Dr. Dohan observed a similar pattern in the hunter-gatherer Stone Age culture of New Guinea, Micronesia, and the Solomon Islands, where he was a member of a team of field researchers. Prior to Western influence, schizophrenia was virtually unknown, diagnosed in only 2 of 65,000 inhabitants in one New Guinea population previously unacquainted with Western ways. As Western eating habits infiltrated these populations and wheat products were cultivated, beer was made from barley, and corn was introduced, Dr. Dohan watched the incidence of schizophrenia skyrocket sixty-five-fold.2 On this background, he set out to develop the observations that established whether or not there was a cause-and-effect relationship between wheat consumption and schizophrenia.
In the mid-sixties, while working at the Veterans Administration Hospital in Philadelphia, Dr. Dohan and his colleagues decided to remove all wheat products from meals provided to schizophrenic patients without their knowledge or permission. (This was the era before informed consent of participants was required, before the infamous Tuskegee syphilis experiment became publicized that triggered public outrage and led to legislation requiring fully informed participant consent.) Lo and behold, four weeks sans wheat and there were distinct and measurable improvements in the hallmarks of the disease: a reduced number of auditory hallucinations, fewer delusions, less detachment from reality—they weren’t cured, but just showed less severe signs of schizophrenia. Psychiatrists then added the wheat products back into their patients’ diets and the hallucinations, delusions, and social detachment rushed right back. Remove wheat again, patients and symptoms got better; add it back, they got worse.3
The Philadelphia observations in schizophrenics were corroborated by psychiatrists at the University of Sheffield in England, with similar conclusions.4 There have since even been reports of complete remission of the disease, such as the seventy-year-old schizophrenic woman described by Duke University doctors, suffering with delusions, hallucinations, and suicide attempts with sharp objects and cleaning solutions over a period of fifty-three years, who experienced complete relief from psychosis and suicidal desires within eight days of stopping wheat.5
While it seems unlikely that wheat exposure caused schizophrenia in the first place, the observations of Dr. Dohan and others suggest that wheat is associated with measurable worsening of symptoms. In the years since Dr. Dohan’s early observations, the explosion of more recent investigations suggests that consumption of gluten-containing foods is associated with increased intestinal permeability, or “leakiness,” along with alterations in the bowel microbiome that underlie the troublesome mind pathology of schizophrenia.6 Modern observations also corroborate Dohan’s observations with dramatic reversal of schizophrenic phenomena within days to weeks of gluten removal, even after years of unremitting symptoms.7 It has also become clear that celiac disease and schizophrenia are two different varieties of grain-induced disease and the psychotic behavior of schizophrenia can occur independently of celiac disease.8
Another condition in which wheat may exert effects on a vulnerable mind is autism. Autistic children suffer from impaired ability to interact socially and communicate. The condition has increased in frequency over the past forty years, from rare in the mid-twentieth century to 1 in 150 children in the twenty-first.9 Initial small samples have demonstrated improvement in autistic behaviors with gluten removal.10, 11 The most comprehensive clinical trials to date with formal measures of autistic behavior have demonstrated improvement with gluten elimination (sometimes combined with elimination of casein from dairy and a variety of different nutritional supplements).12, 13, 14
While it remains a topic of debate, a substantial proportion of children and adults with attention deficit/hyperactivity disorder (ADHD) may also respond to elimination of wheat. However, responses are often muddied due to sensitivities to other components of diet, such as sugars, artificial sweeteners, additives, and dairy.15
It is unlikely that wheat exposure was the initial cause of autism or ADHD but, as with schizophrenia, wheat appears to be associated with worsening of the symptoms characteristic of these conditions.
Though the laboratory rat treatment of the unsuspecting schizophrenic patients in the Philadelphia VA Hospital may send chills down our spines from the comfort of our fully informed and consenting twenty-first century, it is nevertheless a graphic illustration of wheat’s effect on mental function. But why in the world are schizophrenia, autism, and ADHD exacerbated by wheat? What is in this grain that worsens psychosis, prompts hearing voices and other abnormal behaviors?
