Why is celiac disease getting more common?

A new study suggests that celiac disease is four times more common today than it was even fifty years ago. That's an extraordinary finding. And lest we think that this is simply due to an uptick in awareness and diagnosis, the researchers disproved this with a very interesting approach.  They tested stored blood samples taken from American soldiers in the 1950s. Only one in every 700 samples contained the antibody that signals celiac disease. Today, about one in 170 people test positive for the antibody.

Celiac is caused by an intolerance to gluten, a protein found in wheat and other cereal grains.  When challenged with gluten, the body's immune system attacks the cells lining the small intestine causing digestive chaos and nutrient malabsorption. It's treated by strict avoidance of gluten-containing products.

Possible explanations

Scientists are stumped.  But it strikes me that we might consume a lot more gluten today then they did in the 50s. As anyone trying to avoid gluten can tell you, gluten is in virtually every type of processed food and our diet has become increasingly dominated by processed foods.  Perhaps over-exposure to this protein increases the chance of developing an intolerance?

Other possible explanations include environmental and lifestyle changes.  As people spend more time indoors (and slather themselves with sunscreen when they go out), vitamin D deficiency has been on the rise, and has been linked with other auto-immune conditions, particularly multiple sclerosis.

Perhaps widespread use of over-the-counter and prescription acid-blockers (unavailable in the 50s) plays a role in this digestive disorder. All that stomach acid we're suppressing normally helps break down proteins. Incompletely digested proteins could be more likely to provoke an immune reaction, especially if they "leak" into the blood stream from the large intestine.

Perhaps a decrease in our consumption of naturally-fermented foods with beneficial bacteria plays a role? Beneficial bacteria help maintain the integrity of the intestinal lining and prevent large molecules (such as intact proteins) from being absorbed into the bloodstream.

It doesn't seem like a stretch to imagine that the increase in refined sugar consumption could be related.  A high sugar diet can affect the intestinal flora and function.

Obviously, there are a lot of paths for future inquiry. I don't expect definitive answers anytime soon.

Avoiding gluten has gotten easier

 The good news is that manufacturers are responding to the growing demand for gluten free products. Avoiding gluten has become fashionable among people without celiac disease as well. A return to unprocessed, whole foods can also make gluten avoidance easier--no mysterious ingredients, no hidden gluten.

Resources

More information on celiac disease

Resources for gluten-free living

Gluten-free foods

Feel free to post other resources below.

Being a carb-counting vegan is a tough job

Q. I'm attempting to maintain a 40-40-20 macronutrient balance with the assistance of your website's tools.  As a vegan athlete, I eat more vegetables and grains than an omnivore, and it is nearly impossible to achieve the 40-40-20 balance without cutting down on either vegetables or carbs, which I believe would not be healthy for me. Is there a way for the caloric ratio pyramid tool to take into account the difference between vegetable carbs and cereal/grain carbs?

A. Not really--but I'm not sure how that would help.  The Caloric Ratio Pyramid shows you how your calories are divided between carbohydrates, protein, and fat but doesn't distinguish between different sources of these macronutrients.  So, your carbohydrate percentage will include the carbohydrates you get from grains, vegetables, dairy products and fruits.

But here's the thing: Although vegetables are almost 100% carbohydrate, most are still very low in carbohydrates. So cutting down on vegetables isn't going to change your macronutrient distribution nearly as quickly as cutting down on grains.  A one cup serving of brown rice, for example, contains 216 calories and 45 grams of carbs. If you are eating 2100 calories a day, that would be 10% of your calories, right there.

A salad made with SIX CUPS of raw spinach, on the other hand, contains just 42 calories and 6 grams of carbs (or about 2% of your 2100 calorie diet).  So, I'm not sure it makes much sense to try to the adjust the carbohydrates proportion of your diet by cutting back on vegetables.

You're absolutely right: Vegans usually end up consuming a diet that's higher in carbohydrates and lower in protein than omnivores. After all, some of the most common vegan protein sources--legumes--contain about as much carbohydrates as protein. Nonetheless, it's possible for a vegan to eat a lower carb/higher protein diet. Tough, but possible. (Whether or not its necessary or desirable is a subject for another post).

ND Tools for customizing your diet

Here on ND, you might want to start by setting your preferences so that results from meat, dairy, and egg categories don't show up in your searches. Then, try a search with our Nutrient Search Tool for foods high in protein and low in carbohydrates. Click on the various categories to refine your searches.

Or, use our super-cool Caloric Ratio Search tool!

 

Position your cursor on the pyramid to select a certain macronutrient ratio and click to see a list of foods that match that ratio. Keep in mind that in a 40/40/20 diet, very few individual foods are likely to be 40/40/20.  But say your typical mealplan always seems to lean too heavy on the carbs and fat and too light on the protein. Put your cursor on the part of the pyramid that's high in protein and low in carbs and fat and click for a list of foods that can help you balance your diet.

