You know the old saying, you have to eat a peck of dirt before you die? (In case you were wondering, a peck is two gallons). And most of us have heard (and then tried to forget) how a certain, albeit small, bit of dead flies and rat droppings makes its way into any food produced en masse in a factory. We swallow a lot of things we don't mean to eat--cat hair, soap, anything we forgot to wash off our hands, the particles of viruses in someone's sneeze we didn't manage to avoid breathing in. Luckily, our immune systems can deal with it most of the time. Unless you happen to have Celiac disease, and you have without even meaning to gotten a bit of gluten inside you somehow. Unlike the cat hair and dead flies, you are not going to be oblivious--you are going to realize what happened all too clearly.
For people with Celiac disease, the predicament is that the immune system is reacting to gluten as if it were a germ, and making antibodies to attack and destroy it. That's kind of weird and pointless, like whacking a bush with a sword, but in itself is not the problem. The problem arises because celiacs also happen to have a biochemical signature which makes the anti-gluten antibodies attack their own bodies, usually the cells lining the small intestine. This causes the gut cells to become inflamed and die, and the finger-like projections called microvilli that absorb nutrients from the food we eat to flatten out and become ineffective. This damage begins within minutes of eating gluten for some people and has been observed by an endoscope, a small camera that can watch the inside of your gut. The digestive discomfort, malabsorption of nutrients such as calcium and iron, and lesions that can eventually lead to cancer are due to this attacking of gut cells by the body's own immune system.
Note how remarkable it is that we understand so much about what causes Celiac (even though there is a lot we still don't know, such as what triggers the making of antibodies to something passing through the gut, whereas the immune cells are usually confined to the bloodstream--i.e., in the donut proper, see the previous post). There are a number of autoimmune disorders, including diabetes, lupus, rheumatism, among others, but this is the only one for which we know the trigger. And therefore we have a complete cure, even if a bit onerous in terms of being a strict diet.
So, the immune system is marvelously sensitive, meaning it can detect and destroy invaders--that is, non-self cells in the body--before they multiply enough to be a problem. When you notice you are sick, your immune system has partly failed, but it generally rallies and wins eventually, nowadays with the help of antibiotics as needed. But this backfires when it comes to a Celiac eating gluten, as here the body is overreacting to something that it should ignore. And even a trace amount, a crumb too small to notice, that may fall off someone's hand as they reach across your plate at the dinner table, is enough to make you sick for days, even a few weeks.
Imagine how paranoid that could make you.
Is it even fair to call it paranoid, when the danger is quite real? But as you can imagine, learning how to be careful enough yet not drive yourself crazy with worry is not a simple process. And communicating it to others is quite a challenge too.
To be continued....
Tuesday, July 9, 2013
Saturday, July 6, 2013
Yes, Mr. President, we are all of us donuts
Back in the '60s, so I heard the tale, President Kennedy was visiting Germany and wanted to show his fellow-feeling for the citizens of Berlin. "Ich bin ein Berliner!" he declared, and the Berliners applauded enthusiastically. They were making acommodations for this charismatic American, politely ignoring his grammatical mistake that caused the sentence to mean: I am a donut. As in: I am a hamburger (to say you are a citizen of Hamburg would be "Ich bin Hamburger"--the 'ein' makes all the difference between person and comestible).
But nevertheless, it's true, you know: we are all donuts. Animals that are higher than jellyfish and sea anemones--which is nearly the whole the animal kingdom--including creepy crawlies and worms of all kinds (round, tape, earth, lug...) as well as the scaly-feathery-furry sort--animals are all donuts, with an outer outside but also an inner outside, namely the hole running through the middle that is the gut passage.
Just as we have a layer skin to protect us from all sorts of insults, so we have specialized layers lining our mouths, throats, stomachs, small and large intestines that protects us as needed from what we ingest, and from our own stomach acid for that matter. Unlike our skin, though, the intestinal lining decides what to allow in as well as what to keep out. How that works is a fascinating subject which I will explore further another time. It is where all the trouble with gluten begins, too. So your gut is not your inside, not quite, even though we are used to thinking of it that way; it's more of a holding tank and processing site.
By the way, anemones and their ilk have a gut running through their middles too, but they are not donuts because the hole does not go all the way through. This has the interesting consequence that their mouth has to double as their anus.
And this business of the donut hole is fundamental to animal architecture. It may be because a key feature of animals is that they consume other living things. In embryonic development of virtually all animals, the first hint of structure of the dividing ball of primordial cells that arise from the fertilized egg is when a pouch or dent appears and deepens to form the gut. And the first major division of animals is based on which opening forms first in embryonic development, the mouth or the anus. One group is called Protostomes, or First-mouths; the other however is not called Protoprocts or anything of the sort, but rather the more polite "Deuterostomes," or Second-mouths. Guess which group we chordates, we mammals, we poor clever apes, are in. Along with our first cousins the Sea Squirts,
and our third cousins the echinoderms, we comprise the Deuterostomes.
