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While the scientific community has widely accepted celiac disease as a condition caused by gluten and other related proteins, non-celiac gluten sensitivity has remained a topic of heated debate in the media and among the general public.

In this article, I’ll talk about the reasons I have acknowledged non-celiac wheat sensitivity as a real condition for many years, and I’ll describe the results of a new research study performed at Columbia University that adds supportive evidence. Before we jump in, though, let’s review the difference between celiac disease and non-celiac wheat/gluten sensitivity.

Celiac disease vs. non-celiac wheat sensitivity

Celiac disease and non-celiac wheat sensitivity are two distinct conditions, with a few major differences.

Celiac disease (CD) is an autoimmune disease characterized by an inflammatory immune response to wheat gluten, rye, barley, and related proteins. It results in marked disruption of normal gut tissue structure, including atrophy of epithelial cell projections called villi and an enlargement of intestinal crypts where new epithelial cells form from stem cells. CD is strongly associated with the haplotypes DQ2 and DQ8 of the HLA gene (1). In terms of blood markers, transglutaminase 2 (TG2) autoantibody is considered the most sensitive marker for celiac disease (2).

Non-celiac wheat sensitivity (NCWS, and also called non-celiac gluten sensitivity) is a term applied to individuals who experience symptoms in response to wheat or gluten ingestion but lack the characteristic markers of celiac disease. Symptoms can range from GI discomfort to fatigue and other neurological issues. These people tend to improve on a gluten-free diet (3). Unfortunately, many are mocked or ridiculed for avoiding wheat and told that their sensitivity is “all in their head.”

New research confirms gluten intolerance is real—and the haters are wrong.

Wheat sensitivity: Is it all in your head?

In response to continued suggestion by the media and some of the medical community that wheat sensitivity is merely psychological, I have written extensively on my blog in support of NCWS as a real condition. For one thing, a variety of different proteins in wheat can elicit an immune response beyond gluten. NCWS might even be more serious than celiac disease, as many people who test negative for celiac disease continue to eat wheat and put themselves at serious risk for developing autoimmunity.

Gluten free is not a fad, and self-reported NCWS has been associated with a wide variety of disorders in epidemiological studies. Those who claim that gluten sensitivity isn’t real often cite this study, attributing any negative reactions to gluten to FODMAPS. However, as I addressed in a previous article, the researchers chose whey protein for their control group, a pretty poor choice considering that many of their subjects likely had inflamed guts and multiple food sensitivities. The evidence, both on paper and from my own clinical experience, clearly points to the existence of NCWS.

The latest research study

Still not convinced? In a recent study, researchers at Columbia University Medical Center sought to obtain objective evidence to determine if NCWS is real (4). They enrolled 80 individuals with self-reported non-celiac wheat sensitivity (NCWS), 40 individuals with celiac disease, and 40 healthy subjects for the study. NCWS patients were excluded if they showed any of the characteristic diagnostic markers of celiac disease (celiac-specific IgA, anti-TG2 autoantibody, or celiac-like histology).

The researchers took blood samples and intestinal biopsies from all 160 patients. The blood samples were used to look for particular signaling molecules and proteins in the blood, while the biopsies were used for histological analysis of the tissue microstructure. In addition to comparing these measures between conditions, they also took a subset of 20 NCWS patients who had adhered to a gluten-free diet for six months and compared their blood and biopsy samples before and after gluten avoidance.

Gluten-sensitive individuals have leaky gut

So what did they find? Non-celiac wheat sensitive individuals have … drumroll … leaky gut! NCWS subjects showed increased intestinal permeability compared to healthy subjects. This is not really all that surprising, since we know that gliadin, a component of gluten, can affect tight junction proteins (5).

In addition, subjects in the NCWS group had systemic immune activation. Serum levels of both lipopolysaccharide-binding protein (LBP) and sCD14 were significantly elevated in individuals with NCWS in comparison with individuals with celiac disease and healthy controls. These are sensitive markers of microbial translocation. In other words, they indicate that bacteria and other microbes from the gut interior are “leaking” into the bloodstream, inducing a low-grade, chronic inflammatory response from the immune system (6).

Histological analysis of biopsy tissues showed that the NCWS group also had epithelial cell damage similar to the celiac disease group, a result supported by elevated levels of serum marker FABP2 (7). Moreover, in the subset of NCWS individuals analyzed before and after adherence to a gluten-free diet, they found that inflammation and cell damage markers improved significantly after six months of gluten avoidance.

