But if we look only at overweight people who are not severely malnourished at the time of diagnosis who remove wheat from their diet, it becomes clear that this enables them to lose a substantial amount of weight. A Mayo Clinic/University of Iowa study of 215 obese celiac patients showed 27.5 pounds of weight loss in the first six months of a wheat-free diet.11 In another study, wheat elimination slashed the number of people classified as obese (body mass index, or BMI, 30 or greater) in half within a year.12 Oddly, investigators performing these studies usually attribute the weight loss of wheat- and gluten-free diets to lack of food variety. (Food variety, incidentally, can still be quite wide and wonderful after wheat is eliminated, as I will discuss.)
Advice to consume more healthy whole grains therefore causes increased consumption of the amylopectin A form of wheat carbohydrate, a form of carbohydrate that, for all practical purposes, is little different, and in some ways worse, than dipping your spoon into the sugar bowl.
GLUTEN: WE HARDLY KNOW YA!
If you were to add water to wheat flour, knead the mixture into dough, then rinse the glob under running water to wash away starches and fiber, you’d be left with a protein mixture called gluten.
Wheat is the principal source of gluten in the diet, both because wheat products have come to dominate and because most Americans do not make a habit of consuming plentiful quantities of barley, rye, bulgur, kamut, spelt, einkorn, emmer, or triticale, the other sources of gluten. For all practical purposes, therefore, when I discuss gluten, I am primarily referring to wheat.
While wheat is, by weight, mostly amylopectin A carbohydrate, gluten protein is what makes wheat “wheat.” Gluten is the unique component of wheat that makes dough “doughy”: stretchable, rollable, spreadable, twistable, baking gymnastics that cannot be achieved with rice flour, corn flour, or any other grain. Gluten allows the pizza maker to roll and toss dough and mold it into the characteristic flattened shape; it allows the dough to stretch and rise when yeast fermentation causes it to fill with air pockets. The distinctive doughy quality of the simple mix of wheat flour and water, properties food scientists call viscoelasticity and cohesiveness, are due to gluten. While wheat is mostly carbohydrate and only 10 to 15 percent protein, 80 percent of that protein is gluten. Wheat without gluten would lose all its unique qualities that transform dough into bagels, pizza, or focaccia.
Glutens are the storage proteins of the wheat plant, a means of storing carbon and nitrogen for germination of the seed to create new wheat plants. Leavening, the “rise” process created by the marriage of wheat with yeast, does not occur without gluten, and is therefore unique to wheat flour.
The term “gluten” encompasses two primary families of proteins, the gliadins and the glutenins. Gliadins, the protein group that most vigorously triggers the immune response in celiac and other diseases, has three subtypes: α/β-gliadins, γ-gliadins, and ω-gliadins. Importantly, gliadin proteins are responsible for effects beyond celiac disease, such as initiating autoimmune diseases, direct intestinal injury, and opiate effects on the brain, effects we shall discuss later. Glutenin proteins are long repeating structures, or polymers, of more basic units. The strength of dough is due to the large polymeric glutenins, a genetically programmed characteristic purposefully selected by plant breeders.13 Glutenins are likewise a source of health problems for unwitting humans consuming them.
Gluten from one wheat strain can be quite different in structure from that of another strain. Gluten proteins produced by einkorn wheat, for example, are distinct from the gluten proteins of emmer, which are, in turn, different from the gluten proteins of the thousands of strains of Triticum aestivum.14, 15 Because fourteen-chromosome einkorn has the smallest chromosomal set, it codes for the fewest number and variety of glutens. Twenty-eight-chromosome emmer codes for a larger variety of gluten. Forty-two-chromosome Triticum aestivum has the greatest gluten variety, even before any human manipulation. Breeding efforts of the past sixty years have generated numerous additional changes in gluten-coding genes in Triticum aestivum.16 Because breeding efforts focus only on agricultural and baking interests and not on human health, genes contained in modern wheat are most frequently pinpointed as the source of glutens that trigger celiac disease, effects amplified compared to traditional strains.17
It is therefore modern Triticum aestivum that, having been the focus of all manner of genetic shenanigans by geneticists, has accumulated substantial changes in genetically determined characteristics of gliadin and glutenin proteins within gluten. It is also the source for many of the other odd health phenomena experienced by consuming humans.
