What Could Joint Pain Have in Common with ADHD?

wpid-IMAG0804.jpgOne of my daughters is sensitive to gluten.  I knew it made her seasonal allergies worse, but I didn’t realize some of its other effects until she shared them with me.  When she did, it tore my heart out.  She said, “Mom, when I eat that stuff, it makes me really sad.  I cry and I can’t fall to sleep at night.”  Whoa.

Research indicates that one in 133 people have celiac disease (a serious, destructive autoimmune disorder to gluten) in the USA and 6% have gluten-sensitivity (The exact mechanism is still being determined but it does not appear to be destructive like celiac disease–but symptoms may be just as uncomfortable!).  The proteins in gluten are very, very, very difficult proteins for our bodies to digest.  So what?  Haven’t they always been?  Well, this has become more problematic in our current time as the bacteria we humans rely on to guard our gut linings have been terrorized by antibiotics, food preservatives, and reliance on processed foods.  When the proteins are not broken down properly, our immune systems can be triggered in different ways.  Some people’s bodies handle this in stride.  Others do not, and each person will have his own unique response resulting in different symptoms.

Please remember, my articles are never intended for medical advice.  I observe.  I study.  I read.  I write up what I think is interesting and others may benefit from reading.  It’s your job to be safe, talk to your doctor, and be a diligent bulldog for your health.

Three Reasons Doctors Shun the Gluten-Free Idea 

If gluten is such an issue, why doesn’t your doctor tell you about it?  There are a few reasons.  One, it is easy to dismiss a gluten-free diet because research on atypical celiac presentation and gluten-sensitivity is slow to trickle down to doctors practicing in the community.  They aren’t going to jump on the bandwagon simply for some article that shows up in your USA Today.  However, research studies and case reports abound on the negative effects of gluten and other wheat proteins and the changing face of celiac disease.  Alessio Fasano, MD and colleagues have made amazing discoveries about celiac disease, gluten-sensitivity, wheat allergy, and gluten in general.  Your decision on wheat would be remiss if you didn’t consider Dr. Fasano’s work.  On the other hand, he is fairly conservative, but I think that is what has allowed his ideas to surface so quickly and to be well-received by the stubborn medical community.

Secondly, gluten problems can appear so differently from person to person!  Celiac disease and gluten sensitivity can cause diverse symptoms, and frustratingly there is no objective test for gluten sensitivity.  Nowadays, celiac disease is presenting with strange, atypical symptoms which doctors are not prepared to identify!  It’s a tough gluten-disorder diagnostic world!  I have a friend whose mother was diagnosed with celiac disease a couple of years ago–and her mom is in her 70s!  No doctor was thinking of this until the poor woman drove to the Mayo ER and said, “I’m not leaving this hospital till you figure out what’s wrong with me!”

And thirdly, the glut of gluten-free processed food products on the market targeting susceptible consumers is preposterous and attack-worthy.  People associate gluten-free with healthy.  No.  Gluten-free oranges are healthy.  Gluten-free broccoli is healthy.  Gluten-free shrimp are healthy.  But gluten-free bread and gluten-free cookies are not.

And lastly (I know I said “a few,” but I just thought of this one.), most patients and most doctors think a gluten-free lifestyle is too hard.

What Symptoms Would I Look for to Consider a Gluten-Disorder?

What kind of symptoms would a gluten-sensitive person experience?  I’ve listed some.  Maybe you’ll see something here on your health record or that of a loved one.  My list is not conclusive.  I realize now I left off skin disorders, like eczema.

    • Joint pain and swelling: Gluten-sensitive people may present with pain and swelling in one or more joints. The understanding of how and why this happens is not clear yet. The symptoms may not occur right away after gluten is eaten (It can take several days.), and this delayed onset can make diagnosis confusing. Besides causing joints to become painful and swollen, gluten can also make known arthritis more painful, including rheumatoid arthritis.
    • Stomach troubles: Some people will have irritable bowel symptoms with stomach pain, bloating, and diarrhea. Others will simply have stubborn constipation. It is not understood why some people get diarrhea and others get constipation, but recent studies show that a gluten-free diet can help these digestive symptoms.
    • Fibromyalgia and fatigue symptoms: Sometimes people develop painful muscles as a negative response to gluten. The severe muscle aches can be debilitating and receive a diagnosis of fibromyalgia, usually accompanied by chronic fatigue. Gluten-removal for some people helps eliminate or reduce this chronic pain and fatigue. Severe fatigue and tiredness can occur, too, without the muscle aches, and again, gluten removal wonderfully helps some people regain their vitality.
    • Headaches: Some people will get headaches with gluten exposure, but in addition, they may also have dizziness and a “fogginess” in their head that they cannot shake no matter how much sleep or caffeine they get. Imagine their satisfaction when they wake up headache-free and clear-headed for the first time in years.
    • ADHD and autism symptoms: Removing gluten from a child’s diet is challenging in today’s world, but studies do suggest that removal can help ADHD and autism symptoms. However, in autism, the studies are done most often with a combination of gluten and dairy removal, and so it is hard to attribute the improvement to gluten over dairy.
    • Depression, anxiety, bipolar disorder, schizophrenia, and obsessive compulsive disorder: There is no doubt that the diagnosis of mental illness is tragically on the rise. Amazingly, some people find relief from these mental illnesses with simple dietary changes such as gluten removal. But how many people with depression or anxiety are prescribed dietary changes such as a gluten-free diet? Not many. Depression, anxiety, bipolar disorder (a disease which alternates between high, energetic, sometimes delusional symptoms and extreme depression), schizophrenia, and obsessive compulsive disorder (a disease where a person has repetitive thoughts and actions they cannot remove from their minds) may be the prime symptoms for some gluten-sensitive individuals.  Personally, I know a bipolar patient who told me, “I am NOT giving up my morning toast, Terri.”  Okay then.