Gluten sensitivity exists—here’s how to know if you might have it

Evidently, there are certain individuals who possess non-celiac wheat sensitivity and would benefit greatly from avoiding wheat. It’s unfortunate that so many people who might benefit from a gluten-free diet never try it or don’t stick with it because of the lack of support from media, the medical community, and the general populace. I hope that this new research study (and others that will surely follow) will make it just a bit easier for people to make the right choice for their health.

So how can you know if you have NCWS? The biological markers used in this particular study may be used in the future to help diagnose NCWS, but at the moment, they are purely used for research purposes. Nevertheless, there are two ways to determine your gluten tolerance:

• A Cyrex panel: Cyrex Array 3 is a panel that tests your potential for wheat and gluten protein reactivity and autoimmunity. It must be ordered by a healthcare practitioner.

• A self-experiment: Eliminate gluten from your diet for 60 days and then perform a gluten challenge, taking careful note of any symptoms. I still hold that this is the best way to determine your tolerance for gluten.

Now I’d like to hear from you. Did this article change your perception of gluten sensitivity? Do you or someone you know have non-celiac wheat sensitivity? Have you ever tried a gluten challenge? Share your opinion in the comments!

http://chriskresser.com/

While the scientific community has widely accepted celiac disease as a condition caused by gluten and other related proteins, non-celiac gluten sensitivity has remained a topic of heated debate in the media and among the general public.

In this article, I’ll talk about the reasons I have acknowledged non-celiac wheat sensitivity as a real condition for many years, and I’ll describe the results of a new research study performed at Columbia University that adds supportive evidence. Before we jump in, though, let’s review the difference between celiac disease and non-celiac wheat/gluten sensitivity.

Celiac disease vs. non-celiac wheat sensitivity

Celiac disease and non-celiac wheat sensitivity are two distinct conditions, with a few major differences.

Celiac disease (CD) is an autoimmune disease characterized by an inflammatory immune response to wheat gluten, rye, barley, and related proteins. It results in marked disruption of normal gut tissue structure, including atrophy of epithelial cell projections called villi and an enlargement of intestinal crypts where new epithelial cells form from stem cells. CD is strongly associated with the haplotypes DQ2 and DQ8 of the HLA gene (1). In terms of blood markers, transglutaminase 2 (TG2) autoantibody is considered the most sensitive marker for celiac disease (2).

Non-celiac wheat sensitivity (NCWS, and also called non-celiac gluten sensitivity) is a term applied to individuals who experience symptoms in response to wheat or gluten ingestion but lack the characteristic markers of celiac disease. Symptoms can range from GI discomfort to fatigue and other neurological issues. These people tend to improve on a gluten-free diet (3). Unfortunately, many are mocked or ridiculed for avoiding wheat and told that their sensitivity is “all in their head.”

New research says there is such a thing as gluten sensitivity.

Wheat sensitivity: Is it all in your head?

In response to continued suggestion by the media and some of the medical community that wheat sensitivity is merely psychological, I have written extensively on my blog in support of NCWS as a real condition. For one thing, a variety of different proteins in wheat can elicit an immune response beyond gluten. NCWS might even be more serious than celiac disease, as many people who test negative for celiac disease continue to eat wheat and put themselves at serious risk for developing autoimmunity.

Gluten free is not a fad, and self-reported NCWS has been associated with a wide variety of disorders in epidemiological studies. Those who claim that gluten sensitivity isn’t real often cite this study, attributing any negative reactions to gluten to FODMAPS. However, as I addressed in a previous article, the researchers chose whey protein for their control group, a pretty poor choice considering that many of their subjects likely had inflamed guts and multiple food sensitivities. The evidence, both on paper and from my own clinical experience, clearly points to the existence of NCWS.

The latest research study

Still not convinced? In a recent study, researchers at Columbia University Medical Center sought to obtain objective evidence to determine if NCWS is real (4). They enrolled 80 individuals with self-reported non-celiac wheat sensitivity (NCWS), 40 individuals with celiac disease, and 40 healthy subjects for the study. NCWS patients were excluded if they showed any of the characteristic diagnostic markers of celiac disease (celiac-specific IgA, anti-TG2 autoantibody, or celiac-like histology).

