn, PhD, here.



    That's all I got. The autistic kids on GFCF diet had less gut permeability even than normal controls. None of the permeability findings or intestinal symptoms were related to celiac markers or intestinal symptoms.

  2. Good points, it is nice to have someone challenging what seems to be just so accepted around this blogosphere.

    So just intestinal permeability, then? This is the best one I could find from one of Loren Cordain's articles. I'm not much of an expert so I'll let you read it over. It is with isolated gliadin and so maybe that can't be extrapolated to dietary gluten. Doesn't it stand to reason that gluten=gliadin or are we talking the whole gluten molecule causing intestinal permeability? Anyway...

    Usually people just sort of assume that if you can say it about wheat gliadin you can say it about the oat equivalent, which is indeed an assumption.

    I just know that grass seeds want me dead, heh.

  3. I've not read them, and one of these you already took apart with fine-toothed comb, but many are listed:


    Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines.

  5. Dr. Emily, thanks for the study! It's quite interesting, although it doesn't seem to offer any support to the idea that gluten causes leaky gut even in autistics, though it might. Unlike people with "non-celiac gluten sensitivity," the paper suggests that a high proportion of autistics and their first-degree non-autistic relatives have leaky gut. The authors concluded from this that leaky gut seems to be a result of direct genetic predisposition. I agree their data support a role for biological inheritance, although they do not seem to have provided any cause-and-effect data tracing this to specific genetic or non-genetic types of biological inheritance. They state that only two subjects were on a gluten-free, casein-free diet, so it seems somewhat meaningless to compare them to the other 88 autistic children, especially since we don't know why they went GFCF. They also state that only two subjects had high serum levels of anti-gliadin antibodies, but they do not state if they were the same two subjects as the two who were on a GFCF diet. If they were, then perhaps this represents the decreased intestinal permability that Fasano et al observed in "non-celiac gluten sensitivity" even when subjects had been eating gluten for four months. The authors remark in their concluding statement, "Different IPT [intestinal permeability] values were obtained in children with ASD [autism] based on their diet. The latter data require controlled studies to be confirmed." I definitely agree.

    Stabby, thanks! Yes, all I am writing about is intestinal permeability. The post is meant to be "short," not comprehensive! I have less of a problem extrapolating from isolated gliadin to bread -- though this clearly involves a major logical fallacy if it is meant to do anything other than suggest a hypothesis that should be investigated -- than I have with extrapolating from a test tube system supposing to mimic human intestines and the actual human digestive process. The study you link to is not conducted in living humans. The two studies I linked to were. The study you link to is worth justifying the *hypothesis* that eating gluten may cause leaky guts in people who do not have celiac disease, but it cannot be logically construed as *support for* that hypothesis. The studies I linked to, especially the double-blind, randomized controlled trial that came out of Australia, clearly test and clearly refute that hypothesis.

    Anonymous, I have seen that post, although as much as I appreciate the author collecting research, for someone who admits they haven't actually read any of the studies and leaves little commentary about their strengths or weaknesses or how to interpret them, I'm not sure it makes much sense for me to try to pick apart each study in response. I would just like, instead, for people advocating the very specific hypothesis that gluten causes leaky gut in people without celiac disease to either provide a single controlled studiy conducted in living humans showing that this is the case, or to acknowledge that the available data conducted in living humans so far refutes that hypothesis.

    Gluten could be the devil, of course, but if the devil isn't going around making people's guts leaky, then it wouldn't follow that gluten would do so.

  6. Having digestive issues with sweet potato could be the mannitol in sweet potatoes. Some people have trouble with sugar alcohols. I do.

    Does whole spelt flour have beatine in it? My internet searches seem inconsistent on if spelt contains beatine or not. I'm in the middle of testing spelt right now. I appear to be able to digest spelt easier than white flour. I'm afraid to try whole wheat flour. My IBS started 20 years ago when my mother started buying whole wheat bread. I run into fructan build up issues with homemade white bread as it is.

    Also, I seem to have more trouble in general when I ferment foods. Buckwheat and white wheat bread are the only item that I can tolerate in fermented form. Brown rice, beans and spelt seem more difficult to digest if I ferment them. I don't understand why fermenting foods would make them more difficult to digest. Is it worth eating spelt if I can't ferment it?

