Читать книгу Wheat Belly Total Health: The effortless grain-free health and weight-loss plan - Dr Davis William - Страница 11

There is nothing more frightful than ignorance in action. Johann Wolfgang von Goethe

If you’re like most people, you were persuaded that grains, in all their processed or whole grain glory – flaked, puffed, dried, sugar-coated, sprouted or crisped – were perfect human foods. Like a widget on a factory production line, you and your life have been assembled, stamped, approved and moulded by forces that stand to profit from the commoditization of the human diet.

But you weren’t given the whole story. You were told that ‘healthy whole grains’ were the ticket to nutritional heaven, not the most destructive choices on your plate. You weren’t informed that this cheap, convenient way of eating was also the most expedient way to feed the world’s booming population while profiting those who are properly positioned to benefit. The ‘healthy whole grains’ yarn enjoys the company of other marketing fictions, such as ‘children in Third World countries will be healthier on soy infant formula than on breast milk’.

It didn’t start as deception. It began as an act of desperation, when humans first consumed the seeds of grasses strictly because they needed the calories. But desperation took a detour when taste and the physiology of grain-derived opiates took over, revealing the unexpected appeal of tasty foods crafted from the seeds of grasses. Our acute need caused us to ignore chronic consequences, even while our teeth rotted and fell out. From the 20th century on, though, economic opportunism and dietary misinterpretation have been largely responsible for establishing the current grains-as-food-for-every-meal lifestyle.

But before we get to all the ways you can regain health by removing grains from your diet, let’s discuss how to recognize what the destruction of health from grains looks like. This will help you understand what can be blamed on grains and what should not. While we might be able to blame grains, for instance, for a tumultuous marriage plagued by irrational behaviour that ends badly, or for years of unexplained diarrhoea prompting repeated unnecessary endoscopies and colonoscopies and bewildered, glazed looks from doctors, we should not blame grains for the chronic health impact of Lyme disease acquired from a tick bite 12 years ago or the despair caused by chronic lead exposure. Understanding these issues will help you more capably craft a programme for health, avoid unrealistic expectations (although expectations should indeed be high) and better recognize related problems when they appear. But I can assure you that there is probably no aspect of life, physical or emotional, untouched by your consumption of grains.

In Wheat Belly, I was guilty of oversimplification. I knew that just persuading the world that modern wheat was not the dietary angel it was portrayed to be, but rather the most awful Frankengrain, was a huge enough undertaking for one book. For readers of the original Wheat Belly, I will cover some familiar ground in this and the next chapter, but I will expand the discussion, relate new lessons and include the latest science.

When you read what happens to typical grain-consuming people, you can’t help but be struck by the realization that we are describing nearly everyone around us. The range of destructive health effects wrought by grain consumption is so far-reaching that, by the end of this chapter, and certainly by the end of this book, you will come to understand that the wide-ranging and myriad chronic health conditions that afflict humans can, to an astounding degree, be blamed on grain consumption. Accordingly, when we remove this collection of things called ‘healthy whole grains’, we regain health in ways that, even today, continue to astound all of us engaged in this adventure.

I’ll begin the discussion of the adverse health effects of grains at the first place your body has waged its battle against grains. This is dietary ground zero: your gastrointestinal tract.

Grains wreak an astonishing array of digestive havoc. People struggle for years, dealing with the turmoil of bloating, abdominal pain and diarrhoea, many of them eventually ending up in the emergency room, endoscoped top and bottom, typically with no cause identified, only to be prescribed one of the few catchall drugs: acid-suppressing medication, laxatives or antibiotics. A particularly common complaint of the grain consumer is disruptive and embarrassing bowel urgency that keeps people from leaving their homes or travelling, or that forces them to dash to the toilet with barely a warning. Some of the worst constipation you could imagine, called obstipation, with bowel movements happening as infrequently as every several weeks, is silently endured, as fibre and laxatives are ineffective against it. The range and frequency of bowel disruption by grains is all the more astounding when we hear just how much they are supposed to be good for gastrointestinal health.

Grains are not only not good for gastrointestinal health, but they are actually poisonous when consumed chronically. Diarrhoea, constipation, obstipation, malabsorption and inflammatory bowel disease should come as no surprise to those who consume the collection of toxins contained in the seeds of grasses. Let’s quickly map out the digestive system to give you a greater appreciation for just how grains upset the entire system and to help you understand why additional efforts are often required to regain health after grains are removed.