If you have chronic, troubling symptoms, don’t wait for your doctor to tell you that you have gluten-sensitivity or atypical celiac disease.  Ask your doctor to please evaluate you or your child for celiac disease and then ask if it is safe for you to proceed to a gluten-free diet.  Don’t be deterred if your doctor dismisses your concern and belittles your endeavors.  Your doctor may think going gluten-free will not work–and maybe it will not–but there is plenty of research to support your trial.  But first make sure there is not celiac disease!  A celiac patient should not even use the same toaster that has toasted gluten-containing products!  A celiac patient must know where “maltodextrin” came from.

Closing

What questions do you have?  I know this diet stuff is confusing and immensely complex.  And I know that’s a part of what makes people throw their hands up and go eat whatever their little, ol’ tongues desire.  I understand that.  I get it.  But I also know the statistics, and I know that gluten affects some of my own family members.  So does my daughter ever eat gluten?  She does, usually on vacation or at birthdays or potlucks.  She acknowledges an unusual passion for gluten products, and she has asked me (I did not suggest it.  I lead by example and try to teach my kids information and good observation so they can make good decisions their whole lives through.  I hope my daughters never have eating disorders and intend to do all I can to promote a positive relationship to food.) to help her moderate portions and to not order certain things on vacation or special dinners out.  She is becoming her own health advocate.  Please become yours.

Terri

PS:  My take on gluten and grains is much, much more complex than these mere 1000 words allow.  But I hope this article raises awareness that gluten can definitely be a problem!  (Of course, so can other foods as well.  And this leads us to leaky gut.  And so on.  This stuff is so fascinating.)

Sources:

  1. Non-Coeliac Gluten Sensitivity and Autoimmunity: A Case Report.  Isasi C, Colmenero I, Casco F, et al.  European Journal of Case Reports in Internal Medicine.   EJCRIM.  2014;1
  2. Spectrum of gluten-related disorders: consensus on new nomenclature and classification.  Sapone A, Bai JC, Ciacci C, et al.  BMC Medicine.  2012. 10:13.
  3. Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten-Sensitivity. Jackson JR, Eaton WW, Cascella NG, et al.  Psychiatric Quarterly.  March 2012, Volume 83, Issue 1, pp91-102.
  4. Fibromyalgia and non-gluten sensitivity: a description with remission of fibromyalgia.  Isasi C, Colmenero I, Casco F, et al.  Rheumatology International.  2014; 34 (11):  1607-1612.
  5. Fasano, Alessio and Susie Flaherty.  Gluten Freedom.  Wiley, 2014.

44 thoughts on “What Could Joint Pain Have in Common with ADHD?

  1. Susan

    Thanks Terri! I’ve been off gluten for a little over a year and life is good albeit challenging when eating out as you well know! I miss good bread and my sister’s delicious cookies (she owns a cookie company) but I don’t miss the brain fog, shakiness, joint pain and stomach issues! Appreciate your blog very much – helps to keep me on track!

    Cheers,
    Susan

    Reply
    1. thehomeschoolingdoctor Post author

      Hello, Susan! Sorry it took me time to get back! Your sister owns a cookie company! OUCH! What is God punishing you for? (Joking. 🙂 )

      I miss those things too, but then when the reality is offered to me, strangely, it’s as if the need goes away. Like once a coach told me, when I hit a hard spot in college, “Go home! Take this semester off and go back home for a break!” I was like, “What!? I CAN’T do that.” She said, “Yes! You can!” Then, after that, I realized I could but I didn’t need to. I don’t know. Probably over-philosophizing food. HA! But the brain fog and headaches and mood changes I get aren’t worth any food, although I do endeavor to try whatever I can (within reason) to be able to eat a real, whole food diet (aka, cure my “leaky gut”) and feel good so I can enjoy the time I have to teach my kids, read, go for walks with my husband. And so on. Good luck to you on your endeavors! Thanks for the encouragement for me!

      Terri

      Reply
  2. Bob Niland

    re: Your decision on wheat would be remiss if you didn’t consider Dr. Fasano’s work.

    His work is consistent with a cliché I’ve used for some time: we are all celiac; it’s just a matter of degree and decades.

    Fasano clearly shows that wheat-triggered zonulin opens the gut tight junctions in everyone, not just celiacs. This allows all sorts of things into the blood that don’t belong there (including wheat proteins), triggering both immediate reactions and immune reactions leading to auto-immunity.

    Perlmutter strongly suspects that the blood-brain-barrier is also compromised. The consequences of that are even more troubling.

    re: …most patients and most doctors think a gluten-free lifestyle is too hard.

    Wait ’til they read the rest of the memo. Over 97% of what passes for food in modern markets is unfit for routine human consumption. Wheat by itself and wheat in processed food is just a place to start, and leaky gut is just one of the charges on the wheat rap sheet. Added sugars (and high net carbs generally) are next, followed by Omega 6 industrial seed oils, low fat mania, various dysbiosis factors, crucial micronutrient deficiencies, and a long list of other adverse agents.

    re: “I am NOT giving up my morning toast, Terri.”

    Many people are content to suffer their optional ailments as long as they have someone willing to listen to them complain.

    Reply
    1. thehomeschoolingdoctor Post author

      Dear Bob, Hello and happy Wednesday. I hope you and your family have been doing very well. Okay. Let’s see. I will reply within your comment and see if it turn out readable:

      re: Your decision on wheat would be remiss if you didn’t consider Dr. Fasano’s work.

      His work is consistent with a cliché I’ve used for some time: we are all celiac; it’s just a matter of degree and decades.

      My response: Metaphorically, I see what you’re saying. Of course, we both know that not everyone will be celiac as they don’t have the genes for that particular response. I’m just not sure, though, that everyone will be gluten/gliadin sensitive. Although, I’d argue that we are all sensitive to multiple foods, like eggs/ dairy/ nuts/ nightshades/ and so on if we are discerning enough and complete an elimination diet. But I’m still not sure that means we shouldn’t be eating all these foods. I’m still thinking, observing, and trying to learn more.

      Fasano clearly shows that wheat-triggered zonulin opens the gut tight junctions in everyone, not just celiacs. This allows all sorts of things into the blood that don’t belong there (including wheat proteins), triggering both immediate reactions and immune reactions leading to auto-immunity.