Calling all low-carb and athlete vegans:

Seems to me we've had some low-carb vegans commenting on this blog in the past and I know we have some vegan body-builders. Anyone out there want to share some more strategies or resources?

Study: Gluten-free diet decreases beneficial bacteria in gut

The headline of this study caught my eye: Gluten-free diet not friendly to gut bacteria.  People with celiac disease (and increasingly, many others) avoid wheat and other sources of the protein gluten. This study showed that after following a gluten-free diet for a month, subjects had fewer beneficial bacteria in their intestines. At first glance, this would suggest that a gluten-free diet might have unintended consequences on intestinal health and immunity.

Reading further, however, I ended up with more questions than answers. First, the study only involved ten people--a very small group. The study was also done on healthy volunteers. People with celiac disease might (indeed, probably) would experience different results because their guts are very different from healthy guts. I also think it somewhat likely that going off gluten could cause a temporary decrease in beneficial bacteria. As your system adjusts, I wouldn't be surprised if the gut flora rebounded.

But this is still a very interesting finding and I hope more research will be done.  In the meantime, if I were following a gluten-free diet, I might be motivated to add more fermented foods (such as yogurt) to my diet in an effort to keep my gut colonized with the right stuff.

Thoughts?

The New Vegetarian: A new take on an ancient diet

October is Vegetarian Awareness Month!

It was a lot tougher to be a vegetarian ten years ago, when many restaurants had no vegetarian or vegan options and you'd have to go to a health food store to find soymilk. Today, most restaurants offer at least one vegetarian entree, hosts routinely ask guests ahead of time about their eating preferences, and vegetarian options abound at grocery stores.

Although the number of people that meet the strict definition of vegetarian (do not eat meat, fish, or fowl) or vegan (also do not eat eggs and dairy) has stayed about constant, there are a lot more people who have cut back on their consumption of animal products and seek vegetarian options at least part of the time.  (See the details  of a recent national poll by the Vegetarian Resource Group and then vote in our poll of Nutrition Data users.)

People choose vegetarianism for a variety of reasons: including religion, ethics, health, environment, economics, and simple preference. But for both full-time and part-time vegetarians, there have never been more options.

No More Protein Combining

Many people considering (or practicing) a vegetarian diet still worry about the need to combine complementary proteins--the old beans-and-rice gambit.  According to the latest guidelines, however, this lore is outdated. Assuming you are getting sufficient protein (at least 10% of your daily calories), your body will get all the amino acids it needs without any fancy food combinations. See this recent post for more on protein quality and combining.

Beware of the junk food trap

Vegetarian options at the grocery store have never been more plentiful, but don't assume that "vegetarian" or "vegan" automatically means that something is healthful.  Vegetarian foods can still be highly-processed and refined, or high in fat, sugar, sodium, and/or calories. Junk food comes in all kinds of guises!  See this recent post for the shocking truth about many "healthy" diets.

Low-carb vegetarianism?

Vegetarians who consume eggs and dairy should have no problem following a low- or reduced-carb regime but, but low-carb vegans have their work cut out for them!  Most low carb diets rely heavily on animal products to provide enough calories. And most vegan sources of protein (such as beans and legumes) are high in carbohydrates. 

Still, I'm told it's not impossible.  Here are  some resources for low-carb vegetarians but I'm also interested to hear from Nutrition Data users who may have some experience or advice. 

The shocking truth about many "healthy" diets

Attention "healthy" eaters: Your diet may not be as healthy as you think. 

We tend to make certain assumptions about diet: If it's organic (or all-natural), it's good for you.  A meatless diet is a healthy diet.  Vegans are all skinny.

People, it ain't necessarily so.  Junk food comes in all varieties, including organic, raw, and vegan. And simply eliminating certain foods or classes of foods from your diet does not automatically yield a balanced, nutritious diet.

My colleagues who practice nutrition counseling are reporting an uptick in the number of obese vegan clients, including children.  Their diets are found to be extraordinarily high in sugar, fat, refined carbohydrates and highly-processed junk food.  Ironically, many vegans don't eat anywhere close to the recommended servings of fruits and vegetables. 

Scientists also make false assumptions about "healthy" diets.  A study recently published in the International Journal of Obesity notes that "A food pattern rich in vegetables is associated with lower risk of obesity and non-communicable chronic disease in Western countries."

However, the researchers went on to discover that in certain parts of China a diet rich in vegetables is linked to increased rates of obesity. Why?  The researchers concluded that it's because all those healthy vegetables are stir-fried in oil, which makes these vegetable-rich diets higher in calories. 