It Starts with a Gulp

Digestion is the miraculous process of converting things ingested, animate or inanimate, into the components of your body. The human gastrointestinal tract starts at your lips and teeth, which begin the process of tearing food into fragments. Your tongue and sense of smell serve testing functions, distinguishing the distasteful and foul-smelling (and thereby potentially unsafe) from the tasty (which is our main criterion for determining what should or should not be eaten). Salivary glands provide lubricant and are the first source of digestive enzymes. The oropharynx at the back of your throat divides and protects your respiratory from your digestive system and is lined with lymph tissue to respond to foreign invaders. Then comes your oesophagus, the muscular passageway to your stomach. In your stomach, powerful hydrochloric acid degrades food and provides an environment inhospitable to microorganisms. Protein breakdown is initiated by the stomach enzymes pepsin and gastric lipase, followed by a soup of digestive enzymes (including pancreatic lipase, trypsin, chymotrypsin, collagenase and others) released by your pancreas to further digest proteins, fats and carbohydrates.

Your liver then joins the process by producing bile, a green-coloured liquid synthesized from discarded haemoglobin from aged red blood cells – an example of the incredible efficiency of nature. Bile is stored in your gallbladder, neutralizes the acidity from your stomach acid and is secreted into your small intestine to further digest fats. Your liver also receives nutrients absorbed via your small intestine, converting them into forms transportable through the bloodstream and usable by various organs. Partially digested food and liquids proceed through your duodenum, then jejunum and ileum, segments of the small intestine responsible for nutrient absorption. Though labelled ‘small’ because of its narrow diameter, your small intestine is the longest part of your gastrointestinal tract, typically measuring 24 feet in length. This adaptation makes us efficient digesters of protein compared with ruminants, who have shorter small intestines.

After passing through your small intestine, food finally gets to your colon, the organ charged with the function of completing unfinished digestion. It does so by housing trillions of microorganisms that digest any remaining polysaccharides, even those indigestible by humans, and absorbing any residual nutrients while also helping maintain hydration by absorbing water from its semi-liquid contents and converting those contents into semisolid form. Lower down, your rectum serves a storage function that allows the elimination of its contents to occur at opportune moments, rather than in the middle of a business meeting or when doing star jumps.

I recount this amazingly elaborate process to highlight just how many steps along the way can be disrupted. In fact, given its complexity, it almost seems a wonder that digestion ever occurs smoothly. Safety mechanisms and redundancies built into the system through evolutionary adaptation maximize the likelihood that what you’ve ingested will be safely converted into the nutrients you require, while the undigested remains will be passed out quietly and without fanfare. The complexity of your digestive system is part of its beauty, but also part of its vulnerability. Disruption of this multistep process can come in many forms, including pinpoint disruption of intestinal permeability by poisons such as cholera toxin, autoimmune attacks against layers of small intestinal tissue characteristic of Crohn’s disease and factors that alter the composition of microorganisms.

Grains: A Disemboweling Experience

Let’s put it all together and describe what happens when us non-ruminants choose to eat the seeds of grasses in multigrain bread, cornflour, puffed rice in a rice cake or a bowl of oatmeal. It should come as no surprise that disruptions of this otherwise marvellous system develop. We don’t fatally succumb to our first or second bite, of course, but over an extended period of time our health declines and we wonder why, though we’re eating what we thought were healthy foods in moderation, exercising and heeding conventional health advice, we end up with disastrous health consequences. These are the gastrointestinal effects of consuming the seeds of grasses.

Acid Reflux and Reflux Oesophagitis

Millions of people are plagued by the discomfort of acid reflux and oesophageal inflammation and are prescribed acid-suppressing medications such as Prilosec, Prevacid, Pepcid and Protonix, which they take every day for years. Treatment for acid reflux and reflux oesophagitis has proven to be enormously profitable. Annual revenues for these drugs for one company alone, AstraZeneca, exceeded £15 billion in 2011.¹ More than one billion people – one out of every seven people on the planet – have been prescribed these drugs since their appearance on the market 35 years ago.

These drugs are not without health consequences. They have been associated with vitamin B₁₂ and magnesium deficiency; impaired calcium absorption, osteoporosis and increased bone fracture risk; and increased risk of pneumonia.² Use of such prescription drugs has been associated with changes in bowel flora resulting in dysbiosis (disrupted bowel flora) and increased potential for intestinal infection with Clostridium difficile.³ The dysbiosis provoked by such drugs is believed by some to explain the deterioration of multiple sclerosis symptoms that often develops with their use.⁴ Because the drugs are often ineffective and result in their own collection of health problems, doctors increasingly advise patients to undergo surgical procedures, such as fundoplication (surgically wrapping the stomach around the oesophagus) to avoid using the drugs. But for the majority of people taking these drugs for acid reflux and reflux oesophagitis, the real solution is as simple as saying ‘no’ to all grains.

