Elimination Diet Kickstarts Fatloss in "People Who Cannot Lose Weight" - 16% Body Fat Reduction in 6 Months, But...

Many of these foods contain supposed allergens and have thus to be eliminated from your diet... is it any wonder that this triggers weight loss? Hardly...

While I have to admit that I am a bit skeptical about the reliability of the results of a recent study from the Sifa University, Faculty of Health Sciences in Turkey, I cannot ignore that Meltem Yaman Onmus, Elif Cakirca Avcu, and Ali Saklamaz claim that "people who cannot lose weight by low-calorie diet can lose weight and fat with elimination diet according to the results of FI [food intolerance] test. FIED [FI elimination diet] is also significantly effective in triglyceride levels" (Onmus. 2016). I know that sounds as if it was taken from the latest unreferenced blogpost on a dubious website, but let's not judge prematurely and instead take a closer look at the design and results of the study.

Unlike elimination diets, fasting must be considered a scientifically proven weight loss trick

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82 patients (24 male, 58 female) were included in the study. The mean age was 42.04±11.81 (18-65 years). All of them were "unable to lose weight", i.e. patients who said of themselves that they couldn’t lose weight by diet programs and who had a positive reaction to at least one nutrient in food intolerance test and a BMI value ≥ 25kg/m² - in other words: the subjects were the average Internet bullet-in board dwellers searching for the "magic key" to weight loss.

This is obviously an important fact, because it increases the significance of the study for said group of subjects. Whether the results are significant for anyone else, though, is questionable, since patients who had no food reaction in food intolerance test were excluded from the study. The same goes for subjects who had chronic diseases like diabetes mellitus, coronary heart disease, renal diseases, etc., or individuals who use(d) weight loss drugs and who had allergy to any drug or food and who overuse medications or have pure menstrual migraine or headache that associated a disorder.

No health benefits from "eliminating" foods: Interestingly, the food intolerance elimination diet failed to do what its proponents say it's actually doing: Improve the subjects health. With the exception of a statistically significant decrease in triglyceride levels, there was no improvement in health markers (fasting blood glucose, A1C, total cholesterol, HDL-cholesterol, LDL-cholesterol, AST, and ALT) the scientists didn't observe in the control group, too.

As you can see in Figure 1, this particular group of subjects saw significant benefits from following a diet that did not allow the subjects to consume any of the foods to which they showed an IgG response in the previously conducted food intolerance test for 6 months. Otherwise, the diets of the elimination diet (ED) and control diet were personalized diets with "identical" (according to the size, weight, physical activity, dietary habits and socioeconomic status) energy content.

Figure 1: Pre- and post-intervention weight, body fat, lean body mass, and waist / hip ratio (x10); * indicates significant inter-group difference, this means that everything, but the effect on lean mass was sign. more pronounced in the ED group.

Against that background it is unquestionably striking that the subjects in the elimination diet group lost 16% body fat, while the control group didn't lose either significant amounts of fat or weight. Now, the obvious question is: "Which foods were eliminated?" Unfortunately, this question is neither answered in the study at hand, nor in previous studies showing that elimination diets reduce also reflux disease, chronic fatigue syndrome, and headaches (Selvin. 2007; Akmal. 2009).

Unlike Onmus et al., Akmal et al. publish-ed a list of allergens their IgG test could supposedly identify. A list eliminated foods is yet missing from study, too.

Why's it a problem that we don't know which foods were eliminated? Actually, the answer to this question should be obvious. Let's assume you're "allergic" to sugar, alcohol and high omega-6 vegetable oils like soybean oil. Would you be surprised if you lost significant amounts of body fat if you dropped all sugary and pro-inflammatory high omega-6 foods and stopped drinking alcohol? I, for my part, wouldn't and I guess you wouldn't and you certainly shouldn't be surprised either.

Accordingly, the study at hand does unfortunately not provide enough information to decide whether it provides convincing evidence of using IgG-tests to guide you when you're designing diets for yourself or your clients. Hopefully future research will do just that | Comment!

References:

• Akmal, Mohammed, Saeed Ahmed Khan, and Abdul Qayyum Khan. "The Effect of the ALCAT Test diet therapy for food sensitivity in patient’s with obesity." Middle East Journal of Family Medicine 7.3 (2009).
• Onmus, Meltem Yaman, Elif Cakirca Avcu, and Ali Saklamaz. "The Effect of Elimination Diet on Weight and Metabolic Parameters of Overweight or Obese Patients Who Have Food Intolerance." Journal of Food and Nutrition Research 4.1 (2016): 1-5.
• Selvin, E., Paynter, N. P., Earlinger T. P. "Nutrition and allergy." Arch Intern Med, 167.1 (2007): 31-39.

Gluten Free, But not Suitable For Celiacs: Milk, Chocolate, Corn, Instant Coffee and 20 Other Foods & Food Ingredients That Could Cross-React With Gluten Anti-Bodies

Unless you got the right, i.e. breast milk as a baby and have rendered your gut "gluten proof" - being breast fed, when you are first exposed (or being exposed later in life) has after all been suggested as a protective factor (Farrell. 2005)

This is not going to be a long post; and still, at least for some of you it is going to be an important post. A post that may have the potential to change your life for the better or for the worse depending on whether you actually suffer from gluten-intolerance or have simply been bamboozeled by the "gluten is the devil" messages that are plastered all over the Internet these days.

