What Causes Gluten Illness?

 This is the $60 million question! There are several theories, but the permeability of the gut and other body barriers is the real key to solving the problem, in my opinion, after a lengthy and solid research review of the subject. This is the basis of the Barrier Plan.

The Process As I See It

 Prof Vodjani

In effect, damage to the gut caused by viruses in childhood, gluten in the genetically-susceptible, infections, environmental chemicals etc etc leads to a loss of oral tolerance of food and environmental peptides.

In 80% of people, especially those who are gluten sensitive, it also leads to an upregulation of a substance called zonulin which breaks down the tight junctions in the gut wall, causing a leaky gut.

Celiac-Disease-Leaky-Gut

Gut/Mucosal Immunity Starts

You start to get mucosal immune reactions where you produce antibodies in the gut initially which causes even more gut leakyness. This is the first stage of immune reaction and can be measured. If it weren’t for the zonulin and damage done by the gluten especially, the immune reaction would stay at a mucosal level – in the mucosal area of the gut.

Systemic Inflammation and Immune Reactions Start

The second stage is systemic (in the blood stream) where the food and non-food peptides have gone through the gut wall and a different type of immune reaction starts, with you producing different types of antibodies and immune complexes to them as they are seen as foreign bodies.

This kicks off two main problems in the gluten-sensitive: inflammation causing tissue damage and auto-immunity.

In the latter, because memory cells become involved, you start to react every time the peptide is seen in the blood, and eventually to anything that looks similar to it – a cross-reactive food or your own tissue/cells. Antibodies have been found in villi (coeliac disease), skin (dermatitis herpetiformis) adrenal, thyroid, ovary, brain, heart, kidneys etc so wherever the cross-reaction takes place is where the problem will start to show eventually.

You can see why gluten sensitivity is linked to so many conditions. It is termed by some as a ‘foundational’ disorder ie. at the heart of a lot of diseases, and as a ‘multi-organ-system disorder’ by some immunologists. And most people (and most health professionals) don’t even know about it!

Not Just A Leaky Gut: Broken Body Barriers

The other thing to watch is that zonulin. If we know it can break down the gut tissue junctions, does it not stand to reason that it can make other body barriers leaky too? Our barriers include the blood-brain, gut, lungs and skin. No coincidence then that most gluten sensitives have a problem with poor cognition & memory, neurological issues like anxiety, migraine, muscle and nerve issues, skin, gut symptoms and asthma!

Obviously it is a lot more complicated than that, but that is, in essence, what is believed to happen.

Can We Solve It?

Researcher Alessio Fasano published a paper in 2011 called ‘Leaky Gut and Autoimmune Diseases’. In it, he said:

“The autoimmune process can be arrested if the interplay between genes and environmental triggers is prevented by re-establishing the intestinal barrier function.”

That was a lightbulb moment and, in effect, he is saying that if we strengthen the gut (and other barriers in my opinion), we stop the foods and other antigens getting through to where they shouldn’t be and consequently stop the inflammation and immune processes which get triggered by them. Sounds simple.

He also said that for auto-immunity to develop, there need to be three triggers:

  1. A genetic predisposition (he was talking about the coeliac genes)
  2. An exposure to the environmental trigger (eg gluten in our case)
  3. Increased intestinal permeability (ie the leaky gut)
Fasano is a fantastic coeliac disease researcher and we wouldn’t know half this stuff without him. But I reckon you could actually take that much further. Here’s my version:
  1. A genetic predisposition (all coeliac and non-coeliac gluten sensitivity genes, not just DQ2 and 8 but all DQ genes bar DQ4 have been implicated in gluten illness)
  2. An exposure to the environmental trigger (eg gluten in our case, agreed)
  3. Increased permeability (of the gut first, I have no doubt, but other body barriers are structurally similar and will fall prey to the same problems eventually)

Here’s a nice visual picture of the process from SCD Lifestyle as it is thought to happen in coeliac disease. From ‘Leaky Gut’ bit onwards, it could go anywhere; this just shows the coeliac auto-immunity process:

Leaky Gut Theory of Celiac Disease

I developed the Barrier protocol in the Plan to take into account all of the stages taking place, then sourced and checked all the supplements to ensure they are totally trulyglutenfree, not just gliadin-free. This is one thing that makes the Barrier Plan totally unique and took months and months of research, trial and error to find them. 99% of supplements contain the very substances that cause the problem in the first place, no matter that they say ‘gluten free’ on the label. They are not trulyglutenfree!

