Jump to content



Celiac.com Sponsor (A1):



Celiac.com Sponsor (A1-m):


  • You've found your Celiac Tribe! Join our like-minded, private community and share your story, get encouragement and connect with others.

    💬

    • Sign In
    • Sign Up
  • Dr. Tom O'Bryan
    Dr. Tom O'Bryan

    Gluten and Autoimmunity

    Reviewed and edited by a celiac disease expert.

    No Human Can Fully Digest Wheat! It’s inflammatory to All of us.

    Gluten and Autoimmunity - Image: CC BY 2.0--geopungo
    Caption: Image: CC BY 2.0--geopungo

    Celiac.com 06/19/2020 (Revised 06/24/2020) - It is not uncommon to have received blood testing from your doctor to see if you have celiac disease, and it comes back negative, when in fact your body is actually having a problem and you are on the celiac spectrum. The tests most doctors use to determine whether or not someone has celiac disease are very accurate for end stage celiac disease-after you have total villous atrophy, but not earlier stages of the disease (1). In those earlier situations, these tests often come back negative, even though you truly have a problem and are reacting to wheat moving towards total villous atrophy (1, 2, 3, 4, 5). It’s the wrong test.

    If you have an earlier stage in terms of the amount of damage incurred, the standard blood tests can be wrong over 70% of the time giving false negatives

    Standard blood tests for celiac disease have been extremely accurate and dependable if a person has total villous atrophy celiac disease. However, the accuracy of the blood test results for the two accepted blood markers (Endomysium and Tissue Transglutaminase) with anything less than total villous atrophy drops tremendously (to as low as being wrong 7 out of 10 times) (8,9). The reason these tests are often wrong in some people is that the research to validate the test used subjects who all had been diagnosed with celiac disease which by definition was total villous atrophy (Marsh IIIa,b,c). The earlier stages, Marsh 1 and 2 by most are considered ‘potential celiac disease’. So, when researchers were looking to validate if their blood tests were accurate in diagnosing celiac disease, they tested the blood of people diagnosed with celiac disease (total villous atrophy). And in that scenario, endomysium and tissue transglutaminase are highly accurate.



    Celiac.com Sponsor (A12):






    Celiac.com Sponsor (A12-m):




    dr_tom_chart_1.jpg
    from Lerner A, Jeremias P, Neidhöfer S, Matthias T (2017) Comparison of the Reliability of 17 Celiac Disease Associated Bio-Markers to Reflect Intestinal Damage. J Clin Cell Immunol 8: 486.

    dr_tom_chart_2.jpg
    from Lerner A, Jeremias P, Neidhöfer S, Matthias T (2017) Comparison of the Reliability of 17 Celiac Disease Associated Bio-Markers to Reflect Intestinal Damage. J Clin Cell Immunol 8: 486.

    Why? Celiac disease is defined as total villous atrophy. However, you don’t just magically go to sleep one night fine and wake up the next morning with total villous atrophy celiac disease. This disease, like all diseases, needs to be looked at more as a spectrum. That’s why Prof. Michael Marsh identified the spectrum of celiac disease development (Marsh I, II, III a, b, c). Bottom line? The test for total villous atrophy celiac disease (Marsh III a, b, c) are not the tests to rely on for earlier phases of the spectrum (Marsh I, II). 

    The end result is many people have been told they do not have celiac disease and wheat is not a problem continue eating this food that is leading them further down the path of autoimmune disease. And of course, the tests for celiac disease are NOT the tests for the spectrum of Wheat Related Disorders (9).

    Predictive autoimmunity can tell you what areas of your body are under attack. Identifying an autoimmune mechanism early in the spectrum of development gives an opportunity to address it before there is so much tissue damage, now you have an autoimmune disease. Autoimmunity is the number 3 cause of death and highly preventable. If you could peek inside and determine what is going on before it does irreparable damage, it gives you a window of opportunity to address the problem early on and change the course of your health. This is called Predictive Autoimmunity (30). Identifying that you are on the celiac spectrum at Marsh I, gives you the opportunity to take action (gluten-free diet) and prevent progressing to Marsh III total villous atrophy. So the tests that are highly accurate for Marsh III are the wrong tests for Marsh I and II. They may be helpful and they may be misleading

    Gluten, Autoimmunity, and Your Gut

    Dr. Alessio Fasano is the chair of pediatric gastroenterology at Mass. General Hospital, Harvard, and director of Mucosal Immunology and Biology Research Center at Mass General Hospital for Children. He has done extensive research in the area of mucosal lining of the gut. He discovered, in the early 2000’s, a trilogy present in the development of autoimmunity: genetics, triggers, and intestinal permeability. (10) With celiac, we all know this – DQ2/DQ8, gluten, leaky gut = vulnerability to developing celiac disease.

