It seems that no good deed goes unpunished. Here’s a little personal anecdote of what happened to me recently. Plus some nerdy data to back it up.
In November my mom was in Thailand for her annual visit to her wayward son. During her visit we rented a condo from one of Thailand’s many seaside resort towns. Us being on holiday and with limited cooking options we ended up eating more foods that don’t need cooking or preparation. Typical breakfast consisted of whole wheat buns, muesli, yogurt and fruits. I ate more buns as snacks. I averaged 3 buns and a bowl or two of muesli per day.
By normal Western standards this is still healthy food. We didn’t eat sugary or junk foods.
Normally, I eat some wheat every now and then. The occasional pizza or a bakery product, but nothing like what I ate during The Binge. In fact, during these 10 days I ate more wheat than I would eat in 3 to 4 months. Eating some wheat every now and then doesn’t cause any problems; no gut upset or breakouts. Knowing that I have some sensitivity to wheat I expected my gut and skin to act up a bit during The Binge. Anyway, I have never thought that wheat would be a big issue for me, given how the occasional indulges don’t cause any problems.
Now, 6 weeks later, I’m beginning to think otherwise.
Since my mom went back to Finland I reverted back to my normal diet; very little wheat, moderated carbohydrate consumption, focus on fat and protein, plenty of fruits and vegetables. To my surprise my gut hasn’t recovered. I mean I’ve had ups and downs but by and large I still get much more digestive problems than before The Binge. Not to mention I get persistent mild acne; whereas pre-binge I got occasional mild acne (a few pimples every week or two, depending on how well I followed my own advice).
It seems likely that my wheat binge caused more than transient damage to the gut, which then shows up on my skin. Turns out, there’s fairly good evidence to support this.
So now that my personal anecdote is over let me geek out and show you what I mean.
As a side note I want to say that there’s a reason I don’t share a lot of personal anecdotes and “here’s what happened to me” type of stuff. Acne is a complicated disease and there’s a good chance that what’s relevant to me is not relevant to you.
More importantly, as humans we are very bad observers and relying on personal observations in conditions with many moving parts can be misleading. This happened to me some time back when I proclaimed that SLS in shampoos caused my scalp acne – only to later discover that it had nothing to do with SLS.. I fell for confirmation bias. The tendency of humans to seek out and pay more attention to information that confirms our existing beliefs and ignore anything that challenges them. In other words, we only see what we want to see and remain blissfully ignorant of inconvenient facts.
But back to the business at hand.
Zonulin the molecular link between gluten, inflammation and acne
I’ve written many times about the link between gut and skin problems. I have always thought that gluten likely causes gut problems for some people, but it seems that gluten may have a larger part to play than I assumed.
The gut is a long tube that runs from the stomach to the anus. But calling it a tube doesn’t do justice to the complicated tasks it handles. The gut has to allow water and nutrients to pass through while keeping bacteria and harmful substances out of the body.
One way it does this is by opening and closing tiny gaps between cells in the intestinal wall. These gaps are called tight junctions in medical speak.
In 2000 Dr. Alessio Fasano published a paper describing zonulin, a protein that controls the tight junctions between intestinal cells.
Here’s how Dr. Fasano explains it:
With celiac disease, we could never understand how a big protein like gluten was getting through to the immune system. Now we have the answer,” explains Dr. Fasano. “People with celiac have an increased level of zonulin, which opens the junctions between the cells. In essence, the gateways are stuck open, allowing gluten and other allergens to pass. Once these allergens get into the immune system, they are attacked by the antibodies,” adds Dr. Fasano.
“I believe that zonulin plays a critical role in the modulation of our immune system. For some reason, the zonulin levels go out of whack, and that leads to autoimmune disease,” explains Fasano.
Later work by his research group showed that exposure to intestinal bacterial and gliadin (a component of gluten) are among the most important triggers:
Among the several potential intestinal luminal stimuli that can trigger zonulin release, we identified small intestinal exposure to bacteria or gluten as the two more powerful triggers.
Fasano, A. Zonulin, regulation of tight junctions, and autoimmune diseases. Ann. N. Y. Acad. Sci. 1258, 25–33 (2012).
The intestinal wall is covered with mucus that physically keeps bacteria, both good and bad, away from the intestinal wall cells. If the mucus barrier breaks and the bacteria come in contact with the intestinal wall, the tight junctions open and allow water to enter the intestines. This is thought to be a defense mechanism that flushes out the bacteria. One would also assume that this is one factor that causes diarrhea and loose stools.
Similarly, exposing intestinal cells to gliadin triggers zonulin release and opens the tight junctions. This leads to increased intestinal permeability (or leaky gut syndrome in normal English).
