Thursday, July 26, 2007

Gluten Addiction?

It's probably been a couple of weeks now, but Kate asked a question about the potential for becoming addicted to gluten.  I mean, I think that many of us wish we could eat a juicy doughnut every once and a while, but Kate seemed to think that there is something more to it for some people.   Are some people Jonesin' for a doughnut for more reasons than that they smell good around 4:00?  I've read up on it while taking a break from getting ready for my dissertation defense and now that I've finished, it seems like a good time to share what I found.


First off, we know the incomplete digestion of gliadin produces peptide fragments that are also known as exorphins.  Where that name comes from, I don't know.  As I understand it, an exorphin will have comparable action but opposite effects to an endorphin.  They interact with the opioid receptors, the mu, kappa and delta receptors, which are located predominantly in the central nervous system (CNS) as well as in the digestive tract.


These are the same receptors that are involved with opium and its purified components morphine and codeine, as well as heroin, which is a semi-synthetic derivative of morphine.  Mu receptors generally are responsible for the analgesic effects, respiratory depressant, pupil constriction, euphoric and physical dependence properties.   Kappa receptors also affect analgesia, as well as sedation, physical dependences and dysphoria, possibly by inhibiting mu receptors.  Delta receptor action is poorly understood, at least when the book I was looking at was written.


An interesting side note that I hadn't been aware of before is the fact that the opioid receptors in the CNS become habituated, whereas the receptors in the digestive tract do not.   The consequence of this is that to get the same high, an addict needs to take more drug than they used to, but as they do so the effect of the drug on the gut becomes more and more extreme.   When you realized that morphine has been used to relieve diarrhea, it makes me think that perhaps they might need to be taking Alli to balance out the effects.


Biologically, these receptors are activated or deactivated by drugs but they are designed to function in response to chemicals that are made in the body rather than chemicals made in a poppy or a chemistry lab.   These endogenous ligands are called endorphins.  They are responsible runners high, where a person gains a boost of energy, mental acuity and relief from pain.   It isn't clear exactly how this works, because inhibition of runners high using opioid receptor antagonists does not produce the opposite of these effects.   Exorphins on the other hand DO cause the opposite effect of a runner's high: loss of energy, loss of mental acuity and the onset of pain.  That sounds like a pretty complete explanation of what I feel when I ingest gluten, I'd say.


This is where the speculation and anecdotal evidence begins.  I have found that my sensitivity to gluten has increased, rather than decreased as I have been on a gluten free diet.   That is, I now get terrible headaches when I eat gluten that I didn't notice having continually before.  My speculation is that a similar habituation process can occur with gluten that occurs with heroin.   When I ate gluten all the time, I needed more to get the same effect.  The difference is that heroin makes you feel good and gluten makes me feel bad.   Now that I am off gluten, I have become de-habituated, if that is a word, and am more sensitive.


Second, if gluten peptides are interacting with the same receptors that heroin does, is it unreasonable to assume that for some people they can be habit forming in a similar way.   I have often heard that heroin is relatively easy, though extremely messy, to get off of.  The withdrawal symptoms are painful and messy, but they end and then the former addict can go on with life.   However, approximately 25% of heroin addicts are never free of the craving, and must continue methadone treatment indefinitely. 


We do know that aside from the usual withdrawal symptoms, there is something called protracted abstinence syndrome that can last up to six months.   It includes depression, abnormal response to stressful situations, drug hunger, decreased self-esteem, anxiety and other psychological disturbances.   My book says "Long-term opioid craving might result from a pre-existing or an opioid-induced hypofunction of the endogenous endorphin system.  Therefore, to rehabilitate these addicts and keep them in a functional state, low levels of opioid may be necessary."   Could there be an "opioid induced hypofunction of the endorphin system" that causes a person to crave gluten forever?  I haven't found any research on it in the scientific literature, but it makes sense.  


It may be protracted abstinence syndrome that persists for up to six months, and you are giving in and having a slice of Poppa John's pizza within that time frame, thus re-entering the craving cycle, whereas if you just refrained a little longer, you could break out.  It may be that there is a persistent physical dependence similar to addiction.  Or, it may simply the case that no one sells a good gluten free donut.   Someone should do some fMRI studies on this, I think.  That isn't my bailiwick, though.