    In the last 15 years, research has continued to expand to include two more features - thus a total of 5 components in the development of autoimmune diseases. In addition to genetics, environmental triggers and intestinal permeability, we now know that a dysbiotic microbiome and a systemic inflammatory immune response are involved. (11)

    This is important in our understanding of treatment. You can arrest the development of autoimmunity by healing the gut and addressing intestinal permeability. The majority of people with leaky gut do not show symptoms in the gut. A leaky gut spews out macromolecules into the blood stream that travel throughout your body that are considered foreign objects that your immune system will protect you from. And the resulting systemic inflammation from a leaky gut can affect any area of your body. And what are the most common triggers that will trigger a leaky gut? Gluten and small intestinalal bacteria overload. (11)

    Dangers of a Gluten-Free Diet

    Now this is a ‘Big Picture’ concept, but when you read the science it is clear that no one can fully digest the proteins in wheat (11, 12, 13, 14). It is indigestible to all humans, and in every single person causes a transient state of intestinal permeability (12, 13). Having said that, not everything about wheat is bad. Wheat (78%) and barley (3%) account for 78 - 81% of total prebiotics in the Western diet (14, 15, 16). When you remove wheat from your diet, a large percentage of the good bacteria will likely starve. This may be a contributing factor to the jaw-dropping statistic from the largest study ever done on mortality and celiac disease, that being diagnosed with celiac disease is associated with an 86% increased risk of mortality from a cardiovascular incident within 1 year (18). Just by being diagnosed. As far as I know, no one has pursued further research on this fact. What is different after diagnosis? People go on a gluten-free diet. What else? For most people, nothing else-they just stat eating gluten-free foods. You MUST be conscious of replacing the loss of prebiotics in your diet. Replacing wheat-based products with gluten-free products is a landmine. The vast majority of gluten-free products do not have prebiotic fibre, are not enriched, and are just tasty white paste. There’s nothing wrong with a gluten-free blueberry muffin once in a while, or gluten-free pasta on occasion. But these products are not healthy for you and can NOT be the cornerstone of your new diet. Be mindful of this at the onset of starting your gluten-free diet, so that you replenish your body with the necessary prebiotic nutrients your microbiome needs to increase diversity and balance. (14) 

    So many people make the same newbie mistakes of just shopping in the gluten-free aisle and walk away with gluten-free cookies and snacks. I’m sorry to say that those are pretty much just as unhealthy, or worse, than the gluten versions. They just lack the antigen gluten.

    You need to look towards the produce aisle, vary your food choices from day to day, eat a wide variety in colour and types of organic fruits and vegetables, eat fermented foods rich in probiotics, and feed that good bacteria in your gut with foods that are prebiotics (root vegetables daily).  

    I highly recommend finding a Certified Gluten-free Practitioner (CGP) who has received extensive training in celiac disease, gluten sensitivities, wheat-related disorders and autoimmunity. That is the most comprehensive training out there in this area. Find a CGP in your area-they’re all over the world, and most do on-line private consults.

    Addressing the intestinal permeability that has been developing with every exposure to wheat (12), within 5 minutes of wheat coming out of the stomach into the small intestine (20), is a game-changer in your overall health. There are over 300 autoimmune conditions. With the ‘Gateway’ in the development of autoimmune diseases being intestinal permeability, addressing this, and focusing on healing the gut can bring big rewards. 

    Heal the Gut

    • Identify and eliminate your triggers.
    • Reduce inflammation.
    • Reduce stress.

