A geriatric nurse practitioner disabled with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) living as well as I can with a chronic illness. Always a bit introverted, tendency to geek out about medicine, health, nutrition, gardening/permaculture. Hoping to make someone's path easier by sharing information on diet, medical research and what I've found works for me ~~ Ellie Strand, MSN, RN, APRN (Ret.)
The debate between following a low-fat, weight-loss diet and eating to lower carbohydrates and thereby lose weight appears to be settled after a large medical study. Some people, including many ketogenic and paleo dieters, believe cutting back on carbohydrates helps them lose weight. Others, including many physicians and medical centers, promote diets that cut back on saturated fats found in red meats and dairy products, as recommended by the US Department of Agriculture in its Food Pyramid.
In a 600-person, year-long study, the two eating styles helped dieters drop almost exactly the same number of pounds — and there didn’t seem to be much rhyme or reason as to who succeeded on which plan.
Going into the study, which was published today in the Journal of the American Medical Association, researchers wanted to settle the debate but they also wanted to know if blood insulin levels or genotype had an effect on weight loss.
High blood levels of insulin are a sign of insulin resistance, which often precedes Type 2 diabetes. Many believe high serum insulin promotes storing calories as fat. Researchers looked at the genetic profile of each participant and determined which ones had particular genetic traits thought to lead to weight gain. To the researchers’ surprise, neither genetic predisposition nor high insulin levels had any effect.
Results show you can lose weight with either eating plan
People studied were between 18 and 50 years old, and all overweight or obese but otherwise healthy. They attended nutrition classes taught by a health educator. There were no calorie restrictions. Everyone was directed to minimize their intake of sugars, refined flours, and trans fats. At the same time, they were encouraged to eat vegetables and nutrient-dense foods. Everyone was encouraged to adopt healthy habits like cooking at home and sitting down for structured meals with family members.
As you would expect, not everyone on the diets lost weight and some had dramatic losses. The outliers were one individual who gained 20 pounds and another who lost 60. However, the average weight loss in each group was almost identical: 11 pounds in the low-fat group, compared to 13 pounds in the low-carb group.
“It’s not so much about that food — it’s really about [changing] this crazy way that Americans eat.”
About 30% of people in the study had a genetic signature that, in theory, should have pointed to success on the low-fat diet, while 40% had a low-carb “profile”. But the data didn’t show any strong similarity between these genetic markers and weight loss on the corresponding diet. Neither did measures of insulin resistance, which the team also thought would be related to success.
The successful dieters, regardless of which group they were in, credited their achievement to a reframed relationship with food. They began eating more mindfully, cooking at home more often and focusing on whole foods instead of processed, packaged foodstuff.
According to the lead researcher, Christopher D. Gardner, Ph.D., “That was more powerful than differentiating between low-carb or low-fat. Just getting them to be a lot more mindful about what they were eating. It’s not so much about that food — it’s really about [changing] this crazy way that Americans eat.”
Are recommendations to avoid grains and legumes due to anti-nutrient content predicated in science or founded in fear mongering? An evidence-based analysis of the good, the bad, and the ugly when it comes to lectins, phytates and autoimmune disease recently appeared in GreenMedInfo. Due to the length of this evidence-based article, I broke it up. Another section, this one on diet for chronic illness, will be posted tomorrow.
Written by: Ali Le Vere, B.S., B.S. – Senior Researcher-GreenMedInfo
In the past decade, some paleo diet proponents have popularized the notion that anti-nutrients, or compounds in foods which undermine health, are responsible for the prevailing epidemics of chronic illness. In fact, one of the fundamental tenets of the paleo diet, that grains contribute to disease and degeneration, is due in part to arguments about their content of lectins, some of the most infamous anti-nutrients. This review will serve as a preliminary examination of the evidence and will shed light on whether fears about this and another commonly vilified anti-nutrient, phytic acid, are groundless or justified.
Lectins: A Self-Survival Mechanism
Lectins are ubiquitous carbohydrate-binding proteins, present in almost a third of our food supply, which constitutes an adaptive mechanism that plants evolved to confer protection against predation and pests. For instance, lectins act as effective biological agents against insect attack by destabilizing insect metabolism, interfering with enzyme activity, and disturbing the protective, digestive, and secretory functions of the gut (1). Due to their insecticide properties, “insect-resistant plants produced by expression of lectin genes in transgenic plants are already a reality,” which is cause for alarm due to the potential health hazards posed by artificially manipulating lectin content.
Lectins act as agglutinins, or sticky proteins, which cause particles to coagulate and form aggregate masses. While most concentrated in seeds, other vegetative tissues such as barks, bulbs, flowers, leaves, roots, and rhizomes also contain lectins . Two of the best-characterized families of plant-derived lectins are the leguminous lectins and cereal lectins, which is the impetus for their exclusion by paleo diet adherents due to their high levels of prolamins and agglutinins, two types of lectins which are purported to most adversely affect the barrier function of the gut. Solanaceae lectins, which occur in the nightshade vegetables potatoes and tomatoes, are also excluded on the more restrictive autoimmune paleo (AIP) protocol.