The researchers took blood samples and intestinal biopsies from all 160 patients. The blood samples were used to look for particular signaling molecules and proteins in the blood, while the biopsies were used for histological analysis of the tissue microstructure. In addition to comparing these measures between conditions, they also took a subset of 20 NCWS patients who had adhered to a gluten-free diet for six months and compared their blood and biopsy samples before and after gluten avoidance.

Gluten-sensitive individuals have leaky gut

So what did they find? Non-celiac wheat sensitive individuals have … drumroll … leaky gut! NCWS subjects showed increased intestinal permeability compared to healthy subjects. This is not really all that surprising, since we know that gliadin, a component of gluten, can affect tight junction proteins (5).

In addition, subjects in the NCWS group had systemic immune activation. Serum levels of both lipopolysaccharide-binding protein (LBP) and sCD14 were significantly elevated in individuals with NCWS in comparison with individuals with celiac disease and healthy controls. These are sensitive markers of microbial translocation. In other words, they indicate that bacteria and other microbes from the gut interior are “leaking” into the bloodstream, inducing a low-grade, chronic inflammatory response from the immune system (6).

Histological analysis of biopsy tissues showed that the NCWS group also had epithelial cell damage similar to the celiac disease group, a result supported by elevated levels of serum marker FABP2 (7). Moreover, in the subset of NCWS individuals analyzed before and after adherence to a gluten-free diet, they found that inflammation and cell damage markers improved significantly after six months of gluten avoidance.

Gluten sensitivity exists—here’s how to know if you might have it

Evidently, there are certain individuals who possess non-celiac wheat sensitivity and would benefit greatly from avoiding wheat. It’s unfortunate that so many people who might benefit from a gluten-free diet never try it or don’t stick with it because of the lack of support from media, the medical community, and the general populace. I hope that this new research study (and others that will surely follow) will make it just a bit easier for people to make the right choice for their health.

So how can you know if you have NCWS? The biological markers used in this particular study may be used in the future to help diagnose NCWS, but at the moment, they are purely used for research purposes. Nevertheless, there are two ways to determine your gluten tolerance:

• A Cyrex panel: Cyrex Array 3 is a panel that tests your potential for wheat and gluten protein reactivity and autoimmunity. It must be ordered by a healthcare practitioner.

• A self-experiment: Eliminate gluten from your diet for 60 days and then perform a gluten challenge, taking careful note of any symptoms. I still hold that this is the best way to determine your tolerance for gluten.

Now I’d like to hear from you. Did this article change your perception of gluten sensitivity? Do you or someone you know have non-celiac wheat sensitivity? Have you ever tried a gluten challenge? Share your opinion in the comments!

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Jess & Mikaylah’s Simple and Sweet Austin Cottage

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Porches. They make houses look official, they give the mailman a place to drop off your latest Amazon/ASOS splurge, and they have a long history in American architecture. For centuries, porches have served as places for people to congregate, share stories, gossip, and convene.

This is especially true where I’m from — Down South — where the power of the porch is comparable to the power of the stiff drink. It’s no wonder that the porch features prominently in Queen Bey’s visual album, Lemonade. The porch is where she “finds her chill … giving middle fingers to her tormentors, and belting out freedom hymns before the mothers of black boys slain by police,” writes reporter Brentin Mock in CityLab.

But you don’t need to take it to those extremes — and you don’t even need to have a real porch. Below are five ways to porch, minus the actual porch.

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(Image credit: Susanna Hopler)

The main goal of summer cooking is simple: Buy all the fresh vegetables you can and try to not turn on the oven. At all. If you must, boil some pasta or sauté the vegetables on the stovetop, but that hot box should remain off as much as possible. How to cope? There are outdoor grills if you have a yard, but I advise to focus the bulk of your efforts on the fine art of assembling, which is basically cooking without the heat.

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Smoked Turkey Sandwich for a Crowd

(Image credit: Christine Han)

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Don’t mistake sandwiches as a lunchtime-only food. Yes, PB&J might not be the most exciting dinner, but there are plenty of complex (but not complicated) sandwiches out there that will satisfy you for your evening meal.

Here are a dozen of our favorite dinner-worthy sandwiches.

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For a nation of supposedly obese, lazy, and sedentary layabouts, American consumers sure are interested in tracking their daily activity levels. In 2015, they bought 13.4 million dedicated activity trackers, up 50% from the previous year, and spent almost $1.5 billion on the devices. That’s in addition to the hundreds of millions of smartphones in circulation that also track your daily steps, sleep quality and duration, and calorie expenditure. From FitBit to Jawbone to Apple Watch to dozens of others, the wearable fitness-tracking gadget industry is growing quickly. Venture capital has responded, pouring billions into the wearable industry.

