Gluten, Keto and Gluten Intolerances

'A ketogenic diet is naturally very low in gluten, but if you do not have gluten intolerance or celiac disease, there is no need to avoid low-carb products that contain small amounts of gluten such as soy sauce (which is made from fermented wheat).' - Dr Stephen Phinney

06-May 2020, by Bronwyn MacRitchie

Gluten and Keto are Completely Unrelated

Let's clear up this VERY common misconception right off the bat. Gluten has nothing to do with keto.

Literally nothing. Nada. Not a thing.

However, there are two main reasons for this confusion.

1. Confusion Confusion Between Keto and Paleo

The paleo lifestyle DOES exclude gluten, all grains, dairy and legumes. Keto does not. People have started following other people who have become confused. And have themselves started putting out information without ever going back to the source or ensuring that they understand the meaning of the word keto or the science and purpose behind it.

And in the world of social media people may appear as authorities simply because they have amassed a following, but lack any training in the field. We ask you to think for yourselves and make sure your source is a trusted, trained institute or individual when making decisions.

2. Gluten Was Always Packaged in High Carb Foods

Another reason that this misconception was formed early on in the keto realm is that most products containing wheat, barley and rye are NATURALLY quite high in carbohydrates. Foods like traditional breads and pasta.

This made them almost impossible to include in a keto diet which requires carbohydrate intake to be extremely low, even for the most metabolically flexible among us. Which is why they ended up on many of the exclusion lists when authorities tried to simplify keto for the public. However with Vital Wheat Gluten this is no longer the case, gluten CAN be included in extremely low carb foods.

This basic understanding, along with the growth and popularity of the paleo diet joined forces to confuse the public. However, at ingfit, we totally believe that the public is entirely capable of recognizing flawed thinking and 'unlearning and rethinking' as is so often required in a world where science and information are growing at the rate that they do.

Sticking with dated ideas just because it's too hard to adjust our thinking is what's keeping us behind the curve of nutritional science the world over. We urge you not to fall victim to the inflexible thinking trap, the more of us that are able to think for ourselves and adjust accordingly, the healthier we will be.

What About 'Nutritional Ketosis'?

This term is being misused in the keto space in the UAE specifically. Nutritional ketosis (also often referred to as ENDOGENOUS ketosis) simply means that you have achieved ketosis through nutritional means (the reduction of carbohydrates) rather than exogenous means (taking ketone salts or ketone esters)(1,2).

Nutritional ketosis can be achieved simply by dropping your carb intake low enough. You could be eating only foods that FEED disease (fast food without the carbs etc) and still achieve nutritional ketosis. Meaning you have achieved ketosis through the manipulation of your nutrient intake, by greatly reducing the intake of carbs.

What About 'Clean Keto'?

This is another one that is being misused in the keto space in the UAE specifically. Clean keto means keto that focuses on a whole foods approach, excluding ingredients that are known to be harmful to human health.

It has NOTHING to do with the inclusion or elimination of gluten, legumes, dairy or any other foods which may or may not be inflammatory for certain individuals. In fact being lactose intolerant is far more common, with up to 83% (3) in some randomly selected study groups, and 65-70% (4,5) in the adult population of the world. As opposed to an estimated frequency of 25% in gluten intolerance.

That's 40% more. But somehow dairy is included in some random definitions of clean keto while gluten is excluded. The mind boggles.

In fact, the Virta Study (the largest and longest study on keto in humans to date) is showing that many markers of inflammation, such as the white blood cell count, as well as CRP in its participants are being reduced with the keto diet INDEPENDENT of gluten or wheat consumption (6). I would be fascinated to hear their opinions on the categorization and terminology being accepted online.

What we are left with is misinformation that has spread from opinionated person to opinionated person with nothing concrete to support it.

At ingfit we are a team of trained nutritional authorities, and backed by our Board of Directors, leading doctors, coaches and nutritionists among them.

We consistently update our information, and prefer to turn to truly authoritative sources when we do. For example those leading the medical field in the implementation of keto as a dietary intervention to heal diseases such as obesity or diabetes. Virta Health, lead by Drs Stephen Phinney and Sarah Hallberg, is one such source.

When directly asked the question this was Dr Phinney's response,

'A ketogenic diet is naturally very low in gluten, but if you do not have gluten intolerance or celiac disease, there is no need to avoid low-carb products that contain small amounts of gluten such as soy sauce (which is made from fermented wheat).' (7)

With a biography as solid as Phinney's, including numerous books (among them a New Atkins for a New You with Drs Westman and Volek), peer reviewed studies on keto, and currently heading up the biggest long term study on ketosis in humans to date (the Virta Study), we are pretty sure he knows what he is talking about.

Enter Vital Wheat Gluten - Misinformed Keto Police Run Riot!

More recently, Vital Wheat Gluten has entered the playing field. This is the protein from wheat with the starches removed, making it an incredibly low carbohydrate ingredient which is easy to include in low carb baked goods, as is noted in this blog post.

With only 8g of total carbs per 100g, using this protein as an ingredient in keto breads, pastas and baked goods brings back the elasticity lost in their gluten-free counter parts. Making the inclusion of this wheat derivative completely fine for inclusion in a keto diet FOR MOST PEOPLE.

The fact that gluten-free diets and keto are NOT the same thing is widely confirmed through a variety of sources including gluten-free living and celiac disease sites themselves(8,9), as well as the definition of a keto diet in contrast to gluten free diets in clinical studies (10).