Digestive Impairments Due to Lectins
When consumed, lectins survive digestion and bind to carbohydrate moieties of cells lining the gastrointestinal tract, triggering deleterious local or systemic reactions in the animal that ingested the lectin-containing food (Source). By binding to cell surface sugars on the intestinal mucosa, lectins can interfere with stomach and intestinal architecture, and damage the luminal (inward-facing) membranes of the epithelial cell lining (Source). As a result, “Lectins may induce changes in some, or all, of the digestive, absorptive, protective or secretory functions of the whole digestive system and affect cellular proliferation and turnover” (Source).
For instance, lectin-induced changes to intestinal morphology can cause loss of brush border digestive enzymes, required for breaking down food, accelerate cell loss, and create irregularities in the microvilli, or the tiny hairlike projections from intestinal cells that increase absorptive surface area (Source). Cumulatively, these adverse changes impede carbohydrate and protein utilization and transport, which inhibits the growth of the organism (Source). As a compensatory countermeasure, trophic effects can occur, or an abnormal increase in the volume of the intestine due to cellular hyperplasia (Source).
The secretion of gastric acid, required for protein digestion, is also inhibited in some animal models due to lectins attaching to mucosal and parietal cells in the stomach, which generate hydrochloric acid. For example, lectins can result in incomplete proteolytic degradation of immune-stimulating dietary proteins, as evidenced by the ability of the lectin phytohaemagglutinin (PHA) from red kidney beans to decrease the hydrolysis of the dairy protein casein as well as bovine serum albumin.
Importantly, lectins from legumes and cereal grains, for example, can disrupt the integrity of the tight junctions which regulate trafficking of molecules across the gut barrier, causing intestinal hyperpermeability, the gateway to all autoimmune disorders. In other words, lectins can cause the spaces between cells lining our intestines to become excessively leaky and allow the entry of foreign immune-provocating agents. Violation of gut barrier integrity invites bacteria, dietary components, and toxins into systemic circulation.
Microbiome Alterations Due to Lectins
Due to its effects on epithelial cell metabolism, lectins have been demonstrated to result in dramatic overgrowths in coliform bacteria, and Escherichia coli (E. coli) in particular. Lectins also preferentially increase the growth of Lactobacillus lactis, which is associated with the development of rheumatoid arthritis along with E. coli. The lectin PHA from red kidney bean can provide increased levels of substrates upon which E. coli grow due to “PHA-mediated mucus secretion, epithelial cell loss, serum protein leakage and reduced digestion of dietary protein,” all of which serve as nutrient sources that promote bacterial replication (Source). In animal models, lectins also cause severe atrophy of the thymus, the organ where some immune cells mature, which could compromise the cell- and antibody-mediated immune responses that normally keep gut bacteria in check (Source).
This proliferation of bacteria may, in turn, promote overproduction of bacterial toxins such as lipopolysaccharide (LPS), the outer wall from gram-negative bacteria that are implicated in insulin resistance, metabolic syndrome, polycystic ovarian syndrome (PCOS), non-alcoholic fatty liver disease (NAFLD), diabetes, and cardiovascular disease. Also relevant is that the resultant dysbiosis, or bacterial imbalance, that can occur due to lectin ingestion is a causative factor in autoimmune and allergic disorders, metabolic disease, gastrointestinal conditions such as Crohn’s disease and ulcerative colitis, and neuropsychiatric illnesses. Altering the commensal flora of the digestive tract can modulate the immune system in an unfavorable direction since the majority of the immune system interfaces directly with the gut.
Immune Derangements Due to Lectins
After binding to cells of the small intestine known as enterocytes, lectins are internalized at high rates via a process called endocytosis, where a part of the cell membrane invaginates (buds inward) and engulfs material (Source). Once present in the peripheral tissues, lectins can deposit in distant tissues and organs, promoting their enlargement or atrophy, disrupting macronutrient metabolism, and altering hormonal balance (Source). Lectins that translocate across the gut wall can also be perceived by the resident sentinel cells in the gut-associated lymphoid tissue (GALT) called macrophages, which present lectins to other immune cells called lymphocytes and evoke an immune response (Source).
Moreover, lectins can penetrate systemic circulation via regional lymph nodes and bind to glycoproteins (sugar-proteins) on diverse tissues such as that of the pancreas, thyroid, liver, kidney, nasopharynx, pituitary, eye, heart, breast, adrenal glands, myelin sheath, intestines, blood vessels, lymphatic system, cartilage or collagen (Source). This creates a neo-antigen which is perceived as a foreign entity by the immune system, potentially eliciting an immune attack. When self-tissue is caught in the crossfire of the immune response, tissue-specific autoimmune diseases manifest (Source).
Lectins stimulate the immune system via mechanisms such as T-cell proliferation, which expands the pool of autoreactive white blood cells, up-regulation of cell signaling molecules called inflammatory cytokines, which perpetuate tissue damage and recruit more inflammatory immune cells, and production of Th17-cells, which drive tissue destruction in autoimmunity (2). Similarly, lectins are known to incite release of histamine from basophils, as well as interleukin-4 (IL-4) and IL-13, which are instrumental in transitioning to a Th2-centered immune response favoring allergy and other atopic diseases such as asthma (Source).