In celiac disease, the one conventionally accepted (though miserably underdiagnosed) example of wheat-related intestinal illness, gliadin proteins, specifically α-gliadin, provoke an immune response that inflames the small intestine, causing abdominal cramps and diarrhea. Treatment is simple: complete avoidance of anything containing gluten. Unfortunately, this association has caused most people, including doctors, to believe that the only problem with wheat and grains is gluten when there are actually dozens of toxic compounds in the seeds of grasses.
The “wheat is only a gluten problem” has blinded many people into thinking that, if you don’t have celiac disease, then eating all the ciabattas, donut holes, and tortellini you want is actually healthy. It has led to silly research efforts such as those conducted at Monash University in Australia in which purified gluten was administered to people with presumed non-celiac gluten intolerance and the majority (92 percent) tolerated it without gastrointestinal consequences, causing the authors to declare that gluten is not a problem for most people.18 Removing nicotine from cigarettes does not make smoking healthy. Tolerating purified gluten over a brief period of observation does not negate the potential for long-term harm, such as autoimmune diseases or brain effects, not to mention the harmful consequences of the dozens of other components besides gluten.
Did you want a low-tar cigarette with that salami sandwich?
IT’S NOT ALL ABOUT GLUTEN
You now know that gluten isn’t the only potential villain lurking in wheat flour.
Beyond gluten, the other 20 percent or so of non-gluten proteins in wheat include albumins, prolamins, and globulins, each of which can also vary from strain to strain. In total, there are more than a thousand other proteins that are meant to serve such functions as protecting the grain from pests, providing water resistance, and supplying reproductive functions. There are agglutinins, peroxidases, α-amylases, serpins, and acyl CoA oxidases, not to mention five forms of glyceraldehyde-3-phosphate dehydrogenases. I shouldn’t neglect to mention β-purothionin, puroindolines a and b, and starch synthases. Wheat ain’t just gluten, any more than southern cooking is just grits.
Let’s take just one of these non-gluten proteins, wheat germ agglutinin, which has been enriched in modern strains of wheat through breeding to take advantage of its pest-resistant effects, making a stalk of wheat more resistant to fungi and molds. Wheat germ agglutinin is completely indigestible to humans, passing through the entire gastrointestinal tract unfazed by stomach acid, thumbing its nose at digestive enzymes and bile, eventually exiting into the toilet. But, in its travels from swallow to flush, it wreaks gastrointestinal havoc. One milligram (just a speck—there are 4,000 milligrams in just one packet of sugar) of purified wheat germ agglutinin fed to a laboratory animal results in extensive damage to the intestinal lining.19 While grains such as ancient wheat, rye, barley, and rice contain a single form of wheat germ agglutinin, modern wheat contains three different varieties, given its heightened genetic pliability. And this is just one protein among many beyond gluten in wheat and related grains.
There are also allergic or anaphylactic (a severe allergic reaction resulting in shock) reactions to non-gluten proteins, including α-amylases, thioredoxin, and glyceraldehyde-3-phosphate dehydrogenase, along with about a dozen others.20 Exposure in susceptible individuals triggers asthma, rashes (eczema and hives), and a curious and dangerous condition called wheat-dependent exercise-induced anaphylaxis (WDEIA) in which rash, asthma, or anaphylaxis are provoked during exercise. WDEIA has been attributed to ω-gliadins and glutenins.
Wheat and grains are rich in phytates, compounds that, like wheat germ agglutinin, provide pest-resistance to the plant. Once again, plant geneticists select strains richer in phytates and thereby are more pest-resistant. Phytate content parallels fiber content. This means that conventional advice to consume plentiful fiber from grains, such as whole grain breads and bran cereals hawked for promoting bowel regularity, thereby increases exposure to phytates. Problem: Phytates are effective binders of any mineral that has a positive charge. This includes iron, zinc, magnesium, and calcium. Phytates from grains are therefore a common cause of iron deficiency anemia, unresponsive to iron supplementation (since the iron never makes it to the bloodstream).21, 22 Zinc deficiency from phytates results in slowed wound healing, increased susceptibility to infections, skin rashes, impaired taste and smell, and slowed growth in children.23 Wheat consumption is one of several causes of magnesium deficiency that is ubiquitous and results in bone thinning, higher blood pressure and blood sugar, muscle cramps, and heart rhythm disorders.24 You may begin to appreciate just how many ironies there are in conventional diet advice: Eating more “healthy whole grains” to ensure adequate nutrition actually achieves the opposite.
