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.

Qing Li was born in China but attended medical school in Tokyo and is now a research physician at Nippon University. As a student he noticed how well he felt and performed after a few hours in a woodland. He now is regarded as the leading investigator into the benefits of a “stroll in the woods.”

Li’s research has documented improvement in blood pressure, blood sugar, memory and immune system function from occasional forest bathing, leading him to suggest that the most important part of urban planning and development is planting many trees. His work suggests that some of the benefits are due to phytoncides, smell causing chemicals released by the trees.

The impact of this work has been far reaching: Japan has designated and supported 62 forest bathing sites, some in cities, throughout the country. Clubs of forest bathers have sprung up around the world- the one in San Francisco has 1000 members who meet regularly for a leisurely stroll in the woods.

If you have one form of SAD there is a much higher chance you will have PAD.

Acronyms are often easy to remember handles; a few are perfect descriptions of something, but one, SAD, is a perfect description of two different things.

For psychiatrists SAD means seasonal affect disorder, depression which occurs in winter and which is usually well treated with regular use of light of a certain wavelength. Nutritionists use SAD to mean standard American diet, food that is mostly processed, high in sugar, salt and fat. It would be hard to find any acronym more descriptive than either SAD.

Michael Greger (NutritionFacts website) hypothesizes that we are genetically programmed to be depressed when we are inflamed. The genetic advantage is that will we rest and withdraw when we are infected, allowing more rapid and effective healing. Until western civilization’s recent dietary change to SAD general body inflammation was usually due to infection, but now most Americans are always chronically inflamed. As discussed in prior blogs, SAD changes bowel flora and does not supply enough essential nutrients, setting off a cascade of physiological events which precipitate chronic inflammation and many forms of chronic illness.

Multiple studies have confirmed a strong association of chronic inflammation with depression which is not seasonal but persistent. A Danish study of over 70,000 people found a high correlation of elevated C-reactive protein, a frequently used marker for chronic inflammation (see my earlier blogs), with depression. Thus I have created my first acronym, PAD (persistent affective disorder), to describe the type of depression associated with the chronic inflammation of SAD. Give up SAD and you may get rid of PAD!

No discussion of depression and lifestyle would be complete without again mentioning the strong effect of exercise to improve PAD (see Ratay’s wonderful book Spark.)

Dale Bresden’s book The End of Alzheimers is a best seller with a provocative title. Extravagant titles are always a red flag: please read and analyze me closely since I have made a radical claim. Unfortunately, the title is misleading: the book is not about the end to AD but about how to best avoid and manage it.

The credentials of a health or science book’s author are a good way to start a review. Dr. Bresden’s are impressive. He has been affiliated with top level research programs and compiled an extensive CV. Two decades ago he split from established academic centers to start the Buck Institute, an independent research center with excellent credentials. More recently he started MPI Cognition which had two main divisions- a program offering educational aids and a cognition dementia business which last year was acquired by AHNP Precision Health. This later business markets an expensive program based on the material in Bresden’s best seller. I asked a friend, an expert in education, about the educational aid business which he described as “great marketing with little results.” Now we have another large red flag- a “scientific” book promoting a well funded for-profit ventures.

The book itself is impressive. The author is obviously very knowledgeable about AD. The main thrust of his proposed treatment for preventing and reversing AD is the best lifestyle medicine very similar to much of what I have described in past blogs: diet which is mainly whole plant foods with very little animal products, refined grains, sugar, alcohol, processed foods; exercise; meditation; a good social network; intermittent fasting. There is no doubt that this lifestyle will help avoid or mitigate the development of clinical AD for many people.

I have big problems with some of his ancillary advice. The most glaring is a recommendation to keep cholesterol above 150. This recommendation caused me to review what I could find in the scientific literature. Much work has been done on the relationship of cholesterol levels and dementia including AD. There are some conflicting studies. Most show a strong correlation between low cholesterol and avoidance of later AD, but it is not at all certain that this is true for those whose low cholesterol is due to drugs. A few studies show that those with higher cholesterol in middle age have less AD when they get very old. Also, people over 85 who have higher cholesterol have less AD than those whose cholesterol is very low, but many frail, sick people have low cholesterol as part of a general malnutrition.

Bresden also recommends avoiding gluten seconding the advice of his friend David Perlmutter (author of Grain Brain.) As I discussed in a prior blog this advice is key for those with celiac disease (like me!), gluten allergy or sensitivity; but whole grains, including those with gluten, are otherwise well documented to be associated with better health. This caused Perlmutter to be labeled a medical charlatan by an expert in lifestyle medicine.

The other questionable, and possibly dangerous, advice in this book is that promoting and maintaining a mild ketosis is brain healthy. Bresden recommends use of coconut oil and MCT oil (a synthetic vegetable oil) to help create this ketosis. But all plant oils are toxic to blood vessels and coconut oil is probably the worst because of its very high level of saturated fat. Blood vessel health together with good amounts of all the nutrients and fiber found in whole plant foods is the key to good health including avoiding AD.

A recent book, The End to Alzheimer’s, has become a best seller. In my next post I will discuss this book, but to understand the book and my review of it it’s necessary to know what the terms “dementia” and “Alzheimer’s” (AD) mean.

Dementia is a loss of overall brain power: reasoning, analytic thought, behavior and memory are all effected to a varying degree. Dementia may be acute or chronic; reversible or permanent; stable, improving or progressive. Many causes of dementia have been discovered but most cases, especially in the elderly, are due to some combination of vascular disease and AD.

