Last Friday during lunch I bought some spelt crackers and ate them, and nothing happened. Spelt is a type of grain that is strongly related to wheat. Why did I decide to try it? Well I have been trying to eat gluten-free since May 2016 when I was diagnosed with Hashimoto’s thyroiditis (and later on with Hashimoto’s encephalitis). I had been seeing a psychiatrist since October 2015 but I wasn’t responding to any of the prescribed psych meds, so my mom ordered the family doctor to refer me for autoimmune testing and high levels of anti-Tg and anti-TPO antibodies were found. I also tested positive for deamidated gliadin IgG, but negative for transglutaminase IgA antibodies. Total IgA was within normal range. Clinical websites state that if total IgA is normal and tissue transglutaminase (tTG)-IgA is negative, there is a low probability of the patient having celiac disease and a biopsy may not be necessary. My doctor did order a biopsy because of the elevated deamidated gliadin antibodies and the results indicated that there were no atrophic features identified (celiac disease causes persistent villous atrophy).
So what happened next? I think a rational doctor at this point should have said that I could go on with my bread eating, since the biopsy is the main test for celiac disease detection, and my results came back normal. But psychiatrically I was not well and my mom was very scared, she didn’t know what to do, since the psychiatrist was also out of ideas. When conventional medicine fails, people turn to alternative. Soon here we were, with my mom at a naturopath’s office. Consultation price per hour was around $250. The man in a white coat, pretending to be a doctor, asked me about my symptoms. He stated that I had to stop consuming gluten, dairy, needed to do a food sensitivities test, hair analysis test, should stop taking my antidepressant medication, and should buy $100 worth of supplements from him. He also mentioned eating cooked kale. In total this one consultation, after my mom also paid for all the tests he ordered, cost my mom around $2000 – $2500. That’s how you make money, ladies and gentlemen.
It’s very easy to come across articles online with scary titles about gluten. “Is Gluten Causing Your Depression?”, “The Surprising Link Between Gluten and Depression”, “Is gluten messing with your mind? Find out how.” One articles states that it could be actually FODMAPs (fermentable oligo di mono-saccharides and polyols) causing bowel inflammation and in turn depression. Wheat is high in FODMAPs and it’s effects could be misinterpreted as caused by gluten. This theory has some research to support it. Personally since I started eating gluten already a month ago, I did not experience abdominal pain from wheat products. I did notice bloating and pain after eating yeast containing products, such as bread, but no problem with eating wheat rotis, flatbread, etc. I am also using helminthic therapy, as I mentioned in previous posts, so this also could have helped with abdominal inflammation.
Some other articles outright claim that gluten causes “hundreds of symptoms”, also causing depression, psychosis, schizophrenia, and autism. To make extraordinary claims you have to provide extraordinary evidence. I have not been able to find strong evidence that gluten consumption causes any of the above conditions. There do exist several studies finding negative symptoms from gluten consumption, but I would not call this strong evidence. There are also other studies indicating negative impact of a gluten-free diet. I will list some of the studies below, covering both sides of the argument:
- Mood Disorders and Gluten: It’s Not All in Your Mind! A Systematic Review with Meta-Analysis. Meta-analyses with random-effects were performed. Three randomised-controlled trials and 10 longitudinal studies comprising 1139 participants fit the inclusion criteria. A gluten-free diet (GFD) significantly improved pooled depressive symptom scores in GFD-treated patients (Standardised Mean Difference (SMD) −0.37, 95% confidence interval (CI) −0.55 to −0.20; p < 0.0001), with no difference in mean scores between patients and healthy controls after one year (SMD 0.01, 95% CI −0.18 to 0.20, p = 0.94). There was a tendency towards worsening symptoms for non-coeliac gluten sensitive patients during a blinded gluten challenge vs. placebo (SMD 0.21, 95% CI −0.58 to 0.15; p = 0.25). Our review supports the association between mood disorders and gluten intake in susceptible individuals. The effects of a GFD on mood in subjects without gluten-related disorders should be considered in future research.
- Effects of a gluten-free diet on gut microbiota and immune function in healthy adult humans. The trial included 10 healthy subjects (30.3 years-old), which were submitted to a GFD over one month. Analysis of fecal microbiota and dietary intake indicated that numbers of healthy gut bacteria decreased, while numbers of unhealthy bacteria increased parallel to reductions in the intake of polysaccharides after following the GFD. Fecal samples of subjects under a GFD, which represent an altered microbiota, also exerted lower immune stimulatory effects on peripheral blood mononuclear cells than those of subjects on a regular gluten-containing diet.
