IF WHEAT CAN grasp hold of organs such as the brain, intestines, arteries, and bones, can it also affect the largest organ of the body, the skin?
Indeed it can. And it can display its peculiar effects in more ways than Krispy Kreme has donuts.
Despite its outwardly quiet facade, skin is an active organ, a hotbed of physiologic activity, a waterproof barrier fending off the attacks of billions of foreign organisms while hosting those that are friendly, regulating body temperature through sweat, enduring bumps and scrapes every day, regenerating itself to repel the constant barrage. Skin is the physical barrier separating you from the rest of the world. Each person’s skin provides a home to ten trillion bacteria, most of which assume residence in quiet symbiosis with their mammalian host.
Any dermatologist can tell you that skin is the outward reflection of internal body processes. A simple blush demonstrates this fact: the acute and intense facial vasodilatation (capillary dilation) that results when you realize the guy you flipped off in traffic was your boss. But the skin reflects more than our emotional states. It can also display evidence of internal physical processes.
Wheat can exert age-advancing skin effects, such as wrinkles and lost elasticity, through the formation of advanced glycation end products. But wheat has plenty more to say about your skin’s health than just making you age faster.
Wheat expresses itself—actually, the body’s reaction to wheat expresses itself—through the skin. Just as digestive by-products of wheat lead to joint inflammation, increased blood sugar, and brain effects, so too can they result in reactions in the skin, effects that range from petty annoyances to life-threatening ulcers and gangrene.
Skin changes do not generally occur in isolation: If an abnormality due to wheat is expressed on the skin surface, then it usually means that the skin is not the only organ experiencing an unwanted response. Other organs may be involved, from intestines to brain—though you may not be aware of it.
Acne: the common affliction of adolescents and young adults, responsible for more distress than prom night.
Nineteenth-century doctors called it “stone-pock,” while ancient physicians often made issue of the rash-like appearance minus the itching. The condition has been attributed to everything from emotional struggles, especially those involving shame or guilt, to deviant sexual behavior. Treatments were dreadful, including powerful laxatives and enemas, foul-smelling sulfur baths, and prolonged exposure to X-ray.
Aren’t teenage years already tough enough?
As if teenagers need any more reason to feel awkward, acne visits the twelve- to eighteen-year-old set with uncommon frequency. It is, along with the onslaught of bewildering hormonal effects, a nearly universal phenomenon in Western cultures, affecting more than 80 percent of teenagers, up to 95 percent of sixteen- to eighteen-year-olds, sometimes to disfiguring degrees. Adults are not spared, with 50 percent of those over age twenty-five having intermittent bouts.1
While acne may be nearly universal in American teenagers, it is not a universal phenomenon in all cultures. Some cultures display no acne whatsoever. Cultures as wide ranging as the Kitavan Islanders of Papua New Guinea, the Aché hunter-gatherers of Paraguay, natives of the Purus Valley in Brazil, African Bantus and Zulus, Japanese Okinawans, and Canadian Inuit are curiously spared the nuisance and embarrassment of acne.
Are these cultures spared the heartbreak of acne because of unique genetic immunity?
Evidence suggests that it is not a genetic issue, but one of diet. Cultures that rely only on foods provided by their unique location and climate allow us to observe the effects of foods added or subtracted to the diet. Acne-free populations such as the Kitavans of New Guinea exist on a hunter-gatherer diet of vegetables, fruits, tubers, coconuts, and fish. The Paraguayan Aché hunter-gatherers follow a similar diet and are also spared completely from acne.2 Japanese Okinawans, probably the most long-lived group on planet earth, consumed a diet rich in an incredible array of vegetables, sweet potatoes, soy, pork, and fish until the eighties; acne was virtually unknown among them.3 The traditional Inuit diet, consisting of seal, fish, caribou, and whatever seaweed, berries, and roots they could find, likewise leaves Inuits acne-free. The diets of African Bantus and Zulus differ according to season and terrain, but are rich in indigenous wild plants such as guava, mangoes, and tomatoes, in addition to the fish and wild game they catch; once again, no acne.4
In other words, cultures without acne consume little to no wheat, sugar, or dairy products. As Western influence introduced processed starches such as wheat and sugars into groups such as the Okinawans, Inuits, and Zulus, acne promptly followed.5, 6, 7 In other words, acne-free cultures had no special genetic protection from acne, but simply followed a diet that lacked the foods that provoke the condition. Introduce wheat, sugar, and dairy products, and Clearasil sales skyrocket.