      My response: But wheat proteins are not the only substances known to open the tight junctions! Many other “healthy” foods affect the tight junctions too, but they are not so well studied. This article has a section on “Effects of dietary components on TJ integrity”: http://jn.nutrition.org/content/141/5/769.full So I still can’t bring myself to say that NOBODY should never eat wheat/gluten.

      Perlmutter strongly suspects that the blood-brain-barrier is also compromised. The consequences of that are even more troubling.

      My response: Based on my daughter’s response (and probably my own response if I undertook a gluten challenge, which I will one day do), the CNS is clearly affected. Why? Is it a systemic inflammatory response leading to changes in the CNS (kind of like how you feel crummy when you get a virus/cold/flu) or is it the blood-brain-barrier is compromised? I don’t know. I look forward to this being teased out in the future. As we learn how permeable our gut is, how our lungs and placentas aren’t sterile, so may the impermeable blood-brain-barrier concept be changed.

      re: …most patients and most doctors think a gluten-free lifestyle is too hard.

      Wait ’til they read the rest of the memo. Over 97% of what passes for food in modern markets is unfit for routine human consumption. Wheat by itself and wheat in processed food is just a place to start, and leaky gut is just one of the charges on the wheat rap sheet. Added sugars (and high net carbs generally) are next, followed by Omega 6 industrial seed oils, low fat mania, various dysbiosis factors, crucial micronutrient deficiencies, and a long list of other adverse agents.

      My response: Yes. I know.

      re: “I am NOT giving up my morning toast, Terri.”

      Many people are content to suffer their optional ailments as long as they have someone willing to listen to them complain.

      My response: It is SO hard for people to believe that what they eat/don’t eat can make that huge of a difference. I wouldn’t have believed it had I not come from that world into this one. Even still, I doubt myself–which is my natural tendency anyhow–but I think once you live on an island so long, you forget what the winter is like. (Meaning, I’ve eaten this very nutritious way for about 4 years now, that it’s easy to forget how bad I felt. When I look at my old journals, as I’m a journaler, I remember.) So—-my bottom line is—I still will not concede that gluten should never be eaten by anybody. I think other foods also probably affect TJ, both positively (my beloved butyrate) and negatively. Anyone with chronic health issues as described above (and others I left out, like ataxia for one) need to talk with their doctors about getting CD tested and then undergoing a gluten-free challenge (although you know I’d prefer a GF/DF/whole foods/good omega 3s/and so on diet as the GF diet). Intensive, well what the world sees as intensive, nutrition makes a difference.

      Terri

      Reply
  3. Tim

    Terri – I’m torn on gluten. My health greatly improved when I gave it up 5 years ago, but I also made numerous other diet changes. I’ve been experimenting adding gluten back, but in the form of homemade whole-wheat, whole-rye, and whole-spelt bread. I’d forgotten how wonderful pizza and toast are!

    I agree that some people cannot handle any gluten, but for others, maybe it’s the processed, fortified wheat flour that causes problems. Maybe also gut problems on SAD make gluten worse than on a healthy gut.

    I still haven’t embraced any store-bought breads. Real bread gets moldy and stale very fast, unlike the “Dave’s Killer Bread” or “Ezekial” brands that seem to last for weeks. There’s probably a lesson to be learned from this, eh?

    Reply
    1. thehomeschoolingdoctor Post author

      Dear Tim,

      I think I question the need to eliminate gluten-containing grains forever based on how they’re fairly effective at bringing about butyrate production. Take them out temporarily until health goals achieved or at least attempted to be achieved–yes! I look forward to experimenting with whole grains, and I think I’ll ferment them (as Jo tB does) and make sourdough bread first.

      I also think that other foods besides gluten probably affect our leaky guts and probably even zonulin. So it will be so much fun to watch this transpire over the years! I linked to this same article above for Bob, but I’ll link it here because I know we all have different ways that the comment/reply feeds come to us: http://jn.nutrition.org/content/141/5/769.full

      I’ll see if I can excerpt the pertinent part:

      “Effects of dietary components on TJ integrity
      In addition to bacteria, TJ are also regulated by dietary components. In celiac disease, pathogenesis is induced by gliadin, a glycoprotein present in wheat. When IEC6 and Caco-2 cells are exposed to gliadin in vitro, interaction between occludin and ZO-1 is compromised and the cytoskeleton is rearranged, leading to increased monolayer permeability (73). The mechanism for this has been linked to zonulin, the human homolog of the zonnular occludens toxin from Vibrio cholera that is known to modulate TJ (74). Gliadin induces zonulin release, leading to PKC-mediated cytoskeletal reorganization (75). Ex vivo human intestinal samples from celiac patients in remission also showed zonulin release when exposed to gliadin, causing cytoskeletal rearrangement and ZO-1 reorganization, leading to increased permeability (73). Gliadin causes zonulin release by binding to the CXCR3 receptor in intestinal cells (76).

      Most food components have not been studied in this way, however. In a screening of vegetable extracts, an extract of sweet pepper was found to decrease TEER in Caco-2 monolayers after a 10-min incubation period (77). In another study, Solanaceae spices, such as cayenne pepper (Capsicum frutescens) and paprika (Capsicum anuum), were found to cause an immediate decrease in TEER in vitro in the ileocecal adenocarcinoma cell line HCT-8 (78). In the case of paprika, this was accompanied by an increase in small molecule permeability and aberrant staining of ZO-1. Conversely, black pepper (Piper nigrum), green pepper, nutmeg, and bay leaf extracts caused an increase in TEER, although small molecule permeability and ZO-1 organization were not affected. The active compound in sweet pepper was identified as capsianoside, and this was shown to reorganize actin filaments and decrease TEER (79). The increase in TEER caused by black and green pepper can be attributed to piperine (78). Although the authors speculate that the decrease in ion permeability was caused by cell swelling, the possible involvement of TJ was not investigated.