But as Dave Dixon points out in his blog, the vegetable-rich diets weren't all that much higher in fat or calories. They were, however, substantially higher in refined carbohydrates. Whatever the explanation, it's clear that eating more vegetables doesn't necessarily make your diet healthier.

Or, consider this recent study published in the American Journal of Clinical Nutrition, which found that a "Prudent" diet pattern (higher in low-fat dairy, whole grains, fruit and fruit juice, legumes, and vegetables) was associated with an increased risk of breast cancer. A "Mediterranean" diet pattern (higher in liquor consumption, poultry, seafood, vegetables, salad greens, and high-fat salad dressings) was associated with a lower risk of breast cancer.

This is, of course, a very surprising result that contradicts previous findings. Investigators acknowledge that more research is needed to figure out what it was about the "Prudent" diet pattern that seems to have contributed to higher breast cancer risk in this study.  But the fact that scientists chose the value-loaded word "prudent" to describe this dietary pattern demonstrates that they are making certain assumptions about what makes diets healthy.

My real point here is this: We tend to think that our healthiest habits (such as eating a lot of vegetables or not eating meat) characterize the quality of our entire diet. Some might argue that it is our worst habits (such as drenching those vegetables in oil or eating a lot of junk food) that actually characterize the quality of our diets.

I'll take the middle road: You've got to look at the whole picture to really see what's going on.

Here are the take home lessons for all of us:

1. Vegans, vegetarians, raw foodists, and "health-food" aficionados still need to pay attention to the amount of calories, fat, and refined carbohydrates in their diets to maintain a healthy body weight.

2. Just because foods are organic, natural, vegan, or raw does not mean that they aren't fattening or that they are nutritious.

3. Even if all the foods in your diet are healthy ones, your diet is only healthy if it is balanced. Using Nutrition Data's diet tracking tools can help you ensure that your diet is balanced and meeting your nutritional needs.

Your thoughts?

Summer Travel Part 2: Gluten-Free on the Road

Yesterday, I had some tips to help keep summer travelers on track with their healthy eating plans.  But for those who are gluten-sensitive, the challenges are even greater.  Gluten is found in many grains so most baked products are out. But it also sneaks its way into condiments, flavorings, additives, and most processed foods, so vigilant label reading is a must.

(Here is a list of foods and ingredients considered unsafe for those with gluten sensitivities from celiac.com and another helpful guide from the Celiac Sprue Association.)

The world is becoming a slightly friendlier place for the gluten-insensitive, though.  Cheryl Harris, a dietician specializing in gluten sensitivities has compiled some great tips for traveling gluten-free, including directories of restaurants with gluten-free options.

Raw food diets: Pros and cons

I'll just say right up front that I have no desire to "convert" any raw food enthusiast away from their practice. Most raw foodies claim that they feel better on a raw food diet than they ever have before and far be it from me to argue with success.

However, there are claims that are often made in regards to raw food diets that I think lack scientific support. The one I see most often is that you benefit from enzymes that are destroyed by the cooking process. On the other hand, very few of these enzymes survive the extremely acidic environment of the stomach, so I'm not sure how big a deal this really is.

There's no doubt that cooking (exposure to heat and water) can reduce the vitamin and mineral content of foods. (See our Effects of Processing page for details.) Then again, exposure to light and air can also reduce vitamin content.

Some nutrients, notably lycopene, in tomatoes, are actually rendered more absorbable by cooking. Other nutrients, such as proteins and starches, are made more digestible through cooking. 

In addition to the nutritional advantages of some cooked foods, there are also considerations of safety and convenience.  Eating raw meat and eggs increases your risk of food-borne illness. And producing "cheese" and "mayonnaise" out of nuts and seaweed requires a fair amount of commitment and time. 

Some have also noted that raw food diets tend to be shockingly high in fat because of extensive use of nuts and seeds to substitute for, well, everything. On the other hand, raw food diets are also notable for what's missing: all the processed junk food!

My take: You can certainly appreciate the benefits of raw foods (especially raw fruits and vegetables) as part of a diet that also includes cooked foods, which offer certain benefits of their own. 

Your thoughts?

Meet Troy: A Body-builder goes vegan

  Troy Loferski first got interested in body-building during his college years. Back then, he says, he had a typical body-builder’s approach to nutrition. “I was focused entirely on macronutrients: how much protein, carbohydrate, and fat I was getting. I ate a lot of tuna, eggs, whey protein, and whole grains, but hardly any fruits and vegetables.  I’d read that they were so filling that they made it difficult to consume enough calories to support muscle gains.”

Troy became absorbed by his career and drifted away from training. With his 30th birthday looming, though, he decided in the Fall of 2007 that he wanted to get back in shape. This time around, however, some things had changed.