    The following supplements all have many studies showing their value in addressing intestinal permeability: Glutamine (21), Fish oils (22), Vitamin D (23), Colostrum (24), Turmeric (25), Pre (26) and Probiotics (27). Each of these basic nutrients modulates (has their hands on the steering wheel) of genes to reduce inflammation achieving a similar end goal, but they each work in different ways. Using a pleiotropic approach ensures success (great scrabble word-pleiotropic-means ‘all roads lead to Rome’.

    When you have a gluten-related disorder, the treatment is a strict gluten-free diet - without exception. Don’t let the treatment be the trigger for more problems. I’m known for the saying “You can’t be a little pregnant, you can’t have a little gluten” (if your immune system is activated fighting any of the peptides of wheat). Cheating once-per-month increases your risk of early death 6-fold! (19)

    Take measures to protect yourself against nutritional and vitamin deficiencies associated with a gluten-free diet. The benefits of a ‘Coach’ to learn the correct basics through this transition cannot be overemphasized (28, 29). A CGP, Nutritionist, trained Registered Dietician, Health Coach, … are invaluable in you learning the basics of this transition into a new way of eating. Eat different colors of the rainbow at every meal, every day. It will help restore balance to your gut health and rebalance your immune system.

    If you’re going to do this alone, avoid wheat (gluten), dairy, and added sugar for a month. Eat nutrient dense organic foods, such as quinoa, amaranth, vegetables, and quality meats. Gauge how you feel. Is your weight better managed? Do your hands and feet no longer feel cold? Are you able to think more clearly? If so, continue to eliminate those offending foods and eat a varied diet rich in nutrients. If you reintroduce and notice a problem, now you know those were foods that are inflammatory to you. And be careful of your tricky mind. Humans are the only species on the planet that finds something that works, and they stop doing it! 

    References:

    1. Lerner A, Jeremias P, Neidhöfer S, Matthias T (2017) Comparison of the Reliability of 17 Celiac Disease Associated Bio-Markers to Reflect Intestinal Damage. J Clin Cell Immunol 8: 486
    2. Immunoglobulin A autoantibodies against transglutaminase 2 in the small intestinal mucosa predict forthcoming coeliac disease.
    3. Salmi TT, Collin P, Järvinen O, Haimila K, Partanen J, Laurila K, Korponay-Szabo IR, Huhtala H, Reunala T, Mäki M, Kaukinen K.Aliment Pharmacol Ther. 2006 Aug 1;24(3):541-52
    4. Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease. Brar P, Kwon GY, Egbuna II, Holleran S, Ramakrishnan R, Bhagat G, Green PH.Dig Liver Dis. 2007 Jan;39(1):26-9
    5. Seronegative celiac disease: increased prevalence with lesser degrees of villous atrophy. Abrams JA, Diamond B, Rotterdam H, Green PH.Dig Dis Sci. 2004 Apr;49(4):546-50
    6. Utility in clinical practice of immunoglobulin a anti-tissue transglutaminase antibody for the diagnosis of celiac disease. Abrams JA, Brar P, Diamond B, Rotterdam H, Green PH.Clin Gastroenterol Hepatol. 2006 Jun;4(6):726-30
    7. Tests for Serum Transglutaminase and Endomysial Antibodies Do Not Detect Most Patients With Celiac Disease and Persistent Villous Atrophy on Gluten-free Diets: a Meta-analysis. Silvester JA, Kurada S, Szwajcer A, Kelly CP, Leffler DA, Duerksen DR.Gastroenterology. 2017 Sep;153(3):689-701
    8. Screening for celiac disease.Lebwohl B, Green PH.N Engl J Med. 2003 Oct 23;349 (17):1673-4
    9. Joint BAPEN and British Society of Gastroenterology Symposium on 'Coeliac disease: basics and controversies'. Coeliac disease in the twenty-first century. Dickey W. Proc Nutr Soc. 2009 Aug;68(3):234-41.
    10. Mechanisms of disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases. Fasano A, Shea-Donohue T. Nat Clin Pract Gastroenterol Hepatol. 2005 Sep;2(9):416-22.
    11. Fasano A. All disease begins in the (leaky) gut: role of zonulin-mediated gut permeability in the pathogenesis of some chronic inflammatory diseases. F1000Res. 2020;9:F1000 Faculty Rev-69. Published 2020 Jan 31. doi:10.12688/f1000research.20510.1.
    12. Celiac Disease and Nonceliac Gluten Sensitivity: A Review. Leonard MM, Sapone A, Catassi C, Fasano A. JAMA. 2017 Aug 15;318(7):647-656.
    13. Effect of gliadin on permeability of intestinal biopsy explants from celiac disease patients and patients with non-celiac gluten sensitivity. Hollon J, Puppa EL, Greenwald B, Goldberg E, Guerrerio A, Fasano A.Nutrients. 2015 Feb 27;7(3):1565-76.
    14. Lerner A, O'Bryan T, Matthias T. Navigating the Gluten-Free Boom: The Dark Side of Gluten Free Diet. Front Pediatr. 2019;7:414. Published 2019 Oct 15. 
    15. Effects of a gluten-free diet on gut microbiota and immune function in healthy adult Human subjects - comment by Jackson. Jackson FW. Br J Nutr. 2010 Sep;104(5):773.
    16. On the presence of Inulin and Oligofructose as natural ingredients in the western diet Jan Van Loo , Paul Coussement , Leen De Leenheer , Hubert Hoebregs & Georges Smits Critical Reviews in Food Science and Nutrition, Volume 35, 1995 - Issue 6.
    17. Prebiotic effects of wheat arabinoxylan related to the increase in bifidobacteria, Roseburia and Bacteroides/Prevotella in diet-induced obese mice. Neyrinck AM, Possemiers S, Druart C, Van de Wiele T, De Backer F, Cani PD, Larondelle Y, Delzenne NM. PLoS One. 2011;6(6):e20944.
    18. Small-intestinal histopathology and mortality risk in celiac disease. Ludvigsson JF, Montgomery SM, Ekbom A, Brandt L, Granath F., JAMA. 2009 Sep 16;302(11):1171-8.
    19. Mortality in patients with coeliac disease and their relatives: a cohort study. Corrao G, Corazza GR, Bagnardi V, Brusco G, Ciacci C, Cottone M, Sategna Guidetti C, Usai P, Cesari P, Pelli MA, Loperfido S, Volta U, Calabró A, Certo M; Club del Tenue Study Group.Lancet. 2001 Aug 4;358(9279):356-61.
    20. Confocal endomicroscopy shows food-associated changes in the intestinal mucosa of patients with irritable bowel syndrome. Fritscher-Ravens A, Schuppan D, Ellrichmann M, Schoch S, Röcken C, Brasch J, Bethge J, Böttner M, Klose J, Milla.  PJ.Gastroenterology. 2014 Nov;147(5):1012-20.
    21. Glutamine and the regulation of intestinal permeability: from bench to bedside. Achamrah N, Déchelotte P, Coëffier M.Curr Opin Clin Nutr Metab Care. 2017. Jan;20(1):86-91
    22. Potential of Omega-3 Polyunsaturated Fatty Acids in Managing Chemotherapy- or Radiotherapy-Related Intestinal Microbial Dysbiosis. Zhang Y, Zhang B, Dong L, Chang P.Adv Nutr. 2019 Jan 1;10(1):133-147.
    23. Novel role of the vitamin D receptor in maintaining the integrity of the intestinal mucosal barrier. Kong J, Zhang Z, Musch MW, Ning G, Sun J, Hart J, Bissonnette M, Li YC.Am J Physiol Gastrointest Liver Physiol. 2008 Jan;294(1):G208-16.
    24. Peptide Immunotherapy: Colostrum, A Physician's Reference Guide Hardcover, Keech A., AKS Publishing; 1St Edition edition (2009) ISBN-10: 0692002421.
    25. Potential therapeutic effects of curcumin, the anti-inflammatory agent, against neurodegenerative, cardiovascular, pulmonary, metabolic, autoimmune and neoplastic diseases. Aggarwal BB, Harikumar KB.Int J Biochem Cell Biol. 2009 Jan;41(1):40-59.
    26. Modulation of the gut microbiota by nutrients with prebiotic properties:  consequences for host health in the context of obesity and metabolic syndrome. Delzenne NM, Neyrinck AM, Cani PD.Microb Cell Fact. 2011 Aug 30;10 Suppl 1(Suppl 1):S10
    27.  Gut Microbiota in Celiac Disease: Is There Any Role for Probiotics?  Pecora F, Persico F, Gismondi P, Fornaroli F, Iuliano S, de'Angelis GL, Esposito S.Front Immunol. 2020 May 15;11:957.
    28. Factors that influence adherence to a gluten-free diet in adults with celiac disease. Leffler DA, Edwards-George J, Dennis M, Schuppan D, Cook F, Franko DL, Blom-Hoffman J, Kelly CP.Dig Dis Sci. 2008 Jun;53(6):1573-81.
    29. Gluten-free diet: the medical and nutrition management of celiac disease. See J,  Murray JA.Nutr Clin Pract. 2006 Feb;21(1):1-15.
    30. Predicting and preventing autoimmunity, myth or reality? Harel M, Shoenfeld Y.Ann N Y Acad Sci. 2006 Jun;1069:322-45.