Are they worth it?

It depends. According to some data, about a third of users stop using their devices within six months of getting them. Then again, “most people” don’t know the difference between polyunsaturated and saturated fat. “Most people” don’t care enough to watch their carb intake, or pay a little extra for grass-fed beef, or eat a Big Ass Salad every day. These statistics collate yet ignore individual data points. If you decided to pick up a FitBit or a Jawbone or an Apple Watch, the only data point that matters is yours. Most people might stop using their wearable after a couple months. You might keep wearing it.

Are they accurate?

According to research from December of last year, they aren’t very accurate at tracking data beyond step count. Researchers analyzed 22 studies exploring the ability of FitBit and Jawbone (the two most popular trackers) to accurately track, sleep, steps, calories burned, distance, and physical activity. They were both good at counting steps, but missed the boat on almost everything else.

They overestimated sleep duration. Overall, accelerometer-based sleep-tracking wearables compared poorly to established medical devices for tracking sleep, like polysomnography (used in sleep studies) and actigraphs.

They underestimated distance traveled at high speeds and overestimated distance traveled at low speeds.

One study found that the FitBit accelerometer was fairly accurate when assessing physical activity; others found that both the Fitbit’s and the Jawbone’s were not.

Both tracker brands underestimated and overestimated calories burnt, depending on the study.

A 2016 study looked at four different brands—FitBit Charge HR, Apple Watch, Mio Alpha, and Samsung Gear S—of wrist trackers and found that while heart rate tracking was accurate, energy expenditure tracking was not.

Another 2016 study found that while most trackers are accurate with step tracking over flat ground, step tracking on stairs is less accurate, and distance tracking on stairs is overestimated by at least 45%.

That said, these aren’t huge hits against wearables. Raw step count and resting HR are the most important features of today’s fitness trackers, as they allow you to track:

Daily activity. Are you moving frequently at a slow pace? Are you hitting the 10k step mark? Walking is the foundation of good physical, mental, and psychological health. It’s fundamental to our species—we’re walkers.

Heart rate zone. If you’re at all interested in becoming a fat-burning beast, spending a lot of time in the aerobic heart rate zone (180 minus age) will get you there, and a HR monitor can help you figure out what it looks and feels like.

The million dollar question: do they encourage more activity?

Surprisingly, few researchers have even explored this fundamental question: whether fitness trackers increase activity. What exists isn’t very encouraging.

A 2015 study gave overweight middle aged women either a standard pedometer (counts steps and distance) or a wearable fitness tracker. Both groups were coached to take 10,000 steps a day and engage in moderate aerobic activity for 150 minutes a week. After four weeks, the pedometer group saw no improvement. The fitness tracker group was little better, only increasing weekly activity by 38 minutes. No one reached 10,000 steps a day.

Anecdotes of how wearing a tracker changed this person’s fitness and helped them lose a dozen pounds and lose that baby weight abound, and I’m hesitant to discount them. If tracking your activity really does encourage you, then it works. For you. And since this thing we call society consists of millions of subjective realities traipsing about, each crafting a separate narrative, “for you” is the only relevant qualifier.

Okay, all that aside, most of the downsides I’ve discussed derive from limitations of the technology. Wearables are still young. Future tech will improve, and I’m confident that within 5-10 years we’ll have consumer-level devices that accurately track sleep, calorie expenditure, metabolic rate, fat-vs-sugar-burning ratio, and dozens of other biomarkers. It’s only a matter of time.

But there’s another potential downside, one that has little to do with the accuracy of the technology or the technology itself. It’s how we silly humans exalt numbers over feelings, objectivity over subjectivity.

This has its advantages. When we can track it, people who otherwise might not put in the effort suddenly care about getting enough steps each day. Put something down on paper/in an app and it becomes real. You care more about what you can quantify. You pay closer attention to your steps per day, and aim for more each day, when you’re getting real time feedback, your friends are getting notifications when you hit your goals, your wrist is buzzing with excitement over your 10,000th step. When you’re wearing a fitness tracker, getting 10,000 steps doesn’t just make you healthier, it makes you happier. And health-seeking behaviors only become second-nature when we can derive intrinsic value—happiness, in this case—from their pursuit.