Investigators at the National Institutes of Health (NIH) set out to find some answers.
EXORPHINS: THE WHEAT-MIND CONNECTION
Dr. Christine Zioudrou and her colleagues at the NIH subjected gluten, the main protein of wheat, to a simulated digestive process to mimic what happens after we eat bread or other wheat-containing products.16 Exposed to pepsin (a stomach enzyme) and hydrochloric acid (stomach acid), gluten is degraded to a mix of polypeptides. (Unlike the proteins in, say, eggs or pork chops that are broken down into single amino acids, the proteins of wheat are either indigestible or only digestible to polypeptides, small chains of amino acids, because humans lack the digestive enzymes to break down the components of seeds of grasses.) The dominant polypeptides were then isolated and administered to laboratory rats. These polypeptides were discovered to have the peculiar ability to penetrate the blood-brain barrier that separates the bloodstream from the brain. This barrier is there for a reason: The brain is highly sensitive to the wide variety of substances that gain entry to the blood, some of which can provoke undesirable effects should they cross into your amygdala, hippocampus, cerebral cortex, or other brain structure. Once having gained entry into the brain, wheat polypeptides bind to the brain’s morphine receptors, the very same receptors to which opiate drugs like fentanyl and oxycodone bind.
Zioudrou and her colleagues dubbed these polypeptides “exorphins,” short for exogenous morphine-like compounds, distinguishing them from endorphins, the endogenous (internally sourced) morphine-like compounds that occur, for instance, during a “runner’s high.” They named the dominant polypeptide that crossed the blood-brain barrier “gluteomorphin,” or morphine-like compound from gluten. The investigators speculated that exorphins might be the active factors derived from wheat that account for the deterioration of schizophrenic symptoms seen in the Philadelphia VA Hospital and elsewhere.
Even more telling, the NIH group found that the brain effects of gluten-derived polypeptides are blocked by administration of the opiate-blocking drug naloxone.
Let’s pretend you’re an inner-city heroin addict. You get knifed during a drug deal gone sour and get carted to the nearest trauma emergency room. Because you’re high on heroin, you kick and scream at the ER staff trying to help you. So these nice people strap you down and inject you with a drug called naloxone, and you are instantly not high. Through the magic of chemistry, naloxone immediately reverses the action of heroin or any other opiate drug such as morphine or oxycodone.
In lab animals, administration of naloxone blocks the binding of wheat exorphins to the morphine receptors of brain cells. Yes, opiate-blocking naloxone prevents the binding of wheat-derived exorphins to the brain. The very same drug that turns off the heroin in a drug-abusing addict to reverse life-threatening overdose also blocks the effects of wheat exorphins.
In a World Health Organization study of thirty-two schizophrenic people with active auditory hallucinations, naloxone was shown to reduce hallucinations.17 Unfortunately, the next logical step—administering naloxone to schizophrenics eating a “normal” wheat-containing diet compared to schizophrenics administered naloxone on a wheat-free diet—has not been studied. (Clinical studies that might lead to conclusions that don’t support drug use are often not performed. In this case, had naloxone shown benefit in wheat-consuming schizophrenics, the unavoidable conclusion would have been to eliminate wheat, not prescribe th
e drug.)
The schizophrenia experience shows us that wheat exorphins have the potential to exert distinct and peculiar effects on the brain. Those of us without schizophrenia don’t experience auditory hallucinations from exorphins resulting from a cinnamon raisin bagel, but these compounds are still there in the brain, no different from in a schizophrenic. It also highlights how wheat is truly unique among grains, since other grains such as millet and oats do not generate exorphins (because they lack the gliadin protein from gluten), nor do they cultivate obsessive behavior or opiate withdrawal in people with normal brains or people with abnormal brains.
So this is your brain on wheat: Digestion yields morphine-like compounds that bind to the brain’s opiate receptors. It induces a form of reward, a mild euphoria. When the effect is blocked or no exorphin-yielding foods are consumed, many people experience a distinctly unpleasant withdrawal.