      In a more recent screening of over 300 food extracts, galangal (Alpinia officinarum), marigold (Tagetes erecta), Acer nikoense, and hops (Humulus lupulus) were found to decrease TEER and increase paracellular flux of Lucifer yellow across Caco-2 monolayers, without having any cytotoxic effect on the cells (80). Extracts of linden (Tilia vulgaris), star anise (Illicium anisatum), Arenga engleri, and black tea (Camellia sinensis), on the other hand, were found to decrease paracellular flux and increase TEER.

      Surfactants are known to affect TJ permeability. The food-grade surfactant sucrose monoester fatty acid causes a decrease in TEER and an increase in the permeability of the egg white allergen ovomucoid across Caco-2 monolayers (81). Furthermore, the perijuntional rings of the surfactant-treated cells were partially disbanded when examined under fluorescence microscopy. Similarly, when Caco-2 monolayers are exposed to Quillaja saponin at nontoxic levels, TEER decreases and paracellular flux increases (82).

      Some proteins and amino acids alone modulate intestinal permeability. For example, protamine (an arginine-rich protein) decreases paracellular flow of lactulose in vivo in rat small intestines (83). In contrast, TJ permeability is shown to increase following l-alanine perfusion in rats (84). The casein peptide Asn-Pro-Trp-Asp-Gln increases TEER in Caco-2 cells in a dose-dependent manner, which correlates with increased levels of occludin gene and protein expression (85). Feeding diabetes-prone rats hydrolyzed casein decreased intestinal permeability as demonstrated by reduced lactulose uptake (86). This correlated with an increased level of ileal claudin-1 gene expression and increased TEER in ex vivo ileal samples. β-Lactoglobulin (from skim milk) increases TEER across Caco-2 monolayers when the TJ are destabilized by culturing in serum free media (87). The putative mechanisms of action involve PKC-mediated signal transduction pathways, because treating the Caco-2 monolayer with a PKC inhibitor before adding β-lactoglobulin reduces the TEER increase. The authors also concluded that β-lactoglobulin–induced increases in TEER may be caused by modifications to the cytoskeletal structure, because treating the cells with cytochalasin D (known to disrupt the cytoskeleton) also inhibits β- lactoglobulin–induced increases in TEER. This could be further verified by immunostaining cytoskeletal structures of Caco-2 cells both untreated and treated with β-lactoglobulin.

      At supraphysiologic levels, tryptophan disrupts TJ in hamster small intestinal epithelia, shown by visible perturbations in TJ (transmission electron microscopy), decreased TEER and increased insulin flux (88). In contrast, glutamine can restore stress-induced loss of barrier integrity (89). With Caco-2 monolayers where maturation was achieved by treatment with sodium butyrate (compared with spontaneously matured Caco-2 monolayers), exposure of cells to the atmosphere during media change leads to a temporary decrease in TEER. The speed of TEER recovery is improved if the cells are exposed to glutamine before the stress. Furthermore, when Caco-2 cells are deprived of glutamine via inhibition of glutamine synthetase, occludin, claudin-1, and ZO-1 protein expression is decreased (90). Studies have shown that treatment with glutamine leads to activation of the MAPK, ERK, and JNK (91); thus, glutamine could potentially modulate TJ via a MAPK-dependent signal transduction pathway.

      As well as having nutritional value, trace elements such as zinc may also assist with the maintenance of intestinal barrier integrity. Caco-2 cells grown in zinc-deficient media have reduced TEER and altered expression of ZO-1 and occludin (localized away from the cell boundaries, less homogenous) compared with Caco-2 cells grown in zinc-replete media (92). This is accompanied by disorganization of F-actin filaments.

      Other dietary components such as fatty acids, polysaccharides, and flavonoids are also known to alter TJ. The medium-chain fatty acids capric acid and lauric acid increase paracellular flux and cause a rapid decrease in TEER in Caco-2 cells (93). DHA, γ-linolenic acid, and EPA have also been shown to decrease TEER and increase paracellular permeability of fluorescein sulfonic acid in a concentration-dependent manner (94, 95). Caco-2 cells exposed to sodium caprate had irregular expression of ZO-1 and occludin at the cell boundaries. Whereas the decrease in paracellular permeability was observed within 3 min of capric acid exposure, reorganization of TJ proteins took at least 60 min. Sodium caprate is known to increase TJ permeability in rat ileum ex vivo, reducing TEER, increasing parcellular flux, and inducing dilations in TJ visible by transmission electron microscopy (96). Conjugated linoleic acids have also been shown to modulate paracellular permeability in epithelial cells (97). Caco-2 cells grown in media supplemented with the trans-10 isomer of conjugated linoleic acids have a slower rate of TEER increase, increased paracellular flux, and altered distribution of occludin and ZO-1. Chitosan, a polysaccharide widely used in the food industry, is also known for its absorption-enhancing properties (98). Caco-2 cells treated with chitosan have altered distribution of ZO-1 and F-actin leading to increased paracellular permeability (99). Quercetin, the most common flavonoid in nature, increases TEER (100, 101) and reduces paracellular flux of Lucifer yellow (101) across Caco-2 monolayers in a dose-dependent manner. This was accompanied by an increase in claudin-4 (100, 101). Although the overall expression of claudin-1, occludin, and ZO-2 was not affected (100, 101), these protein were redistributed and associated with the actin cytoskeleton (101). Furthermore, there was greater localization of claudin-1 and -4 at TJ in Caco-2 cells treated with quercetin (100, 101). Quercetin is also shown to inhibit activity of PKCδ; TJ regulation by quercetin is likely PKCδ dependent (101).

      Although dietary components may regulate TJ permeability by directly targeting signal transduction pathways involved in TJ regulation, certain dietary components have been identified that influence cytokine signaling, thereby modifying TJ permeability. For example, epigallocatechin gallate, the predominant polyphenol in green tea, when incubated with T84 monolayers does not affect epithelial permeability. When treated concomitantly with IFNγ, however, epigallocatechin gallate prevents the IFNγ-induced decrease in TEER and increase in paracellular flux (102). Soy milk fermented by L. plantarum, Lactobacillus fermentum, and L. rhamnosus is also shown to prevent IFNγ-induced decrease in TEER in the Caco-2/TC7 cell line (103). This effect, however, cannot be seen with nonfermented soy milk. The protective effect of soy milk is attributed to isoflavone aglycones synthesized in the fermented milk, thus demonstrating the importance of food-bacteria interactions in barrier function regulation. Similarly, the isoflavonoid genistein prevents TNFα-induced decreases in TEER in the colonic cell line HT-29/B6, but does not affect TEER itself (104).”