While flies and lobsters and all manner of worms and molluscs and strange colonial creatures called bryozoanl are Protostomes. But the lot of us, barring the anemones who don't know their barf from their fewmets, are all basically donuts.
Just as we have a layer skin to protect us from all sorts of insults, so we have specialized layers lining our mouths, throats, stomachs, small and large intestines that protects us as needed from what we ingest, and from our own stomach acid for that matter. Unlike our skin, though, the intestinal lining decides what to allow in as well as what to keep out. How that works is a fascinating subject which I will explore further another time. It is where all the trouble with gluten begins, too. So your gut is not your inside, not quite, even though we are used to thinking of it that way; it's more of a holding tank and processing site.
By the way, anemones and their ilk have a gut running through their middles too, but they are not donuts because the hole does not go all the way through. This has the interesting consequence that their mouth has to double as their anus.
And this business of the donut hole is fundamental to animal architecture. It may be because a key feature of animals is that they consume other living things. In embryonic development of virtually all animals, the first hint of structure of the dividing ball of primordial cells that arise from the fertilized egg is when a pouch or dent appears and deepens to form the gut. And the first major division of animals is based on which opening forms first in embryonic development, the mouth or the anus. One group is called Protostomes, or First-mouths; the other however is not called Protoprocts or anything of the sort, but rather the more polite "Deuterostomes," or Second-mouths. Guess which group we chordates, we mammals, we poor clever apes, are in. Along with our first cousins the Sea Squirts,
and our third cousins the echinoderms, we comprise the Deuterostomes.
While flies and lobsters and all manner of worms and molluscs and strange colonial creatures called bryozoanl are Protostomes. But the lot of us, barring the anemones who don't know their barf from their fewmets, are all basically donuts.
What to do if you eat gluten by mistake (co-authored by Matilda)
1. Try holding a heating pad against your stomach.
2. Drink peppermint or other herb tea.
3. Don't drink milk or eat ice cream, it can make your tummy ache worse. Avoid all dairy for a few days; butter and hard cheese are probably OK.
4. Lie around and rest as much as you can, reading or watching a movie can help; it really does feel like having the flu and you need to rest to get better faster.
5. Don't eat unless you feel like it; it can make your tummy ache worse. Note to parents: it is better to let your child eat very lightly while they are getting over a gluten incident. They will make up for it afterwards, believe me!
6. Be patient with yourself, you may have a hard time thinking clearly and if you try to think too hard it can give you a headache!
7. Try to figure out where you got the gluten from, so you can at least learn from the mistake.
The Fabled Land of Glutenfri
Nowadays, it only exists in fragmentary and beleaguered outposts, the once vast realm of Glutenfri. In olden times it spanned most of the world, and people like my nine-year old daughter lived free, eating the same food as their families and friends, unafraid to share dishes, with no thought of being laid low by the merest crumb. In those days people ate a great variety of foods--wild greens, tubers, fruits and berries in season, nuts and seeds, mushrooms, wild game, wild birds' eggs, fish, mussels, clams, seaweed....
Then agriculture was invented. Some historians have blamed women for that, claiming they must have wanted a more settled and secure life and hounded the men into becoming farmers. The lure of raising a dozen children and spending one's days cooking and cleaning does not seem so appealing to me, however. It's pretty well established that the hunting-gathering lifestyle involves something like 4-hour workdays, and families of manageable size. Farming is much harder work by any measure.
Another idea is that as populations grew to higher densities, a gradual shift to agriculture allowed still more people to occupy a given space, and the innovations continuing to this day have created our runaway population explosion. That is, we keep on figuring out how to turn more of the standing biomass of the planet into human flesh, in an attempt to stave off hunger that only creates more mouths to feed. Not that all this is evenly distributed by any means. But biology trumps economics: this sort of growth can't continue indefinitely. However clever we may be, we still live in the physical world and must grow our year's food with the year's sun and whatever water and minerals can be found (at least CO2, the other necessity of plant life, is nowhere in short supply).
Then there is the astonishing notion is based on the discovery in Turkey of 11,000-year old ruins at Gobekle Tepe. These are immense stone monuments built long before any cities, that would have taken thousands of people decades to construct. So it may be that the drive to create monuments for artistic and religious reasons led scattered tribes of hunter-gatherers to organize themselves and develop a more reliable and settled food supply.
