An overlooked health problem. . - Book Corners - Dangerous Grains, Why Gluten Cereal Grains May Be Hazardous to Your Health - book review

Townsend Letter for Doctors and Patients,  July, 2003  by Beatrice Trum Hunter

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Dangerous Grains, Why Gluten Cereal Grains May Be Hazardous to Your Health

by James Braly, MD and Ron Hoggan, foreword by Jonathan Wright, MD

2002, Avery, available from Price Pottenger Nutrition Foundation, 800-366-3748

Quality paperback, 244 pp, $14.95 US/$22.99 Canada, plus handling/mailing

It is well-recognized that celiacs must avoid eating whole grains that contain certain protein fraction (gluten, gliadin, and glutenin). The avoidance must be total and lifetime. However, less appreciated is that these same protein fractions may be factors in a host of other health problems, including autoimmune diseases, osteoporosis, brain disorders, intestinal disorders and diseases, and cancers.

Both Dr. Braly and his co-author, Hoggan, were motivated to research gluten-containing cereal grains because their personal backgrounds and family histories provided supporting evidence about the hazards for non-celiacs who cannot tolerate them. Dangerous Grains is an in-depth study, with documentation, relating gluten, gliadin, and glutenin to more than 200 chronic health problems and diseases. Unfortunately, health professionals fail to differentiate between celiac disease and non-celiac gluten sensitivity, and may give unsatisfactory medical advice to the latter group. Positive test results indicating non-celiac gluten sensitivity may be dismissed, assuming that such results are non-specific. Such patients may not be encouraged to follow a strict non-gluten diet. More commonly, their immune reactions to gluten may not even be mentioned, and dismissed as irrelevant.

Braly and Hoggan demonstrate, chapter after chapter, the negative role of gluten in various health problems. For example, one chapter relates gluten to osteoporosis -- a major problem for more than 28 million Americans, mostly women. Gluten can interfere with the maintenance of strong, healthy bones in several ways with non-celiac sensitive individuals.

It has been assumed that widespread osteoporosis among celiacs results from malabsorption. This assumption, according to Braly and Hoggan, is wrong. Gluten has a greater impact on calcium metabolism than on actual absorption, because it increases how much calcium is wasted after being absorbed. Frequently, a gluten-free diet results in dramatic improvement in the mineral content of the celiac's bones, largely due to increased calcium retention.

The authors attribute osteoporosis prevalence to current dietary fads, in part. Calcium supplementation does not help remineralize the celiac's bones as much as magnesium supplementation does. Magnesium is important for activating bone-building osteoblasts that deposit calcium and add collagen to bones. Also, magnesium helps repair the parathyroid gland that produces the hormones PTH, which regulate most of the body's calcium metabolism. According to Braly and Hoggan, "These hormones signal the kidneys to recover calcium from the urine, to elevate blood levels of calcium, and to activate vitamin D (calcitrol), which signals the intestine to absorb calcium from the food we eat. Clearly, adequate dietary calcium is of little value if we are not getting enough magnesium for the parathyroid gland to function properly." For these reasons, calcium supplementation, unless balanced with magnesium, may impact negatively on bones. Magnesium, calcium, zinc, boron, and vitamins D and K -- all reported to be deficient in many celiacs -- are absorbed from the intestine by the same mechanism (active transport). "Loading the digestive tract with calcium alone overwhelmingly invites this part of our absorptive capacity with a single mineral, albeit the most common one in our body." Yet, many, many food products currently are being fortified with calcium, but not with magnesium. This practice obviously sells products as "value added" but is shortsighted and potentially harmful. Calcium fortification, willy nilly, may induce a deficiency of magnesium and other necessary minerals that are supplied less abundantly, and frequently are deficient in the typical American diet. Deficiencies of magnesium and phosphorus, induced by excessive calcium intake, may pose a much greater risk of causing bone mineral loss. This risk is independent from the traditional suspect of malabsorption in gluten-induced bone damage.

Braly and Hoggan caution that great care needs to be exercised in recommending calcium supplementation, especially for those individuals who already have bone demineralization, and for those at greatest risk of developing such problems. The authors state "a typical healthy intestine only absorbs a small portion of the calcium that is available from our food. At the same time, evidence suggests that excess calcium intake competes with magnesium absorption, further aggravating a poor magnesium status. Flooding our diet with more and more calcium is a dangerously simplistic approach to this complex problem."

Non-celiac gluten sensitivity is related to numerous health problems. Yet, rarely is it suspected as a factor. Because the condition can be prevented or managed by food avoidance rather than by medication, dietary changes should be given a chance.