Ironically, it was “common knowledge” in the early twentieth century that acne was caused or worsened by eating starchy foods such as pancakes and biscuits. This notion fell out of favor in the eighties after a single wrongheaded study that compared the effects of a chocolate bar versus a “placebo” candy bar. The study concluded that there was no difference in acne observed among the sixty-five participants regardless of which bar they consumed—except that the placebo bar was virtually the same as the chocolate bar in calories and sugar content, just minus the cocoa.8 (Cocoa lovers rejoice: Cocoa does not cause acne. Enjoy your 85 percent cacao dark chocolate.) This didn’t stop the dermatology community, however, from pooh-poohing the relationship of acne and diet for many years, largely based on this single study that was cited repeatedly, reflecting dermatologists’ nutritional sophistication as not even skin deep.
In fact, modern dermatology largely claims ignorance on just why so many modern teenagers and adults experience this chronic, sometimes disfiguring, condition. Though discussions center around infection with Propionibacterium acnes, inflammation, and excessive sebum production, treatments are aimed at suppressing acne eruption, not in identifying causes. So dermatologists are quick to prescribe topical antibacterial creams and ointments, oral antibiotics, and anti-inflammatory drugs.
More recently, studies have once again pointed the finger at carbohydrates as the trigger of acne formation, working their acne-promoting effects via increased levels of insulin.
The means by which insulin triggers acne formation is beginning to yield to the light of day. Insulin stimulates the release of a hormone called insulin-like growth factor-I (IGF-I), within the skin. IGF-1, in turn, stimulates tissue growth in hair follicles and in the dermis, the layer of skin just beneath the surface.9 Insulin and IGF-1 also stimulate the production of sebum, the oily protective film produced by the sebaceous glands.10 Overproduction of sebum, along with skin tissue growth, leads to the characteristic upward-growing reddened pimple.
Indirect evidence for insulin’s role in causing acne also comes from other experiences. Women with polycystic ovarian syndrome (PCOS), who demonstrate exaggerated insulin responses and higher blood sugars, are strikingly prone to acne.11 Medications that reduce insulin and glucose in women with PCOS, such as the drug metformin, reduce acne.12 While oral diabetes medications are usually not administered to children, it has been observed that young people who take oral diabetes medications that reduce blood sugar and insulin do experience less acne.13
Insulin levels are highest after carbohydrates are consumed; the higher the glycemic index of the consumed carbohydrate, the more insulin is released by the pancreas. Of course, wheat, with its uncommonly high glycemic index, triggers higher blood sugar than nearly all other foods, thereby triggering insulin more than nearly all other foods. It should come as no surprise that wheat, especially in the form of sugary donuts and cookies—i.e., high–glycemic index wheat with high–glycemic index sucrose—causes acne. But it’s also true of your multi-grain bread, cleverly disguised as healthy.
Also in line with insulin’s ability to provoke acne formation is the role of dairy. While most health authorities obsess over the fat content of dairy and recommend low-fat or skim products, acne is not caused by the fat. The unique proteins (specifically whey) in bovine products are the culprit that trigger insulin out of proportion to the sugar content, a unique insulinotropic property that explains the 20 percent increase in severe acne in teenagers consuming milk.14, 15
Overweight and obese teenagers generally get that way not through overconsumption of spinach or green peppers, nor of salmon or tilapia, but of carbohydrate foods such as breakfast cereals and soft drinks. Overweight and obese teenagers accordingly should have more acne than slender teenagers, and that is indeed the case: The heavier the child, the more likely he or she is to have acne.16 (It does not mean that slender kids can’t have acne, but that statistical likelihood of acne increases with body weight.)
