Many people today are talking about diets that are “gluten-free.” Restaurants are offering “gluten-free” menus. There are websites, chiropractors, and others proclaiming that going on a gluten-free diet will provide improved health. But lets be clear- unless you have an allergy to gluten, removing gluten from your diet will not provide better health, weight loss, but eliminating gluten will dramatically limit what you can eat.

But there are some people who are “allergic” to gluten- and for them having a gluten free diet is the difference between health and illness – between a risk of some rare cancers for which we don’t have great treatment for. We call that condition celiac disease – for those who have celiac disease, being gluten free is critical. Other names for this disease include celiac sprue, gluten sensitive enteropathy, non-tropical sprue, and a few other names.

Gluten is a protein that is found in wheat, barley, rye, and oats. Gluten is a protein that allows wheat to have “elasticity” – meaning you can roll out the dough- or toss it in the air and make a great pizza crust. You can’t do that with non-gluten grains—no one can make a pizza or great bread from corn alone. Gluten is also used to thicken soups, ketchup, soy sauce, and is found in almost every processed food out there. Take gluten out of the American diet and you will be challenged to find good alternatives.

When a person is allergic to gluten their symptoms include malnutrition, anemia, osteoporosis, infertility, short stature, and inability to thrive. However, the “classic” symptoms are not necessarily common. There are a number of patients who have silent celiac disease, where they will be discovered to have atrophy of their absorptive surface of the small bowel without any symptoms, or just mild symptoms such as an iron deficiency anemia. There are a number of forms of celiac disease that respond well to a gluten free diet – and remain normal after introduction of gluten into the diet.

Celiac disease is best diagnosed with a biopsy of the small intestine. Most often the biopsy is performed endoscopically from the first part of the small bowel, the duodenum. However, those biopsies can be negative, and more distal small bowel may show the classic pathologic appearance. Those biopsies most often have to be done surgically, or with advanced endoscopic equipment.

The small bowel, under a microscope, has many small finger-like projections called villi. These serve to increase the surface area of the small bowel to allow for maximum absorption of nutrients. In celiac disease, there is atrophy of these villi – seen microscopically- and this improves when gluten is removed from the diet.

Above normal villi, below- atrophied

While celiac disease is classically called an “allergy” to gluten – it does promote some antibodies against the connective tissue elements – leading some to call this an auto-immune disease. However, when the foreign protein is withdrawn, there is no residual auto-immune function. The “auto-antibodies” may simply reflect the gluten protein unfolded – and having a similar structure to the bodies own endomysium protein.

There have been various reports about the prevalence of celiac disease – ranging from 1:300 among Northern Europeans (Celtic) to 1:122. There is a large genetic distribution of the disease – with a high concordance among identical twins of up to 70 per cent. There are some genetic markers that have a high association with celiac disease, but the expression of the disease is variable – meaning that the genetic marker is a tendency but not a certainty of celiac disease. If everyone who had the genetic markers were to develop the disease, it would be estimated that 1 in 22 people would have this. However, this is not the case.

Diagnosis of celiac disease is made based on clinical suspicion of the classical presentation (iron deficiency, osteoporosis, with abdominal complaints) followed by some tests. A biopsy is the most reliable test, however there are blood tests ( IgA anti-gliadin and IgA anti-endomysial and anti-tissue transglutaminase) that are over 90 per cent accurate. Even with a negative blood test but a high enough suspicion, duodenal biopsy or even surgical biopsy is warranted.

There are plenty of questions about celiac disease- we don’t know the actual prevalence in the population, we don’t know if being gluten free as demonstrated by follow up biopsy has a lower incidence of lymphoma.

What we do know is that gluten is not a health issue in people who do not have celiac disease. Gluten-free will not cure autism. Gluten free will not facilitate weight  loss. There are, however,  groups who will claim that gluten is a health issue- there is no basis for this claim. If someone has told you to remove gluten from your diet, and you do not have a test showing celiac disease (one of the tests listed above)- please see a physician to resolve this.

For people who have celiac disease- there is a bit of culinary hope. Thomas Keller, one of the world’s greatest chefs and owner of Ad Hoc, French Laundry, Per Se, and Bouchon- has developed a flour that works well. You can purchase it from Williams-Sonoma.

Thomas Keller has come up with a great flour, gluten Free.

Vaccinations

Growing up in the 1960′s I can remember lining up in my grade school and getting some of the first polio vaccines. I didn’t like getting shots, but we had to have them. During my youth I managed to acquire a number of infectious diseases such as measles, rubella, measles, and whopping cough.

Orphans of infectious disease - Alaska Natives

But vaccines mean a bit more to me, than to most.  The reason is that my father is an orphan. He was an orphan raised in an orphanage in Seward, Alaska called the Jesse Lee Home.  He wrote a book about his, “Jesse Lee Home: My Home.”   You may recall that home from my father’s book, but more likely you will remember Balto – popularized by Walt Disney.

Unalaska, Alaska

The reason there were over 100 Native American (Alaska Natives, including Eskimo, Athabascan, Aleuts, and Tlingit) children in the orphanage was because of the  outbreaks of infectious diseases that killed their parents. Alaska Natives, much like their cousins in the lower 48 (American Indians) have a higher death rate from infectious diseases of Europeans than descendants of Europeans.