The immune response is amplified as undigested food particles, bacterial toxins, and pathogenic byproducts that translocate across the gut barrier secondary to lectin-induced gut permeability also incite antibody production, which can, in turn, cross-react with human tissue that possesses similar amino acid sequences (Source). In this way, an immune attack against invading bacterial and food antigens can lead to the development of autoimmune disease via a process called molecular mimicry. This occurs as a result of homology, or similarity, between lectin-bound tissue and motifs (amino acid sequences) on these ‘invading’ substances which are the target of immune response (Source).
Gluten and Wheat Germ Agglutinins: Particularly Harmful Lectins for Autoimmune Disease
While the jury is still out on some lectins, the lectin wheat germ agglutinin (WGA)may be particularly problematic for health for a multitude of reasons. Humans consuming wheat germ exhibit biologically intact wheat germ agglutinin (WGA) in both their ileostomy effluent and fecal collections, indicating the ability of lectins to persist within the gut lumen (Source).
WGA has an affinity for N-acetyl glucosamine, an essential signaling molecule and structural component of the extracellular matrix of animal cells (Source). WGA also binds to the sialic acid called N-glycolylneuraminic acid (Neu5Ac) found at the terminal position of the surface-exposed sugars that comprise the glycocalyx, a fuzz-like coating on the plasma membrane of epithelial cells in the gut that plays a role in cell recognition, adhesion, and communication. Diets high in wheat, which contain the potent lectin WGA, have been shown to cause changes in the mucosal architecture of the jejunum, the middle portion of the small intestine, even in normal subjects (Source). This lectin not only causes leaky gut syndrome, jeopardizing the barrier function of the gut, but it also enables cellular entry of WGA and provokes a pro-inflammatory immune response (Source).
Gluten, on the other hand, is a mixture of prolamin lectins present in wheat, rye, barley, and oats which are evolutionarily conserved proteins that share similar ancestral origins. Prolamins are proline-rich storage proteins in plants that function in germination and are resistant to protease-mediated digestion in the human gastrointestinal tract (Source). Not only are human digestive enzymes incompatible with prolamin degradation, but prolamins also contain protease inhibitors which impair our digestive capacity. Examples of prolamins are gliadins in wheat, hordeins in barley, secalins in rye, and avenins in oat.
However, because gluten-reactive immune cells that react to gliadin, hordein, and secalin do not react to epitopes in avenin, oats are classified as inherently “gluten-free” for celiac patients. Other studies, however, have shown that consumption of oats is pathogenic in one of ten celiac patients, and the potential for gluten cross-contamination of oats is high (Source).
Gluten is particularly detrimental in autoimmune disease since it triggers the release of the intestinal peptide zonulin, which regulates the tight junctions between cells in the gastrointestinal epithelium in a manner that is rapid, reversible, and reproducible (Source). Studies have demonstrated that intestinal exposure to gliadin [the protein sub-fraction of gluten] leads to zonulin upregulation and consequent disassembly of intercellular tight junctions and increased intestinal permeability” in all individuals, not just celiac patients with active disease and in remission, but in patients with non-celiac gluten sensitivity (NCGS) and in non-celiac healthy controls (Source).
Leaky Gut Syndrome
Induction of pathologic intestinal hyperpermeability, or leaky gut syndrome, via zonulin release, is prerequisite for the development of autoimmune diseases such as rheumatoid arthritis, Hashimoto’s thyroiditis, lupus, ulcerative colitis, Type one diabetes, Grave’s disease, vitiligo, Crohn’s disease, Addison’s disease, pernicious anemia, multiple sclerosis, and psoriasis. In fact, researchers state that “The autoimmune process can be arrested if the interplay between genes and environmental triggers is prevented by re-establishing intestinal barrier function” (Source).
Translocation of gluten-related peptides into the body secondary to so-called leaky gut syndrome are perceived by the gut-associated lymphoid tissue (GALT), the part of the immune system surrounding the gut. This induces innate and adaptive immune responses that can result in the production of pro-inflammatory signaling molecules which perpetuate the breach in the gut barrier and recruit more inflammatory immune cells. Eventually, these immune responses can cause “friendly fire” against our own body tissues, resulting in autoimmune disease, by processes such as the bystander effect or cross-reactivity between foreign antigens and our own tissues (Source).
Celiac disease results in increased infiltration of immune cells and villous atrophy, flattening the shag carpet of the intestines into Berber, and leading to nutrient malabsorption, chronic diarrhea, weight loss, and other adverse sequelae (Source). However, the empirical diagnosis of gluten sensitivity or NCGS is serious in its own right. NCGS can incite not only gastrointestinal symptoms but extra-intestinal manifestations such as ataxia, neuropathy, encephalopathy, autism, and mood disturbances including anxiety, depression, schizophrenia, and psychosis (Source).
This is a lot of highly detailed information for people with brain fog to take in at one reading! 🙂 Please let me know in the comments below if this is too technical and I will translate future articles like this.