Most people who are currently avoiding gluten because they think they can’t digest it actually just eat like shit and they rarely exercise—and that’s why their body hurts. They probably don’t drink enough water either (since poor diet, not enough exercise and not enough water is an epidemic trifecta in our society). But wheat is taking a lot of the blame.
That’s because people have received hundreds if not thousands of messages via mass media and private conversations that maybe wheat gluten is causing their discomfort. Celiac’s Disease is rare but real and, I suspect, there are people without Celiac’s who nevertheless have a lesser but still immutable biological problem with gluten. However, I suspect a third group of people avoiding wheat is even bigger than the other two combined.
It’s natural that a huge population of people having received a barrage of negative messaging about wheat would develop a nocebo response to it—opposite of placebo. That is, when they eat wheat gluten, they might experience real pain and discomfort precisely and maybe only because they were told wheat might hurt them. When they avoid wheat, they might feel relatively better mostly because some expert told them this would be so (placebo response). Placebo and nocebo responses are stronger than many drugs that are themselves efficacious. If you’re skeptical, I advise you go down the placebo rabbit hole and get obsessed with this awesomely interesting piece of humanity. Because a person’s pain comes from a “placebo response” is not the same thing as saying “it’s all in your head” since the pain is real.
I’m not the only one who thinks maybe many, many people are confused about their own body’s capabilities and allergies.
The medical establishment is onto it. There are medical tests for Celiac’s but not for this less “non-Celiac’s gluten sensitivity.” Idiots are making millions developing medical tests to help people determine if they are non-Celiac’s gluten sensitive. But who can afford professional American medicine anymore? Not this guy.
Thus, this isn’t medical advice. The results are not actually very scientific. But we’re going to steal some of the best, most important elements of scientific experimentation to try to detect—and maybe diffuse—a potential nocebo response illness around wheat gluten.
Here’s how I conceive of a decent at-home gluten sensitivity test that you could do with your partner, child or roommate—anyone you cook for. It’s only a single-blind non-randomized study, but you could modify my plan to make it double blind by bringing a third person into the mix as a laboratory assistant. We’re not going to randomize—even though that’s gold-quality science—because we’re focussing on just one person, not a sample of people representative of the population at large.
Plan six or seven meal items that you could cook or serve both in a wheat gluten version and without it. This could be as simple as a lettuce wraps with a flour tortilla versus a quinoa/rice tortilla. It’s important that the two be indistinguishable or almost to your test subject—which is pretty hard, this is actually the greatest weakness of this test and really finicky test subjects with highly sensitive palettes may always be able to detect gluten by the mouthfeel and flavor which undermines the whole point of the test, but try your best. The whole idea is to isolate a person’s digestive system to determine if it has trouble with gluten, so you want to neutralize the power of a person’s visual cues, palette, or preexisting knowledge that would otherwise help them determine if something is gluten free or not. If you tried to serve pasta (gluten) and then quinoa (gluten free), the person knows which one is gluten free—and when eating pasta their brain has been triggered to fire the very nocebo response we’re trying to study and maybe undermine. The idea is we’ll be serving our test subject dishes and they can’t know at the time they are eating and digesting whether those dishes actually contain wheat gluten or not. If you need to blind fold your test subject while they eat because visual cues could alert them to which dishes are gluten free, then literally blind fold them while they eat. Tell your test subject that each meal will be served twice, once as a gluten-free version and a second time as a glutenous version, but they won’t know in what order. This is kind of a fib because actually you’re not going to serve each meal in one version or the other, there will be a curve ball or two, but let them think that each dish will be served to them in each way. You can easily hide gluten in gravies and sauces even if it adds nothing to the flavor of the dish (just use flour versus corn meal or arrowroot to thicken your sauce:)
Cook one of your meals and serve it to your test subject without giving any hints as to whether it contains gluten or not—it doesn’t matter where you start, with a gluten or not. Once you’ve got six or seven items planned that you can prepare that are more or less indistinguishable from each other in both gluten and gluten-free options, plan a schedule. You probably only want to do your experimental meals once every two or three days (or more) because after each meal is served, you’ll want to observe and note the person’s digestive system for some time, especially during but not just the first 24 hours after eating (ask about gas, cramping, bowel movements, etc.). Mix it up. Don’t just alternate between a gluten-free version and then the wheat-version of the same dish; introduce as much uncertainty and confusion as possible to really reinforce the blindness. Serve two or three wheat or non-wheat dishes in a row. To help confuse your test subject about palette and visual cues that might tip them off to which one is gluten free, serve the two versions some time apart from each other. For an extra curve ball, note any dishes that were surprising. Did a gluten-containing dish cause no pain, or a gluten-free dish cause pain? Then serve that dish the same way a second time and see if the test subject’s response to it changes. If the test subject reports that one dish caused digestive pain and the other did not—despite being identical in ingredients—their problem probably isn’t gluten, doncha think? Your test may have a different food allergy that they have confused with gluten insensitivity, may have an allergy to something else, so keep the recipes between your glutenous dishes and gluten-free dishes as identical as possible to isolate gluten as the only variable between the two versions of the same dish. All the while, the person should be avoiding wheat gluten during non-expiremental meals.