Bowel Urgency and Irritable Bowel Syndrome

I am astounded by the number of people who relate tales of explosive bowel urgency, often with just seconds of warning, that cause their lives to be filled with anxiety during social situations, travel or a simple trip to the shops. While grains are commonly painted as good for bowel health because of the fibre they contain, the other components of grains create feelings of urgency, the symptoms of which are often labelled irritable bowel syndrome (IBS). Gliadin and related prolamins, glutenins, wheat germ agglutinin (WGA), alpha amylase and trypsin inhibitors are bowel toxins, and bowel urgency is your body’s way of telling you that it is trying to get rid of some toxin causing irritation. It is wise to listen to your bowels, and they are saying, ‘stop the grains’.

IBS, particularly if diarrhoea is present, is also proving to be more coeliac disease-like than previously suspected in that it is associated with increased intestinal permeability and a high likelihood of dysbiosis.⁵ IBS and/or ‘gluten sensitivity’ are therefore not as benign as previously advertised, given that increased intestinal permeability has the potential to initiate autoimmune processes, among other issues.

Dysbiosis

Grains and other factors cause changes in bowel flora, allowing unhealthy species of bacteria to proliferate while suppressing or entirely knocking off healthy species, a condition called dysbiosis or small intestinal bacterial overgrowth (SIBO). Abnormal bacteria can also migrate into the upper small intestine and stomach, where they don’t belong, rather than being confined to the lowest end of the small intestine and the large intestine. In its most severe form, dysbiosis is experienced as nausea, abdominal distress, diarrhoea or constipation (typically diagnosed as irritable bowel syndrome), fatigue and low energy, inflammation of the skin and joints, diffuse muscle pain (often called fibromyalgia), nutrient deficiencies and autoimmune diseases.

One of the ways grains can trigger dysbiosis involves your gallbladder and pancreas, which are normally part of a wonderfully orchestrated system. When oils or fats are sensed in the duodenum, the hormone cholecystokinin (CCK) is released, stimulating the gallbladder to release bile and the pancreas to release a mix of digestive enzymes, all of which work to digest food. Funny thing, though: CCK receptors in the gallbladder and pancreas are glycoproteins, the kind of protein that WGA loves to bind.⁶ This blocks the CCK signal received by the gallbladder to release bile and the pancreas to release digestive enzymes. The result is inefficient, incomplete digestion. Undigested food ferments and decays in the presence of bacteria, effects you experience as bloating, gas and changes in stool character, including lighter colour and floating (due to undigested oils and fats). Over time, dysbiosis sets in, as the rotting food encourages growth of decay-causing bacteria. To top it all off, the failed release of bile by the gallbladder leads to bile stasis, which allows formation of gallstones.

Dysbiosis can also exacerbate existing conditions. Some people, genetically predisposed, develop inflammatory bowel diseases, ulcerative colitis and Crohn’s disease after exposure to the bowel toxins of grains. Should dysbiosis develop, these conditions are made even worse, as sufferers may experience diarrhoea, bleeding in the stool, poor nutrient absorption, pain and a long-term risk for complications, such as colon cancer for those with ulcerative colitis or small intestinal lymphoma and fissures for those with Crohn’s disease.

Constipation

A condition as pedestrian as constipation serves to perfectly illustrate many of the ways in which grains mess with normal body functions, as well as just how wrong conventional ‘solutions’ can be. Constipation remedies are like the Keystone Kops of health: they stumble, fumble and bump into each other, but never quite put out the fire.

Drop a rock from the top of a building and it predictably hits the ground – not sometimes, not half the time, but every time. That’s how the bowels are programmed to work, as well: Put food in your mouth, and it should come out the other end, preferably that same day and certainly no later than the following day. People living primitive lives without grains, sugars and soft drinks enjoy such predictable bowel behaviour: eat some turtle, fish, clams, mushrooms, coconut or mongongo nuts for breakfast, and out it all comes that afternoon or evening – large, steamy, filled with undigested remains and prolific quantities of bacteria, no straining, laxatives or stack of magazines required. Live a modern life and have pancakes with maple syrup for breakfast, instead. You’ll be lucky to pass that out by tomorrow or the next day. Or perhaps you will be constipated, not passing out your pancakes and syrup for days or passing it incompletely in hard, painful bits and pieces. In constipation’s most extreme forms, the remains of pancakes can stay in your colon for weeks. The combined effects of impaired CCK signalling, reduced bile release, insufficient pancreatic enzymes and changes in bowel flora disrupt the orderly passage of digested foods.