Balto, as you may recall, led the sled dogs on the Iditarod trail to Nome, bringing with him vaccines against diphtheria. They arrived in time, and many were saved. While most recall the heroic dog and his master, few will recall that the reason was to bring vaccines to a population that would have been decimated.

Dining hall of Jesse Lee Home, an orphanage in Alaska

Balto - guarding Central Park in New York City

In 1900 1/3 of the population of Unalaska was wiped out from measles, and again in 1919 over half were victims of influenza. The village of Knik, which was, at the time, the largest city in South Central Alaska, with an estimated population of over 20,000 was reduced to three villagers after the influenza epidemic.

These epidemics resulted in a number of orphans, all Alaska Natives, in a time when American Indians were not even granted the right of citizenship in the United States.

Alaska Native Children of the Jesse Lee Home- my dad on the left

We then come to the modern era where vaccines are widely used, and on a schedule, by pediatricians throughout the United States. Vaccinations offer a high level of protection against the disease, and are the most effective mechanism we have to protect people from the virus, some bacteria, and even against other diseases — potentially now with some forms of cancer.

Science, not politics, not celebrity, should determine how medicine should work. Jenny McCarthy has a son who has autism. For a while she proposed that he has some “special” abilities and was in two planes, but now admits that he simply suffers from autism. She relates this to vaccination.

The anti-vaccination crowd states that autism has a striking similarity to mercury poisoning – and will show you charts of patients who have mercury poisoning, and compare them with people who suffer from autism. They relate how the preservative used in the vaccines, thermasol, contains an ethyl mercury — and contend that it is this mercury that causes the damage to the children.

The difficulty with their argument are multiple but here are a few simple ones:

The FDA mandated removal of thermasol from all vaccines in 2002. The rates of autism have not decreased.

When careful examination of children who have autism the signs of it are found as early as 9 months of age, but at one year. Typically it is the second year of a child when vaccinations are administered. Parents see the correlation — a child gets vaccinated and the child begins more overt signs of autism, and seeks to make that correlation.

There have been many studies done and none have found a correlation between autism and vaccination. None. Yet, people without a background in science, or those who don’t get the scientific method continue to pound their anecdotal evidence that there is a connection.  There is not.

It is now clear that autism is genetic, coming from a range of mutations – not one in particular. So the anti-vaccination crowd focus on how vaccines are an environmental toxin – that can alter DNA.  Again, this is not supported by science. The DNA is set in an individual when they are born- there is no evidence a vaccine can alter DNA – although live virus can.  Once again, the group who supports not vaccinating does not believe science, or the studies – they believe in anecdotes – stories, things they see. This is very sad.

The new worry is that the agents used to preserve the vaccine- aluminum or formaldehyde are toxic and we should not be injecting them into our children. This in spite of over sixty years of vaccines, and minimal side effects.  In large doses aluminum can be toxic, but we still use aluminum in many deodorants as well as in antacids.  Aluminum is the third most abundant element on planet Earth – it is not a “heavy metal” as some allege- in fact, it is one of the lightest. There are levels of aluminum in our drinking water, in our blood, and in our bones.  Too much is a problem- much like too much vitamin B6 is a problem.

Formaldehyde is a natural byproduct of biochemical reactions that happen in our body every day.  Everyone has a level of formaldehyde in them – and while high doses are bad – the body uses formaldehyde.

So while I feel sorry for all who have autism, lets look at what having the measles vaccine alone has done for the population of the United States. It has saved 52 million people from getting the disease that I suffered as a child. It has prevented 17,400 of them from being mentally retarded, and prevented 5200 deaths. Worldwide the estimate of lives saved is over 1.4 million.

July 20, 2010 my son was born. In the hospital he received his first vaccine, and has received every one, on schedule, since then. I won’t risk my son’s life or the lives of other children, by not vaccinating him. Since he is 1/8th Native American (Athabascan) – it is difficult to say if the 7/8th European genes would protect him against the western diseases – but I won’t take that chance.

My son, born July 20,2010 - vaccinated

There is a concept of “herd” vaccination — that if you vaccinate enough people (typically around 85%) of the population, the other 15% will be so much less likely to get the disease that one can effectively call the disease as extinct. Don’t tell that to residents of Tucson, Arizona. Last year an outbreak was associated with a patient from Europe, and over 500 people were exposed to measles. Some 15 cases were confirmed. In the first few months of 2008 there were 64 cases in the United States, 63 of those were not vaccinated against measles. The problem with the herd concept is when a disease is highly contagious, it can quickly spread through a population and that 15% number become irrelevant.  Sadly, this has become evident, as the numbers of measles cases has increased in the last few years – a disease we  should have eradicated is making a comeback – now over 152 cases mid way through 2011.

To be able to eliminate a disease that almost wiped out a people, as it did in Alaska in the last century, is an amazing leap in science. To let such a disease run wild is genocide. Letting infectious diseases, like measles, out of Pandora’s box when it could be eliminated, is beyond foolish – it is homicidal. To be a celebrity and advocate against vaccination  represents the worst of celebrity over science and is defacto a celebrity advocating for genocide against Native Americans.