      Take good care of your health.

      Terri

      Reply
      1. gabriella kadar

        ‘Many people are content to suffer their optional ailments as long as they have someone willing to listen to them complain.’

        Perfect! After 35 years as a dentist, I’ve heard all the excuses:
        “You need yet another root canal treatment.”
        “But baking cakes, cookies and pastries is part of my cultural heritage.”
        “Go ahead and bake them. Just don’t eat them.”

      2. thehomeschoolingdoctor Post author

        You and Bob are harsh. 🙂

        Seriously, I LOVED to bake. I was very sad to leave that behind. I never believed anything would change that. I knew I loved that stuff. To the point of addiction. However, strangely, being about four years out now, I feel detached from that stuff.

        You still practicing?

      3. Tim

        The paper you linked was one of the first I read when I started researching the gut. It’s filled with seemingly contradictory results, ie. “The medium-chain fatty acids capric acid and lauric acid increase paracellular flux and cause a rapid decrease in TEER in Caco-2 cells.”

        If this were the case with real foods containing capric and lauric acid, then coconut oil should be an extremely unhealthy fat. I also find it strange that the gold standard for testing gut permeability is the CACO-2 cell, derived from human colon cancer cells. This is 30 year old technology and probably needs to be replaced with models that take bacteria, fungi, and healthy cells into consideration (maybe this can be the topic of my next paper, lol).

        In 2005, a study on CACO-2 cells for permeability tests noted: “Culture-related conditions, as well as the different Caco-2 cell lines utilized in different laboratories, often make it extremely difficult to compare results in the literature.” (http://www.ncbi.nlm.nih.gov/pubmed/15868485).

        So here we are full-circle. What we need is a healthy, SCFA fueled digestive system, and to experiment incessantly on ourselves until we find the right combination of fiber/food/fitness and read research papers simply for an understanding of the mechanisms at play.

      4. thehomeschoolingdoctor Post author

        Yes. I agree. And I never take any paper (or sermon) as is. It simply provides clues. To me, I left that paper with the idea: Gluten may open zonulin, but we haven’t learned yet what else does the same/similar type thing(s). Therefore, since we don’t know, then I must remain open. I cannot simply state across the board that nobody should eat gluten/grains because it fits my story/ideas well. Gluten has not gone over in the past well in our family. Gluten itself? Our poor gut health? The fact the gluten we ate was in processed foods? The fact the gluten we ate was standard flour? I don’t know. Like you, I will at some point re-try high quality gluten (soaked/fermented) since we are not celiac.

        We are full circle! Back to a moderate standpoint once the gut gets healthy again, I say! Good to know about the CACO-2 cell technology. I’m not versed in that at all other than the basic few lines that appears regarding gluten/leaky gut.

        Always enjoy hearing your take and article referrals.

        Terri

    2. Jo tB

      Tim, I’m not sure whether I have gluten issues, but knowing how genetically modified wheat is, I prefer to use “Ancient grazins” like Spelt and Kamut. I believe Teff and Einkorn are also ancient grains, in which case their gluten doesn’t affect people as much as wheat does. I have lately (as Terri stated) been trying to make sourdough bread. The first attempt with just rye flour was too heavy, so am in the process of lightening it with Spelt flour. The recipe called for 350 gram of rye and 150 grams spelt, but I am going to try it the other way round 350 grams spelt and 150 gram rye and see how it turns out. A bread I baked recently completely of whole wheat flour turned out like a brick, I had to throw it away. So, that bread needs tweeking as well. Years ago I used to bak an Irish Soda bread made with just Kamut flour. It had a lovely nutty taste. Commercial breads are baked with bromide, fast acting, long lasting. I think I would prefer the bread to get moldy and stale very fast. that way I know I’m eating the proper stuff. Anyway I freeze my fresh breads in daily portions. That way I have fresh bread when I want it. Hope this helps both you and Terri.

      Jo

      Reply
      1. thehomeschoolingdoctor Post author

        Thanks, Jo! I was wondering, how does the fermenting go when it’s so cold out? (I think you live somewhere cold right now, too, if I remember correctly.) We turn our heat down at night very cold. This may be a stupid question, but I’ve not even made homemade bread in such a cold place. 🙂 Do you place it in “warm spot?” Or not worry about it at all? Probably by the time I get around to trying, it’ll be warm here anyhow. Ha! I found a very easy recipe for injera (an Ethiopian bread from teff–which is naturally gluten-free, high in iron, and I had no issues with) that is fermented. (http://yumuniverse.com/authentic-ethiopian-injera-100-teff-flat-bread/) But from my reading back on butyrate, I’m very curious about rye. Not to mention all the traditional tales about rye and the gut. And I, too, worry about the extras used for processing that won’t be mentioned on the label. Ugh.

      2. gabriella kadar

        Jo, I don’t know why it is that people think that wheat is GMO. It’s no more genetically modified than the child of a woman from Hong Kong and a man from Nigeria. A Great Dane is not a genetically modified Chihuahua.

        Wheats are hybrids. Like Tulips in Holland, there has been organized cross pollination of different varieties.

        There is a GMO wheat but it is not being planted for commercial purposes. And there is no GMO oat or rye at all. There are no GMO tomatoes. Just because the label says ‘non GMO’ doesn’t mean the alternate option even exists. It’s plain and simple a marketing tool.

        Ironically, either Spelt or Kamut (I’d have to go dig up the information) has been found to be more irritating than regular wheat for people with gluten sensitivity (not coeliac).

      3. thehomeschoolingdoctor Post author

        Hi, Gabriella! How are you today? Thank you for your comments. Yes. Check. Our wheat products are not from GMO wheat. They are from excessively hybridized wheat.