As if this protein/enzyme smorgasbord weren’t enough, food manufacturers have also turned to fungal enzymes, such as cellulases, glucoamylases, xylanases, and β-xylosidases, to enhance leavening and texture in wheat products. Many bakers also add soy flour to their dough to enhance mixing and whiteness, introducing yet another collection of proteins and enzymes. And farmers add their own unique collection of herbicides and pesticides such as glyphosate, imazamox, malathion, and chlorpyrifos. Choosing organic sources may reduce or eliminate exposure to such chemicals, but you’ve still got to contend with all the components intrinsic to the wheat plant.
In short, wheat is not just a complex carbohydrate with gluten and bran. Wheat is a smorgasbord of compounds that vary widely according to genetic code. Just by looking at a poppy seed muffin, for instance, you would be unable to discern the variety of gliadins, wheat germ agglutinins, and other non-gluten proteins, phytates, and amylopectins contained within, much of it unique to modern semi-dwarf wheat. On taking your first bite, you might enjoy the immediate sweetness of the muffin’s amylopectin A, as it sends your blood sugar skyward, but you may be largely unaware of the toxic effects of its many other components until disaster strikes—in the form of pain and swelling caused by rheumatoid arthritis or stumbling and warm incontinence caused by cerebellar ataxia.
Let’s next explore the incredible wide-ranging health effects of your muffin and other wheat-containing foods.
PART TWO
WHEAT AND ITS HEAD-TO-TOE DESTRUCTION OF HEALTH
CHAPTER 4
HEY, MAN, WANNA BUY SOME EXORPHINS? THE ADDICTIVE PROPERTIES OF WHEAT
ADDICTION. WITHDRAWAL. DELUSIONS. Hallucinations. Wild, unrestrained outbursts. I’m not describing mental illness or a scene from One Flew Over the Cuckoo’s Nest. I’m talking about this food you invite into your kitchen, share with friends, and dunk in your coffee.
I will discuss why wheat is unique among foods for its curious effects on the brain, effects shared with opiate drugs. It explains why some people experience incredible difficulty removing wheat from their diet. It’s not just a matter of inadequate resolve, inconvenience, or breaking well-worn habits; it’s about severing a relationship with something that gains hold of your psyche and emotions, not unlike the hold heroin has over the desperate addict.
While you knowingly consume coffee and alcohol to obtain specific mind effects, wheat is something you consume for “nutrition,” not for a “fix.” Like drinking the Kool-Aid at the Jim Jones revival meeting, you may not even be aware that this thing, endorsed by all “official” agencies, is fiddling with your mind.
People who eliminate wheat from their diet typically report improved mood, fewer mood swings, improved ability to concentrate, and deeper sleep within just days to weeks of their last bite of bagel or baked lasagna. I have been impressed with how consistent these observations are, experienced by the majority of people once the initial withdrawal effects of mental fog and fatigue subside. I’ve personally experienced these effects and also witnessed them in thousands of people.
It is easy to underestimate the psychological pull of wheat. Just how dangerous can an innocent bran muffin be, after all?
“BREAD IS MY CRACK!”
Wheat is the Haight-Ashbury of foods, unparalleled for its potential to generate entirely unique effects on the brain and nervous system. There is no doubt: For some people, wheat is addictive. And, in some people, it is addictive to the point of obsession.
Some people with wheat addiction just know they have a wheat addiction. Or they identify it as an addiction to some wheat-containing food, such as pasta or pizza. They already understand, even before I tell them, that their wheat-food-addiction-of-choice provides a little “high.” I still get shivers when a well-dressed, suburban soccer mom desperately confesses to me, “Bread is my crack. I just can’t give it up!”
Wheat can dictate food choice, caloric consumption, timing of meals and snacks. It can influence behavior and mood. It can even dominate thoughts. A number of my patients, when presented with the suggestion of removing it from their diets, report obsessing over wheat products to the point of thinking about them, talking about them, salivating over them constantly for weeks. “I can’t stop thinking about bread. I dream about bread!” they tell me, leading some to succumb to a wheat-consuming frenzy and give up within days after trying to banish it from their lives.
