Fab and very detailed article in the Townsend Letter recently about gluten sensitivity, autoimmunity and cross-reactive foods, so very close to our TGF hearts since these are three key areas I based the Barrier Plan around – thanks to J, who sent it in for us.
As you can see, the piece is written by Dr Aristo Vojdani, the immunologist whose work I have referenced several times on here and whose Mucosal Barrier test we use. And whose lab tests we are STILL waiting for in the UK from Cyrex Labs (only 2 years now; what the heck is holding them up when they have been available in the US now for a year, harrumph, harrumph?!)
Anyway, please get a cuppa and sit and read the whole piece. If you need a mini primer, see this post I wrote before in 2011, would you believe?!:
So, here, as always, are a few bits I picked out from this Townsend article, and my comments on them for you..
The Link Between AutoImmune Antibodies and Gluten Sensitivity
Here, Dr Vojdani is talking about the prevalence of auto-immune disease, which is growing. Scientists are now identifying specific tissue markers and antibodies that they believe are linked to certain diseases or at least to the development of autoimmune problems. The belief now is becoming that if we can identify the most predictive antibodies or tissue markers, we can take steps to prevent the autoimmune disease developing. That is MAJOR. He says:
Researchers have identified more than 80 autoimmune conditions and suspect at least 40 more disorders of having an autoimmune basis.
Interestingly, he says this growing autoimmune problem is not about increased diagnostics but rather a problem of our current environment:
this crisis is due to factors in our environment, in particular, toxic chemicals. Due to exposure to these chemicals and the binding of chemicals or metabolites to human tissue, cellular defenses designed to protect the body attack the body’s own tissues instead.
…predictive autoantibodies appear in the blood years before people show symptoms of various disorders. Tests that detected these molecules could warn of the need to take preventive action.”2
In patients with celiac disease (CD) or non-celiac gluten sensitivity (NCGS), it has been established that the probability of having one (or several) other autoimmune diseases is 30 times higher than in those who do not have these conditions. The incidence of gluten ataxia, for example, which manifests in disorders such as autism, is increased up to 30-fold in patients with celiac disease.5
We are waiting for the specific auto-immune markers test from Cyrex but before it was even available, I developed my own with the kind help of one of our labs. You can do the Basic autoimmunity test or organ-specific tests currently. See here for AutoImmunity tests info.
Gluten Sensitivity and Cross Reactive Foods and Tissues
The next issue Dr Vojdani tackles is that of cross-reactivity. As you know, the body can confuse food and body tissue proteins and fractions that look very structurally similar to gluten – your body gives you the same reaction as it would to gluten. Not good. That’s why I have suggested the removal of the main cross-reactive foods until we can get the cross-reactivity test done by Cyrex. Not much I can do about your body tissues!
In the piece, Dr V goes through some of the key foods they have tested for gliadin cross-reactivity and pinpoints dairy, yeast and other grains especially. One point to note is that, yet again, the scientists are researching the proteins of foods – since they can look at the amino acid sequences that only occur in proteins – and gliadin because Dr V is looking at coeliac disease specifically (rather old-fashioned in my view, as you know…! Though, to be fair, the new Cyrex test at least looks at several gliadin and gluten fractions so better).
Gliadin is a prime example of an antigen that cross-reacts with other foods, as well as with human tissue antigens, causing symptoms of celiac disease beyond the gut.6 Food cross-reactivity is a sinister phenomenon that occurs as a result of the similarity in the sequence of amino acids in food proteins and in tissues and organs.
…research has found that when CD patients were put on a gluten-free diet, after six months only 8% of these patients had reversal of villous atrophy. An additional 65% of patients showed 50% improvement. The remaining 27% experienced no improvement in their clinical condition.8
We concluded that for patients who do not show improvement in digestion or other symptoms on a gluten-free diet, attention should be given to various cross-reactive foods, such as dairy products, grains, and yeast. This intervention is ideally used in a phased approach. If patients do not initially improve on a gluten-free diet, they should be advised to remove cross-reactive foods. If they still do not improve after the elimination of dairy products, grains, and other reactive foods, it is important to check for other food intolerances. In some cases, symptoms may be associated with factors beyond cross-reactivity. Based on my communications with many clinicians, indications are that the majority of patients who had been diagnosed with non-celiac gluten sensitivity (NCGS) showed significant improvement in their symptomatologies after a gluten-free diet that also eliminated cross-reactive foods.
Yep, so, that’s grain and dairy free pretty much then, I thank you! I agree with the phasing, although it would be ideal to test the cross-reactive foods list and then KNOW what has to come out rather than guess – come on Cyrex, puurlease! Currently, I have taken the view that all out is better than continuing the inflammatory/autoimmune process just in case. Not ideal and makes it more restrictive than it might need to be, but what choice do we have? Well, we do have one, I suppose – and that’s why I developed the IgA, IgM, IgG food intolerance test so that we could look at most of them and see if we had antibodies in the blood to them.
Body tissues that seem to have a cross-reaction with gliadin include some in the brain, nervous system, adrenals, pancreas and I think I recall reading parietal cells in the stomach (production of acid and instrinsic factor for B12), but he doesn’t mention that here:
In our research, antibodies found to cross-react against alpha-gliadin also reacted significantly with a number of human tissues, including asialoganglioside, hepatocytes in the liver, glutamic acid decarboxylase (GAD-65) in the pancreas, adrenal 21 hydroxylase in adrenal glands, and various neuronal antigens (such as synapsin, myelin basic protein, and cerebellar).