As we would expect from this line of reasoning, nutritional efforts that reduce insulin and blood sugar should reduce acne. A recent study compared a high–glycemic index diet to a low–glycemic index diet consumed by college students over twelve weeks. The low-GI diet yielded 23.5 percent less acne lesions, compared to a 12 percent reduction in the control group.17 Participants who cut their carbohydrate intake the most enjoyed nearly a 50 percent reduction in the number of acne lesions.
In short, foods that increase blood sugar and insulin trigger the formation of acne. Wheat increases blood sugar, and thereby insulin, more than nearly all other foods. The whole grain bread you feed your teenager in the name of health actually worsens the problem. Though not life-threatening in and of itself, acne can nonetheless lead the sufferer to resort to all manner of treatments, some potentially toxic such as isotretinoin, which impairs night vision, can modify thoughts and behavior, and cause grotesque congenital malformations in developing fetuses.
Alternatively, elimination of wheat reduces acne. By also eliminating dairy and other processed carbohydrates such as chips, tacos, tortillas, and soft drinks, you’ll largely disable the insulin machinery that triggers acne formation. If there’s such a thing in this world, you might even have a grateful teenager on your hands.
Dermatitis herpetiformis (DH), meaning skin inflammation in the form of herpes, is yet another way that an immune reaction to wheat gluten can show itself outside of the intestinal tract. It is an itchy, herpes-like (meaning similar-looking bumps; it has nothing to do with the herpes virus) rash that persists and can eventually leave discolored patches and scars. The most commonly affected areas are the elbows, knees, buttocks, scalp, and back, usually involving both sides of the body symmetrically. However, DH can also appear in less common ways, such as sores in the mouth, on the penis or vagina, or odd bruising over the palms.18 A skin biopsy is often required to identify the characteristic inflammatory response.
Curiously, most DH sufferers do not experience intestinal symptoms of celiac disease, but most still show intestinal inflammation and destruction characteristic of celiac. People with DH are therefore subject to all the potential complications shared by people with typical celiac disease if they continue to consume wheat gluten, including intestinal lymphoma, autoimmune inflammatory diseases of other organs, and diabetes (types 1 and 2).19
Obviously, the treatment for DH is strict elimination of wheat and other gluten sources. The rash can improve within days in some people, while in others it dissipates gradually over months. Particularly bothersome cases, or DH that recurs because of continued wheat gluten consumption (sadly, very common), can be treated with the drug dapsone. Also used to treat leprosy, this is a potentially toxic drug marked by side effects such as headache, weakness, liver damage, and occasionally seizures and coma.
Okay, so we consume wheat and develop itchy, annoying, disfiguring rashes as a result. We then apply a potentially toxic drug to allow us to continue to consume wheat, but expose ourselves to very high risk for intestinal cancers and autoimmune diseases. Does this really make sense?
After acne, DH is the most common skin manifestation of a reaction to wheat gluten. But an incredible range of conditions beyond DH are also triggered by gluten and other components of wheat, some associated with increased levels of celiac antibodies, others not.20, 21 As with most other health problems provoked by wheat, you do not have to have celiac disease to suffer, say, peculiar discolorations or annoyingly itchy rashes. Wheat, like drugs, viruses, and cancer, therefore shares potential with other foreign substances and organisms to cause these rashes.
Wheat-related rashes include:
Oral ulcers—Red inflamed tongue (glossitis), angular cheilitis (painful sores on the corner of the mouth), and mouth burning are common forms of oral rashes associated with wheat.
Eczema—Common red, itchy, raised rash that afflicts one-third of all humans on the planet, especially children. Attributed to all manner of causes, from excessive cleanliness to neurosis, wheat and related grains are at the top of the list.
Seborrhea—Common red rash that typically occurs along the sides of the nose and eyebrows, chest, back, and scalp (labeled dandruff) related to proliferation of a fungus. Seborrhea, especially on the face, reverses so consistently with wheat elimination that I call it the “signature” rash of wheat consumption.
