***DISCLAIMER: for brevity, I am not going to put references to individual studies in this article. Instead, at the end of each section, I will direct you to great resources and authors whom I have read in-depth (including analysis of the studies upon which their work is based) and who give a good overview understanding of the science in that respective area.
Additionally, since writing this piece, I have had the pleasure to hear Dr John Douillard (referenced in this article) on the Ben Greenfield Fitness podcast and the High Intensity Health podcast. He has promoted his angle on ‘drains not grains’ impeccably, and approaches this topic in a similar vein to my own. Where we may slightly diverge is in the area of what empowers digestive wellness… but I go into much more detail in this post, and in the next two or three articles which I have planned…***
Where Do I Stand In the Gluten and Grain Debate?
I am frequently asked, sometimes jokingly, sometimes pleadingly, what my take on gluten and/or grains is. Sometimes the question is, “should I eat bread”, sometimes “do your clients get to eat wheat?” and often, “am I allowed to eat gluten”?
Rolled into all of these questions is a variety of answers, and a host of different complicated scientific explanations – some of which I will go into in this article.
However, whilst the arguments for and against wheat are multifaceted and can fill whole books, those asking me to make an overarching judgement about gluten or grains are often disappointed with my actual response. But my response to this question is actually a fundamental principle upon which my entire practice in nutrition and Functional Medicine is based.
What you can or can’t eat has nothing to do with the food, and everything to do with you.
Is Gluten Healthy or Not?
Before I go totally off-piste, however, let’s start at the beginning and with the facts.
If you are coeliac then no, gluten is not healthy for you. It causes an autoimmune reaction inside the digestive tract itself, blunting and destroying the little brushes (villi) which are designed to absorb nutrients from ingested foods. This leads both to all sorts of gastrointestinal issues including GI distress, malabsorption, inflammation and microbiome disturbance, but also to a host of issues associated with this inability to absorb nutrients from food.
However, approximately 1% of people are diagnosed with coeliac disease (a figure which potentially rises to 3% when undiagnosed sufferers are taken into account). What about the billions of other people who either suspect Non-Coeliac-Gluten-Sensitivity, or think they are ‘intolerant’ to wheat? Are they making it up?
It is more than likely that these individuals are symptomatic upon ingesting wheat and/or gluten. However, for these individuals the symptomatic effect occurs through a different mechanism.
Gluten is a protein found in wheat, barley and rye. It is a complex chain of peptides which can only be incompletely broken down by the human digestive system. This is the protein that is ‘reacted’ to by those with coeliac disease, and causes the autoimmune attack on the villi.
In non-coeliac individuals gluten has still been shown to have potentially deleterious effects. The gluten protein increases levels of a protein within the gut called Zonulin. The role of zonulin is to regulate the ‘tightness’ of so-called ‘tight junctions’ within the gut. In the presence of the increased zonulin upon consumption of gluten such junctions open slightly farther than they ‘should’ increasing the permeability of the gut lining.
This is not an ideal situation. Food should be kept inside the gastrointestinal tract, nutrients absorbed across the barrier of the intestines, and those particles which can’t be absorbed should be detoxed through excretion or removal into the lymphatic drainage system or hepatic portal vein direct to the liver.
It is partly due to its capacity to affect the permeability of the intestines that gluten gets a reputation for being ‘bad for you’.
What happens when the junctions are widened is that more intact proteins and foodstuffs start to escape the confines of the GI tract and our immune system becomes alert to these invaders. In situations such as these – where there are proteins and molecules creeping into places that they should not be – our immune system does what it should do: it attacks. This attack is against the invading substances, of which gluten protein is the lead domino.
What happens next depends on the person, but essentially when inflammation starts it either focuses around the localised area (bloating, pain, GI symptoms, swelling, abdominal distress). Or it can cause systemic impacts (anything from joint pain to skin complaints to brain fog). It can also set off a cascade of other immune factors which begin attacking our own tissues (thyroid, myelin around nerves, the GI tract itself etc.)