Which brings us to another source of this confusion and misinformation. About a quarter of the human population ARE sensitive to gluten in varying degrees of intensity.

Gluten Sensitivity, Celiac Disease and IBS

Many people are sensitive to gluten, there are no clear figures on this but estimates on IBS (which is often exacerbated by gluten) sit around 25% of the world's population.

Some people are completely gluten intolerant, the world average sits at around 6-8%. And some have celiac disease, 1-2%, which is the most concerning condition, an autoimmune disease in which gluten deeply impacts the lining of the gut and colon, and accidentally consuming it can have serious consequences for sufferers.

How Do I Know if I'm One of Them?

Some people who are sensitive to gluten are completely unaware of this sensitivity. At ingfit we strongly encourage allowing your own body to give you feedback on certain foods, as more and more information is being published on how a 'one size fits all' food list is antiquated and outdated thinking. For more information on that we highly recommend this book.

As a simple test for yourself, coming off gluten is a great idea for a period of at least 21 days, but preferably a month. During your break from gluten, monitor any changes in your body and wellbeing during this time.

When you have been entirely gluten free for this entire time, reintroduce gluten (preferably in a healthy, lower carb clean food), quite regularly for 2/3 days, and then carefully gauge how you feel after eating it. Take note of any digestive issues, mood changes, skin irritations, energy levels or other discomfort.

This will give YOU the opportunity to know if it actually IS an issue for you or not.

One has to remember that the gluten issue is highly nuanced, and there are differences in gluten dependent on where its source is grown. Crops from the Americas are far more genetically modified and also often saturated with glyphosates which increases the chance of sensitivities.

Wheat and other gluten containing grains grown and produced in Europe are far less inflammatory and seem to be more readily included in healthy lifestyles in this region. All of the gluten contained in the ingfit range is sourced in Europe for this reason.

However, there are also people whose bodies simply are not impacted by gluten and can continue to include it in whichever whole foods lifestyle they choose, keto, low carb or just clean real foods. However, not paleo, as the thinking behind paleo, unlike keto, requires the exclusion of all grains.

What Does the Science Say?

So, while the science is still building on whether gluten is an inflammatory food for ALL people, it continues to build overwhelmingly on the individual sensitivity side. Some recent studies suggest that it is not problematic for the entire population (11,12,13), while some suggest that it may be (14).

In light of this conflicting information, and our commitment to stay on the cutting edge of nutritional science as it evolves, ingfit has chosen to range some foods that contain gluten, and many that do not.

It is imperative to understand that information, especially on nutrition and health is not static, but is growing in depth and precision daily. And because of this we cannot develop rigid rules and judgements around food, but should instead stay on top of the latest developments and adjust accordingly.

Your body KNOWS what it likes and what it doesn’t, and if you give it the chance to send you those signals by removing and then reintroducing this food, you will find the most accurate answer for YOU.

References

1. Gershuni, V. M., Yan, S. L., & Medici, V. (2018). Nutritional ketosis for weight management and reversal of metabolic syndrome. Current nutrition reports, 7(3), 97-106.

2. https://www.dietdoctor.com/low-carb/ketosis

3. Klemm, P., Dischereit, G., & Lange, U. (2019). Adult lactose intolerance, calcium intake, bone metabolism and bone density in German-Turkish immigrants. Journal of Bone and Mineral Metabolism, 1-7.

4. Bayless, T. M., Brown, E., & Paige, D. M. (2017). Lactase non-persistence and lactose intolerance. Current gastroenterology reports, 19(5), 23.

5. Malik, T. F., & Panuganti, K. K. (2019). Lactose Intolerance. In StatPearls [Internet]. StatPearls Publishing.

6.https://www.virtahealth.com/blog/inflammation-ketosis-diabetes

7. https://www.virtahealth.com/faq/can-i-eat-gluten-ketogenic-diet  

8.https://www.glutenfreeliving.com/blog/is-the-keto-diet-gluten-free/

9. https://www.celiac.com/articles.html/the-differences-between-a-gluten-free-and-keto-diet-r4770/

10. El-Rashidy, O., El-Baz, F., El-Gendy, Y., Khalaf, R., Reda, D., & Saad, K. (2017). Ketogenic diet versus gluten free casein free diet in autistic children: a case-control study. Metabolic brain disease, 32(6), 1935-1941.

11. Freire, R. H., Menta, P. L., & Alvarez-Leite, J. I. (2017). Is the Immunogenic Action of Gluten Enough to Aggravate Obesity in Non-coeliac Individuals?. Nutrition & Food Science International Journal, 2(5), 101-104.

12.     Barbaro, M. R., Cremon, C., Morselli-Labate, A. M., Di Sabatino, A., Giuffrida, P., Corazza, G. R., ... & Fuschi, D. (2020). Serum zonulin and its diagnostic performance in non-coeliac gluten sensitivity. Gut.

13.     Lis, D. M. (2019). Exit Gluten-Free and Enter Low FODMAPs: a novel dietary strategy to reduce gastrointestinal symptoms in athletes. Sports Medicine, 49(1), 87-97.

14.     Fasano, A. (2020). All disease begins in the (leaky) gut: Role of zonulin-mediated gut permeability in the pathogenesis of some chronic inflammatory diseases. F1000Research, 9.

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Bronwyn MacRitchie

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