Of course, this is just the ones referencing alpha gliadin, what would that list look like if we included all gluten fractions?
The Link Between Gluten Sensitivity, Leaky Gut and Body Barriers and AutoImmunity
As we know, gluten upregulates zonulin, which is the substance that partly controls how leaky you are. If you keep allowing the antigens through, it is only a matter of time before the autoimmunity kicks in, experts believe.
Increased intestinal permeability (leaky gut) is a major gateway to environmentally induced autoimmune disorders. This malfunction occurs, for example, in gluten-sensitive individuals when gluten and other cross-reactive or immuno-reactive foods are consumed. In the gut, inflammation opens the tight junctions, allowing unwanted antigens into the bloodstream, including food proteins, fragments of normal gut flora, intestinal pathogens, and toxic chemicals such as alcohol or bisphenol A from plastics.
The passage of reactive food proteins and other substances through the gut lining can have an immediate effect on dendritic cells and other immune cells located just below the gut lining. At that point, inflammatory cytokine production increases. The continuous stimulation of this process due to ongoing consumption of reactive foods is a major factor in the development of autoimmunity.
Absolutely spot on. He yet again mentions the zonulin/occludin Cyrex test we need. That we don’t have. And I haven’t been able to replicate that one, sorry. But we do have the Barrier Test to give an idea of how leaky you are, and he had a hand in developing that one I believe.
But, as we know, it’s not just the gut that becomes leaky. He mentions the blood brain barrier as a major area of permeability problems. There are others, of course, like the skin, lungs etc
If inflammation becomes chronic, inflammatory cytokines and other factors can also open the blood-brain barrier (BBB). As a result, unwanted molecules (including dietary proteins and peptides, toxic chemicals, and even infectious agents or their antigens) gain access to the nervous system, causing damage… As a result, autoimmune reactivity to various triggers can occur within brain tissue or the nervous system in general, over a period of exposure from months to years.
Finally, he goes through the various stages of autoimmunity development. The point to note here is just how long it takes to build – 3-10 years in most cases, but it can be much quicker or slower. That is why many people say they were perfectly fine for years and then suddenly BOOM, the symptoms start. I constantly hear patients – and their loved ones – in incredulous and often very disbelieving tones say: “well, I/she/he never had a problem with it before and have eaten it for years, it can’t possibly be that”. But, it actually is, sorry.
Gluten Sensitivity and AutoImmunity Treatment
In terms of treatment, Dr V quite rightly says it is not enough to just identify the presence of the autoimmune antibodies – that we know about, but we have to try and discover the triggers underlying their production. Why are they there?
Note his first trigger, especially in neurological conditions, is gluten and cross-reactive foods. Next comes viruses like Epstein Barr and environmental toxins. There are no doubt others, especially bacterial and yeast infections, heavy metals and stress, in my clinical experience.
I note that in people who test positive to several autoimmune markers, which I have found in the few times I have actually tested this in gluten sensitives, he says you have to repair the body barriers to have any chance of reversing the autoimmune progression:
When testing indicates significant levels of autoantibodies against five, six, or even ten different tissue antigens, it is vital to determine whether that patient is experiencing a problem with intestinal permeability. If leaky gut is present, we must first resolve this condition or we will not be able to reverse the course of autoimmune disease. We must evaluate the gut and blood-brain barriers, try to repair them, and explore potential environmental triggers. It is essential that we look deeper: is it the diet? Infectious agents? Toxic environmental chemicals? Unless we identify underlying exposures and triggers and remove them from the patient’s environment, we will not be able to significantly help our patients.
That is the basis of the whole Barrier Plan. (I am allowing myself a tiny smug feeling at this moment ;))
The difficulty, as we know, is in finding all the triggers and dealing with them! Mine was adrenal flat-lining (should I have found this earlier on the auto-immune marker test, doh!??), emotional stress, toxic metals, periodontal infection and unidentified gluten sensitivity, as far as I know anyway!! I’ve dealt with the adrenals, gluten, cross-reactive foods, stress (?!) and have the infections to go. I feel, despite the rough, tough journey, that I have probably stopped any autoimmune progression that had started. I will be doing the autoimmune tests myself to confirm soon. For now, my priority is the dreaded gum infection which I am well aware is perpetuating the leaky barriers, albeit far less so since the cumulative inflammatory/damage load, if you like, has reduced significantly with the removal of the grains. cross-reactive foods, selected lectins, adrenal support etc etc etc, thank goodness.
In conclusion, a man after my own heart, he says:
the final answer then for the prevention of autoimmune disease is to remove offending food antigens such as gluten from the diet of sensitive individuals; to pay attention to and maintain the balance of the gut microbiota; and to be wary of the viruses, pathogenic bacteria, and toxic chemicals that are responsible for the formation of neoantigens in our bodies.
The Barrier Plan. Although perhaps I need to do more about the environmental toxins side. I will look at that. For now, I have given you a plan to help you:
identify the major triggers such as adrenal fatigue, infections, residual viruses, heavy metals, state of your gut environment (good and ‘bad’ bacteria, SIBO, candida etc etc), other genetic intolerances like histamine, fructose etc and plans to address each one as needed – see the Barrier Breakdown checklist that comes with your Barrier Plan and the various TGF treatment plans (eg candida, adrenal, gut etc) on the Purehealth shop.
an all-encompassing treatment plan to meld the whole thing together and guide you through the maze…
Y’know: I think we’re doing rather well and seem to certainly be on the right track, well done us