- The Gluten-Free Diet: Fad or Necessity?
Some evidence indicates that there are significant drawbacks to following the gluten-free diet. For example, gluten-free processed grain products (e.g., breads, cereals, and crackers) are often lower in fiber, iron, zinc, and potassium (29). The gluten-free diet also may increase the risks for nutritional deficiencies, especially in B vitamins, iron, and trace minerals (30). In addition, gluten-free products continue to be significantly more expensive. A 2015 study found that gluten-free bread and bakery products were on average 267% more expensive than gluten-containing breads, and gluten-free cereals were found to be 205% more expensive than gluten-containing cereals (29).
Individuals following the gluten-free diet also may fail to adhere to recommendations regarding daily servings of grain products. One study found that 38% of patients with celiac disease included no grain or starch choice at meals; when patients did choose a grain product, 44% most frequently chose rice (31). In another survey of people with celiac disease, 80% were eating less than half of the recommended daily amount of grains, and only 1.1% ate the six recommended servings each day. Of those who did eat grain products, 61% most frequently chose rice and corn (32).
Personally I don’t see any strong evidence that a gluten-free diet would reduce depressive symptoms in persons with no celiac disease. In the first study, the authors state “anti-gliadin IgG antibodies disappeared in NCGS patients [34] and markers of systemic inflammation were reduced in IBS patients [36], as well as healthy mice [37] following initiation of a GFD.” I don’t see this applicable to me because I tested and I do not experience any IBS symptoms from consuming wheat or spelt. I do find myself having strong abdominal pain after consumption of regular cow milk products or yeast containing products, such as leavened bread. I have no problem with muffins prepared with baking soda, rotis, tortillas, or breakfast cereals. I see no reason to not eat these foods as they are healthy whole grains and contain B vitamins. In general I don’t want to have specific constrains for myself and feel guilty after eating once piece of pie. I know some naturopaths will say that even one piece of a cookie with gluten can make you depressed, but I see that as non-scientific nonsense. I have been gluten free, dairy free, on the autoimmune protocol diet, and I am still depressed. Depression can be caused by genetics, female hormones (such as premenstrual dysphoric disorder), epigenetics. One piece of pie isn’t going to make it or break it for me, but it does make that moment sweeter. I’m not going to be eating pie often and I do limit my sugar intake, but once a week at a friend’s house is no big deal.
By law, in Canada white wheat flour has to be enriched, therefore by eating flour products you obtain several B vitamins. “The mandatory enrichment of white flour with B vitamins, iron and folic acid is a cornerstone of Canada’s fortification program aimed at helping to prevent nutrient deficiencies and maintain or improve the nutritional quality of the food supply.
Section B.13.001 (Food and Drug Regulations):
[S] Flour, White Flour, Enriched Flour or Enriched White Flour
(d)shall contain in 100 grams of flour
- 0.64 milligrams of thiamine
- 0.40 milligrams of riboflavin
- 5.30 milligrams of niacin or niacinamide
- 0.15 milligrams of folic acid, and
- 4.4 milligrams of iron
(e) may contain
(xv) in 100 grams of flour
- 0.31 milligrams of vitamin B6
- 1.3 milligrams of d-pantothenic acid, and
- 190 milligrams of magnesium
(f) may contain calcium carbonate, edible bone meal, chalk (B.P.), ground limestone or calcium sulphate in an amount that will provide in 100 grams of flour 140 milligrams of calcium.
All white flour and foods containing white flour that are sold or intended for sale in Canada, both imported and domestically produced, are expected to be in compliance with the enrichment requirements for white flour.
White flour is processed and has high glycemic index, so it’s not advised to eat it often, but I am no longer trying to completely avoid it. Whole grain gluten flours such as whole wheat, splet, and kamut, also contain B vitamins. I am also glad to eat fortified cereal again, as they are cheap, convenient, and in one bowl you get a lot of B vitamins, plus magnesium, zinc, and iron. For example, I bought a giant box of bran flakes for $5 at Drug Mart and only 3/4 of a cup contains 30% DV iron, 45% DV thiamine, 10% DV B6, 8% DV folate, 10% DV zinc. It’s pretty hard to get that nutrition from consuming gluten-free corn cereal or puffed rice. Also it tastes better, so why not eat it? Unless someone provides strong and clear scientific evidence to do otherwise.
Notes of a Neuropsychiatry Amateur 