Cutaneous vasculitis—Raised, bruise-like skin lesions that have inflamed blood vessels identified by biopsy.
Acanthosis nigricans—Black, velvety skin that usually grows on the back of the neck, but also on the armpits, elbows, and knees. Acanthosis nigricans is frighteningly common in children and adults prone to diabetes.22
Erythema nodosum—Shiny red, hot, and painful one- to two-inch lesions that typically appear on the shins, but can occur just about anywhere else. Erythema nodosum represents inflammation of the fatty layer of the skin. They leave a brown, depressed scar on healing.
Psoriasis—A reddened, scaly rash, usually over the elbows, knees, and scalp, and occasionally the entire body. (Psoriasis is complicated by a common condition called small intestinal bacterial overgrowth [SIBO] that also requires attention.)
Vitiligo—Common painless patches of non-pigmented (white) skin. Vitiligo often reverses with wheat elimination.
Behçet’s disease—These ulcers of the mouth and genitalia generally afflict teenagers and young adults. Behçet’s can also show itself in myriad other ways, such as psychosis due to brain involvement, incapacitating fatigue, and arthritis.
Dermatomyositis—A red, swollen rash that occurs in combination with muscle weakness and blood vessel inflammation.
Ichthyosiform dermatoses—An odd, scaly rash (“ichthyosiform” means fishlike) that usually involves the mouth and tongue.
Pyoderma gangrenosum—Horrific, disfiguring ulcers involving the face and limbs that are deeply scarring and can become chronic. Treatments include immune-suppressing agents such as steroids and cyclosporine. The condition can lead to gangrene, limb amputation, and death.
ALL OF THESE conditions have been associated with wheat consumption, and improvement or cure observed with removal. For the majority of these conditions, the proportion due to wheat versus other causes is not known, since wheat is often not considered as a potential cause. In fact, most commonly a cause is not sought and treatment is instituted blindly in the form of steroid creams and other drugs (a mindless approach that defines most of modern medicine, by the way).
Believe it or not, as frightening as the above list appears, it is only partial. There are quite a few more skin conditions associated with wheat that are not listed here.
You can see that skin conditions triggered by wheat range from nuisance to disfiguring disease. Outside of relatively common mouth ulcers and acanthosis nigricans, most of these skin manifestations of wheat exposure are uncommon. But in the aggregate, they add up to an impressive list of socially disruptive, emotionally difficult, and physically disfiguring conditions.
Are you getting the impression that humans and wheat may be incompatible?
Compared to the great apes and other primates, modern Homo sapiens are relatively hairless. So we prize what little hair we have.
SEVEN-YEAR ITCH
Kurt came to me because he was told he had high cholesterol. What his doctor labeled “high cholesterol” proved to be an excess of small LDL particles, low HDL cholesterol, and high triglycerides. Naturally, with this combined pattern, I advised Kurt to eliminate wheat forthwith.
He did so, losing 18 pounds over three months, all from his belly. But the funny thing was what the diet change did to his rash.
Kurt told me that he’d had a reddish-brown rash over his right shoulder, spreading down to his elbow and upper back, that had plagued him for more than seven years. He’d consulted with three dermatologists, resulting in three biopsies, none of which led to a firm diagnosis. All three agreed, however, that Kurt “needed” a steroid cream to deal with the rash. Kurt followed their advice, since the rash was at times very itchy and the creams provided temporary relief.
But four weeks into his new wheat-free diet, Kurt showed me his right arm and shoulder: completely rash-free.
Seven years, three biopsies, three misdiagnoses—and the solution was as simple as (eliminating) apple pie.
My dad used to urge me to eat hot chili peppers because “it will grow hair on your chest.” What if Dad’s advice was to avoid wheat instead because it made me lose the hair on top of my head? More so than cultivating a man-like “heavage,” losing my hair would have captured my attention. Hot chili peppers really don’t trigger hair growth on the chest or elsewhere, but wheat can indeed trigger hair loss.