According to other research, this gluten-triggered increase in intestinal permeability does not happen to everyone who consumes gluten. It only occurs in genetically susceptible people.
From leaky gut to acne, depression, and other health problems
In my gut-skin axis post I went over research that showed people with acne (and other skin problems) have higher rates of intestinal permeability and gut problems than people with clear skin. Scientists are still trying to figure out how this leads to acne, but the most likely explanation is leakage of bacterial toxins, live bacteria, and other inflammatory substances. This would increase systemic inflammation and deplete skin-protecting antioxidants. Earlier research showed that the immune system of acne patients reacted more strongly to toxins from gut bacteria (indicating previous exposure).
Disturbances in the gut bacteria, combined with leaky gut, have also been linked to diabetes and are known to trigger blood sugar problems. Insulin, of course, is one of the cornerstones of hormonal acne and reduction in blood sugar and insulin levels often helps people with hormonal-type acne.
Many acne patients suffer from varying degrees of depression. Part of it may be due to acne itself, but there’s also reason to believe that depression and acne are joined at the gut. The so-called inflammatory theory of depression states that inflammatory substances can trigger and worsen depression.
The aim of this article is to present a new hypothesis connecting the inflammatory theory of depression with IgG food hypersensitivity and leaky gut syndrome. This new potential pathway that may mediate the pathogenesis of depression implies the existence of subsequent developmental stages. Overproduction of zonulin triggered, for example, by gliadin through activation of the epidermal growth factor receptor and protease-activated receptor causes loosening of the tight junction barrier and an increase in permeability of the gut wall (“leaky gut”). This results in a process allowing larger molecules that would normally stay in the gut to cross into the bloodstream and in the induction of IgG-dependent food sensitivity. This condition causes an increased immune response and consequently induces the release of proinflammatory cytokines, which in turn may lead to the development of depressive symptoms.
Karakuła-Juchnowicz, H. et al. The role of IgG hypersensitivity in the pathogenesis and therapy of depressive disorders. Nutr Neurosci (2014). doi:10.1179/1476830514Y.0000000158
In line with this, a recently published study showed that women taking prebiotic supplements showed healthier emotional response as compared to women taking placebo supplements. The anti-depressant effect was similar to existing anti-depressant drugs (source).
Finally, it seems that leaky gut and mild gut inflammation sets the stage for more serious gut inflammation. People with intestinal permeability often develop more serious gut problems several years later.
Conclusion and take away
Gluten sensitivity remains a controversial issue. Earlier I posted about studies that showed people who claim to be gluten sensitive react just as badly to placebo than to gluten. These studies suggest that what people believe to be gluten sensitivity is in fact a FODMAP sensitivity. And the problems I experienced after my wheat binge could have been caused by FODMAPs in wheat rather than gluten.
The discovery that gluten triggers zonulin release and contributes to development of leaky gut shows it can cause problems for some people.
The larger point is that gut problems (leaky gut, bacterial imbalances) underlie many different diseases, from skin problems and depression to autoimmune diseases and food allergies. They could be ‘the root cause’ behind many chronic health problems.
Scientifically speaking, none of this is proven. This is still a theory, or hypothesis. But it will take years, probably a decade, for scientists to build enough evidence to prove this. And I don’t know about you, but I’m not planning to wait that long. We have enough evidence to suspect that leaky gut and gut problems are behind many chronic health problems. And, I believe, this is a possibility anyone struggling with chronic, adult acne should take seriously. Even more so considering that treatment options are both affordable and cause little to no side effects.
Wonderful, Seppo, as usual! And thank you for always qualifying anecdotes like this, reminding us that these issues are complex and that we should be aware of confirmation bias.
Glad to hear you liked it 🙂
Hello Seppo i really like your work i am just coming from a vegan diet to “detox” and to make my pH more alkaline.. 😀
but it doesn’t really help much..
so i have a few questions:
what do you think about the acne no more system of mike walden.. its all about detox and you have to buy enormous amount of supplemnt, …
so do you think it works? and if yes is it because of detox or other reasons, like dont eat triggers..
Another question.. i was eating highcarb lowfat 801010 for a while.. whats your opinion for that? why do you think so many people heal things like diabetes with it? :))
its just really confusing everybody is telling another ratio with is good for health.. one does praise sugar to be the cause of all and you have to go lowcarbpaleo other say fat is the bad guy and you have to eat a highcarblowfatplantbaseddiet..
last question.. what do you think of dr.bronners soap for the face?
I’m not a big fan of Mike Walden’s book. Not because he’s a competitor but because he promotes the same natural health myths and misconceptions I try to warn people of. Some of the things Mike recommends do make sense and can help your skin, but not because they ‘detox’ your body. They help because they affect the well-known risk factors, or causes, behind acne (hormones, inflammation, etc.).
