Gluten and me

A small fraction of the population suffers from something called coeliac disease — a severe allergy to gluten, a key protein in wheat (the thing that gives bread its springiness and dough its stretchiness). A larger number of people may, it would seem, suffer from gluten intolerance — they don’t suffer an instant allergic reaction on eating wheat, but effects show up on a slower time scale. Exactly what constitutes gluten intolerance, how many people suffer from it, and even whether the problem is gluten or something else (eg, a carbohydrate in wheat) remain controversial questions. Nevertheless, the number of people opting to eat gluten-free, especially in developed countries, has skyrocketed in the past few years. More recently, there seems to be a bit of a backlash against gluten-free diets — see here and here for example.

What follows is strictly anecdotal, not a scientific study: make of it what you will.

A little over a year ago, in April 2013, the three of us went gluten-free. There were several reasons, the primary one being that the kid seemed to have undiagnosed food allergies (he had problems with dairy when young; that seems to be over, but there were still issues). But also on my mind were several symptoms that I had been having — lethargy (caused by hypothyroidism), joint pain, and other things, and several articles on gluten that I had been reading such as this one about a young boy with excruciating joint pain who seemed to have been miraculously cured by going gluten-free. Why not give it a try?

This is not a small project — it means avoiding anything made of wheat (atta or maida), rye, barley, reading ingredients carefully on all packaged food, limiting one’s menu when eating out, and learning new ways to make chapatis or bread at home. More on that later. On the plus side, here in South India gluten-free food — both healthy and junk — is plentiful (wheat is not used in most traditional preparations).

A year down the line, the joint pains seem greatly reduced. The energy levels are higher, but the blood tests show no great improvement in thyroid function. These could well be placebo effects, but what is real was something I did not expect at all. My psoriasis cleared up.

I have written of my psoriasis before. It started developing in 2001, as a small patch on my right ankle. Within a year it was a large patch on my right foot. Over the next several years it spread to my left foot and my left hand. It was always raw and itchy, usually cracked and bleeding. There were days that I couldn’t walk without a limp, couldn’t type with my left hand. The area around the gear stick in my car was covered with flakes of dead skin. I wore socks all the time, partly for comfort, partly because otherwise I left a trail of dead skin wherever I went. I sought treatment three times, from three different doctors. Each time the prescription was a corticosteroid ointment (various betamethasone preparations); the first couple of times, it “cleared up” the psoriasis, but left the skin feeling thick and leathery, and after I stopped it rebounded worse than before. The third time — well, I describe that in my earlier post, but I did try the ointment and it had little effect, while the rebound was even worse.

So, as I say, after April 2013 the psoriasis just started clearing up. I didn’t even make the connection at first, but in May 2013 on a trip to Bangalore I had wheat products a couple of times, and my foot itched furiously. After cutting out wheat again, the improvement was steady — the psoriasis disappeared from the fingers and toes, and the patches that remained retained a dryish appearance but stopped itching, cracking or bleeding.

In December 2013, on a flight to Delhi, I had a bun since there was no gluten-free breakfast available. A couple of days later, the itching and flaking resumed and took 2 weeks to subside.

Since then I have been careful to avoid gluten in any form (even on a trip to Europe — Italy in particular was surprisingly gluten-free-friendly). In February 2014, I gave the corticosteroid another try (for three weeks) to clear the stubborn areas. The psoriasis disappeared entirely from my hand and has not returned. It has also disappeared from the ankle where it originally appeared. There was no rebound. There continued to be improvement in the five months after ceasing to use the ointment. As of today, only two dryish-looking patches remain on my upper feet, unnoticeable unless one is looking for them.

Looking at the literature, I found that there is some evidence of gluten being implicated in quite a few auto-immune conditions, including psoriasis and Hashimoto’s thyroiditis. In my case, this is not all. In the mid-1990s I developed a seasonal cough that remained undiagnosed for years (even by highly-recommended chest specialists) until a modest general practitioner at an academic institute in Bangalore told me it was asthma. I had no shortness of breath, only a cough. A salbutamol inhaler fixed it. In the past year, it seems to me that this, too, has greatly improved: I hardly used the inhaler even during the peak of the usual “season”.

What of the others? My wife sees clear improvements in some other conditions (specifically, migraines — once very frequent, now very rare — and hyperacidity). With the kid it is less clear. But then I had no symptoms until I was in my twenties. I definitely increased gluten consumption — both during meals (I preferred chapatis to rice) and in terms of junk food like biscuits — after I moved from my parents’ home to a hostel. And as a postdoc in Paris, which is where the psoriasis first developed, I was eating gluten three meals a day (what to do, the bread was so awesome, and if it wasn’t bread it was pizza or pasta). It could be that in some people, gluten intolerance manifests itself only with an excess of gluten. Indeed, this seems to be the reason for the awareness in Italy: their traditional diet consisted almost wholly of gluten, and this gluten overdose could be responsible for increased occurrence of gluten-intolerance. The kid, therefore, sometimes eats gluten outside, though we are gluten-free at home.