The protocol has to take into account the inflammation, immune reactions and leaky gut/barriers, as well as the likely consequences of having long-term unchecked NCGS – malabsorption, nutrient deficiences and system/organ dysfunction eg hypothyroid, hypoadrenia, hypochlorydia – oh yes, one of the antibody links I found was to the stomach parietal cells which begins to explain why so may gluten sensitives are short of stomach acid and hence malabsorbing!

Obviously gluten ingestion in the genetically-sensitive is enough to kick off this problem but there are many other factors we need to consider that affect barrier breakdown specifically.


9 thoughts on “What Causes Gluten Illness?

  1. […] more about why gluten causes migraine, read up about the auto-immune and barrier breakdown process here. And here too is a migraine tip for you. I generally find boosting magnesium levels with the […]

  2. […] What Causes Gluten Illness? […]

  3. You have an interesting speculation about how celiac disease works. What is the key scientific literature that leads you to this conclusion?

    • If you look at this site, you will see I am not talking about coeliac disease, but gluten related disorders like non-coeliac gluten sensitivity and grain problems, which is a whole other ballgame and in very early infancy of being understood or recognised. Except by the people like me who suffer with it, unfortunately!

  4. Thanks, Micki.
    A recent study by the Fasano group found that gut permeability was DECREASED in patients who had non-celiac gluten sensitivity. We discussed this in an article last year:
    http://ultimateglutenfree.com/2011/04/mechanism-gluten-sensitivity-celiac-disease/
    This work provides further evidence that “gluten sensitivity” is quite distinct from celiac disease (although the precise mechanism is still unclear). While increased gut permeability may be a consequence of celiac disease, its importance in health is unclear. (Exceptions would include trauma, major blood loss, systemic bacterial infections—none of which are relevant to gluten).

    • Thanks Peter, interesting. I shall have a close look at the research. We have so much to learn about gluten illness. I would immediately say that the fact that gluten is known, by Fasano’s own research, to upregulate zonulin which controls the tight junctions of the barriers seems to fly in the face of this finding, but perhaps there is a genetic aspect to it – and I haven’t read the full report yet. Ta.

      • Have now looked at it. Can’t promise to understand it all, of course, I am not a researcher.

        First, I note they were using the lactulose mannitol test which has been found to be unreliable even in coeliac disease, especially silent and early types. I advise against using this test because the lactulose is dairy and the mannitol is corn-derived anyway, which wouldn’t suit my truly gluten free grain sensitive people.

        My other thought really is that this paper suggests it is an innate immune response going on in gluten sensitivity – which they describe only in terms of gut symptoms – but for an innate immune response to take place, as I understand it, there has to have been some breach of a barrier for the body to see the food as a foreign invader and trigger this protective response. It also doesn’t make sense when you think of all the gluten related symptoms which have nothing to do with the gut. Most of us suffer myriad symptoms as a result of ingesting gluten – not least neurological like migraine and tinnitus, pain in limbs, skin problems etc. If there was no breach of even initially the bowel barrier, how would there be such distant reactions nowhere near the gut, for example? It has to affect other barriers like the blood-brain and be in the bloodstream for the initial inflammatory (even at the innate stage) response to occur.

        It’s a minefield and I don’t pretend to understand the complex immune mechanisms going on – and we have far more research to do on all forms of gluten illness in my view. Interesting, though, and thank you for pointing me to it. I will keep my eye out for further research and read some more around this.

  5. […] a read from Truly Gluten Free’s fantastic article on the leaky small intestine.  They simplified the process, speak on inflammation, and discuss […]

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