“I’d been thinking about adopting a vegan lifestyle. Initially, it was for ethical reasons but the more I looked into it, the more I was convinced that the vegan diet was also the ultimate healthy diet and great for longevity. And, of course, there’s a huge emphasis on fruits and vegetables and all the micronutrients and phytochemicals they provide.

“So, I wanted to pursue this healthy diet but I also wanted to start body-building again. At first, I wasn’t sure if it would be possible to do both. But I found a vegan body-building site [veganbodybuilding.com], and then I found Nutritiondata.com.

Troy last year (before becoming a vegan) and now:

“I just kept plugging different foods into the tracking tools to find the combinations that would provide the optimal balance of macronutrients and micronutrients.  I used the Nutrient Search Tool to find foods that had a certain nutritional profile. For instance, that’s how I discovered chia seeds, which I now eat almost every day. I didn’t even know you could eat them…I thought they were just for chia pets! They are a great source of omega-3 fats.

“I still log in everything I eat on most days. The tools on ND are fantastic, especially the pantry and the custom entry tool. The caloric ratio pyramid shows me my macronutrient ratios and the total consumption report helps me track all the micronutrients.

“I eat about 3,800-4000 calories per day with a ratio of about 55% carbs, 20% protein, and 25% fat. That’s way less protein than most body-builders eat—most of them don’t believe it’s possible to do what I’m doing. But my strength and energy levels are fantastic and I feel terrific. Plus, I know that this diet is also really healthy for me over the long-term. My friends and family were a little skeptical about me becoming a vegan, but now that they see how healthy I am, they are very supportive.

“Eating that many calories on a vegan diet can be a challenge. Fruits and vegetables are micronutrient rich but not macronutrient rich. It ends up being a lot of food. I drink 2-3 green smoothies a day, made with pea protein powder, flax or chia, nuts, fruit, and greens. They are 600 or 700 calories each (and no chewing!) so they help me meet my caloric needs. Usually I get about 200% or more of the DV for all the vitamins and minerals, except for sodium, which is usually less than 100%.

“I’m constantly telling other body-builders (and vegans) about Nutritiondata.com. It’s been a big part of making this work for me!”

If you'd like to be profiled as one of our ND Champions, we'd like to hear your story!  Anyone who has used Nutrition Data to make positive changes in their health and lifestyle can be an ND Champion. Click here for details.

Round Up of Good Posts

Here are several interesting posts from health and nutrition blogs this week:

On The Flying Trapeze, Sara Grace explains  "Why I don't bother with Fat-Free Baked Goods."  In a nutshell: they don't taste as good and are not as satisfying. I agree with Sara: I'd rather have one really good treat than a big pile of so-so, fat-free compromises.

On The Weight of the Evidence, Regina Wilshire defends the very low-carb (ketogenic) diet against  negative findings published by Barry Sears (author of the Zone) and colleagues from Arizona State University.  While Sears and Co. conclude that the ketogenic diet increases the risk of osteoporosis, fatigue, and "bad" cholesterol,  Regina points out some weaknesses and inconsistencies in the studies.

On the Diet Blog, J.M. Graham muses on a recent study finding that it costs (a lot) to eat heatlhy foods. Is a healthy diet becoming unaffordable for too many people? I agree with several commenters who point out that buying healthy whole foods (as opposed to organic frozen meals and highly-processed "healthy" snack foods) is one way to keep the cost of eating healthy down.

Resolved to do more healthy cooking from scratch? Jessica Seinfeld's new cookbook, Deceptively Delicious, shows you how to sneak more nutrition into favorite dishes. Her recipe for Macaroni and Cheese (with stealth squash and cauliflower) is profiled by Dana Lilienfeld on our own Diet and Weight Loss Blog. Dana posts a new healthy recipe, with complete nutritional analysis, every day.

And finally, those on gluten-free diets may be feeling a little deprived with all the holiday goodies making the rounds these days. If so, be sure to check out Mike Eberhart's post on his new "Miracle gluten-free baking ingredient." on the Gluten Free Blog.

Gluten-free for the holidays

For the millions of Americans who are gluten-intolerant, the holiday season can be tricky.  Traditional favorites like cornbread stuffing or Grandma's snicker-doodles may be off-limits but there's no need to feel deprived.  There are an ever-expanding range of gluten-free foods and ingredients available to help you develop your own gluten-free holiday traditions.

Karina ("The Gluten Free Goddess") recently posted some great tips for a gluten- and dairy-free holiday, complete with all the trimmings. And if you live in the NYC area, you might want to check out the Culinary Institute of America's special class on gluten-free holiday baking. (The first session is already sold-out.)

Got your own favorite tricks? Post them below.