When I was in medical school Alzheimer’s was termed pre-senile dementia. The original description was from the early 20th century: a middle aged woman developed progressive dementia and died after several years. At autopsy she had severe loss of brain tissue and unusual changes in some parts of the brain. These pathologic findings are still the definitive way to diagnose AD. In recent decades AD has become epidemic, especially in older people. Half or more of people over 85 may have AD, and AD is one of the leading causes of death in the United States.

Specific genes make development of AD more likely and there is now a lively debate on the usefulness of genetic testing for it.

BUT- some people with strong genetic patterns favoring AD never get the disease, and some people with large amounts of the diagnostic brain pathology changes at autopsy had no dementia while alive.

Over 30 years ago Larry Smarr, professor of computer science at UCSD, first proposed the idea of super computer centers based at universities and convinced the National Science Foundation to fund these centers. He also developed systems allowing the internet to be created, but more recently his work has focused on another of his brainstorms, Calit 2, which explores advanced digital technology for medical practice. The structure and work of Calit 2 has been so successful that top level computer scientists have left much better paying jobs to join Smarr in his work.

In addition to computer applications Smarr has studied medical research, concluding that lifestyle was the critical variable for good health and longevity. Optimally, this is patient controlled as he demonstrated in the management of his own Crohn’s disease. Exercise, sleep and relaxation are all important features of best lifestyle but diet is the most critical. Smarr has concluded that the gut microbiota are key to many aspects of health including his own Crohn’s. Maintaining a wide variety of “good” gut microbes requires the right food. Smarr attempts to eat 32 varieties of whole plant food regularly, often incorporating them into smoothies. He comments- “Although I am not a vegetarian, I am a follower of what Thomas Jefferson once said: “I eat meat only as a condiment to the vegetables which constitute my principal diet.”” Smarr cites Michael Pollan’s classic book, In Defense of Food, as an excellent analysis of the best approach to diet. He limits animal products to a maximum of 10% of his diet.

https://www.theatlantic.com/magazine/archive/2018/03/larry-smarr-the…/550883/

https://en.wikipedia.org/wiki/Larry_Smarr

In recent decades the incidence of three devastating brain diseases, Alzheimer’s(AD), Parkinson’s(PD) and autism, has exploded. Increase in AD and PD is partially explained by increasing population longevity, but the cause of much of their increase has not been determined. Autism is now better recognized, explaining a modest part of the increased incidence, but change in frequency of this disease is much higher than can be explained by more awareness from physicians and the general public.

A logical possible cause of these increases include increased environmental toxins. Indeed, a small number of PD is caused by exposure to certain agricultural chemicals and some AD from aluminum in drinking water. An initial report connecting early childhood vaccinations to autism has been completely discredited by large scale studies.

Typical diet has changed greatly since WW II. Some relationship of diet to AD is quite clear, perhaps attributable to vascular disease promoting AD brain pathology. As research in the microbiome progresses, its effects on the brain have become clearer. Experiments with mice have demonstrated major effects on mouse AD, PD and autism-like behavior by manipulating the mice microbiome. Many researchers are trying to determine which bacterial strains are responsible and how they work to change behavior, brain chemistry and pathology. Since diet controls the microbiome it’s likely that western society’s recent change to a very unhealthy diet is driving the increase in AD, PD, autism and, perhaps, depression and schizophrenia. All scientists now agree that diet has caused our epidemics of heart disease, stroke and cancer. There’s a good chance that other major brain diseases will be added to the list of diet-induced health issues.

A recent article in the medical literature reviewed the scientific studies showing benefits and harms of regular tea drinking. The conclusions of this review were that nothing has been scientifically proven to support either tea consumption or abstinence. Careful examination of this paper was a big surprise after reading the conclusion since almost all the studies showed significantly less cardiovascular disease, cancer and other major diseases among tea regular tea drinkers. There was little controversy about this among those who looked at large groups of tea drinkers. Medical “science” has decided that studies must be performed in a certain way, typically prospective and double blinded, to be conclusive. Since it is impossible to conduct most analyses of nutrition effects in this manner, all nutrition studies are inconclusive. By these standards penicillin has not been shown to be effective against any infections and smoking not shown to cause cancer and other diseases. Ironically, prospective double blinded studies meeting scientific statistical criteria for validity have been shown to be wrong 20-50% of the time when better studies were done at a later time.

Food businesses have made good use of this sort of nonsense by sponsoring studies showing their product healthy or at least harmless and then proclaiming that while their studies are not totally scientifically proven neither are all the others done by top level independent researchers showing harm.

Dr. Patricia Gilbreath reminded me that Christian religious practices also can use meditation; indeed repetitive prayer like the rosary is a form of meditation. Virtual all religious traditions have individuals and groups who espouse a mystical worldview in which transcendence is a critical part of their religious practice. Meditation is often, but not always, the route into the transcendent state which can become permanent in some people. Permanent transcendence is termed enlightenment, a condition described by shamans in “primitive” societies; the Kabbalah in Judaism; sufis in Islam (where transcendence may be attained through dance- the whirling dervishes); some Christian saints and ascetics; others who espouse no particular formal religion.

The title of Rosenthal’s most recent book, Super Mind, refers to the state of enlightenment which some TM practitioners reach, usually after many years of regular practice. Most TM practitioners use it for practical purposes: blood pressure reduction, anxiety or stress relief, help with addiction or insomnia and not to attain enlightenment. I have a large reading list for those interested in mysticism and enlightenment but decided that this was not pertinent for What Really Matters since, unfortunately, I have no credentials as a mystic.