See my About Me page about 80/10/10. I did that for a few years and almost gave myself a diabetes while at it. It was a total disaster for me. Why some people cure their diabetes with it? For most it probably comes down to losing weight. Being overweight is one of the worst things for blood sugar levels. Also, eating plenty of fruits and vegetables also helps. As does cutting out junk foods.
There are no magical macronutrient ratios. Some people do better with more fat others do better with carbs. From the research I’ve seen, it does seem like moderate carbohydrate restriction (something like 30 to 40% of total calories) gives the best results. Generally speaking. I’m sure there are people who do better with more carbs.
My suggestion would be not to worry too much about macro ratios. Eat in a way that makes you happy and suits your life.
I don’t know anything about Dr. Bronner’s soaps. A quick look at some of their ingredient labels doesn’t show anything too alarming. Generally speaking it doesn’t really matter what you wash your face with, as long as it doesn’t irritate your skin.
i cannot reply to your comment but thank you for your opinion…
nowadays the vegan lowfat diet is such a trend.. and i know people on youtube who drink smoothie with 10banans + dates and they say it s ok if your fat intake is low.. they also measure there bloodsugar levels and there are not much rises..
yeah i am also no big fan of the mike walden book.. if you follow the plan you will reduce inflammation in the body.. thats for sure.. but the supplements i think are a big reason why these plan work..
so my last question and thank you so much for your answers..
whats your opinion generally on juice cleanses? why do they work so good ?
I’m sure some people do well with 80/10/10 style diet, but there’s no evidence to show that eating fat would cause insulin resistance. It doesn’t clog the blood or anything like that. This is actually what opened my eyes when I was doing 80/10/10rv. I went looking for the evidence they keep talking about. I actually wanted to show it on my books and blog that this is what the science says. Alas, I couldn’t find any.
My take is that people with healthy glucose metabolism can get a way with such high carb diet, but I would never recommend it for anyone with insulin resistance or diabetes.
I know it may look like the diet works for many people, but you have to remember that there’s a lot of self-selection going on in that group. The people for whom it didn’t work, like me, move on. So the only people promoting the diet is are the ones who got food results with it. You get kind of an echo chamber effect. To be fair, it’s the same thing with other diets.
Juice cleanses? I don’t know why anyone would bother. The sad truth is that anything to do with detoxing or cleansing is utter nonsense. You don’t need to do any of that. Your body can detox just fine without any cleanses or support. If you indeed have some toxicity issues, and I believe most people don’t, then the best thing you can do is to eliminate the source and let your body detox. That’s all you can do. Anything else is just going to be a wasted effort and perhaps even detrimental.
Did you ever recover? I had a similar story with some wheat & sweets and now I’m having some unpleasant moments in the bathroom. And I’m breaking out.. while on tane. Not that it’s unheard of, but during my peak moment in the first month with perfect digestion, and now where my digestion is suffering. My acne is kinda vengeful but not as bad since I have accutane on my side. 😛
I’m trying to fix it though
I did recover. Sort of. I’m actually going through my own gut healing protocol now and that seems to have calmed things down.
I’m taking a soluble fiber called Arabic gum right now, which should function as a powerful prebiotic too. Great for IBS-management too. Let’s see what it can do.
I’d like to learn more about Arabic gum for IBS. You have any links or further information? I’ve been taking beef gelatin. It also helps the gut lining to heal and prevents toxins from ‘leaking’ out of the gut.
Well, I came across this product called Acacia Senegal (Which is just another word for Arabic gum),
https://www.amazon.com/Heathers-Tummy-Organic-Acacia-Senegal/dp/B0002ON8DU
Chris kresser recommended it in his Prebiotic articles. I did do some research on it and found some studies that it does promote significant positive changes in the gut after 4 weeks.
Regarding the IBS, it is a soluable fiber so it should help, Heather, the one who made the product, she doesn’t seem like some holistic ”doctor” but it does seem like she has done her research. You can find sections like Yoga and Hypnosis on her website against IBS, but it’s just to perceive the health problems in a different way.
I know it’s only Anecdotal, but it seems like lots of people have had a positive result from it, I’d say it’s worth looking into it.
Thanks. I was able to find 1 study that touched on acacia fiber. In the study they added some acacia fiber and probiotics to yogurt. The people taking the ‘enhanced’ yogurt got better results than people taking yogurt alone.
Here’s a link to the study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435782/
Did you find something else?
Regarding hypnosis. I looked and there’s some evidence to suggest it’s helpful in IBS. It’s not surprising since the brain and nervous system seem to affect IBS.