Actually, I would hope that you belong to neither of the groups and can thus simply ignore this post. For the unfortunate rest, I have prepared a mini-summary of the results of a recent study from the Immunosciences Lab in Los Angeles (Vojdani. 2013)

Milk and cornflakes - a killer combo

A couple of recent studies, as well as reports from patients all of which clearly suggested that "being gluten free" does not equal "being symptom free" had spiked the researchers interest. Was it possible that the persistent symptoms were brought about by cross-reactions between the anti-bodies that would usually attach to the gluten proteins to trigger an immune reaction and other molecules? Molecules from such innocent foods, as dairy, chocolate, and even coffee!?

Suggested read: "Leaky Gut & Gluten Belly: Bacterial Firebugs Translocate from Your Gut to Your Ever-Growing Visceral Fat Depots" | read more

"[W]hen histological response was assessed in celiac patients after 6 months of following a GFD [gluten free diet], complete normalization and reconstruction of villous architecture was observed only in 8% of individuals, while 65% of these patients were in remission and 27% did not respond to GFD and had no observable change in their clinical symptoms (Lanzini. 2009).

The lack of improvement in histopathology and clinical symptomatology in a subgroup of patients on a GFD may be associated with dietary non-ad-herence or cross-reactive epitopes triggering a state of heightened immunological reactivity in gluten-sensitive individuals (Hadjivassiliou. 1997)." (Vojdani. 2013)

The hypothesis certainly isn't totally odd. Kristjansson et al. were for example able to show that 50% of their celiac patients experienced a significant mucosal inflammatory response similar to that elicited by gluten, when they were exposed to cow’s milk protein. Of the 15 healthy controls in their study, however, not a single one showed the slightest signs of auto-immune related inflammatory processes (Kristjansson. 2007).

So is this "real" celiac disease?

It should be obvious though that the corresponding "cross reactive" agents do not induce celiac disease (which is per definition an auto-immune disease that's triggered by the reaction to gliadin). They are however well able to alter the intestinal barrier integrity - a symptom that is also one of the key feature of the early stages of celiac disease.

Figure 1: Reaction of affinity-purified α-gliadin 33-mer polyclonal antibodies to gliadin and different food antigens; data in large figure relative to control, data in small inset relative to a-gliadin (Vodjdan. 2013)

If full remission of celiac disease cannot be achieved even on gluten-free diet, the underlying reason may thus well be the presence of peptides and antigens that (cross-)react with the same anti-bodies the body of celiac patients produces against the α-gliadin 33-mer peptide aka gliadin. Scientists even speculate that the co-exposition to these agents could eventually lead to the establishment of "new" auto-immune diseases and food allergies and some argue that the ever-increasing spectrum of allergies is partly a result of untreated autoimmune reactions which are then "spreading" to other previously well-tolerated foods and food ingredients.

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Suggested read: "Beyond Celiac: Study Sheds New Light on Obesogenic Effects of Gluten - Are PPARs & Bacteria Both Involved?" | read more

The problem seems real, if you're really gluten intolerant: With milk, all sorts of dairy products (including whey), instant coffee (but not espresso; see small inset), avenin containing oat products (unfortunately, I cannot tell you how you can recognize the "unproblematic" oats at the super market, but if you google "avenin-free oats" you will see a couple of products and stories pop up; Comino. 2011) and corn having a significant potential for cross-reactivity, it appears almost reasonable that some people come back from their visit with a mostly self-proclaimed expert in all things celiac with an endless list of items they are not supposed to eat and a tiny 5-item list of foods they are supposed to live on for the rest of their lives.

What is not reasonable, however, is that this is the case for more and more people who are basically asymptomatic... well, aside from their "inability to lose weight" that is obviously not related to their "inability to exercise" and their "inability to stop watching TV and browsing the Internet for easy quick-fix solutions to obesity problems", but most obviously be brought about by gluten intolerance ;-(

References:

• Comino I, Real A, de Lorenzo L, Cornell H, López-Casado MÁ, Barro F, Lorite P, Torres MI, Cebolla A, Sousa C. Diversity in oat potential immunogenicity: basis for the selection of oat varieties with no toxicity in coeliac disease. Gut. 2011 Jul;60(7):915-22.
• Hadjivassiliou M, Chattopadhyay AK, Davies-Jones GA, Gibson A, Grünewald RA, Lobo AJ. Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry. 1997 Dec;63(6):770-5.
• Kristjánsson G, Venge P, Hällgren R. Mucosal reactivity to cow's milk protein in coeliac disease. Clin Exp Immunol. 2007 Mar;147(3):449-55.
• Lanzini A, Lanzarotto F, Villanacci V, Mora A, Bertolazzi S, Turini D, Carella G, Malagoli A, Ferrante G, Cesana BM, Ricci C. Complete recovery of intestinal mucosa occurs very rarely in adult coeliac patients despite adherence to gluten-free diet. Aliment Pharmacol Ther. 2009 Jun 15;29(12):1299-308. 
• Vojdani A, Tarash I. Cross-reaction between gliadin and different food and tissue antigens. Food and Nutrition. 2013; 4:20-32.