Hair can be a very intimate thing for many people, a personal signature of appearance and personality. For some people, losing hair can be as devastating as losing an eye or a foot.
Hair loss is sometimes unavoidable due to the effects of toxic drugs or dangerous diseases. People undergoing cancer chemotherapy, for instance, temporarily lose their hair, since the agents employed are designed to kill actively reproducing cancer cells, but inadvertently also kill active non-cancerous cells, such as those in hair follicles. The inflammatory disease systemic lupus erythematosus, which commonly leads to kidney disease and arthritis, can also be accompanied by hair loss due to autoimmune inflammation of hair follicles.
Hair loss can occur in more ordinary situations, of course. Middle-aged men can lose their hair, followed soon after by an impulse to drive convertible sports cars.
Add wheat consumption to the list of causes of hair loss. “Alopecia areata” refers to hair loss that occurs in patches, usually from the scalp, but occasionally other parts of the body. Alopecia can even involve the entire body, leaving the sufferer completely hairless from head to toe and everything in between.
Wheat consumption causes alopecia areata due to inflammation of the skin. The inflamed hair follicle results in reduced hold on each individual hair, which causes shedding.23 Within the tender spots of hair loss are increased levels of inflammatory mediators, such as tumor necrosis factor, interleukins, and interferons.24
When caused by wheat, alopecia can persist for as long as wheat consumption continues. Like completing a course of chemotherapy for cancer, elimination of wheat and related grains usually results in prompt resumption of hair growth, no surgical hair plugs or topical creams required.
In my experience, acne, mouth sores, a rash on the face or backside, hair loss, or nearly any other abnormality of the skin should prompt consideration of a reaction to wheat. It may have less to do with hygiene, your parents’ genes, or sharing towels with friends than with the turkey sandwich on whole wheat that was yesterday’s lunch.
How many other foods have been associated with such a protean array of skin diseases? Sure, peanuts and shellfish can cause hives. But what other food can be blamed for such an incredible range of skin diseases, from acne and common rashes all the way to gangrene, disfigurement, and death? I certainly don’t know of any other than wheat.
THE CASE OF THE BALD BAKER
I had a heck of a time persuading Gordon to drop the wheat.
I met Gordon because he had coronary disease. Among the causes: abundant small LDL particles along with the usual accompaniments of low HDL, high triglycerides, and high blood sugar. I asked him to completely remove the wheat from his diet in order to reduce or eliminate the small LDL particles and thereby obtain better control over heart health.
Problem: Gordon owned a bakery. Bread, rolls, and muffins were part of his everyday routine, three meals a day, seven days a week. It was only natural that he would eat his products with most meals. For two years, I urged Gordon to drop the wheat—to no avail.
One day Gordon came to the office wearing a ski cap. He told me how he had started to lose clumps of hair, leaving divot-like bald patches scattered over his scalp. His primary care doctor diagnosed alopecia, but couldn’t divine a cause. Likewise, a dermatologist was at a loss to explain Gordon’s dilemma. The hair loss was very upsetting to him, causing him to ask his primary care doctor for an antidepressant prescription and concealing the embarrassing situation with a cap.
Wheat, of course, was my first thought. It fit Gordon’s overall health picture: small LDL particles, wheat belly body configuration, high blood pressure, prediabetic blood sugars, vague stomach complaints, and now hair loss. I made yet another pitch for Gordon to once and for all remove the wheat from his diet. After the emotional trauma of losing most of his hair and now having to conceal his patchy scalp, he finally agreed. It meant bringing food to his bakery and not eating his own products, something he had some difficulty explaining to his employees. Nonetheless, he stuck to it.
Within three weeks, Gordon reported that hair had begun to sprout up in the bald patches. Over the next two months, vigorous growth resumed. Along with his proud pate, he also lost 12 pounds and 2 inches from his waist. The intermittent abdominal distress was gone, as was his prediabetic blood sugar. Six months later, re-assessment of his small LDL particles demonstrated 67 percent reduction.
Inconvenient? Perhaps. But it sure beats a toupee and a bypass.