Unfortunately for about 1% of the population who are intolerant to gluten, the staple grains these Middle Eastern agriculturalists grew, and which the world has inherited as its dominant foodstuff, were a trio of closely related species: wheat, barley, and rye. These are the only three foods in the entire world that a gluten-sensitive person needs to avoid, so the choices of food are still vast. Yet in our modern world these three grains infiltrate the food supply making it a difficult and socially isolating ordeal to keep from ingesting gluten. Still, I like to remember how it's only an accident of history that gluten is so omnipresent. Sure, it has some useful properties like a tendency to become rubbery when beaten with liquid, which makes for nice bread. But until European culture spread to fill the world in recent centuries most civilizations on most continents remained in the realm of Glutenfri. This is no longer the case--even most soy sauce is now made from fermented wheat.
The natural-born citizens of Glutenfri still roam the world, a scattered and beleaguered people. Parts or all of their kitchens are free of gluten, maybe even the whole house. Once they leave the house, all bets are off. There are peanut-free classrooms in grade-schools to protect the dangerously allergic, but gluten is both too ubiquitous and insufficiently life-threatening to merit such accommodations. Avoiding gluten is a serious, lifelong commitment for many people, essential to their health and comfort in the short and long term. It is hard to explain to outsiders how even a tiny crumb can disable them for a week, hard to have to keep refusing to trust well-meaning friends who have tried to cook safe food, hard to face the inevitable suspicion that one is being overly fussy in taking the necessary precautions.
In honor of the citizens of Glutenfri and their supportive friends and families, I present the following anthem:
(to a sentimental tune)
Fair land of Glutenfri, land that I love,
Forests span to shining seas, wide skies above.
Wild mushroom, wild berry, salmon leaping from icy streams.
Fair land of Glutenfri, home of my dreams.
Chorus (to a bouncier, irreverent tune):
We don't want none of your weevily wheat,
We don't want rye or barley.
But give us rice or maize or oats,
We'll make a cake so fairly.
(to be continued...)
Gluten sensitivity, both due to Celiac disease and from separate unknown causes, is on the rise for reasons we don't really understand. This isn't merely a matter of over-diagnosis or greater awareness: a blood test for antibodies to gluten, one hallmark of Celiac disease, showed a rise of 4.5-fold when blood from U.S. Air Force servicemen from the 1950s was compared to samples taken recently. This means something in the environment must be triggering more cases. As many people are aware, food allergies (which involve a separate part of the immune system from that causing Celiac disease) are also on the rise to a startling extent.
It is interesting to consider how these problems are related to our modern way of life. Maybe all these new food sensitivities arise from modern changes such as antibiotics, more processed food including a huge set of chemicals never seen before in nature, a cleaner living environment causing our immune systems to be less challenged, and changes in the composition of our gut endosymbionts from these and other causes. Still, there is need for caution in guessing at causes and attempting to return to a more "natural" way of eating and living. There is a lot of potential for sloppy thinking and grasping at magical holistic cures.
I am a natural skeptic who has been unwillingly dragged into experiencing firsthand and close up the effects of a variety of dietary sensitivities, foremost having a child who is highly sensitive to gluten. I am a mom who wants to take good care of her gluten-free child and raise her to be happy and at ease in the world. I am a scientist interested in the biological basis for disorders such as celiac disease and other digestive disorders. I am a parent who has been frustrated by the lack of information and understanding from many doctors, and by the inundation of misinformation among the useful information available online and in books and most of all, on food packaging. And I am someone who would like to offer an tour of this land of Glutenfri, in all its myriad and complex aspects, that illuminate topics as wide-ranging as immunology, cooking from scratch, living in a social world with dietary restrictions, implications of mass produced and highly processed foods, managing one's health in the face of imperfect knowledge without resorting to quackery.
It has changed our family's life to have created a gluten-free refuge in our home, and in many ways it has changed it for the better. We cook a lot more, and eat a lot more fresh and simple foods. We are forced to think a lot harder about where our food comes from, and what has been done to it between the farm and our table. And the daily food we give our daughter, by needing more careful thought and preparation than what is called normal food, is a daily sacrament telling her we love her and will give her what she needs to be well. So we go on coping day by day, some days easier than others. As our daughter says, at least she doesn't have to give up blackberries. Or ice cream. Or popcorn. Or the thousands of other delicious foods we can find or make.
Another idea is that as populations grew to higher densities, a gradual shift to agriculture allowed still more people to occupy a given space, and the innovations continuing to this day have created our runaway population explosion. That is, we keep on figuring out how to turn more of the standing biomass of the planet into human flesh, in an attempt to stave off hunger that only creates more mouths to feed. Not that all this is evenly distributed by any means. But biology trumps economics: this sort of growth can't continue indefinitely. However clever we may be, we still live in the physical world and must grow our year's food with the year's sun and whatever water and minerals can be found (at least CO2, the other necessity of plant life, is nowhere in short supply).