This all sounds great, Sisson. What’s the downside? Once you start quantifying your physical activity, activity you don’t track loses value.

If you forget your wearable, you lose your steps. If your exercise session won’t show up on your daily wrap-up, if, God forbid, your FitBit friends won’t see all the walking you did today, you may be less likely to do it. Especially if you’re only walking to pad your stats.

It’s like the tree falling in the forest. Did you really take that walk to the grocery store if your FitBit wasn’t there to record the steps? Did you actually reach the fat-burning aerobic zone in your long easy run if you forgot to wear the heart rate monitor?

Are you walking so much because you like the small hit of dopamine that floods your brain every time you get another thousand, or do you actually enjoy ambling around? Is your motivation truly intrinsic?

Before the trackers, steps taken were lost to the past. You’d step, and shift your weight, and it was over. Gone. You might recall where you walked and what you saw and whom you were with, but you didn’t have any real notion of how many steps you’d taken. The thought to count them never even entered your mind. You could, but it’d be laborious and frankly ridiculous to count your steps in your head.

You know. You know now. But your FitBit friends don’t. And before long—a week or two, maybe—you’ll have forgotten all about it. If that scares you, there may be a problem.

Maybe I’m old school. Maybe I don’t get it. Maybe I’m a Luddite (who just so happens to run a successful online business). But I’m far more interested in fine-tuning my intuition than relying on technology to tell me how healthy I’m being. I’m not saying you shouldn’t use them.

If you want to use one, just do it right:

Wear it on the same spot. You can wear it on your lapel, your hip, your wrist, or your ankle as long as you wear it there every time. The more consistent you are, the more accurate the device will be.

Be accurate when entering your personal data. To give you accurate data, the tracker needs to know your real height and weight. If your weight changes, update it.

Calibrate your step length. Some wearables allow you to calibrate your true step length when you start using the device. Doing so will improve the accuracy of distance tracking.

Stop moving when taking your heart rate. Most consumer wrist-wearables are unable to accurately track heart rate when you’re in motion. To get an accurate reading, stop exercising and rest for 5-10 seconds before checking your HR.

Focus on trends, not absolute numbers. If what the device says about last night’s sleep corresponds to how you feel about last night’s sleep, it has value. If it conflicts—if you feel great despite getting poor marks on your tracker—it’s probably inaccurate. But that makes you wonder: if you’re only using the tracker to confirm your subjective impressions, how valuable is the tracker? Just use your intuition.

Remind yourself every morning that you are a privileged rich person who’s probably already rail-thin. The added weight of your guilt will increase your heart rate and calories burned.

Most importantly, use your fitness tracker to enhance and inform your intuition, not replace it.

This wasn’t intended to be a review of all the available fitness trackers. It was a quick review of the evidence for and against along with my personal take on the technology.

I’d love to hear about your experiences with wearables down below. What worked? What didn’t? What did you gain from wearing a fitness tracker? What have you lost?

Thanks for reading, everyone.

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Pick up a giant watermelon at the grocery store and what’s inside is a bit of a mystery. Knowing the answer to that can be incredibly useful when you’re making a recipe that calls for a certain amount of the fruit. So, exactly how many cups of fruit are in there?

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Pinterest is chock-full of monochromatic white kitchens. They’re sleek, modern, and speak to the pervasive power of Marie Kondo. But at Kitchn, we like a bit of color with our cuisine! You don’t have to paint the town (or your kitchen) bright red, but a touch of moderation never hurt anyone, did it?

Bold, bright hues can be a very good thing, and here are 10 places you might not have thought of splashing them out in the kitchen.

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(Image credit: Jeff Roffman)

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Summer is prime canning season, and while the idea of having a fully stocked pantry full of canned goods to last the winter is quaintly attractive, few of us home cooks have that kind of time. Quick pickling is an easy alternative to canning because it only requires a small amount of produce, some vinegar, and a jar or two.

From cherry tomatoes to dilly beans, here are 15 quick refrigerator pickles to get you through summer and into fall.

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I don’t know about you, but the summer heat is starting to get to me. I’m a wimp, that’s for sure, but still — I’d rather sweat at the gym or on a hike than in my kitchen while making dinner.

I’ll confess to leaning on snacky dinners and take-out when the temperature rises, but my favorite budget-friendly strategy is to have some freezer meals at the ready.

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