We are given advice to include more fibre, especially insoluble cellulose (wood) fibres from grains, in our diets. We then eat breakfast cereals or other grain-based foods rich in cellulose fibres and, lo and behold, it does work for some, as indigestible cellulose fibres, undigested by our own digestive apparatus as well as undigested by bowel flora, yield bulk that people mistake for a healthy bowel movement. Never mind that all of the other disruptions of digestion, from your mouth on down, are not addressed by loading up your diet with wood fibres. What if sluggish bowel movements prove unresponsive to such fibres? That’s when health care comes to the rescue with laxatives in a variety of forms, some irritative (phenolphthalein and senna), some lubricating (dioctyl sodium sulfosuccinate), some osmotic (polyethylene glycol), some no different than spraying you down with a hose (enemas).

The methods of modern health care build on the problem. Perhaps you develop iron deficiency from grain phytates, necessitating prescription iron tablets that cause constipation. You also develop high blood pressure and are prescribed thiazide diuretics and beta-blockers, both of which increase constipation. Autoimmune thyroid disruption that can develop from prolamin proteins of grains also slows bowel function. When joints hurt from grain consumption, non-steroidal anti-inflammatory agents are taken, resulting in slowed stool passage. If you’re emotionally depressed due to grain consumption, antidepressants are prescribed that slow normal bowel reflexes that maintain motility. The constant message is to get more fibre, drink more fluids, take a laxative.

The longer stool-in-progress stays in the lower small intestine and colon, the longer it has to putrefy. Just as food sitting out in the open air rots, so can stool sitting too long in the bacteria-rich environment of the intestinal tract. Slowed passage of putrefied stool has been linked to increased cancer risk, especially of the rectum.⁷ Over time, constipation and the straining it causes lead to haemorrhoids; anal fissures; prolapse of the uterus, vagina and rectum; and even bowel obstruction, a surgical emergency. Once again, the health-care system, with its enthusiasm for procedures, has solutions. As banal, uninspiring and ordinary as it is, constipation has a world of important lessons to teach us about our relationship with the seeds of grasses. Yes, there is order and justice in the digestive world, but you won’t find it in that box of fibre-rich cereal.

Note that I barely mention coeliac disease or gluten sensitivity, as most of the gastrointestinal disruptions caused by grains are of neither variety. When those diseases are removed from the discussion, you can appreciate just how much gastrointestinal distress and disruption is due to the various toxic components of grains. You can also appreciate why defenders of grains, such as the Whole Grains Council, try to minimize the problem by arguing that gluten is the only problem component in grains and that gluten is a problem for a relative few. Nope: grains are simply the innocent seeds of grasses, incompletely digestible just like the rest of grass plants. This indigestibility allows toxins to persist, intact and ready to block, irritate and inflame the gastrointestinal tract of Homo sapiens who never should have eaten the stuff in the first place. This results in insufficient bile and pancreatic enzymes, impaired digestion, gallstones and dysbiosis, coupled with intestinal inflammation – the human gastrointestinal tract doesn’t stand a chance.

The Coeliac Concession and the Clash over Gluten Sensitivity

Defenders of grains would have us believe that the only problem with consuming the seeds of grasses is coeliac disease, the destruction of the lining of the small intestine that occurs in people with genetic susceptibility from carrying HLA-DQ2 or HLA-DQ8 genes, coupled with positive tests for transglutaminase or endomysial antibodies and an abnormal biopsy of the small intestine. Coeliac disease affects around 1 per cent of the population and the gliadin, secalin and hordein proteins of wheat, rye and barley are issues only for these people, they argue. Just a few years ago, this represented a major concession from the defenders of grains.

More recently, this notion has crumbled like stale bread as consensus has grown for the idea that there is another form of intolerance to these same proteins. Labelled non-coeliac gluten sensitivity (NCGS), it is believed to cause many of the same symptoms experienced by coeliac sufferers. Bloating, diarrhoea, abdominal pain, fatigue and headaches are experienced by these people in the absence of the markers for coeliac disease, yet they have symptoms reliably triggered by reexposure to grains. Because of differences in how this condition is defined, anywhere from a few per cent to 30 per cent of the population are estimated to have NCGS.⁸ Some coeliac disease experts have proposed that irritable bowel syndrome, a condition that affects 25 per cent of the population, should be regarded as the same condition as NCGS. People with NCGS have a greater likelihood of antibodies to gliadin; 56 per cent showed such antibodies in one analysis, suggesting that an autoimmune process is at work.⁹ The possibility that NCGS represents reactions to other components of grains, such as WGA or trypsin or amylase inhibitors, has not yet been fully explored. Nonetheless, the expanding world of grain intolerances has kept grain’s defenders busy, and they’ve had to concede that there may indeed be problems with grain consumption in more than the 1 per cent of people with coeliac disease.