Then there is the astonishing notion is based on the discovery in Turkey of 11,000-year old ruins at Gobekle Tepe. These are immense stone monuments built long before any cities, that would have taken thousands of people decades to construct. So it may be that the drive to create monuments for artistic and religious reasons led scattered tribes of hunter-gatherers to organize themselves and develop a more reliable and settled food supply.
Unfortunately for about 1% of the population who are intolerant to gluten, the staple grains these Middle Eastern agriculturalists grew, and which the world has inherited as its dominant foodstuff, were a trio of closely related species: wheat, barley, and rye. These are the only three foods in the entire world that a gluten-sensitive person needs to avoid, so the choices of food are still vast. Yet in our modern world these three grains infiltrate the food supply making it a difficult and socially isolating ordeal to keep from ingesting gluten. Still, I like to remember how it's only an accident of history that gluten is so omnipresent. Sure, it has some useful properties like a tendency to become rubbery when beaten with liquid, which makes for nice bread. But until European culture spread to fill the world in recent centuries most civilizations on most continents remained in the realm of Glutenfri. This is no longer the case--even most soy sauce is now made from fermented wheat.
The natural-born citizens of Glutenfri still roam the world, a scattered and beleaguered people. Parts or all of their kitchens are free of gluten, maybe even the whole house. Once they leave the house, all bets are off. There are peanut-free classrooms in grade-schools to protect the dangerously allergic, but gluten is both too ubiquitous and insufficiently life-threatening to merit such accommodations. Avoiding gluten is a serious, lifelong commitment for many people, essential to their health and comfort in the short and long term. It is hard to explain to outsiders how even a tiny crumb can disable them for a week, hard to have to keep refusing to trust well-meaning friends who have tried to cook safe food, hard to face the inevitable suspicion that one is being overly fussy in taking the necessary precautions.
In honor of the citizens of Glutenfri and their supportive friends and families, I present the following anthem:
(to a sentimental tune)
Fair land of Glutenfri, land that I love,
Forests span to shining seas, wide skies above.
Wild mushroom, wild berry, salmon leaping from icy streams.
Fair land of Glutenfri, home of my dreams.
Chorus (to a bouncier, irreverent tune):
We don't want none of your weevily wheat,
We don't want rye or barley.
But give us rice or maize or oats,
We'll make a cake so fairly.
(to be continued...)
Gluten sensitivity, both due to Celiac disease and from separate unknown causes, is on the rise for reasons we don't really understand. This isn't merely a matter of over-diagnosis or greater awareness: a blood test for antibodies to gluten, one hallmark of Celiac disease, showed a rise of 4.5-fold when blood from U.S. Air Force servicemen from the 1950s was compared to samples taken recently. This means something in the environment must be triggering more cases. As many people are aware, food allergies (which involve a separate part of the immune system from that causing Celiac disease) are also on the rise to a startling extent.
It is interesting to consider how these problems are related to our modern way of life. Maybe all these new food sensitivities arise from modern changes such as antibiotics, more processed food including a huge set of chemicals never seen before in nature, a cleaner living environment causing our immune systems to be less challenged, and changes in the composition of our gut endosymbionts from these and other causes. Still, there is need for caution in guessing at causes and attempting to return to a more "natural" way of eating and living. There is a lot of potential for sloppy thinking and grasping at magical holistic cures.
I am a natural skeptic who has been unwillingly dragged into experiencing firsthand and close up the effects of a variety of dietary sensitivities, foremost having a child who is highly sensitive to gluten. I am a mom who wants to take good care of her gluten-free child and raise her to be happy and at ease in the world. I am a scientist interested in the biological basis for disorders such as celiac disease and other digestive disorders. I am a parent who has been frustrated by the lack of information and understanding from many doctors, and by the inundation of misinformation among the useful information available online and in books and most of all, on food packaging. And I am someone who would like to offer an tour of this land of Glutenfri, in all its myriad and complex aspects, that illuminate topics as wide-ranging as immunology, cooking from scratch, living in a social world with dietary restrictions, implications of mass produced and highly processed foods, managing one's health in the face of imperfect knowledge without resorting to quackery.
It has changed our family's life to have created a gluten-free refuge in our home, and in many ways it has changed it for the better. We cook a lot more, and eat a lot more fresh and simple foods. We are forced to think a lot harder about where our food comes from, and what has been done to it between the farm and our table. And the daily food we give our daughter, by needing more careful thought and preparation than what is called normal food, is a daily sacrament telling her we love her and will give her what she needs to be well. So we go on coping day by day, some days easier than others. As our daughter says, at least she doesn't have to give up blackberries. Or ice cream. Or popcorn. Or the thousands of other delicious foods we can find or make.
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