Although I’ve been retired from the health care profession for over three years, family and friends still ask for my expertise or simply my opinions on a wide range of health issues.

Sometimes my answers are unequivocal and backed by scientific evidence, on other occasions my answers are simply my opinions based on my interpretation of the current data.

Though I’ve never received inquiries from Nichi Bei readership for these issues, since this is the Health and Wellness Issue, I’ll address some of these issues.

Vaccines and Autism
The “scientific evidence” that first linked vaccines, specifically the MMR vaccine (measles, mumps, rubella) to autism was based on a single article published in the British medical journal, The Lancet, in 1998. The primary author describes 12 previously normal children developing autism due to the administration of the MMR vaccine.

However, a subsequent investigation discovered fraudulent data and potential conflicts of interest — several parents of these children were recruited by a law firm to file a lawsuit against manufacturers of the MMR vaccine. Since then, The Lancet retracted the original publication and though the primary author is still a staunch anti-vaccination advocate, his medical license was revoked in the UK nor does he hold a medical license in the U.S. where he currently resides.

But why does autism seem more prevalent? Well, the standard for diagnosing autism (or any other mental disorder) has been the Diagnostic and Statistical Manual of Mental Disorders or DSM as it’s commonly known. Since the first edition (DSM-1) was published in 1952, autism was only mentioned once and thought to be connected to schizophrenia.

When DSM-II was released in 1968, autism was still thought to be related to schizophrenia in childhood. However, when DSM-III was released in 1980, the diagnostic criteria was broadened from six to 16 criteria and instead of meeting all six criteria, patients just had to meet eight of the 16 markers greatly expanding the population of patients that could be formally diagnosed with autism. With DSM-IV in 1994 additional conditions such as Asperger’s Syndrome, childhood disintegrative disorder and Rett Disorder were added to the now autism spectrum of disorders.

The latest update with DSM-V in 2013 consolidated many individual disorders into broader categories so that by 2016, it was estimated that one in 54 children would be diagnosed with autism by the age of eight. The American Academy of Pediatrics also now recommends screening of all patients between 18 to 24 months for autism at routine office visits.

Therefore, with broader criteria to diagnose autism and more screening, it’s not surprising that the diagnosis of autism is on the rise.

To Carb or Not to Carb

Ever since the turn of the millennium when the Robert Atkins diet of high animal protein, high fat and low carbohydrate gained favor with those trying to lose weight, there’s always been some variation of this diet that remains entrenched in the American diet.

For starters, studies have been performed with the Atkins diet and while there is initial weight loss, many subjects weren’t able to maintain the weight loss at one year. Your brain only utilizes carbohydrates as energy, so limiting its energy source probably isn’t the best idea.

Many proponents of these diets also claim that our ancestors during the Paleolithic era didn’t suffer from heart disease, obesity and diabetes like modern humans because modern humans moved away from this hunter-gatherer diet.

Because the Paleolithic era was somewhere between 12,000 to 2.6 million years ago, I’m sure there were genetic changes in man during the interim… OK, maybe some members of Congress haven’t changed. But Paleo man (and woman) didn’t suffer from these chronic conditions because they likely never lived that long — heart disease usually starts at around 60 years and diabetes somewhere in the late-40s to early 50s and Paleo man likely met his demise through conflict, starvation or saber tooth tigers by then. And because fast foods weren’t available and sedentary jobs weren’t even created, starvation was a lot more likely than obesity.

I still recommend a modified approach to these low carbohydrate diets by eliminating simple carbohydrates like sugar and switching complex carbohydrates to the whole grain variety — 100% whole wheat bread in place of white bread, whole grain pasta and brown rice in place of refined pasta and rice and substituting starches in legumes in place of traditional carbohydrates. And replace some of those excess carbohydrates with healthier fats like oils, nuts and seeds.

And select leaner animal proteins or replace some of them with a mixture of plant proteins.

Should I be Gluten Free?
Unless you’ve been diagnosed with celiac disease or non-celiac gluten sensitivity, there’s no reason to eliminate wheat protein from your diet. Combining wheat protein, legume protein and sesame seed protein makes these plant-based proteins comparable to animal proteins. True celiac disease is an autoimmune disorder where gluten (the protein in wheat) triggers an immune response in the intestinal lining and other than digestive sequelae like diarrhea, gas and bloating can also lead to long term consequences like malnutrition, diabetes, osteoporosis and intestinal cancers so these patients MUST eliminate dietary gluten. With non-celiac gluten sensitivity, patients only experience the digestive effects without the long-term consequences. Therefore treatment recommendations usually only consist of a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet and probiotics.

However, many foods included in a high FODMAP diet include beans, cauliflower, celery, garlic, peas, shiitake which are considered healthy foods in other diets or play a role in flavoring other ingredients. Therefore, when I’m asked if you should eliminate or reduce gluten in your diet, my response: definitely NOT if you have no digestive symptoms and probably not if you simply think you might have non-celiac gluten sensitivity.

Remember that with any fermentable food, i.e., high fiber food, you have to start low and increase slowly or digestive symptoms will occur. Though the recommendation for dietary fiber is 25 grams per day, NO dietician or physician will recommend that you immediately consume 25 grams per day to start. And the diagnosis of non-celiac gluten sensitivity is a diagnosis of exclusion so your health care provider first needs to rule out celiac disease (via blood test), wheat allergy (via skin test) and irritable bowel syndrome (which is also another diagnosis of exclusion). It’s not as simple as simply stating “maybe it’s gluten.”

Of course, in this current political environment, getting answers to health questions or recommendations is sketchy at best so ask a trusted health care provider. And a retired provider would be your next option.

Ryan Tatsumoto is a graduate of both the University of Hawai‘i and UC San Francisco. He is a recently retired clinical pharmacist and a budding chef/recipe developer/wine taster. He writes from Kane’ohe, HI and can be reached at gochisogourmet@gmail.com. The views expressed in the preceding column are not necessarily those of the Nichi Bei News.