I don’t envy those in the position of having to defend grains. More recently, they have tried to put a positive spin on ‘gluten-free grains’, such as amaranth, rice and millet, hoping to maintain their market presence but deflect growing antigluten criticism. Defend the seeds of grasses as a dietary staple, and it should come as no surprise that you find yourself in an increasingly lonely corner.

Fortification: Not Good Enough

It should come as no surprise that, given the gastrointestinal disruption caused by grains, nutrient absorption can be impaired enough to create several common deficiencies. Of course, this is contrary to what we’re told will happen if we consume more ‘healthy whole grains’. Grains like wholemeal bread, stoneground oatmeal and multigrain muffins do indeed have a respectable profile of B vitamins, fibre and phytonutrients. But the nutrients of grains are accompanied by factors that impair the absorption of nutrients, which then cause nutritional deficiencies. This vicious cycle only ends when you remove grains from your diet and seek other sources of nutrients.

IRON DEFICIENCY began when early humans first consumed the seeds of grasses. Iron deficiency can impair the ability to run, hunt, gather food or tolerate weather extremes, so it has a potential impact on survival. Because of this, it has exerted an evolutionary pressure over the last 10,000 years that led to the appearance of the gene for haemochromatosis, which partially counteracts the iron-impairing effects of grains.¹⁰ All grains contain high quantities of phytates, the component of grains responsible for impaired iron absorption. Ironically, many grain breeders select high-phytate strains of grains because they have improved pest resistance. Whole wheat, corn and millet, for instance, contain 800 milligrams (mg) of phytates per 100 grams (approximately 3½ ounces) of flour. It takes as little as 50 mg of phytates to slash iron absorption by 80 to 90 per cent.¹¹

Because phytates essentially turn off the human capacity for iron absorption and most of us do not have haemochromatosis, consumption of grains is the most common explanation for iron deficiency anaemia in situations in which blood loss is not the cause.¹² Iron deficiency is a worldwide problem; it’s the most common cause of anaemia. In Egypt, for example, iron deficiency doubled between 2000 and 2005 as grain consumption of baladi bread increased.¹³ The ‘solution’? Fortify the bread with iron. It should come as no surprise that 46 per cent of people with coeliac disease show decreased iron stores (low ferritin levels) and anaemia from iron deficiency, though, because the effect is not mediated by gluten but by phytates, and grain-induced iron deficiency is exceptionally common in those who don’t have coeliac disease, as well.¹⁴ People who have Crohn’s disease, malabsorption and dysbiosis are also more prone to iron deficiency. Grains cause iron-deficiency anaemia with its associated symptoms of fatigue, light-headedness and breathlessness. Grains contain iron, but it is the less well-absorbed ‘non-haem’ form, rather than the more efficiently absorbed ‘haem’ form found in haemoglobin and myoglobin from animal products. Despite the fact that grains contain iron, the net effect of grain consumption is reduced iron status. Iron deficiency is therefore a common health price we pay when we consume the seeds of grasses.

ZINC DEFICIENCY also develops in populations dependent on grain consumption.¹⁵ Deficiency of zinc was thought to be rare until 1958, when a severe case was diagnosed in an Iranian man who appeared to be around 10 years old at the age of 22. He had an enlarged liver and spleen, heart failure and an appetite for eating dirt. Characteristic of his culture, 50 to 90 per cent of his diet consisted of unleavened tanok bread, along with potatoes, fruit, vegetables and occasional meat. Zinc supplementation corrected his health problems.¹⁶ The component in wheat responsible for the deficiency was not clear, however, until chickens and pigs were diagnosed with zinc deficiency due to the phytate content of wheat fed to them. Zinc deficiency has since proven to be widespread.

The phytates that block iron absorption are also responsible for blocking zinc absorption. The phytates contained in just 2 ounces of grain flour are sufficient to nearly completely block intestinal zinc absorption.¹⁷ And in the seemingly endless string of breeding blunders, here’s one more: modern breeding efforts have selected plants with higher quantities of phytates because of their pest resistance. The ever-resourceful grain industry has, not unexpectedly, manipulated grain crops to increase zinc content to compensate. (One method includes using fertilizers supplemented with zinc.)

