The Many Faces of GLUTEN… Masquerader of Disease and Symptoms (Part Two)













Continued from Part One

Who should be tested for gluten sensitivity?

  • Persons with persistent symptoms for which no other cause(s) has been identified
  • Persons with any of the symptoms or health conditions listed in Part Three
  • Persons who are eating well and/or who take nutritional supplements with limited or no success
  • Persons with proven malabsorption disorders
  • Persons who have been diagnosed with leaky gut syndrome
  • Family members who have tested positive for Celiac disease and/or gluten intolerance

Testing for Gluten Intolerance (sensitivity)

Testing for gluten intolerance is a simple matter. Blood samples are tested for three primary antibodies (AB) namely, gliadin AB, transglutaminase AB and reticulin AB. The medical literature suggests that the transglutaminase AB is the most commonly positive type detected on blood testing in those with gluten. However, extensive research on the part of the doctors of Advanced Medicine of Mount Kisco, P.C. seems to suggest that gliadin AB are far more commonly detected in an approximate ratio of 40:2 (gluten AB-to-Transglutaminase AB). The scientific literature generally recommends that all three AB are measured simultaneously in each person suspected of gluten sensitivity.

Testing must extend beyond the initial measurement of one or more AB. Gluten commonly cross-reacts with any number of tissues potentially resulting in multiple nutritional deficiencies directly and indirectly – possibly impairing tissue function to various extents. Studies have demonstrated that gluten intolerance directed intestinally, such as in CD, can cause malabsorpbion (lack of uptake from the gut into the cells) of calcium, protein and vitamin D. Deficiencies of these nutrients may cause a failure of normal bone remodeling and mineralization causing osteoporosis. All of the calcium supplements in the world will not correct the osteoporosis if it cannot be absorbed by the gut. Commonly, osteoporosis medications such as Fosomax are prescribed by well-intentioned physicians in an attempt to reduce continued bone loss. Although seemingly affective, none of the medications used for osteoporosis attempt to correct the underlying malabsorption disorder. After all, disease is not a result of drug-deficiency, but commonly results from or is at least worsened by, nutritional deficiencies. In either case, nutritional interventions including identifying food sensitivities such as gluten and the associated nutritional problems goes a long way towards correcting the underlying mechanisms of disease. In the above case, not only must the extent of gluten involvement be tested, but other nutritional tests such as serum vitamin D levels, urinary hydroxyproline (for protein loss from bone), urinary calcium and protein levels are helpful for determining the most appropriate nutritional interventions. Dietary, nutritional supplements and intravenous and/or intramuscular nutritional administration will correct nutritional deficiencies and improve healing overall.

Here’s an important point, the diseases reviewed in Part Three are commonly treated through the use of medications. No matter the potential symptomatic effectiveness of the medications used for these and other health problems – this approach does not, and cannot:

  • fix the underlying autoimmune process triggered by gluten
  • correct the nutritional deficiencies resulting from the malabsorption
  • heal the secondary tissue damage that gives rise to the various symptoms and diseases (i.e., the thyroid disease, multiple sclerosis, etc.)
  • identify the extent of other tissues involved

Testing for potentially cross-reacting foods and food allergies

Food allergies are commonplace in North America in children and adults. True allergies represent only one type of reaction which the body may have against specific foods. Eating the same foods day after day is one of the major contributing factors towards food allergies and intolerance. Given the opportunity food sensitivities can be resolved, or over a period of time, significantly lessened. Diligence is often required as even minimal exposure periodically can re-sensitize an individual to an offending food.

Although food sensitivity and food allergy will be used interchangeably in this health letter, these terms are technically not identical. What is important to
understand is that persons with gluten antibodies often have other food allergies – most of which they are completely unaware of. Allergists and their patients are fully familiar with what are known as immediate-hypersensitiy reactions also called IgE (Type 1) allergy. Allergic wheels caused by strawberries are an example of Type 1 Hypersensitiy reactions. This type of allergy is obvious as one can notice symptoms either immediately or within 12 or so hours after a food is consumed or the environmental allergen inhaled. Food allergies of a delayed type can manifest as the diseases described in this paper and of course their symptoms. Gluten often causes, or may result from, a breakdown of the intestinal immune systems (known as the Gut-Associated-Lymphoid-Tissue and the Macrophage-Associated-Lymphoid-Tissue). These conditions, and many of their symptoms, are the delayed results of gluten sensitivity directly; it’s secondary tissue effects, nutritional deficiency and other destructive secondary biologic effects.

Possible acceptable substitutions for gluten in the diet

Grains:

Buckwheat, amaranth, teff, keenwa, millet and wild rice

High complex carbohydrate vegetables and tubers:

Yams, sweet potatoes, red and white potatoes, turnips, yucca, taro, winter squash and parsnips (these are all easily substituted for grains).


Note: Food allergy testing will reveal other allergic foods may need to be eliminated from the diet

Other foods containing gluten

The scope of this article does not allow a comprehensive exploration of all of the potential foods that contain gluten. Furthermore, many foods may cross-react with gluten that must be individually determined for each person. With the help of a trained nutritional professional, a balanced, healthy diet can be developed that can be maintained and will eliminate or substantially improve the various potential primary and extended symptoms of gluten and other food intolerances.