        In addition to your list, I’d like add a titch about sweet corn since it is a wonderful, traditional, local, cherished delight in the Midwestern USA. Sweet corn used to be only non-GMO. No longer. I do suggest that people look for non-GMO. There is no need for GMO sweet corn. That’s not really here-nor-there information. Just something I thought of while reading your comment.

        On spelt or Kamut, I could not find the information. I found that Kamut could be better tolerated (but do I know or believe anything I read anymore? No. That’s what keeps me wishy-washy.). Here are three links on Kamut:

        1. http://www.ncbi.nlm.nih.gov/pubmed/25970146
        2. http://www.ncbi.nlm.nih.gov/pubmed/23299714
        3. http://www.ncbi.nlm.nih.gov/pubmed/24521561

        I spent way too long searching for “scholarly” information on spelt. I couldn’t find anything. Just sites claiming it’s “easier to digest.” Whatever.

        Terri

      4. gabriella kadar

        Terri, there is definitely a website in regards to GMO products. This one is a Canadian website. In re: GMO sweetcorn: http://www.cban.ca/Resources/Topics/GE-Crops-and-Foods-On-the-Market/Corn But there’s another site like this that also dealt with GMO sweetcorn in the US.

        There’s a lot of consumer pushback and farmers need to earn a living, so they are not planting GMO sweetcorn. Nothing worse than getting bad press.

        Another bit of really good news: there is no such thing as GMO popcorn. I went through all that after Tim posted about popcorn.

        From what I’ve read, the scientists have not outsmarted nature because pests become resistant to GMO cotton. The boll weevil is alive and well.

        Mind you the big problem with arsenic in rice happens because old cotton fields are changed up to grow rice. This is a problem with Pakistani and American rice. Don’t know about Indian rice. The amounts of arsenic are not significant and anyway, a little peripheral vasodilation will keep us warmer in the winter. 😉

        In the old days, ladies took arsenic so they’d have red cheeks….. oh dear. And arsenic eating was common in some areas. Otzi the Iceman was an arsenic eater. That wasn’t what killed him though. I guess there’s worse things than a little bit of arsenic in rice. Arrows, for example.

      5. thehomeschoolingdoctor Post author

        My DAD, an American farmer, grew GMO sweet corn last summer (only for our family–but he plants A LOT). I was flaming hot at him. Flaming–as I’d just re-introduced sweet corn. I’m still angry about that! 🙂 But, he doesn’t see anything wrong with GMO. I’m working on him. I avoid them but still sorting through things in my mind. He and I go back and forth because he remembers how much pesticide he used to dump on crops. I then suggest that maybe corn and beans shouldn’t be our staple crops then. Maybe we should focus on other veggies/carbs that go well with his land. Then he goes off on feeding the world, starvation, etc. And so on it goes.

        I read the site/link you gave. Thanks. I have a friend from high school (I grew up in rural Indiana) who is selling his dad’s Indiana sweet corn in Washington DC now. It’s not GMO. Truly fresh (non-GMO), Midwestern sweet corn is awesome. Definitely a fond childhood memory. I’m glad some people in Washington DC are getting access to it. 🙂

        That’s awesome news about popcorn. My Grandpa sat at an “elevator meeting” beside Orville Redenbacher. I remember the post Tim had about popcorn having SCFA production capabilities.

        My solution to the rice (because we have successfully re-introduced it) issue, may or may not be the best one. I rotate where the rice we eat is from, since I read, like you say, the arsenic comes from the “land” used. Probably better would be to see arsenic levels tested on select brands/sources. But I’m not there yet.

        Arrows. Arsenic. Lace. Rice. Live. Die. Eat well. Eat to live. May we all feel good!

        Adios–

        Terri

      6. Tim

        I have conflicting thoughts on GMO food crops. Some modifications allow for MORE pesticide to be used (called “Roundup Ready”) and other modifications allow for less pesticide to be used (Bt toxins).

        The Roundup Ready plants are probably safest to eat, unless they are drenched in Roundup (glyphosate). But the plants themselves just have a gene expressed for glyphosate resistance.

        The plants modified with Bt toxins have the pesticide incorporated into the DNA of the plant. These plants are cloned to incorporate Bacillus thuringiensis CRY genes. But pests quickly become resistant to CRY genes, so there are actually 9 or 10 different CRY genes stacked into each plant to ensure successful pest avoidance.

        I actually buy Bt spray and use it for worms on my garden. The directions are specific that it should not be used within X days of harvest, etc… But every single bite of a plant GMO’s with Bt toxins contain the CRY genes that kill insects.

        I would guess that sweetcorn GMO varieties are all Bt toxin types.

      7. thehomeschoolingdoctor Post author

        This is deep area for me to explore. I know it will eat up my time and plant/insect biology brain power, so I am kind of saving it for down the road and simply trying to avoid GMO mostly that I can. When I eat the Roundup Ready stuff, like you suggest, it’s not usually drenched in Roundup at harvest time (although I read something about some farmers doing that for some reason on wheat which I didn’t understand, since wheat isn’t even a Roundup crop—and perhaps this could be inducing the higher celiac/gluten sensitivity rates ???).

        So, if the crop has the Roundup responsive gene, and I eat it—well, don’t I eat tons of other genes in anything I eat? Do you know the significance of the difference? I’m showing my ignorance here… You’re welcome to just say, “Eh. Yeah. Big topic. Just wait till you’re ready…” This doesn’t even approach the Bt toxin stuff. On a practical, real-life note, my dad’s GMO sweet corn sucked compared to his normal “milk and honey” sweet corn.

        So much to learn. Wish people would just keep it real and ask lots of questions and not just believe things from the top down. How do we get that way? Don’t answer that.

      8. Tim

        I look forward to seeing you explore the GMO issue, will make an interesting semester for home schooled ones, too!

        With the Bt toxin plants, this is the crux of the argument: “Cry proteins in GM crops are expressed as large insoluble proteins aggregates, in normal conditions and are safe for humans, higher animals and most insects but become solubilized as active toxin in reducing conditions of high pH = 9.5, as found in mid gut of lepidopteran larvae feeding on Bt Crops which leads to killing of these pests. These characteristics favour long term environmental friendly use as transgenic proteins [30].” (from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338076/ ).