  7. Anonymous, as per my comments above, this study is not conducted in humans. It cannot under any circumstances be logically construed as support for the hypothesis that gluten causes leaky gut in humans. If, in fact, that was observed to be the case, this study could be construed as mechanistic data offering a possible explanation of why that effect occurred. In the absence of such data, it could be used as a justification to investigate the hypothesis. However it cannot logically be construed as an actual investigation of the hypothesis.

    Dr. Fasano's study is observational and cannot prove cause-and-effect, but it refutes the hypothesis that this condition even exists in people who are not celiac but are gluten-sensitive, and the Australian study directly tests and directly refutes the hypothesis that gluten causes leaky gut in people with this condition.


  8. Chris: the Australian study indeed suggests that there was no difference in intestinal permeability between celiacs and non-celiacs eating gluten. But unless I'm misreading the abstract, it also suggests that non-celiacs did have intolerance symptoms to gluten (increased fatigue, bloating, pain, etc.).

    While I agree that it's important to be precise about claims being made about leaky gut and gluten, the most important thing about this study from my perspective as a clinician (and from a patient/consumer's perspective) is that gluten can (and very often does) cause intolerance symptoms even in people who aren't celiac.

  9. Chris, I'm curious about gluten and the idea it could have negative effects on ones health, whether or not it causes leaky gut. Wikipedia states that much more research needs to be done on the subject of leaky gut, but assets the following:

    Alcohol consumption induces a state of "leaky gut" increasing plasma and liver endotoxin levels, leading (in excess) to liver diseases."

    Given that many adults consume alcohol, I wonder if the proteins in wheat are not the cause of leaky gut, but might have an impact on health due to other factors in our diet that cause leaky gut and allow the proteins to create inflammation or allergies. I have no idea if I have leaky gut, but I know that when I reduced my carbohydrate and grain consumption my allergies went away and my joint pain was greatly lessened. In addition, my hsCRP fell from 2.5 to .9 over about an 18 month period after I changed my diet. It may be that removing gluten had nothing to do with the results, as I have insulin resistance, so perhaps the gluten is a red herring, but I have not been willing to add it back.

    I'm curious what your thoughts might be on whether you think gluten or other wheat proteins are safe because they don't cause leaky gut?

  10. Hi Chris, I was the commenter on Paul Jaminet's blog you were referring to. It's not only the gluten in wheat that may cause the leaky gut. I was more aiming at the several different lectins that are found in grains, legumes and nightshades. I wrote this post regarding the subject It is more or less based on the ideas Loren Cordain has on the subject. VBR Hans Keer

  11. Where is the discussion about Candida in the fungal form causing leaky gut and your eating lots of sweet potatoes would be food for the Candida which would cause gas and bloating and other digestive issues.

  12. I have recently been directed to this:

    Apparently it has been known for some time that celiac disease has strong correlations to schizophrenia.
    The researcher has also noted that the relationship is true of non-celiac gluten intolerance.

    Assuming this is all true - (the data is very poorly referenced), then what is the mechanism that is relating gluten intolerance to schizophrenia? My first thought is that it is GUT related, but then why would it still be happening in non-celiac gluten allergy sufferers if their guts are perfectly healthy?

  13. There's a difference between saying that intestinal permeability was lower in gluten sensitive people than control subjects and saying that gluten does not cause leaky gut!!

    The study might mean that leaky gut isn't the source of some people's distress. Or it might be something else, or nothing at all. What it doesn't mean is that wheat doesn't cause leaky gut.

    After all, isn't gluten used as a drug delivery device (for compounds that are otherwise not possible to absorb) precisely because it puches holes in the gut?

  14. Chris,

    I am familiar with the ASD GFCF study posted above. While our families share a genetic predispostition, we also share crappy gut flora as well. Most of us who have our ASD kids on diets also have them on probiotics/fermented foods as well. So it's hard to say how much of that improvement is diet and how much is improvement from gut flora (although my own personal hunch is that the diet is also improving gut flora). As for Fasono research, if zonulin affects tight junctions, could some lack of gut flora allow more gluten to affect tight junctions in non-celiacs?