Once the cascade of inflammation is begun it becomes a worsening scenario – from immune hypersensitivity, to autoimmunity, to pretty much every symptom you can name. An immune system in a state of high alert because of the impact of gluten has the potential to give rise to a host of symptoms. This is why it is sometimes farcical to consider the illnesses which have been tied to gluten issues – but there is a grain of truth in this (no pun intended!) Because of its capacity to set off alarm bells in the immune system, gluten’s impact can and is far-reaching in the body.
It should be noted that gluten is not the only protein in wheat and the role of other proteins is being extensively investigated (see ‘grain’ section below).
It should also be noted that not all gluten, or wheat, is created equal. The gluten, gliadin, gluteomorphin (other wheat proteins) levels vary wildly according to the different strains of the grain. Some wheat is a genetically modified, hybrid, selectively bred version of the grain that is far from the original. This is thought to be far more dangerous for the health of the GI tract and immune system – ironically not because of its gluten content, but because it is essentially a completely unnatural protein. LIkewise, pesticide use in modern farming impacts the tolerability of the grain, as does the processing. Refined grains, devoid of their outer husks, are a very different thing than ancient, wholegrain, intact wheat. And whilst it is not true that modern wheat is more dangerous because it contains more gluten, it is true to state that modern wheat is more indigestible because it is far from a natural grain.
If you’ll note from my explanation above, gluten does its thing in every human digestive system. It has similar effects in everyone.
The answer to whether gluten is healthy or not then becomes a question of whether your digestive system, general health, liver detoxification and lymph draining are at all weakened. If so, you will experience the negative impacts of gluten increasing zonulin within the GI tract. If you are compromised in any way health-wise, the impact of the gluten protein may begin a cascade of reactivity that is difficult to avoid.
That said, if your detoxification pathways, digestive function and internal environment are healthy, the ingestion of gluten may not cause any insurmountable issues within your body. You will naturally digest the protein, excrete through the bowel, the lymph and the liver everything that you could not absorb and be completely fine.
This therefore means that the question should never be “is gluten healthy?”, it should instead be, “is gluten healthy - for YOU?”
(RESOURCES: The leading researcher in gluten is Alessio Fasano – and a great wealth of his research can be found in PubMed by searching his name. A compendium of his gluten studies can be found on the Publications page here, with a great podcast interviewing him found here and a great YouTube video interview here.)
Are Grains Healthy Or Not?
OK, so if you dipped into Fasano’s work you’ll know that gluten is persona non grata in his world. Which is fine. But so often in the Paleo/Autoimmune/Alternative Health worlds we will hear ALL grains be castigated with the same damning appraisal. This is not based on the gluten/zonulin equation, so where does it come from and is it at all relevant or true?
As alluded to above, the lead domino in the increased permeability of the digestive tract is most often gluten. However, our immune system is constructed precisely to prevent damage from all potential invaders/threats. This has two vital results:
- Anything that crosses that gut barrier is officially straying into a location where it should NOT be – and this means it is something that must be attacked
- Anything that even remotely resembles something that might be a threat (i.e. molecularly looks similar) must also be attacked
This means that along with recognising the threat of gluten, the immune system is also primed and ready to attack ‘cross-reactive’ substances. Whilst this isn’t a foregone conclusion, it is very common.
For the purposes of grains (leaving aside dairy for the moment, though this too is a common cross-reactive for gluten), cross-reactives are frequently thought to be other, similar-looking (biochemically and molecularly at least) grains such as oats, rice, millet, corn, etc.
This means that if your lead domino (gluten) has created some degree of gut permeability, there is the possibility of developing intolerance reactions to similar-looking grains.
There is another factor here, and it regards the history of how gluten was originally assessed and classified. This concept was popularised by Dr Peter Osborne in his work, “No Grain, No Pain” where the role of grains in inflammatory conditions (most notably rheumatoid arthritis) is detailed. In his assessment, there has been a misplaced focus on the Alpha-Gliadin part of the gluten protein as a causative factor for coeliac and other gluten-related conditions. He presents compelling evidence that there is a whole family of proteins within wheat, and therefore other grains, and all of these can pose threats to sensitive immune systems, digestive systems and those with genetic susceptibility to so-called ‘gluten’ sensitivity (which may or may not include sensitivity to the Alpha-Gliadin part of the wheat grain).