        However, at least one Cry gene has been shown to effect mouse fetuses: “Studies have shown that Cry1ab unmistakably seem to cross the placenta to the fetus that is dangerous, given the potential harmfulness of these natural contaminations and the delicacy of the fetus.” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209668/ ).

        And another Cry gene was banned from inclusion in stacked modifications because it proved allergenic to humans. A BIG problem is that GMO plants are not treated like drugs and thus not subjected to years of clinical trials, only toxicity studies. Many after-the-fact studies have been done on allergic reactions to GMO crops, many funded by Monsanto, but not all, ie. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338076/

        Then there’s the whole issue of gene transfer to gut bacteria and other microbes. As well as the fact that we just simply cannot keep up with what genes Big Agra is splicing into our food. We all focus on Bt and Roundup ready, but there are also all these: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1364539/table/T1/

        It really is scary. My “gut reaction” is that eating GMO plants is not all that harmful, but there are lots of unknowns and its a multi-trillion dollar business.

      9. thehomeschoolingdoctor Post author

        Hello, Tim: I finally found time to read the links. Thanks. Learned more than I knew on GMO! 🙂 I was surprised at how much they focused on IgE allergenicity to prove safety (your first link). I squirmed in my chair as I thought how much more goes into safety than just allergenicity. The second link and third link went on to hit on that (being more than just allergic reactions).

        I took a minute to Google a concern I remember about GMOs that I don’t have time to read on extensively (some idea that the GMO genes can be found in animal tissues which we then eat…). As I did so, I came across this article: http://www.omicsonline.org/open-access/detection-of-glyphosate-residues-in-animals-and-humans-2161-0525.1000210.pdf .

        I read it, blah, blah, blah, and for some reason, one line hit me hard (probably because I’m married to an orthopedic surgeon who comes home every surgery day and remarks on how “soft” the bone of this young person was that he operated on): “The authors also found that glyphosate accumulated in bones. Considering the strong chelating stability of glyphosate for calcium, accumulation in bones is not surprising.”

        Sorry. Kind of off topic, in a way. [But, goodness, our bones are being smashed by excessive anti-nutrients in grains, low vitamin D from use of sunscreen/get out of the sun recommendations, lack of exercise (playgrounds are dangerous), no vitamin K2 because of low-fat/non-grass fed issues, fluoride, and now glyphosate!? No wonder orthopedic surgeons are seeing such bad quality of bone! And they are!]

        Well, rant over. I grew up with Roundup Ready soybean fields as my back yard. And I can remember tons of empty Roundup Ready containers just sitting around the farm sheds. Strange how I grew up so conventional and now stand looking over the fence. Guess that’s how life happens. We’ll just roll with it! 🙂

        Terri

      10. gabriella kadar

        Terri (tongue slightly in cheek here): eat like an Italian. Damn their bones give me a very hard time. I think it’s from a chronic intake of rapini and green olive oil. Plus decent sun exposure.

      11. thehomeschoolingdoctor Post author

        Honestly, that’s fun to hear from a dentist! My husband (orthopedic surgeon) has a few subpopulations that also have very strong bones within the population. We sit around and speculate as to why! Fun times here! He is more embedded in conventional medicine than I am. I am a more qualitative person and he is staunchly quantitative. When I first introduced some of these eating ideas (grains and anti-nutrients, let go of dairy, move away from sunscreen), they were quite uncomfortable given the numbers on calcium requirements, melanoma, etc. But as he actually works IN people’s bones, he sees that despite all our grains and dairy and sunscreen, our bones as a population are really soft!

        I wonder if my olive oil is green and if broccoli works too. (For anyone reading, rapini is broccoli rabe, kind of like a wispy broccoli head and then lots of leaves. I had to look it up.) But sun. 😦

  4. myjourneythrume

    I’m so sorry your daughter has gluten issues, that’s really hard for a child. But she’s very lucky to have such an aware and supportive Mom like you to help her navigate this path 😊 Interesting what she says about how it affects her mood, I found the same. Jess

    Reply
    1. thehomeschoolingdoctor Post author

      I’ve tried and really enjoyed some of her recipes. Yum.

      We are gluten-free (with some exceptions depending on the individual in the family), although I don’t have it in my head that that’s an absolute for us. Like I have with dairy, I intend, eventually, to probably play with this. To explore. But not today. 🙂

      Cheers.

      Reply
  5. Chris Greene

    Intake of foods that contain Omega-3 fatty acids every day helps in getting rid of pains. You can get them in dietary supplements or in flax seeds, or through foods like fish, and fish oil.

    Reply
  6. Bob Niland

    re: Of course, we both know that not everyone will be celiac as they don’t have the genes for that particular response.

    And we also know that the vast majority of those so predisposed discover it not from a 3rd party analysis of their 23andme raw data, but by experiencing severe intestinal symptoms. And there there’s another 5% of the population who are merely NCGS, and they usually don’t discover that from a Cyrex Array 3. Both groups suffer further at the hands of practitioners who try everything but “how about a wheat elim?”.

    re: Although, I’d argue that we are all sensitive to multiple foods, like eggs/ dairy/ nuts/ nightshades/ and so on if we are discerning enough and complete an elimination diet.

    Relief from various other apparent food allergies, in the wake of wheat elimination, is frequently, but by no means universally reported on the Wheat Belly Blog (where, in the interest of full disclosure, I contribute). I speculated on what might explain some of the variation in responses at:
    http://www.wheatbellyblog.com/2016/01/mutant-ninja-grasses/comment-page-1/#comment-63663

    re: But I’m still not sure that means we shouldn’t be eating all these foods.

    I see zero reason to consume any of the gluten-bearing grains, nor more than deminimus amounts of the merely hi-gly grains. Leaky gut is only one charge on wheat’s lengthy rap sheet, and one not trumped by the obvious convenience factor. It was a Faustian bargain to begin consuming grains 10,000 years ago (but to be sure, agriculture made it possible for us to chat today long distance on hi tech devices).

    re: But wheat proteins are not the only substances known to open the tight junctions!