Record your results. Take note of when you served which meal and then record the health impacts you’ve learned from your post-meal interviews with your test subject. For a double-blind test, have the test subject be interviewed by another person who does not themselves know if the meal contained gluten or no (this is actually really awesome to do if you have the committment from someone else). Ask your test subject to make their best guess based on how their digestion felt as to whether it was a gluten-containing meal or not—have the lab assistant, who is also blind as to whether the dish contained gluten or not, help them in making those guesses if you have that person. If my nocebo response theory is correct and applies to your test subject, we’ll find many people whose reports of pain and sickness do not actually correlate to gluten intake.
Interpret the results. If your person is actually gluten sensitive and has no other digestion problems, we would expect an orderly correlation between gluten and discomfort, gluten-free pain free.
Someone who correctly distinguished all the gluten meals from the non-gluten meals having only their digestive comfort to rely on probably has an immutable biological basis for that gluten-related pain and both you and they can rest assured that all the accommodations made for them and all the inconveniences related to a gluten-free diet are not in vain. It’s also a good suggestion that they don’t have other food-related allergies or problems, at least not ones that you served them.
But what if the test results are really messy—is your test subject faking their gluten sensitivity, is it all in their head? Messy data—meaning there was pain and discomfort experienced by the test subject during gluten-free meals and multiple occasions where glutenous meals caused no pain, might suggest this person has multiple digestion problems, which may or may not include gluten sensitivity (probably not, right?). If they have multiple occasions of eating gluten and not feeling pain—but most of the gluten meals did cause pain—they may have still a gluten problem, but more likely if they ate two or more glutenous meals that didn’t cause pain, that’s a pretty good sign that gluten isn’t the culprit for their problems, doncha think?
If there was a gluten-containing meal or two that gave the test subject no pain and a couple gluten-free meals did cause the pain, then this person is probably not sensitive to gluten but does have other digestive problems. You may want to begin investigating ingredients that legitimately impact far more eaters’ digestion, namely dairy products. You may also want to look at the person’s overall vegetable intake and exercise regimen. Also, keep in mind that avoiding this or that food may or may not be an effective strategy for your test subject to digest without pain. More likely than not more vegetables, more physical activity and more water is going to take care of their problem. I’d advise you to see a doctor, but you’re probably doing this test because you can’t or can hardly afford a doctor, so …
Ok, what if the results aren’t super clear cut but they’re not a total mess either and do seem to suggest some correlation between gluten and pain, but not a perfect one. For example, if your test subject reports discomfort related to digestion after only one gluten-free meal or if your test subject ate one meal that contained gluten but their body felt fine afterward, raise an eyebrow. But if all the rest of the test results suggest a good correlation between gluten and pain, gluten-free pain free, then this one or two outliers can probably be chalked up as anomalies, unexplainable blips.
Note: the reason you have to do this over 12 to 14 meals total is probability. If you did this test only once, i.e. with two meals and only one containing gluten, there’s a 50/50 chance the test subject would guess which contained gluten and which did not—by lucky chance alone. With two tests (four meals), you’ve reduced the chances of lucky guesses down to 25 percent. Another test meal (so six meals total now) and you’ve reduced the chance of guessing correctly to 12.5 percent, eight meals reduces it to 6.25 percent, after 10 meals it’s down to 3.125 percent and finally at 12 meals we reach 98% confidence. At seven gluten meals versus seven non-gluten meals, you’re at 99.2 percent confidence level. That’s pretty good. It means that if your test subject correctly identifies all the meals, there’s only a .8 percent chance that they were just lucky. (if you throw in some curve balls and, say, serve one dish identical both times then these numbers change and confidence level gets even higher).
Now, a word of caution. People are very sensitive about being told their problems might be the result of nocebo response and their relief from those problems a placebo response. People don’t like to feel like sheep and when they realize that marketing has made them profoundly confused about their own body, they sometimes feel shame. Some people are quite happy in the nocebo response-laden bubbles, and I advise you to just leave those people in there.
This test is really for a test subject and cook who care about each other and equally consent to this test. The test subject should be verbally informed that this whole experiment is to discover if their discomfort comes from food, of if it comes from an idea. You’ll need a test subject who believes in logic and scientific principles behind this test so that they actually trust the test results since there will be no point in conducting it if the test subject isn’t going to rely on the results to plan their life and diet.
A test like this can never be done morally without the fully informed enthusiastic consent of the test subject.
So give it a shot. I’d love to see someone do this. I don’t have a gluten-free person in my life, but if a non-Celiac’s person expected me to cook gluten-free for them on a regular basis, I would insist that we investigate their problem and see if the ubiquitous wheat germ known as gluten is really to blame for their problems.
False solutions are worse than no solution at all.