Since my diagnosis of celiac disease I’ve been interested in all aspects of the science about gluten, the trigger for bowel damage and other problems in those of us with this disease.

Web searches are often a clue to the popularity of different approaches. The top hit on Google for “gluten, microbiome” was by Dr. David Perlmutter, author of Grain Brain, whose work I have discussed in earlier blogs. Dr. Perlmutter discusses early gluten exposure and increased type 1 diabetes and mouse studies showing microbiome changes with development of diabetes associated with gluten exposure. He emphasizes the importance of the microbiome for a well functioning immune system and health.

What does a review of the scientific literature show?

1- Change to a gluten free diet produces a modest change to the microbiome which mainly is a decrease in “healthy” bacteria and an increase in “unhealthy” bacteria. One investigator hypothesized that this might be due to less dietary fiber since gluten containing grains are a major healthy fiber source for many.

2. Change to a whole food plant based diet produces a radical change in the microbiome with the opposite effect to a gluten free diet.

3. There is large variation in the microbiome between different populations and even in the same individual from week to week. Some is probably genetic but other variation is due to diet, exercise, sleep and other lifestyle factors.

4. A recent extensive review noted “there is misconceived perception that this diet (gluten free) is healthier.” The reviewer goes on to say that gluten containing foods provide many other important nutrients.

5. A cardiologist whose website is “glutenfreecardiologist” offers a reasonable approach: try a gluten free diet for a few weeks; if you feel better continue, but be sure to get lots of fiber and other nutrients from other sources (limit meat, dairy, sweets in favor of other whole grains, legumes and plant food.)

“Sugar” and Honey” are terms of endearment. “Peach,” “Plum,” and “Apple of my eye” are highly complimentary. We are born liking sweetness and can become addicted since sugar provokes the same brain chemistry patterns as heroin.

In the last few centuries the ability to extract sugar from plants has allowed the creation of a huge industry with many processed foods designed around our love of sweetness. Most extracted sugar has only carbohydrate calories with all other nutrients removed; a few have some retained nutrients: honey, molasses, maple syrup, but the amount of nutrients is very small compared to the amount of calories.

Whole fruits have varying amounts of sugar but the total food package includes vitamins, minerals, micronutrients and fiber. Due to their sugar content fruits are more calorie dense than vegetables, and in general fruits have less fiber than vegetables and so are less satiating- it’s easy to eat more fruit. When fruit juice is made sugar and nutrients are retained but fiber is not. Because of this the sugar is quickly absorbed from the gut into the blood creating a sugar spike and increased insulin production similar to what happens when pure sugar is eaten.

Dried fruits are very sweet since most water has been removed and the sweetest are dried dates (all store bought dates are dried) which typically are 80-90% sugar. Dates are the source of a unique sugar which is made by grinding up dates without extracting fiber or nutrients. In spite of the high sugar content, dates, like other whole fruits, do not cause a drastic blood sugar or insulin spike. The fiber causes sugars to be absorbed more slowly. As I mentioned in a past blog, an Israeli study showed no harmful metabolic effects from eating large amounts of dates. They also seem to suppress appetite since study subjects voluntarily ate less other food during the day causing a net zero total calorie effect. Using date sugar as sweetener for hot drinks or on cereal seems to be a wise choice. Using date sugar to create processed foods like cakes, cookies, candies would probably have little health benefit since so many of the other ingredients are unhealthy. Perhaps a creative chef/baker can create healthy versions. Date sugar has a subtle pleasant flavor which does little to effect the taste of beverages and cereal but does have a grittiness which can slightly effect texture in drinks and baked goods. Date syrup eliminates this grittiness but is expensive compared to the sugar. WARNING- Some commercial date sugars remove the fiber to avoid this grittiness. Since a portion size of sugar is small compared to a whole date the nutritional content table may show 0 fiber but that does not mean the fiber has been removed. Be sure of your product or make it yourself.