A pizza crust, a loaf of French bread and a plate of spaghetti walk into a bar. The bartender says, “What can I get you fellas?” and the pizza crust says, “Some Pepto-Bismol. We all have horrible stomachaches.”

Not very funny, is it? That’s because gluten intolerance is no joke.

Every year, I see more patients complaining of intestinal and joint pain who suspect that wheat products may be the culprit.

Many have acquainted themselves with some of the popular theories addressing the possible causes and cures of gluten intolerance. So before I get into which theories do make sense, let me respond to those that I think hold little water.

Pop theory: Modern high-yield wheat is so different from wheat grown 10,000 years ago that it’s been rendered unsafe to eat.

My take: All crops have been bred to be high-yield; wheat is no exception.

Pop theory: Man evolved as a hunter-gatherer, and shouldn’t eat wheat because it is an agricultural product.

My take: All vegetables (and fruit) are agricultural products, and I don’t think it makes sense to avoid eating vegetables.

Pop theory: Wheat is a grass, something human beings are not adapted to eat.

My take: Rice is a grass, and few people are allergic to it.

Pop theory: Wheat is a seed, and all seeds contain anti-nutrients. In the past, we’d sprout seeds to increase bioavailability of nutrients.

My take: Sprouting is great. But gluten is not an anti-nutrient: It’s a protein.

Now, I acknowledge that it’s become fashionable for doctors and alternative practitioners to talk “underlying causes,” but what’s wrong with the above theories is that they fail to consider the underlying cause of gluten intolerance — namely, inflammation.

Think of white blood cells as a pack of fraternity brothers after a night of drinking Red Bulls and vodka — hopped up, aggressive and easily confused.

If, say, an invading bacteria enters the body, white cells attack it without mercy. They even keep a kind of record of the invader, called an antibody, for later reference. It’s like giving a photo to the bouncer guarding the front door and saying, “If this dude ever shows up again, pin this photo to his chest to identify him so that all the brothers know to escort him off the property.”

The immune system even has special T-cells that chaperone this activity, playing the role of the level-headed fraternity president. If the white blood cells start attacking the wrong thing, these special T-cells call off the attack, saying, “Hey, settle down! It’s cool.”

But what if the fraternity president could no longer keep the overzealous pledges in check?

On a typical American diet rife with sugar, carbohydrates (which turn to sugar once digested) and toxic vegetable oils, our bodies are in a constant state of inflammation. And inflammation impairs the immune system’s ability to self-regulate. It’s as if the president of the fraternity — the responsible one — were passed out next to the keg while the young men in his charge run amok.

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Here’s how this can lead to gluten intolerance. Processed gluten in, say, a snack chip is — much like a polyunsaturated molecule in processed canola oil — distorted, an unnatural shape. In the stomach, this strange shape elicits the attention of the immune system (something that appears foreign enough to get the immune system’s attention is called an adjuvant). The immune system attacks this adjuvant and then creates antibodies in case it ever shows up again.

The particular problem with distorted gluten is that it bears a likeness to certain molecules in the tissues of your body, so much so that these tissues wind up getting tagged with antibodies. When the white blood cells see those tags, they do what they’re supposed to: attack.

When this attack happens chronically, it can start to hurt, especially in the gut and joints. This is celiac disease. And the attack won’t cease until the president of the fraternity sobers up, which is to say, until the chronic inflammation finally subsides.

That’s why I consider gluten intolerance and celiac disease as a symptom of underlying inflammation. This means avoiding gluten is only the first step. To address the underlying cause, we need to eliminate pro-inflammatory foods.

Speaking of which, a French baguette says to his psychiatrist, “I think I’m gluten-intolerant.” The psychiatrist says, “Aha! A classic case of self-loafing.”

OK, that one is a little funny.

We have a five-minute video explaining this issue in more depth at drcate.com/what-is-celiac-disease-a-recipe-for-recovery-beyond-gluten-free.

Cate Shanahan, M.D., is a family physician with Queen of the Valley Medical Associates and can be reached at 251-3681. Luke Shanahan is a food and health writer and aspiring cook. Their books include “Deep Nutrition: Why Your Genes Need Traditional Foods” and “Food Rules: A Doctor’s Guide to Healthy Eating.” Learn more at DrCate.com.

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