Despite the arguments presented by Dr Osborne in his work, he is coming from the basis of those suffering from chronic pain conditions, inflammatory conditions and diagnosable coeliac and/or gluten sensitivity. His argument is more that those who ARE sensitive to gluten would do well to consider more grains in their exclusion diets. He, perhaps erroneously, extends this need for exclusion onto other individuals. In my eyes he does not make such a compelling case for the need for exclusion in such circumstances.
Therefore, the answer to the question of whether grains are healthy becomes very similar to the answer given above when discussing pure gluten. If your health is compromised on any level there is a likelihood that at some point the grains in your diet are going to prove too much for your intestinal milieu to combat. After a series of insults, grains will definitely become unhealthy for you.
Beyond Gut Permeability
Another factor concerning grains, which I’m not going to go too much into depth about here, is their phytate and lectin content.
Almost all grains (and legumes too, and some fruits and vegetables) contain within them self-protecting mechanisms in the form of chemical products which makes them tough to break down and digest. Thought to be the plants’ protection against ingestion by wildlife, researchers postulate that these products are also immune-activating and inflammatory to the human digestive system.
Again – whether this a problem is less to do with the grains and their phytates and everything to do with the human ingesting the grains. If any element of digestion is impaired (lack of stomach acid or digestive enzymes, impaired intestinal motility or intestinal permeability) then there will be complications when taking in foods which come packed with their own little poisons.
(RESOURCES: for work into the impact of grains, particularly gluten, on the body, one of the most powerful advocates of grain free, carbohydrate free living is Dr David Perlmutter – look closely at “Grain Brain”.
However, for an insight into the digestibility of gluten and grains, the medical professional to look into is Dr John Douillard who presents the other side of the story in his book “Eat Wheat” (also see disclaimer above).
And obviously, if you want to research the camp of the anti-grain debate, Dr Peter Osborne (see above) has this covered.)
Is Bread Healthy or Not?
All of which brings me onto the one way in which we typically like to eat wheat: bread.
Remembering everything I’ve said above you should by now be aware that whether gluten or grains are healthy depends on the intestinal and immune environment of the person ingesting them.
However, with bread itself there are additional components to consider.
True bread should be made with flour, water, yeast and possibly a little salt and fat (lard/butter/olive oil). If you’re OK with the grains and the fermentation of yeast then bread should be fine, right?
Well, regrettably, if you look at any loaf you can buy in every supermarket these days, the ingredients list is far more than 4 things. Preservatives, additives, sugar and colouring are just some of the main offenders. This says nothing of the quality of the grain used (see above section on modern wheat grains).
This means that if you are OK with gluten, it doesn’t necessarily mean you’re OK with store-bought bread. I am not going to belabour the point about this but if you want to look at work on the problems with store-bought bread, read Douillard (above) in conjunction with Cate Shanahan’s work “Deep Nutrition”. Essentially think processed and heated seed oils and run a mile.
Do your digestive system a favour and, if you meet all the ‘I’m otherwise healthy’ criteria above, make your bread yourself. Preferably with intact, ancient wheat grains, soaked and sprouted, and sourdough starters etc. As unprocessed as you can make your bread, the better it is for your body. Our bodies evolved digesting grains freshly harvested and unmanipulated. Bread can be healthy, but only insofar as it’s made from ingredients your body can recognise and accept – otherwise you’re back into activating the immune system and engaging your insides in an inflammatory battle.
I should just mention here the concept of nutrition, i.e. the nutrient quality and density of grains. Grains, when unprocessed and non-genetically-modified, have been shown to be high in vital B vitamins and other nutrients. They are also great sources of fibre and carbohydrate for the digestive tract and its bacteria.
In studies grains, including wheat, have been linked with some of the following:
- Brain health
- Weight loss
- Essential digestive support
- Maintaining regular bowel function and detoxification
Are grains nutrient dense? Well in comparison to protein and fats, no. In comparison to nutritious vegetables like sweet potato, yam, squash etc., no, they’re not really better either. However they are a robust source of both calories and vitamins for great swathes of the global population.