Zinc deficiency correlates with grain consumption: the more that’s consumed, the more likely zinc deficiency is to develop.¹⁸ This is a nutritional problem of growing worldwide significance, as increasing reliance on grains, especially wheat, corn and rice, has worsened zinc status in an estimated two billion people.¹⁹ Between 35 and 45 per cent of older adults are zinc deficient, and 67 per cent of people with untreated coeliac disease have zinc deficiency.²⁰

Because zinc is essential for hundreds of different body processes, deficiency can manifest in varied ways. Mild deficiency typically shows as rashes, diarrhoea and hair loss. Vegans, vegetarians and people who limit consumption of animal products are especially prone to zinc deficiency, since plant products contain minimal zinc compared with the higher zinc content of meats, poultry, shellfish and organ meats.²¹ Combine the poor zinc content of plant products with the impaired absorption caused by grain phytates, and it’s not uncommon for vegans and vegetarians to develop difficulties even mounting a normal immune response. Additionally, fertility and reproduction are adversely impacted, children and adolescents can experience impaired growth, and neurological maturation is impaired, among other diverse effects of moderate to severe zinc deficiency. For this reason, the Institute of Medicine has estimated that vegans and vegetarians require 50 per cent more zinc than omnivores.²² Removing grains from the diet improves zinc status, and if lost grain calories are compensated for with an increase in zinc-rich foods, such as meats, there is a net increase in zinc intake and absorption. (Also, see here for more information on how to correct zinc deficiency.)

VITAMIN B₁₂ DEFICIENCY is also common, affecting 19 per cent of people with coeliac disease and 16.6 per cent of people without coeliac disease.²³ B₁₂ deficiency is another signature deficiency of grain consumption, as several grain components collaborate to impair its absorption. Wheat germ agglutinin (WGA) blocks the intrinsic factor protein produced in the stomach and essential for B₁₂ absorption in the small intestine, the means by which 60 per cent of all B₁₂ is absorbed.²⁴ Grain consumption can also trigger antibodies against the intrinsic factor or against the stomach parietal cells that produce intrinsic factor.²⁵

Severe B₁₂ deficiency has serious implications, including pernicious anaemia (fatal if untreated) or macrocytic anaemia, describing the abnormally large red blood cells that develop as a result of this condition. Abdominal pain, an enlarged liver and a characteristic cherry red tongue develop with B₁₂ deficiency. Lesser degrees of deficiency have health and performance implications, too, as they can lead to diminished concentration and learning ability. Typical of the silliness of modern nutritional thinking, the solution often offered is increased B₁₂ supplementation in grains to compensate for these effects.²⁶

Because dietary B₁₂ is obtained mostly from animal-sourced products, such as meat, liver and eggs, vegans and vegetarians who consume grains are especially likely to develop a deficiency. People with inflammatory bowel diseases (Crohn’s disease and ulcerative colitis) are also especially prone to vitamin B₁₂ deficiency.

FOLATE DEFICIENCY is less common than deficiencies of iron, zinc and vitamin B₁₂. It is, however, known to occur in people with coeliac disease and gluten intolerance.²⁷ People with inflammatory bowel diseases also suffer from impaired folate absorption sufficient to cause deficiency. Also, situations in which greater folate needs develop, especially pregnancy, can magnify the severity of deficiency. In all these situations, assessment of folate levels should be performed and supplementation instituted. (See here for more information.) Folate deficiency has serious implications, including birth defects in children born from folate-deficient mothers and increased potential for gastrointestinal cancers. Many of the same phenomena that develop with vitamin B₁₂ deficiency are caused by folate deficiency, since folate and B₁₂ participate in many similar processes.

Folate is the form that occurs naturally in foods, while folic acid is the synthetic form added to foods or taken in supplement form. Because modern diets dependent on processed grains and sugar are potentially deficient in folate, manufacturers in the United States and Canada have been required to add synthetic folic acid to grain products since 1998 to decrease the incidence of birth defects. This has indeed improved the folate status of most people, but it is proving to be a double-edged sword: Folate levels increased more than intended, and increased reliance on synthetic folic acid has also been associated with increased colon and prostate cancers.²⁸

VITAMIN D DEFICIENCY is a widespread phenomenon with significant implications for health. Vitamin D deficiency is the rule, rather than the exception. While we can blame more severe cases of deficiency on grains, it also commonly occurs independent of grain consumption. Various other modern habits have served to worsen our vitamin D status, including inhabiting cold climates deprived of year-round sunlight, wearing clothes that cover skin surface area (since vitamin D is activated in our skin by sunlight), increasingly indoor lifestyles, aversion to organ consumption, especially liver (they contain vitamin D), and ageing, which is associated with a progressive loss of the ability to activate vitamin D in the skin.²⁹ Living in the tropics is no guarantee of adequate vitamin D status, though; a recent assessment of elderly males living in a tropical climate, for instance, revealed that 66.7 per cent were deficient.³⁰ Vitamin D status is such a crucial factor for health that we discuss it at greater length later in the book (see here).