  15. I will try to respond to the other comments soon.

    For now,

    Anonymous, what the two studies show is 1) decreased intestinal permeability *is not present* in gluten-sensitive subjects who have been eating wheat for four months, and 2) deamidated gluten *does not cause* increased intestinal permeability in gluten-sensitive subjects.

    If you want to maintain that wheat causes intestinal permeability, you would have to maintain that this increase in permeability is so small that it can not even raise permeability to the level of control subjects, never mind beyond it, and that it is not caused by gluten.

    It is of course possible that gluten-sensitive subjects have such a dramatically robust intestinal barrier function that the effects of wheat cannot overcome it, but that would obviously raise quite major questions about the physiological relevance of this supposed increase in intestinal permeability that has never been shown in a single human study, and based on the Australian study, these apparently irrelevant effects would have to be caused by something in wheat other than gluten.

    In any case, such probably irrelevant effects have never been shown in humans, and the balance of the evidence thus far refutes the hypothesis that wheat causes leaky gut in non-celiacs.


  16. Chris, as I understand it, wheat causes measurable permeability in everybody. It just didn't cause more in gluten senstitive people.

  17. Anonymous,

    So your conclusion is that no evidence can substantiate that wheat has this effect, because everyone already has a leaky gut from eating wheat? If so, with what evidence do you substantiate the effect of wheat at all?


  18. Chris:

    Thank you for taking on gluten!

    There are lots of good reasons to cut out "grains" from your diet. They will make you fat, as they are easy to over-eat. Low nutritional value. Also, the easiest way to get off the SAD is get off wheat.

    That all being said, eating a few pieces of bread, or pasta, or a slice of pie isn't going to kill you.

    How many gluten complaints just come down to gas and bloating? And how many are taking place in the stomach, versus the gut (time after eating?). You can't factor out the brain here -- if you tell people they are allergic to something they will act allergic.

    gas and bloating isn't fun, but then again neither is brussels sprouts. Eat too much of one thing -- sweet potatoes, meat, bacon, bread -- you're going to get an upset stomach.

    2-3 sweet potatoes a day is going to make you feel like ass. Sorry. too much of one food.

  19. Gordon Rouse dissed my psychology today article as poorly referenced? The free full text link to the main scientific article by Dohan is right there! Also many other articles. Clicky clicky! But the most you will find is circumstantial evidence. There is no smoking gun. (oh, I said that in the article! Why is it that no one actually reads?)

    Chris - yeah, I make no claims the autism study is by any means definitive, but seriously, it is the only study that had a hint of in human gut leakiness linked to GF (and casein free) that I've ever seen. That's why I said "that's all I've got." :-)

  20. While this study is interesting in that it measures the intestinal permeability between celiacs and the gluten sensitive, in no way was it designed to answer the question of whether the consumption of wheat proteins leads to intestinal permeability. To do so would require comparing two groups of people consuming wheat against another group of people consuming none over a period of time to definitively answer that question. And are we all convinced that the only protein in wheat that would cause damage to the mucosal layer is gluten? Have we forgotten that pesky little pesticide called wheat germ agglutinin that is specifically designed by nature to attach itself to carbohydrate receptors on cells with special affinity for mucosal surfaces like the glycocalyx of the intestinal brush border? It seems to me that the case against WGA, especially in regards to its apparent ease in crossing the intestinal barrier as well as the blood brain barrier, is a far more plausible explanation for biological disturbance than gluten alone. Wheat flour and sugar are what were introduced to primitive cultures that seemed to torpedo their health in short order. While I used to focus on sugar, I've begun to believe that flour, or wheat in general, may be the biggest agent of disease.

  21. Ok I promise responses to other comments are coming, but yes, Emily, I entirely took your meaning on "that's all I've got," and in connection with that post, see my latest blog post where I provided five links to substantiate why "Emily Deans rocks," which I would say is very well referenced.

  22. Anonymous, I agree that it is *possible* that WGA causes leaky gut in humans, but again as indicated by my latest post, we at least need to show a population with leaky gut in order to explain it. Then we need to test the hypothesis. I'm not claiming comprehensive refutation, as explicitly admitted in today's post.