(Information taken from "A Primer of Drug Action" by Robert M. Julien, M.D. Ph.D. 1995.)



Dr? Dr!

I'm done.  My defense went pretty smoothly, actually.  I am now semi-officially Dr ElwoodCity, Ph.D.  Of course, this makes my opinion on flour blends SO much more relevant than it was last week.

Monday, July 23, 2007

Gluten-Free, Quick and Easy

I started blogging last summer after discovering that eating gluten-free would help my son, the Maestro. The Maestro has Sensory Integration Disorder, and avoiding gluten and casein has made a huge difference for him. It turns out that I am gluten intolerant too, and feel so much better since avoiding gluten. We all know that going gluten free can be a very intimidating process. Many of the rules of baking get reversed, if not completely thrown out, when you get rid of gluten. I had a lot of question that I couldn’t find the answers to. I thought that if I couldn’t find the answers, probably there were a lot of other people who were having the same problem I had and I needed to share what I had found. Recently I was given a copy of Carol Fenster’s new book, “Gluten-Free, Quick and Easy”. In many ways this is the book I had been looking for, but couldn’t find.

One of my biggest initial frustrations was the huge number of flour mixes that people recommend, and the variety of GF flours that behave completely different from each other. What would I like? What would I need? I have found too many lists that described the most common types of rice flour and omitted grains gaining in popularity. This book has the most complete list of gluten free flours that I have seen in one place, with a good description of the flavours and properties of each. It describes new flours fewer people have had experience with, such as Montina flour and Salba, as well as the most common flours such as rice or Garfava. There is also a smaller list of important staples in a gluten-free pantry that you need to make the recipes in the book, to eliminate the guesswork in getting started.

Another thing we were glad to see was what we call a “mega-cooking” plan. Before eliminating gluten, Riley was excited about making mixes for baking, and making multiple batches of dishes for freezing. Without all-purpose flour, all the air went out of that balloon for us. I have always wanted to do the math and make a big bucket of muffin mix. And waffle mix. And bread mix. And cake mix. The last six months, when my baking had developed to the point that I had the basic recipe that I wanted for scale-up, I have had job applications, interview trips and a dissertation to write instead of working on mixes. Later this week I have my defense, and I suppose I have become the target audience of a quick and easy cookbook. Now Carol Fenster has done the math for me, and there are mix recipes that she uses for her quick breads, her yeast breads and cakes. Carol also includes a plan for purposeful left-overs, called “planned-overs”. There is a month-long sample recipe plan for producing planned-overs and what recipes to use them in. Also, each section has a list of recipes that fit together using planned-overs.

Each recipe calls for ingredients that are naturally gluten-free, but there are also a number of ingredients that may or may not be gluten-free, depending on the brand you choose. For each of these, there are suggestions of common brands that are gluten free, such as tamari soy sauce (Eden, San-J,Hy-VeeI) or Oriental 5-Spice Powder (Durkee, Tone’s, Spice Island).

So far, I have made the bread machine yeast bread recipe, some Swedish meatballs, and a basic pie crust. I have always had better luck baking bread in a bread machine than I have had using an oven, but I have never considered that the pan I am using might be the difference-maker. Apparently it is. I have always had a hard time knowing if bread is done, but I learned that the interior temperature needs to be 200-205 °F. Jabbing my meat thermometer into a loaf of bread isn’t my first choice, but it sure beats having a loaf collapse because it isn’t done on the inside. Perhaps someday I will be able to know when a loaf is done based on the sound when I thump it, but until then a small hole is a small price to pay.

I have talked about my pie crust before, and wished that I had a pie crust recipe that was more malleable. I liked the flavour of my sorghum/tapioca crust, but it cracked whenever I tried to move it. Carol Fenster’s solution is to use some sweet rice flour to make a softer, more pliable dough. The Maestro and I made pumpkin tarts this weekend, and they turned out great.