No that’s all what I have. I found the same study too.
Maybe you should contact them and see if they can offer some more enlightenment.
Either way, I’ve been questioning how much a probiotic supplement can help my gut. So I think I’m going to stick with prebiotics for now.
That’s very useful!
However, it’s interesting that you can tolerate small amounts of wheat. With me, I can’t. If the meat I eat was marinated with soy sauce, I break out (a little but it doesn’t go away for 2 weeks unlike other acne). So now I’m strictly gluten free. BTW, before my blood tests always used to come out as a little low hemoglobin and the doctors said it was just a light anemia and didn’t worry too much. I recently had a blood test and expected the same thing but this time it was normal! After being gluten free for 2 years. I have always had a lot of meat so this can’t be the reason. I read that anemia is one of the most common symptoms of celiac disease. Unfortunately, I can’t make the test now because I don’t want to ruin my skin. But I think a certain percentage of acne sufferers might be celiac. I think it’s important to get tested because unlike FODMAP sensitivity you can’t cheat on your diet if you’re celiac.
Thanks for sharing your experience, Tree. I’m not exactly sure what my issue is. It could be FODMAPs or it could be that I have some form of non-celiac gluten sensitivity. In any case, it makes sense for me to limit wheat and some other grain foods.
I was traveling the last 6 days and again ended up eating more wheat than normally, though not as much as during The Binge. I got my gut calmed down before the trip but now it seems acting up a bit again.
Hey seppo whats the best way to test that that your glucose metabolism is fine?
The best way would be to ask your doctor to do an oral glucose tolerance test and ask him to also check your insulin levels.
You can get reasonable results at home using blood glucose monitor. The problem is that these measure glucose, not insulin. The blood glucose level is a balance between glucose and insulin. Example, Jim and Jill both have 110 mg/d blood glucose 1 hour after a meal but Jim’s body has to release 3 times more insulin to keep blood glucose at that level than Jill’s. While both have similar blood glucose levels, obviously Jill’s glucose metabolism is in a better shape.
You can’t get this info directly out of a blood glucose monitor, but you can get hints of it.
Check this page for what normal glucose levels look like: https://www.phlaunt.com/diabetes/16422495.php
Here’s what I recommend doing if you use at home glucose monitor.
1. Check your glucose levels frequently after a meal, like 15, 30, 60 and 120 minutes following a meal. That gives you an idea how high your glucose spikes after a meal. If it spikes high (like 180 to 200) then you might have a problem with 1st phase insulin secretion, it’s usually the first thing to break on the way to diabetes. 2nd phase insulin may still bring your 60 and 120 minute glucose levels back to normal, and that’s why I recommend checking shortly after a meal.
2. Check your fasting glucose levels. Fasting glucose is not as sensitive indicator as as post-meal glucose, but if you regularly get reading above 90 mg/dl, then you probably have a problem.
3. Check many times. At home glucose monitors have a fairly high error margin. So don’t put too much faith on any single reading, and make sure you test 5 to 10 meals before jumping to any conclusions.
Hey Seppo have you heard of this Youtube “Star” called “Vegan Gains” (https://www.youtube.com/channel/UCr2eKhGzPhN5RPVk5dd5o3g)
the studys he list are really impressive to me(but i have to say i am not good at reading these studies cause my english is not the best(i am from germany) )
if yes would be great to hear your opinion…
I looked at some of his videos and they don’t seem that bad. That being said, I’m not a big fan of anyone who proclaims their special diet is the healthiest for all humans. Vegetarians and vegans generally do better at diet studies but that’s mainly because vegetarians and vegans tend to be more health conscious than other people. As far as my memory servers, there’s not much difference between healthy omnivore and vegetarian/vegan diets.
Humans are omnivores and we have evolved to get by with a wide range of foods. In the big picture diet isn’t even THAT important for health. I mean, once you eat a reasonably healthy diet then further improving that diet isn’t going to get you much healthier.
Finally, we always have to consider the individual. Most of the gut irritating foods for example are vegetarian foods. So someone with bad gut issues 100% vegetarian diet could be a disaster – or at least one would have to be very careful with what one eats.
What type of wheat were you eating? Ancient wheat such as Kamut has half the chromosomes than modern wheat. Did the wheat you were eating contain yeast? Yeasted wheat products could be more of a problem than non-yeasted breads.
More than likely I had problems because wheat contains FODMAPs – poorly absorbed sugars that feed bacterial overgrowth in the intestines. To answer your question, I ate ‘normal’ wheat you’ll find in breads and pastas.
Maybe it’s because you ate whole wheat too. Refined wheat is sometimes easier on the digestive system. I noticed stomach pain when eating whole grains but refined wheat not much.