What happens if normal (i.e., non-schizophrenic) humans are given opiate-blocking drugs? In a study conducted at the Psychiatric Institute of the University of South Carolina, wheat-consuming participants given naloxone consumed 33 percent fewer calories at lunch and 23 percent fewer calories at dinner (a total of approximately 400 calories less over the two meals) than participants given a placebo.18 At the University of Michigan, binge eaters were confined to a room filled with food for one hour. (There’s an idea for a new TV show: The Biggest Gainer.) Participants consumed 28 percent fewer wheat crackers, breadsticks, and pretzels with the administration of naloxone.19
In other words, block the euphoric reward of wheat and calorie intake goes down, since wheat no longer generates the favorable feelings and addictive behavior that encourage repetitive consumption. (Predictably, this strategy has been pursued by the pharmaceutical industry to commercialize a weight loss drug that contains naltrexone, an oral equivalent to naloxone. The drug is purported to block the mesolimbic reward system buried deep within the human brain responsible for generating pleasurable feelings from heroin, morphine, and other substances. Because naltrexone administration alone can replace pleasurable feelings with feelings of dysphoria, or unhappiness, naltrexone has been combined with the antidepressant and smoking-cessation drug bupropion in the recently FDA-approved drug Contrave.)
From withdrawal effects to psychotic hallucinations, wheat is party to some peculiar neurological phenomena. To recap:
Common wheat, upon digestion, yields polypeptides that possess the ability to cross into the brain and bind to opiate receptors.
The action of wheat-derived polypeptides, the so-called exorphins such as gluteomorphin, can be short-circuited with the opiate-blocking drugs naloxone and naltrexone.
When administered to normal people or people with uncontrollable appetite, opiate-blocking drugs yield reductions in appetite, cravings, and caloric intake, as well as dampen mood, and the effect seems particularly specific to wheat-containing products.
Wheat, in fact, nearly stands alone as a food with potent central nervous system effects. Outside of intoxicants such as ethanol (like that in your favorite merlot or chardonnay), wheat is one of the few foods that can alter behavior, induce pleasurable effects, and generate a withdrawal syndrome upon its removal. And it required observations in schizophrenic patients to teach us about these effects.
NIGHT CRAVING CONQUERED
For as long as he could remember, Larry struggled with weight.
It never made sense to him: He exercised, often to extremes. A fifty-mile bike ride was not unusual, nor was a fifteen-mile walk in the woods or desert. As part of his work, Larry enjoyed the terrain of many different areas of the United States. His travel often took him to the southwest, where he hiked for up to six hours. He also prided himself on following a healthy diet: limiting his red meat and oils and eating plenty of vegetables, fruit, and, yes, an abundance of “healthy whole grains.”
I met Larry because of a heart rhythm problem, an issue we dealt with easily. But his blood work was another concern. In short, it was a disaster: blood glucose in the low diabetic range, triglycerides too high at 210 mg/dl, HDL too low at 37 mg/dl, and 70 percent of his LDL particles were the small heart disease–causing type. Blood pressure was an important issue with systolic (“top”) values ranging up to 170 mmHg and diastolic (“bottom”) values of 90 mmHg, even while sitting quietly. Larry was also, at 5 feet 8 inches and 243 pounds, about 80 pounds overweight.
“I don’t get it. I exercise like nobody you know. I really like exercise. But I just cannot—cannot—lose the weight, no matter what I do.” Larry recounted his diet escapades that included an all-rice diet, protein drink programs, “detox” regimens, even hypnosis. They all resulted in a few pounds lost, only to be promptly regained. He did admit to one peculiar excess: “I really struggle with my appetite at night. After dinner, I can’t resist the urge to graze. I try to graze on the good stuff, like whole wheat pretzels and these multi-grain crackers I have with a yogurt dip. But I’ll sometimes eat all night from dinner until I go to bed. I don’t know why, but something happens at night and I just can’t stop.”