There is, of course, a flip side to addiction. When people divorce themselves from wheat-containing products, 40 percent experience something that can only be called withdrawal.
I’ve personally witnessed thousands of people report extreme fatigue, mental fog, irritability, inability to function at work or school, even depression in the first several days to weeks after eliminating wheat. Complete relief is obtained by consuming a bagel or cupcake (or, sadly, more like four bagels, two cupcakes, a bag of pretzels, two muffins, and a handful of brownies, followed the next morning by a nasty case of wheat remorse). It’s a vicious circle: Abstain from a substance and a distinctly unpleasant experience ensues; resume it, the unpleasant experience ceases—that sounds a lot like addiction and withdrawal to me.
People who haven’t experienced these effects pooh-pooh it all, thinking it strains credibility to believe that something as pedestrian as wheat can affect the central nervous system as much as nicotine or crack cocaine do.
There is a scientifically plausible reason for both the addiction and withdrawal effects. Not only does wheat exert effects on the normal brain but also on the vulnerable abnormal brain, with results beyond simple addiction and withdrawal. Studying the effects of wheat on the abnormal brain can teach us some lessons on why and how wheat can be associated with such phenomena.
“GOD, IS THAT YOU?” WHEAT AND THE SCHIZOPHRENIC MIND
The first important lessons on the effects wheat has on the brain came through studying its effects on people with schizophrenia.
Schizophrenics lead a difficult life. They struggle to differentiate reality from internal fantasy, often entertaining delusions of persecution, even believing their minds and actions are controlled by external forces. (Remember “Son of Sam” David Berkowitz, the New York City serial killer who stalked his victims on instructions received from his dog? Thankfully, violent behavior is uncommon in schizophrenics, but it illustrates the depth of pathology possible.) Once schizophrenia is diagnosed, there is little hope of leading a normal life of work, family, and children. A life of institutionalization, medications with awful side effects, and a constant struggle with dark internal demons lies ahead.
So what are the effects of wheat on the vulnerable schizophrenic mind?
The earliest formal connection of the effects of wheat on the schizophrenic brain began with the work of physician F. Curtis Dohan, whose observations ranged as far as Europe and New Guinea. Dr. Dohan journeyed down this line of investigation because he observed that, during World War II, the men and women of Finland, Norway, Sweden, Canada, and the United States required fewer hospitalizations for schizophrenia when food shortages made bread unavailable, only to require an increased number of hospitalizations when wheat consumption resumed after the war was over.1
Dr. Dohan observed a similar pattern in the hunter-gatherer Stone Age culture of New Guinea, Micronesia, and the Solomon Islands, where he was a member of a team of field researchers. Prior to Western influence, schizophrenia was virtually unknown, diagnosed in only 2 of 65,000 inhabitants in one New Guinea population previously unacquainted with Western ways. As Western eating habits infiltrated these populations and wheat products were cultivated, beer was made from barley, and corn was introduced, Dr. Dohan watched the incidence of schizophrenia skyrocket sixty-five-fold.2 On this background, he set out to develop the observations that established whether or not there was a cause-and-effect relationship between wheat consumption and schizophrenia.