How can a traditional food item like wheat be so bad for so many people, and is it the wheat or something else that is responsible? These are good questions. Out on the internet, there are several claims that the problem is not the wheat, but the modern industrial process of bread-making; or the high-yielding dwarf varieties of wheat; or merely the fact that most junk food contains wheat, so by cutting out gluten, you eat healthier; or the carbohydrate hypothesis. The trouble with these explanations is that, in Paris where I first developed these symptoms, I ate high-quality traditional boulangerie bread, not the mass-produced sandwich stuff; it is impossible to ascertain what variety of wheat has been used in the batch of flour you buy or the restaurant you eat in; and, sad to say, we have not actually cut out junk food at all, merely replaced biscuits with “thattais” and “murukkus”. As for the carbohydrate hypothesis, even if it is true, the only solution is to cut out wheat, until they develop a variety without that carbohydrate. In any case, though not long ago I would have shuddered at the thought of cutting out bread, tandoori naan, croissants, and so on, my experience over the last year has destroyed any craving I have for these things, and the idea of doing a controlled experiment — consuming certain types of wheat, prepared in a certain way, and observing the effects — has no appeal either. I’d much rather cut the whole lot out.

Much of the above may strike the reader as speculation and unsourced, and it is — I have put in very few links, and while there is some academic literature, it is far from conclusive, while there is a huge amount of speculative stuff on the internet that I don’t want to endorse. This is my experience — it may or may not apply to anyone else. But here is the thing. If you suspect gluten is the problem for you and want to try going gluten free, it has to be all or nothing — reducing consumption may prevent effects down the line, but it will not cure any autoimmune (or other) condition that is already underway. You need to keep gluten out of your system entirely, for several weeks, to know whether it is the cause or not. And what I learned is it is not as hard as it looks, especially if you mostly eat home-made food. If you eat South Indian food, you can easily get by with rice, idli/dosa, and millet “upmas”. But even if you crave pancakes/chapatis/bread/pizza, it is not too hard.

Here is the current gluten-free mix I use:

  • 500 grams white urad dal (skinned black lentil) flour
  • 500 grams white rice flour
  • 1000 grams jowar (sorghum) flour
  • 500 grams corn starch

(The urad flour betrays my locale — an idli is surely the perfect example of a springy, spongy dumpling made with just two ingredients, rice and urad dal, without even added raising agents: it ferments naturally, at least if you live in south India. Urad dal is mucilaginous and thus contributes to binding and to trapping the bubbles from fermentation — the main problem with gluten-free flour being that the bubbles can escape, resulting in a flat product, and the result is generally crumbly).

For making pancakes with egg and milk, this works as a direct substitute for all-purpose wheat flour. For chapatis or pizza, mix in a teaspoon of guar gum or xanthan gum (necessary for binding, even with the urad flour included — unless you’re trying a traditional “akki-roti” style method), use milk or yogurt or warm water for kneading, don’t make the dough too dry, and let it sit a while before use (it’s even better after sitting overnight in a fridge, wrapped in clingfilm). For bread, use the gum, and either ferment with yeast and water or just mix with baking soda and yogurt (the latter is more reliable), add an egg (egg substitutes may work too), and mix well to make a wet, sticky batter. There are many gluten-free bread recipes on the internet, mostly with scary-looking instructions on using exact mixes of ingredients, exact oven temperatures, and so on; in reality it is not as bad as all that, and the flour mix I use varies a fair bit (eg, replace some of the jowar or rice with some millet flour, reduce the corn starch, etc). I may post my own recipes at some later point.

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  1. The high protein mix you are using is simply awesome. A friend of mine, also from Chennai, has gone on a lentil (dal) diet and is seeing a lot of improvement. Your post is very detailed with a lot of personal insight – makes reading so much more enjoyable. I am looking forward to reading more.

    • Rahul Siddharthan

       /  July 13, 2014

      Thanks! I think I know who you are from fb, which is where I post short stuff these days, blogging is rare now.

    • Rahul Siddharthan

       /  July 13, 2014

      TR – haven’t read that book but have read a lot about the hygiene hypothesis over the years. No question that hygiene and germophobia have gone overboard in recent times. The good news is that doctors are now appreciating the microbiome (including helminths) more these days. It’s going to be a tradeoff between keeping us safe from life-threatening infections and not destroying our immune system’s ability to train itself…

  2. Thanks for the gluten-free mix recipe. I’ve never thought of adding urad dal, does it taste like chapatis or is it too much to ask for? I find it a lot easier to avoid chapatis altogether, and like you said being South Indian helps.

    Also, sorghum apparently is not hypothyroid-friendly. Have you noticed any changes in your thyroid levels after using your mix?

    • Rahul Siddharthan

       /  July 14, 2014

      Nisha, it doesn’t taste like chapatis but at this point I’m beginning to forget what chapatis taste like — it’s not too bad, anyway. I didn’t know or think of a sorghum-thyroid link. Apparently millets should be avoided by hypothyroid people too. Food for thought. Thanks for the information!

  3. Dear Rahul,

    Even if you don’t read the book mentioned above, Moises recently discussed his book with Russ roberts on econtalk



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