Can you live without grains? Undoubtedly yes. Do you need to live without them? Well, given everything I have already said, that actually largely depends on YOU.
Gut Health As The Cornerstone of Total Wellbeing
The health of your digestive system is a major factor in the health of your overall body – this is the basic tenet of Functional Medicine and is increasingly being recognised in the realm of modern healthcare.
However, I also know – from both professional and personal experience – that digestive health is dependent on a host of other factors, both internal and external.
I am NOT talking about lymph drainage, digestive fires, ayurvedic principles, chronobiology and circadian timings. For more on that - read Douillard, above.
Yes, the capacity for your body to effectively digest and process gluten, grains and other so-called ‘inflammatory’ foods is contingent on your body having resilience, detoxification capacity and general health in place.
But my bigger question – one that I have dealt with and contemplated for my whole life – is where does that general resilience (or not) come from in the first place? I have explored the fields of genetics, biochemistry, epigenetics and the conversation around the advancements in modern science affecting our ancestral health (i.e. vaccines and toxicity causing too much oxidative stress for our primitive bodies).
However, there is an area of science which is far more profound for me when it comes to discussing what makes us resilient enough (or not) to ‘suffer’ the onslaught of more ‘difficult’ dietary proteins.
This field is psycho-neuro-endocrine-immunology. And it’s a long and silly word, bolting together several different fields of human science. In doing so, the word belies the interconnectedness upon which true health is fostered.
General resilience is contingent not just on the effective functioning of our physical systems, but also must incorporate emotional, psychological and psychosocial wellbeing.
How well you’re able to tolerate gluten and grains, therefore, may have everything to do with how you’re wired emotionally and mentally and as a human being.
I see remarkable correlation in my practice (and in myself) between a general emotional and social sensitivity and a heightened sensitivity to foodstuffs and digestive sensations.
Generally my senses (emotional, touch, light, sounds etc.) are very alert to the environment around me (both an inherent genetic and an acquired alertness, for reasons too long to fully detail here). This is mirrored by my immune system which is very alert to the elements of the environment that I ingest – food and drink, supplements, passing cigarette smoke etc.)
It makes total sense to me that the assaults and damage to the immune, lymph and digestive system cause complications with digesting proteins, of which gluten and grains are the main offenders.
But it also makes sense to me that even when such systems are “fixed” or “healed” there are some people for whom their baseline of ability to digest and tolerate such proteins is affected by other factors: their sympathetic/parasympathetic dominance, the way their immune system has evolved throughout their life to match their experiences and threat levels etc.
And whilst theoretically all of these can be ‘tweaked’, ‘hacked’ or ‘altered’, some inherent ‘self-ness’ – the essence of who we are and our personality – is caught up within these characteristics. My biggest steps in my own process came when I STOPPED trying to change these factors and instead began to work WITH my innate nature.
My work with clients is therefore not to a goal of ‘full health, able to eat anything, completely fine’. My aim with clients is always to establish the foundations and parameters upon which their personalised optimal health can be built. For some this requires more than treating gut bugs, yeast overgrowth and SIBO (all do-able). It also demands bearing in mind the historic assaults and traumas of their past, any genetic tendency towards hypersensitivity and their emotional self that may be easily overwhelmed.
So, in conclusion, yes – the answer to the simple question of whether grains and gluten are healthy is that it depends on YOU.
But the truth goes further and much deeper than that.
Because “YOU”, and your health and ability to digest these things is dependent on far more factors than the integrity of your GI tract, the effectiveness of your lymph drainage and the ability of your liver to detoxify.
Therefore, in my next blog post, I am going to go down the rabbit hole of everything I work with when I help my clients with understanding the ‘YOU’ of their health journey.
I am also going to begin to share in these articles how I worked on myself, and work with my clients, to truly heal from any illness, WITHOUT resorting to a lifetime of elimination diets, rule books and following gut protocols – but with finding the baseline, learning compassion, understanding how to make decisions and, most importantly, understanding the nature of fear and the complex reality of working through our relationships to our health, our bodies and food.