In the mid-sixties, while working at the Veterans Administration Hospital in Philadelphia, Dr. Dohan and his colleagues decided to remove all wheat products from meals provided to schizophrenic patients without their knowledge or permission. (This was the era before informed consent of participants was required, before the infamous Tuskegee syphilis experiment became publicized that triggered public outrage and led to legislation requiring fully informed participant consent.) Lo and behold, four weeks sans wheat and there were distinct and measurable improvements in the hallmarks of the disease: a reduced number of auditory hallucinations, fewer delusions, less detachment from reality—they weren’t cured, but just showed less severe signs of schizophrenia. Psychiatrists then added the wheat products back into their patients’ diets and the hallucinations, delusions, and social detachment rushed right back. Remove wheat again, patients and symptoms got better; add it back, they got worse.3
The Philadelphia observations in schizophrenics were corroborated by psychiatrists at the University of Sheffield in England, with similar conclusions.4 There have since even been reports of complete remission of the disease, such as the seventy-year-old schizophrenic woman described by Duke University doctors, suffering with delusions, hallucinations, and suicide attempts with sharp objects and cleaning solutions over a period of fifty-three years, who experienced complete relief from psychosis and suicidal desires within eight days of stopping wheat.5
While it seems unlikely that wheat exposure caused schizophrenia in the first place, the observations of Dr. Dohan and others suggest that wheat is associated with measurable worsening of symptoms. In the years since Dr. Dohan’s early observations, the explosion of more recent investigations suggests that consumption of gluten-containing foods is associated with increased intestinal permeability, or “leakiness,” along with alterations in the bowel microbiome that underlie the troublesome mind pathology of schizophrenia.6 Modern observations also corroborate Dohan’s observations with dramatic reversal of schizophrenic phenomena within days to weeks of gluten removal, even after years of unremitting symptoms.7 It has also become clear that celiac disease and schizophrenia are two different varieties of grain-induced disease and the psychotic behavior of schizophrenia can occur independently of celiac disease.8
Another condition in which wheat may exert effects on a vulnerable mind is autism. Autistic children suffer from impaired ability to interact socially and communicate. The condition has increased in frequency over the past forty years, from rare in the mid-twentieth century to 1 in 150 children in the twenty-first.9 Initial small samples have demonstrated improvement in autistic behaviors with gluten removal.10, 11 The most comprehensive clinical trials to date with formal measures of autistic behavior have demonstrated improvement with gluten elimination (sometimes combined with elimination of casein from dairy and a variety of different nutritional supplements).12, 13, 14
While it remains a topic of debate, a substantial proportion of children and adults with attention deficit/hyperactivity disorder (ADHD) may also respond to elimination of wheat. However, responses are often muddied due to sensitivities to other components of diet, such as sugars, artificial sweeteners, additives, and dairy.15
It is unlikely that wheat exposure was the initial cause of autism or ADHD but, as with schizophrenia, wheat appears to be associated with worsening of the symptoms characteristic of these conditions.
Though the laboratory rat treatment of the unsuspecting schizophrenic patients in the Philadelphia VA Hospital may send chills down our spines from the comfort of our fully informed and consenting twenty-first century, it is nevertheless a graphic illustration of wheat’s effect on mental function. But why in the world are schizophrenia, autism, and ADHD exacerbated by wheat? What is in this grain that worsens psychosis, prompts hearing voices and other abnormal behaviors?
Investigators at the National Institutes of Health (NIH) set out to find some answers.
EXORPHINS: THE WHEAT-MIND CONNECTION
Dr. Christine Zioudrou and her colleagues at the NIH subjected gluten, the main protein of wheat, to a simulated digestive process to mimic what happens after we eat bread or other wheat-containing products.16 Exposed to pepsin (a stomach enzyme) and hydrochloric acid (stomach acid), gluten is degraded to a mix of polypeptides. (Unlike the proteins in, say, eggs or pork chops that are broken down into single amino acids, the proteins of wheat are either indigestible or only digestible to polypeptides, small chains of amino acids, because humans lack the digestive enzymes to break down the components of seeds of grasses.) The dominant polypeptides were then isolated and administered to laboratory rats. These polypeptides were discovered to have the peculiar ability to penetrate the blood-brain barrier that separates the bloodstream from the brain. This barrier is there for a reason: The brain is highly sensitive to the wide variety of substances that gain entry to the blood, some of which can provoke undesirable effects should they cross into your amygdala, hippocampus, cerebral cortex, or other brain structure. Once having gained entry into the brain, wheat polypeptides bind to the brain’s morphine receptors, the very same receptors to which opiate drugs like fentanyl and oxycodone bind.
Zioudrou and her colleagues dubbed these polypeptides “exorphins,” short for exogenous morphine-like compounds, distinguishing them from endorphins, the endogenous (internally sourced) morphine-like compounds that occur, for instance, during a “runner’s high.” They named the dominant polypeptide that crossed the blood-brain barrier “gluteomorphin,” or morphine-like compound from gluten. The investigators speculated that exorphins might be the active factors derived from wheat that account for the deterioration of schizophrenic symptoms seen in the Philadelphia VA Hospital and elsewhere.