How gluten causes tissue damage

Gluten is a protein that contains chains of amino acids. These amino acids are in a specific order that is unique to the gluten itself. However, although the amino acids are in a particular sequence (order) in gluten other tissues of the body may have amino acids in a similar (but not perfectly identical) order. When gluten is ingested by a person it comes in contact with the immune system located in the intestinal tract. If the intestinal-immune system of the individual who has consumed gluten reacts to it as a foreign and unfriendly protein it will mount an immune reaction.
This immune reaction is complex and involves the production of antibodies (AB) against the gluten; the gluten is known as an antigen. Thus the body reacts to a foreign antigen, the gluten, producing AB that produces various chemical products. These chemical products initiate an inflammatory type of immune reaction meant to rid the body of the foreign antigen (the gluten). The problems begin when the antigen (gluten) is continuously entering the system that does not want it and the inflammatory response continues of time (chronically). This chronic, inflammatory-immune reaction, initially beginning in the gut, precipitates changes in the intestinal tract that often extent throughout the body.

The gluten has evoked an inflammatory reaction in the gut. This inflammatory immune response is known as immune activation (IA). The IA, when persistent, may result in a breakdown of the integrity of the intestinal wall causing cells of the gut to separate slightly. The areas in the gut where this separation occurs are known as tight junctions. The major purpose of healthy tight junctions is to prevent certain molecules (substances) of certain sizes from readily passing through the intestinal wall from the intestinal lumen (center) into the capillaries that line the intestinal wall. If IA causes the tight junctions to separate gluten itself (or a large portion of it) can pass from the intestinal lumen into the blood stream before it is fully digested. Our immune system is on constant patrol for foreign or unwanted materials that have crossed from the gut into the blood where they do not belong. When discovered, the immune system will mount a vigorous attack against it – in this case against the gluten.

Antibodies (AB) are produced against the gluten over time, as the inflammatory chemicals produced by the immune system continue to circulate and contact tissues causing damage. As damage continues against specific tissues (i.e., the gut, thyroid, brain, ovaries, etc.) the immune system creates AB against these damaged tissues – as, in their damaged state, they appear as foreign proteins. Hence, a chronically activated, inflammatory, autoimmune response perpetuates feeding upon itself. The various disease states and symptoms are the results of the cascade of reactive immune system events.

Sometimes the immune system, once activated, becomes confused and cross-reacts with the gluten and other body tissues causing cellular degeneration and loss of function. Depending upon the cells, tissue or organs that the immune system reacts against (autoimmune reaction) various symptoms can develop. Any number of seemingly unrelated symptoms could develop in a single individual that may have a common precipitator – namely gluten. By the process of cross-reactivity, the immune system has directed an autoimmune response against the gluten and the body – with potentially devastating results.

Can a person develop a gluten sensitivity if he/she never had one?

Yes. People with various autoimmune conditions such as thyroiditis, hepatitis C, allergies, multiple sclerosis and other immune problems are at a higher risk for developing aberrant immune responses against gluten and related proteins in the
diet. The reason for this is because the immune system is already hyper-responsive as a result of the virus (in the case of Hepatitis C and possibly MS). Interestingly, the immune system activation seen in gluten sensitivity (gluten enteropathy) is similar to the immune systems reactions in a variety of different immune diseases. In short, the immune system can respond to perceived threats in just so many ways. Far from completely understood, the immune system commonly responds by producing AB and inflammatory chemicals (i.e., cytokines). It is known that aging in general is associated in an increased production of AB against various tissues and organ systems. Contrary to popular belief, many of the aging and elderly population suffer disease as a result from a heightened immune response rather than a blunted (lowered) one.

The doctors of Advanced Medicine of Mount Kisco, P.C. speculate that aging in general, and its associated decline in stomach acid (HCL) and pancreatic enzyme secretions, could cause malabsorption. The GI tract as a whole and its immune system would have an increased inflammatory immune response to many foods including gluten simply because it cannot digest specific foods well enough. If foods are only partially digested because of inefficient (or absent) HCL and/or pancreatic enzymes then the intestinal lining becomes “leaky” – this is called leady gut syndrome (LGS). LGS allows partially undigested food products to make their way into the general blood circulation. Once in the circulation, where food particles should not be in a partially undigested state, an inflammatory immune response is evoked against food remnants.

The foods could be of literally any type including gluten, dairy (casin), soy or virtually any other. The immune response can cause further damage of the intestinal lining. An important point to remember is that the immune response, initially directed against specific food remnants, can become generalized and affect any other body tissue. In some persons food reactions of this type can cause chronic fatigue, in others thyroid disease and even brain shrinkage (i.e., cerebellar atrophy or gluten ataxia). In summary, in genetically susceptible persons the aging gut could serve as a conduit allowing for the establishment of autoimmune disease, cancer or milder forms of malabsorption.


Continued in Part Three


Copyright American Health Gastroenterology 2001



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Comments

2 Responses to “The Many Faces of GLUTEN… Masquerader of Disease and Symptoms (Part Two)”

  1. The Many Faces of GLUTEN… Masquerader of Disease and Symptoms (Part One) | Healing Base on December 12th, 2011 17:38

    […] Continued in Part Two […]

  2. The Many Faces of GLUTEN… Masquerader of Disease and Symptoms (Part Three) | Healing Base on December 12th, 2011 17:53

    […] The Many Faces of GLUTEN… Masquerader of Disease and Symptoms (Part Three) var addthis_product = 'wpp-262'; var addthis_config = {"data_track_clickback":true,"data_track_addressbar":false};if (typeof(addthis_share) == "undefined"){ addthis_share = [];}Continued from Part Two […]

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