People with coeliac disease are especially prone to vitamin D deficiency, which also contributes to low bone mineral density. In one clinical study, only 25 per cent of people showed normal bone density at the time of their coeliac disease diagnosis.³¹ Bone demineralization (loss of calcium) that weakens bones is also worsened by the impaired calcium absorption characteristic of coeliac disease.

Gut Flora: Don’t Get Your Bowels in an Uproar

You can view bacterial flora that inhabit the intestinal tract like a garden: if you fertilize it properly, provide sufficient water and nutrients, and avoid herbicides and pesticides that disrupt the natural balance, your garden will yield a bounty of vigorous, healthy crops. If you fail to water or fertilize it properly, you will probably have a lousy yield of stunted crops, not to mention lots of weeds. Bowel flora operate on similar principles.

We know that diet plays an important role in shaping the composition of bowel flora, even in the absence of disease. For example, bowel flora of children living in rural Africa and eating traditional diets, when compared with European children eating a modern diet, demonstrate striking differences. The African children have higher than expected numbers of Bacteroidetes, an adaptation theorized to enhance efficiency in digesting plant matter.³² I’ve discussed how the adoption of grains changed the composition of mouth and gut flora in humans. Changes in oral flora have clear implications for dental disease; changes in gastrointestinal flora have less clear implications, but it should come as no surprise that there could be such changes, given the toxic effects grains have on the intestines. The composition of bacteria in the gastrointestinal tract, concentrated in the colon, varies from individual to individual, shifts with age and hormonal status, and is modified by exposure to antibiotics and components of diet. When factors that allow healthy bacteria to survive are altered, bowel flora species change and microorganisms can extend above the normal furthest segment of the small intestine, a situation called small intestinal bacterial overgrowth, or SIBO. That’s when nasty things can happen: bloating, diarrhoea, nutritional deficiencies and inflammation. (See ‘Small Intestinal Bacterial Overgrowth: The Case of the Human Petri Dish’.)

It is estimated that more than 1,000 different species of bacteria dwell in our intestines. Unfortunately, most of our understanding of the composition of bowel flora involves comparing people with various diseases, such as ulcerative colitis, to people without the same disease. It is not clear whether the changes in bowel flora composition are part of the cause or simply a consequence of the disease. People without disease are also assumed to be normal, but this may not be true, since ‘normal’ ignores potentially disruptive factors such as prior antibiotic use, emotional stress and unnatural distortions of diet, such as grain and sugar consumption. Nobody quite knows what normal or ideal bowel flora look like yet.

A number of health conditions have been associated with changes of bowel flora, including multiple sclerosis, fibromyalgia, diabetes (both type 1 and type 2), irritable bowel syndrome, gallstones, acid reflux and oesophagitis, irritable bowel syndrome, ulcerative colitis, Crohn’s disease and food allergies.³³ Funny thing: each and every one of these conditions has also been associated with grain consumption, especially consumption of wheat, rye and barley.

Changes in the composition of our bacteria develop as quickly as days to weeks after a change in diet.³⁴ Right now, our understanding of bowel flora remains limited, but it is rapidly yielding to study. I believe that in the next few years we will know with confidence how to assess an individual’s bowel flora status and how to know when it has been fully corrected. In the meantime, the steps required to reestablish what we currently believe represents an ideal composition of bowel flora will be discussed in Chapter 9.

Small Intestinal Bacterial Overgrowth: The Case of the Human Petri Dish

Put a petri dish out in the open air and, over just a few days, it will be ripe with bacteria and fungi. Likewise, mess up the health of the human intestine by allowing undesirable bacteria and fungi to gain an advantage and reducing normal bacterial species, and you have the equivalent of a human petri dish. Such a situation is common, and it’s called small intestinal bacterial overgrowth (SIBO), or dysbiosis, an abnormal overabundance of bacteria in the normally sparsely populated upper small intestine, or jejunum, along with changed species in other parts of the intestinal tract. (Changed bowel flora also occurs in the large intestine and even the stomach and duodenum, but a SIBO or dysbiosis diagnosis is often made by sampling the contents of the jejunum of the small intestine, which is why we have the somewhat misleading ‘small intestine’ label of the condition.)

SIBO has been associated with a number of conditions, including fibromyalgia, irritable bowel syndrome, Crohn’s disease, ulcerative colitis and anatomical distortions introduced by prior bowel surgery.³⁵ SIBO is common in people with coeliac disease, and when ‘normal’ people are assessed for SIBO, up to 35 per cent demonstrate evidence for abnormal intestinal infestations, even if no symptoms are present.³⁶ When SIBO is diagnosed in people with bothersome symptoms, the conventional treatment is to prescribe an antibiotic, such as rifaximin, to wipe out bowel flora, both good and bad. And it works, though it ignores the question of why the SIBO developed in the first place. And, of course, wiping out bowel flora does not guarantee that your intestines will repopulate with healthy bacteria, particularly if the cause of the SIBO remains uncorrected.