So is this book perfect? No, but it is amazingly close. I think I will continue to use my basic flour recipe for most things, though the pie crust was easier to work with than anything I have come up with. I have to disagree with the explanation on the gluten-free status of oats. The problem with oats is NOT exclusively cross-contamination. A friend of mine who is a plant physiologist has run assays on different strains of oats, grown from seed and never processed with wheat. Some strains have gluten-like proteins that cause an antibody response and some do not. I am pretty sure he has never published this, so a thorough search of the primary literature is not going to reveal the difference. Anyone who decides to grow their own oats needs to keep the strain of oats in mind.

Overall, this book is a great resource for anyone starting on the gluten free lifestyle. I wish I had had it a long time ago. At the same time, someone with more GF experience can still learn a lot from it. The Maestro, who is now four, is already planning what kind of pie he wants to make with our new favourite pie crust.

Wednesday, July 18, 2007

Done (at least this stage)

I have finished, printed and handed my dissertation to my committee.  After printing and before handing it out, I found one important typo.  Any bets on who in my committee finds it in the next week?
Now the focus switches to preparing a presentation for my defense next week and moving out of my lab.  I also have a few things still to take care of in regards to moving out of my house, though Riley is doing a monster job of most of that.  Now I should have more time to help.
No food news today, though I did get quite a kick out of learning more about the latest news from Glaxo-Smith-Kline, where some of my former class-mates work.  Their new weight loss drug Alli (pronounced Ally) has some, shall we call them "interesting" <s>side effects</s> treatment effects.  For a nervous laugh, check out this site, and visit the "How does it work" section, especially the part on treatment effects.  I'm not sure any weight loss plan that includes bringing an extra pair of pants to work is for me.

Tuesday, July 17, 2007

Some links I missed yesterday

There were a couple of links I wanted to pass on. 
Karen has a website that seems like a perfect corellary to mine.  I tend to focus on how to bake gluten free, though I have lately strayed to a more scientific discussion.  Karen writes about what to eat when you aren't baking.  Gluten Free Food Reviews takes all the guesswork out of the GF aisle.  Take a look.
A different Karen, Karen Morgan, has a dessert fetish.  Any dessert you want will eventually pop up at  The Art of Gluten Free Cooking.  She earns my love with her frequent inclusion of sorghum flour, and the artwork.
The abstract writing yesterday went smoothly after my lab-mate pointed out that my committee isn't really going to read it anyway.  As of yesterday I had 90 pages, and over 24,000 words.  Final edit today!

Monday, July 16, 2007

A few random bits

Kate asked me a question about addiction to gluten.  That is a great question, and deserves a great answer.  I have been working on it a bit, and have come up with some information and some speculation.  Stayed tuned for more.
I regret that I wasn't able to come up with a recipe for the Cooking for Karina post at Gluten Free by the Bay.  That is a great idea, and when I get settled in our new place (still a long way off) I plan on working on a post about egg replacers.  Karina, I hope that you found some good recipes.
I have been working on finishing off small bits of random flours that would otherwise be confiscated as I cross the border, and had some good bread using 3 cups 1:1 sorghum/rice flour, with 1/2 cup of Teff as an accent flour.  Some of you might remember that my bread machine died recently, but oven-baking is going well since I figured out to bake it for what seems like too long.  It doesn't freeze well, though, so I look forward to getting a new bread machine soon.  That will also be after the move.
Congratulations, Shauna and the Chef!  May you always have good eats.
The last thing we need for Riley's application for Canadian residency came in the mail today!  And there was much rejoicing in the land.
Well, I should get back to the disseration writing.  I think my abstract is now too long, and I need to cut it down, but I don't have everything that I want to say in it yet.  The hardest part of science writing is the abstract, and I have to have everything done by wednesday.