I counseled Larry on the need to remove the number one most powerful appetite stimulant in his diet: wheat. Larry gave me that “not another kooky idea!” look. After a big sigh, he agreed to give it a go. With four teenagers in the house, clearing the shelves of all things wheat was quite a task, but he and his wife did it.
Larry returned to my office six weeks later. He reported that, within three days, his nighttime cravings had disappeared entirely. He now ate dinner and was satisfied with no need to graze. He also noticed that his appetite was much smaller during the day and his desire for snacks virtually disappeared. He also admitted that, now that his craving for food was much less, his caloric intake and portion size was a fraction of its former level. With no change in his exercise habits, he’d lost “only” 11 pounds. But, more than that, he also felt that he’d regained control over appetite and impulse, a feeling he thought he’d lost years earlier.
WHEAT: APPETITE STIMULANT
Crackheads and heroin addicts shooting up in the dark corners of an inner-city drug house have no qualms about ingesting substances that mess with their minds. But how about law-abiding citizens like you and your family? I’ll bet your idea of mind bending is going for the strong brew rather than the mild stuff at Starbucks, or hoisting one too many Heinekens on the weekend. But ingesting wheat means you have been unwittingly ingesting the most common dietary mind-active food known.
In effect, wheat is an appetite stimulant: It makes you want more—more cookies, cupcakes, pretzels, candy, soft drinks. More bagels, muffins, tacos, submarine sandwiches, pizza. It makes you want both wheat-containing and non-wheat-containing foods. And, on top of that, for some people wheat is a drug, or at least yields peculiar drug-like neurological effects that can be reversed with medications used to counter the effects of narcotics.
If you balk at the notion of being dosed with a drug such as naloxone, you might ask, “What happens if, rather than blocking the brain effect of wheat chemically, you simply remove wheat altogether?” Well, that’s the very same question I have been asking. Provided you can tolerate the withdrawal (while unpleasant, the withdrawal syndrome is generally harmless aside from the rancor you incur from your irritated spouse, friends, and co-workers), hunger and cravings diminish, caloric intake decreases, mood and well-being increase, weight goes down, wheat belly shrinks.
Understanding that wheat, specifically exorphins from gluten, have the potential to generate euphoria, addictive behavior, and appetite stimulation means that we have a potential means of taking back control over eating habits and weight: Lose the wheat and lose the weight, as well as the myriad effects this never-should-have-been-food-in-the-first-place thing has over us.
CHAPTER 5
YOUR WHEAT BELLY IS SHOWING: THE WHEAT/OBESITY CONNECTION
PERHAPS YOU’VE EXPER
IENCED this scenario:
You encounter a friend you haven’t seen in some time and exclaim with delight: “Elizabeth! When are you due?”
Elizabeth: [Pause.] “Due? I’m not sure what you mean.”
You: Gulp…
Yes, indeed. Wheat belly’s abdominal fat can do a darn good imitation of a baby bump.
Why does wheat cause fat accumulation specifically in the abdomen and not, say, on the scalp, left ear, or backside? And, beyond the occasional “I’m not pregnant” mishap, why does it matter?
And why would elimination of wheat lead to loss of abdominal fat?
Let’s explore the unique features of the wheat belly–body configuration.
WHEAT BELLY, LOVE HANDLES, MAN BOOBS, AND “FOOD BABIES”
These are the curious manifestations of consuming the modern grain we call wheat. Dimpled or smooth, hairy or hairless, tense or flaccid, wheat bellies come in as many shapes, colors, and sizes as there are humans. But all share the same underlying metabolic cause.
I’d like to make the case that foods produced with or containing wheat make you fat. I’d go as far as saying that overly enthusiastic wheat consumption is the main cause of the obesity and diabetes crisis in the United States. It’s a big part of the reason why Jillian Michaels needed to badger The Biggest Loser contestants. It explains why modern athletes, such as baseball players and triathletes, are fatter than ever, and why the most popular dress sizes are now 16 to 18. Blame wheat when you are being crushed in your airline seat by the 280-pound man next to you.
Wheat Belly (Revised and Expanded Edition) Page 7