  23. Chris K,

    There are two separate studies. The Australian study did not have any celiacs in it at all. It was a double-blind, randomized, controlled trial that fed gluten-free baked goods that either did (gluten) or did not (placebo) have gluten added, for six weeks, to non-celiac gluten-sensitive patients that had been eating gluten-free. They did claim evidence that the gluten group had a worse increase in symptoms and symptom severity than the placebo group (though both got a lot worse!) but for reasons I explained in my "Gluten Sensitivity -- Promises and Problems" post, and my regression to the mean post, I think the data were reported too poorly to understand how convincing this effect was. In any case, it also showed that gluten had no effect on intestinal permeability or C-reactive protein.

    Then there was Fasano's study, who is working out of Baltimore, and that showed that non-celiac gluten sensitive subjects undergoing a four-month gluten challenge had lower intestinal permeability than controls who were neither celiac nor gluten sensitive. In other words, they had more intestinal integrity than is normal.

    I agree with you that anecdotal evidence is supportive of non-celiac gluten sensitivity, and that one shouldn't need to wait for definitive evidence to act on a reasonable hypothesis and to make judgment calls in the face of uncertainty in an attempt to improve health. Doing that is necessary.

    Nick, I will have to look at the alcohol studies, but increased liver and blood levels of endotoxin is not necessarily a sign of leaky gut. It could just indicate a blunting of the phagocytic activity of Kupffer cells, which are cells in the liver who have as one of their main functions to mop up all the endotoxin that enters the liver and destroy it. I don't know if the gluten is a red herring in your case, but I know that the recent double-blind, placebo-controlled gluten trial found that in non-celiac gluten sensitivity, gluten does not increase C-reactive protein. I find that my allergies are greatly diminished when I avoid too much sugar and caffeine and when I get enough vitamin A, but your experience might be different. I don't think that gluten is safe simply because it doesn't cause leaky gut, but I think the jury is out and I am not ready to condemn gluten even for non-celiac wheat sensitivity. People often assume their problem with wheat is the gluten, and it may be, bu ti tcould also be the WGA or the inulin/FOS, etc. Also, most wheat products are complete garbage.

    Anonymous, I certainly can't rule that out, but I have no evidence that I had leaky gut and I did not have a general reaction to carbs but a specific reaction to sweet potatoes. But you never know.

    Gordon, Fasano found that non-celiac gluten-sensitive patients did not have leaky gut, but his paper does identify some apparent immune activation in the gut that could be a problem. Also, I think the schizophrenia-gluten hypothesis is interesting, but it can hardly be said to be much more than a very interesting hypothesis at this point. But anyway, even starch could contribute to dysbiosis if the gut ecology is primed for it. There are lots of ways to affect the gut and through the gut the rest of the body.

    Mrs. Ed, Yes, gut flora almost certainly affects sensitivity to gliadin as well as gut permeability. There is clear evidence supporting this.

  24. Neither of these studies controlled for pesticides. Grains are probably the most heavily treated food. They are not only sprayed in the field, they are also treated during storage.

    I wonder how much GS is really a reaction to all the pesticide residue. I'd like to see a study using organic and non-organic grains as well as gluten and gluten free food.

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  26. Sorry, Emily, I did miss the link.

    Big scary paper! - still could not find the ref about the mental institute - 1967, which sounded like the best evidence for a correlation existing?


    My wife has celiac and bi-polar, she has a brother with schizophrenia and another brother with epilepsy and an unconfirmed wheat intolerance.

    It sure is smokey here!

  27. It's not just about the gluten, and testing purified gluten doesn't represent wheat or gluten grains...
    1) context may influence conversion of gliadin to gliadomorphin (and so on) in the gut.
    2) lectins in wheat another possibility
    3) ditto FODMAPS
    4) ditto immunological sensitivity to insect parts, rat hairs and faeces.
    5) ditto phytates witholding nutrients needed for tight junctions

    There's probably more...
    Why eat grains anyway? What is it with grass seed? I don't get it.
    Is it the morphine (exorphins), is it the high carb content?
    It sure ain't the nutrition!

    1. Hi George,

      That was the point of the "last post" I linked to above. I agree with you that it isn't just about gluten.

      I dealt with the evidence for "exorphins" in my review of Dr. Davis's book, Wheat Belly, here:


  28. Chris, since you mention the FAILSAFE Diet, what are your thoughts on it?


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