    True, but gliadin does it reliably, and lets wheat proteins in, and they are strong suspects in all sort of inflammatory and AI mischief. Thanks for that paper link, by the way.

    re: Many other “healthy” foods affect the tight junctions too, but they are not so well studied.

    I suspect that all will need to be looked at, in time. The number of things that need elim trials in “AI protocols” suggests that other miscreants are at large.

    re: Based on my daughter’s response (and probably my own response if I undertook a gluten challenge, which I will one day do), the CNS is clearly affected. Why?

    Dr. Davis just posted again on that, at:
    http://www.wheatbellyblog.com/2016/01/brain-drain/
    Perlmutter’s first book was about it.

    re: It is SO hard for people to believe that what they eat/don’t eat can make that huge of a difference.

    Particularly when the their government and consensus medicine are giving them harmful advice. Anyway, we can only help those who want to be helped and are willing to become their own skeptical advocates. Right now, the public diet could be shifting a little faster to optimized ancestral, but there is a limit to how quickly the food industry can respond.

    On to some remarks by other responses…

    re: Commercial breads are baked with bromide…

    Non-native Br may compete with iodine at the thyroid, and added to diets commonly deficient in iodine, and overloaded with other endocrine disruptors, helps explain why hypothyroid is pandemic (the scandalous mis-testing, mis-diagnosis and mis-treatment thereof is a separate matter). Bromates applied to grains in transport and storage are further concern in markets where allowed.

    re: …I don’t know why it is that people think that wheat is GMO.

    I suspect it’s a combination of people misunderstanding the discussion about wheat genetics, and industry standing up straw men in trying to respond to things like Wheat Belly (which is very clear that no GMO wheats have made it to market [yet]). What was done in creating wheat was surely genetic modification (see next link), but not GMO™ as industry would like to narrowly define it.

    re: But, he doesn’t see anything wrong with GMO.

    It’s not a black&white issue. It’s come up often enough on forums I frequent that I’ve written up a summary at:
    https://www.cureality.com/forum/topics.aspx?id=18553

    re: …I read something about some farmers doing that for some reason on wheat which I didn’t understand…

    When it’s for dessication, or staging, it’s killing the crop for convenience of timing the harvest.

    re: Intake of foods that contain Omega-3 fatty acids every day helps in…

    Anything that promotes “Omega 3”, with no further clarification in that same text string, is usually delivering predominantly, or perhaps only ALA. The ω3s we really need, and rarely get enough of, are DHA & EPA, at 3 grams per day. If a product is providing that, they’ll say so. Fish provides it, but as whole fish requires attention to the Hg risk. Welcome to the 21st century.

    Reply
    1. thehomeschoolingdoctor Post author

      Good Morning, Bob. Took me a while to reply because I couldn’t find time to read your links. I finally did. Thank you. I have and have read Wheat Belly (both books) and Grain Brain. Some scientists/doctors quibble about some generalizations made as if they are monumental detractors from the authors’ work. I do not stand in that group. We all use language and numbers to our advantage. Both authors make some amazing points and have helped so many to turn their health around; following Perlmutter’s references totally changed my take on statins. This country needs our health turned around, brains, hearts, guts, and all. These authors suggest some ways to do that which has worked for so many of their patients.

      I’ve read your response, and I agree with most of it so I don’t have much to add to the comment. Thanks for the insight on the RoundUp for harvest timing. Hadn’t heard/didn’t understand that. Would like, eventually, to read more on it.

      I hope your week is productive, bright, and cheerful.

      Terri

      PS: Oh, yes. I know you’ve seen this article, as “Uncle Roscoe” has linked to it on the Wheat Belly blog. But I really appreciated this article as a step forward in linking food and mental illness–in this case, schizophrenia–and wanted anyone reading comments on my blog to see it–although I don’t have time to write about it :-(.

      http://www.nih.gov/news-events/news-releases/schizophrenias-strongest-known-genetic-risk-deconstructed

      To me, the BIG picture I take out of this, as it will be difficult for the lay reader to understand, is that complement is activated for immune processes. Here in this article, they feel complement is responsible for too much “pruning” in the brain, leading to schizophrenia. One way to connect food and complement and thus schizophrenia is to realize that foods cause inflammation. (And Bob would definitely say grains cause more inflammation, as a family, on the whole than most any other food…) So—eat inflammatory foods, get inflammatory response, activate complement, complement activation in the brain looks like it could cause too much pruning.

      Signing off.

      Reply
  7. rantsrulesandrecipes

    Thx for sharing Terri. How insightful that your daughter made that connection! I’ve often theorized these mass shootings are somehow connected to the behavioral and emotional sequela of our nations diet.
    Too conspiracy theory?

    Reply
    1. thehomeschoolingdoctor Post author

      “Too conspiracy theory?”—Maybe you ate wheat today? 🙂 Teasing. I also have wondered about the behavioral and emotional sequelae of our nations diet, lack of sunlight and outdoor activity, and mass exposure to chemicals (Dang. They are everywhere. Dang.).

      Reply
  8. Lindsay

    Any thoughts on larazotide acetate? I used to know everything about it when it was still called AT-1001 in development. Did my PharmD seminar on it. But I haven’t read much since. I’ll put it on my list 😉

    Reply
      1. Lindsay

        By dancing days, do you mean my Tuesday night tap class? LOL

        I though it seemed to have a lot of potential, but this was before I (everyone, really) knew much about “leaky gut” per se and its development was targeted specifically to celiac as we understood it and I think type 1 DM. But since you mention zonulin, I thought of it.

        That’s how it was developed, by looking at ZO toxin and modeling it after that as a inhibitor at the zonulin receptor, thus decreasing permeability at tight junctions. I wish I remembered details, but it’s been ten (!!!) years.

        I’d like to try it if it ever gets approved.

  9. Pingback: What Could Joint Pain Have in Common with ADHD? | justiceforkevinandjenveybaylis

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