Monday, July 02, 2007

Revolution Health and Gluten Sensitivity

A couple of weeks ago I got an email from Cindy, at, inviting me to take part in conference call interview with representatives of the National Foundation for Celiac Awareness.  The most common response I got from friends here to this news was a somewhat confused "But, you don't have celiac disease."  That is true.  My thinking on the issue was that if one is going to eat gluten free, the distinction is going to become a little fuzzy sometimes.   If you are a gluten-free blogger, there feels like a difference between not having celiac disease and being a non-celiac.  It's more like not being Tiger Woods.   I'm not Tiger, but I'm not Tiger in a different way than Not-Tiger, the one who won the U.S. open last week is not Tiger.  I'm not sure if that makes any sense to anyone but me.   Anyway, here was a chance to talk to a real, live Gastroenterologist, and a Spokesperson for the NFCA.  Why not?


No reason other than the fact that I have felt terribly behind on writing my doctoral dissertation, that is.   I have a mostly complete draft that people are editing for me, so I have some time now to actually write a post about this issue, finally.  The audio of the call can be found here.  I wish it could be downloaded, but I haven't been able to do more than stream it.  


The Doctor was Dr. Jay DiMarino, Director of the Gastroenterology Training Program and Director of The Digestive Disease Institute at Thomas Jefferson University and University Hospital, Philadelphia, PA. Several other bloggers were invited to play too.  Shauna James was there, as well as Rachel, Gina, Diane, Sloan, and Jackie Collins, who is RevolutionHealth's resident Gastrogirl.


I had three questions that I really wanted answers to.  First was where we Non-Celiacs fit into the gluten free world.   I'm a little sensitive to this recently, as some of my more recent posts show.  If you ask google about gluten sensitivity or gluten intolerance, you get websites that will tell you that there are many people who are sensitive to gluten and may actually have celiac disease.   It is like my gluten sensitivity is merely and undiagnosed or sub-clinical form of celiac disease.  Is that all I am, then?   This then relates to my second question, which was the rates of false negatives with the diagnostic tests, and the factors that influence the incidence of false negatives.


Sloan beat me to the question of sensitivity vs. celiac disease.  To paraphrase a little bit, Dr. DiMarino said that essentially, celiac disease is an allergy.   It is an immune response, like Hay Fever is an immune response.  The difference being, of course, that Hay Fever makes your nose run and your eyes itch while celiac disease rips your intestines apart. Gluten sensitivity or intolerance is more similar to eating a not-ripe apple.   There is nothing wrong with eating apples, but under-ripe ones just didn't agree with you.


I have to say that I didn't really like the analogy.  I understand what he was trying to say, that eating gluten is leads to an unpleasant response but that there is no built-in immune response.   Feeling sick after eating a green apple suggests that someone needs to man up a bit, or at least not eat green apples on an empty stomach.  They are too acidic, and too crisp.   I've eaten green apples, and never had the headaches and fogginess that gluten gives me.  This is a little more fundamental than a little excess acid making my tummy hurt.


He did mention the issue of prolamines, and seemed to leave it to me to explain.  So, I will.  Proteins are chains of amino acids, of which there are 20 different kinds.  These chains fold into balls, or twist into coils.   Gluten proteins are abnormally high in proline, an amino acid that is different from the others in that the nitrogen in the amino part is part of a ring.  Because of this, when you unwind the coil or untangle the ball of protein, the section with proline doesn't straighten out the same as all the rest.   So you get amino acid chains like rope with an occasional kink in it.  For some of us, Dr DiMarino seemed to suggest, the proline kinks interrupt the enzymes trying to digest the protein, and we end up with short sections of indigestible protein called prolamines floating around in the gut.  


So what do these proline rich peptides do?  Well, if they get into the blood stream and travel to the brain, they fit into opioid receptors.   If you inject them into rats, you get rats that behave as if they are autistic.  This connection is the basis for the GFCF diet many autistic kids are on.   I'm neither a rat nor an autistic child, so what do they do to me?  Well, they give me a headache, for one thing, and make my head a little foggy.   They don't bother my tummy, though. Dr DiMarino is the first person I have heard call them prolamines.  I have seen them some places referred to as exorphins, like the opposite of the endorphins (the pain killers the body produces when we get excited about something).


So that is the difference between gluten sensitivity and clinically diagnosed celiac disease.   It doesn't define the difference between sensitivity sub-clinical celiac disease, however.  That begins to relate to my second question, about testing.   I will leave that to another post, though.