The 2002 book Dangerous Grains by Ron Hoggan, Ed.D., (with co-author Dr. James Braly) stands as one of the most comprehensive explanations available of how gluten may affect your entire body in many different ways, ranging from the intestinal damage found in celiac disease to potential neurological damage found in gluten sensitivity.
I recently had the opportunity to interview Dr. Hoggan, who holds a doctorate in education, serves as an instructor at Royal Roads University in British Columbia and is editor for the quarterly newsletter The Journal of Gluten Sensitivity, about his current thoughts on celiac disease, gluten sensitivity and gluten grains, and how research into those topics has evolved.
Here are some of the questions I asked Dr. Hoggan, and his answers. Keep in mind that in some cases, his views don't reflect established medical science on non-celiac gluten sensitivity; research in that field is still very new and hasn't been accepted by all physicians.
How has your thinking on celiac disease and non-celiac gluten sensitivity evolved over time?
Through reading the many research reports and books about celiac disease and the data that implicated gluten in other illnesses [published from the 1950s into the 1990s], I was increasingly convinced that celiac disease represented only one of many ways in which gluten caused human illness, especially neurological ailments. Many of those early research teams had a profound impact on my thinking.
Then Dr. Rodney Ford, a pediatric gastroenterologist and allergist in New Zealand, invited me to participate in a retrospective study of more than 900 patients with gastrointestinal complaints. We were trying to see if a gluten-free diet would impact school readiness. Although the expected impact showed up in all celiac patients, it quickly became apparent that gluten exclusion also improved school readiness in most of those with non-celiac gluten sensitivity, and we were startled to see that a significant minority of those who tested negative for celiac disease, AGA-IgG and AGA-IgA anti-gluten antibodies [used to detect gluten sensitivity] also showed improvements to school readiness after excluding gluten from their diets for six months.
Dr. Ford coined the phrase "gluten syndrome," which I think is the best term for characterizing the many facets of gluten-induced illness. He also suggested a shocking possibility: the first step by which gluten caused this multi-faceted syndrome began with the induction of neurological damage, according to his theory. Celiac disease, as just one facet of this neurological damage, led to altered immune function that resulted, partly, in injury to the intestinal lining. Other facets of the gluten syndrome arise from additional forms of neurological damage and resulting injuries, according to the theory. And this made perfect sense to me.
What are your views on the hypothesis that different immune system processes are involved in celiac disease and gluten sensitivity? That theory, published by the University of Maryland Center for Celiac Research director Dr. Alessio Fasano, holds that the two are distinct conditions, and that gluten sensitivity can't turn into celiac disease.
I agree that they are distinct, but let's look at what it means. In essence, gluten causes a set of symptoms but sometimes these symptoms are associated with celiac disease and sometimes they are associated with non-celiac gluten sensitivity. That is probably because we have not yet determined the essential character of gluten-induced illness and have inappropriately distinguished celiac disease from other forms of disease caused by gluten. Villous atrophy, the alleged gold standard [to diagnose celiac disease], probably isn't very meaningful.
There's a prevailing notion that gluten sensitivity is less serious than celiac disease what's your reaction to that?
I think it is misguided to assert generalizations about a condition that we don't understand very well at all. The research is extremely limited. In the only study I'm aware of that has compared them, the frequency of lymphoma in non-celiac gluten sensitivity was greater than that seen in celiac disease. It was a small study with a number of weaknesses, but that certainly got my attention. So it just is not supportable to compare non-celiac gluten sensitivity to celiac disease and claim that either condition is more or less severe or dangerous than the other.
Does someone with non-celiac gluten sensitivity need to be less careful about gluten cross-contamination than someone with celiac disease?
That is the current popular belief but it seems foolish to make such assumptions before we learn more about these myriad conditions.
Why do you think the incidence of celiac and gluten sensitivity is increasing?
There are several reasons for the current increasing trend in both celiac disease and non-celiac gluten sensitivity. Not least of these is that wheat yields have been increased exponentially through genetic modifications that have given us dwarf wheat, as explained by Dr. William Davis in his book Wheat Belly. As aspirin and other non-steroidal anti-inflammatory drugs, along with drugs that reduce the amount of acid produced by the stomach, become more available and more widely used, their damaging impact on the intestinal mucosal barrier, increasing intestinal permeability and leakage of undigested and partly digested food proteins into the blood is likely contributing to this problem as well.
The declining cost, relative to the cost of living, of a unit of flour is also a probable contributor. It is only since World War II that cakes, cookies, doughnuts, and other gluten-derived treats have become such a daily feature in most of our diets. Prior to that, they were an occasional treat. Bread was a common feature of the diet but there has been a growing trend of increased gluten consumption over the last 60 years or so.
Where is your research and thinking on gluten health issues taking you these days? Do you have a current project?
As a former school teacher, my greatest interest in diet is connected to learning and behaviors connected with success in school. I'm also intensely interested in psychiatric disturbances that are connected, to varying degrees, with gluten consumption. Bipolar disorder and autism come immediately to mind. I would also like to study the impact of a gluten-free diet on children who are struggling in school. I suspect that many of these children could be helped, both in an academic sense and in that they might avert the development of disturbances such as schizophrenia and bipolar disorder.
What types of foods do you eat? Do you avoid all grains? What do you eat for breakfast, lunch and dinner?
I sometimes eat gluten-free grains such as rice and corn, but I generally try to avoid them. My general approach is to try to eat a diet that is close to that eaten by our Paleolithic ancestors. I always avoid gluten. Beyond that, I try to eat a diet dominated by animal fats and whole non-grain foods that have not undergone processing. When practicable, I try to eat foods that are organic and meats from animals that have not been fed grains. That doesn't happen often because of other factors in my life.
I usually start the day with a fatty cut of meat, bacon, or sausages, sometimes accompanied by a couple of eggs. I often skip lunch or just eat a salad or a bit of fish or other seafood. My evening meal usually starts with a green salad with olive oil or mayonnaise dressing, then includes a cut of fatty meat and a few vegetables. This is far from an ideal diet and I do indulge my sweet tooth far too often with treats made with nut flours and other alternative flours. My wife used to mock me when I ate jujubes by asking what my readers would think if they knew I ate such junk. I try to avoid candies, if only to evade hearing my wife laughing at me. She is very good for my waistline, if not for my ego.