The Difficulties of C. difficile

One disturbing trend in the world of SIBO is the increasing incidence of infection by Clostridium difficile, a strain of bacteria capable of inflicting severe damage on the colon. Called pseudomembranous colitis, in its worst form it can involve sepsis (entry of bacteria into the bloodstream) and death.

Ordinarily, C. difficile quietly inhabits the colons of healthy people (or at least what is commonly regarded as healthy) in low numbers, as it competes with other bacteria for nutrients and is suppressed by factors expressed by other species. We know that C. difficile can emerge following the use of antibiotics that indiscriminately knock off bowel flora, good and bad, which of course requires even more antibiotics. More recently, though, C. difficile has proven to be a source of trouble even without a preceding course of antibiotics. Drugs that are widely prescribed to suppress stomach acid, such as Prilosec, Protonix and Prevacid, have been associated with distortions of bowel flora that allow populations of C. difficile to thrive.³⁷ But the reasons why this organism is becoming increasingly aggressive are unclear. Might the distortions of bowel flora caused by grains, changed by agribusiness, play a role? There are no answers at present, but it sure would add up as cleanly as 2 + 2 = 4.

Your Gut is Leaking

Leakiness is a condition that plagues roofs and bathroom taps or is suffered by spy agencies when errant contractors leak classified US security information, but hopefully your seafaring ship, microwave and intestinal tract are free from leaks. For many years, it has been suspected that an abnormally increased degree of intestinal permeability is responsible for triggering diseases such as type 1 diabetes, Crohn’s disease, ankylosing spondylitis, multiple sclerosis and coeliac disease.³⁸ Every day, your gastrointestinal tract must contend with bacteria, fungi and other organisms, bacterial toxins and even larger critters, such as protozoa and insects. It must therefore make millions of ‘decisions’ every day, with each and every meal: What should be allowed passage into the lymph system and bloodstream? What should not?

This tightly controlled system can go haywire. Fragments of gliadin and related prolamin proteins exert direct toxic inflammatory effects on the intestinal lining in anyone foolish enough to ingest grains – effects that can result in abnormally increased intestinal permeability.³⁹ No genetic susceptibility is required for this effect; all testing for coeliac disease or ‘gluten sensitivity’ may be negative in those with intestinal permeability.

In addition to these direct effects, gliadin can also indirectly increase intestinal permeability. While at the University of Maryland, Dr Alessio Fasano discovered that the zonulin protein in the lining of the gastrointestinal tract is a target for the gliadin protein of wheat.⁴⁰ Once activated, the zonulin protein triggers increased leakiness of the barriers (‘tight junctions’) between intestinal cells, permitting molecules that should be confined within the intestinal tract to gain access to the rest of the body. While the intensity of the effect is variable (depending on the genetically determined form of zonulin), everyone is subject to this effect to one degree or another. Given their structural similarities, the prolamin proteins of other grains exert similar effects.⁴¹ The implications of Dr Fasano’s work are huge. His findings mean that the abnormally increased intestinal permeability induced by gliadin and related proteins is the first step leading to autoimmunity, as the body’s immune system is tricked into attacking its own organs in those with genetic susceptibility. In other words, even if you have a genetic susceptibility to rheumatoid arthritis, joint swelling, inflammation and disfigurement may never show unless the process is initiated by consumption of grain proteins. Or, if you have a genetic susceptibility to multiple sclerosis, fatigue, numbness, incoordination and bladder or bowel dysfunction may never appear unless grain proteins cause increased intestinal permeability that allows the genetic susceptibility to manifest. We discuss this distinct pathway that relates autoimmune diseases with grain consumption in Chapter 13.

Venomous, Debauched, and Depraved

If, at the end of this discussion of the gastrointestinal effects of grains, you conclude that grains are not only harmful for bowel health and nutrition but are also a dreadful, nasty, trouble-making collection of bowel toxins, you are empowered with the key to understanding why so many people are plagued by chronic gastrointestinal complaints, regardless of how ‘balanced’ their diet, how vigorously they exercise or how many nutritional supplements they take.

While the gastrointestinal system is ground zero for the human body’s battle against grains, it is by no means the only battleground. We’ll discuss the rest of the battered, barren, land mine-strewn health landscape in Chapter 5.