     



    User Feedback

    Recommended Comments

    Guest where is the update that i

    Posted

    I respect Dr. O'Bryan and would like to see the responses he made.  My celiac was discoverd by anti Ttg.  back in 1990.  I was thankful for that lead. I also have studied Dr. 0'Bryan's work as well as Dr. Fasano and Dr. Green and many others.  I have appreciated the web sources as the local "experts" were clueless back then.

     

    Link to comment
    Share on other sites

    I think some of this article really states the reality of gluten in the body. No matter who you are you are not able to digest gluten, so do we really need to question anything else. Any information is worth taking note to, doesn't mean it is all correct but at least more and more research is being done. Take what you want from it and leave the rest.

    Link to comment
    Share on other sites


    Join the conversation

    You are posting as a guest. If you have an account, sign in now to post with your account.
    Note: Your post will require moderator approval before it will be visible.

    Guest
    Add a comment...

    ×   Pasted as rich text.   Restore formatting

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • About Me

    Dr. Tom O'Bryan

    Dr. Tom O'Bryan, founder of theDr.com, is an internationally recognized speaker, best-selling author, and autoimmune expert. Bringing insight with compassion and common sense to the complexities of immune health, he is the modern day Sherlock Holmes for chronic diseases.

    Having trained tens of thousands of practitioners around the world, his work around wheat-related conditions, identifying triggers for autoimmunity, and eliminating toxins for health have taken center stage.

    His empowering message of healing echoes throughout his best selling book The Autoimmune Fix, his latest best seller How to Fix Your Brain, his 9-part Betrayal docuseries, and his podcast event The Gluten Summit - A Grain of Truth.

    He demonstrates that changing the microbiome (regenerating a healthy environment in the body), and changing the microbiome within our soil (regenerative agriculture) creates incremental and powerful changes to our health. In fact, these changes are vital to the health of both the patient and the planet.


  • Celiac.com Sponsor (A17):
    Celiac.com Sponsor (A17):





    Celiac.com Sponsors (A17-m):




  • Related Articles

    Dr. Tom O'Bryan
    Celiac.com 04/12/2019 - In this 4-part Series, we’re going to look at the world of gluten sensitivity, what the current science tells us, the frustrations gluten sensitive and celiac patients often experience, and how to use the science in getting healthier. 
    Part 1: Why the Tests are Often Wrong Part 2: Why Don’t I Feel Great on a gluten-free diet: Cross-Reactive foods Part 3: Why Don’t I Feel Great on a gluten-free diet: the Intestinal Milieu Part 4: Why Don’t I Feel Great on a gluten-free diet: Invaders in the House Many of us believe that the toxic peptides of gluten found in wheat, rye and barley may detrimentally affect any tissue in the body and are not restricted to the intestines. As a matter-of-fact, one of the ‘mantras’ of the Gluten Sensitivity Network comes from an 8-year old article: “That gluten sensitivity is regarded as principally a disease of the small bowel is a historical misconception.(1)” There is a key word in this statement which I suspect emphasizes the Author’s message and sets the tone for this article (and this network movement). That key word is ‘principally’.  Is Gluten sensitivity ‘principally’ a disease of the small intestine? Point-blank answer-no, it is not. For every Gluten sensitive patient with the symptoms of an enteropathy (classic celiac disease), there are 8 more with no GI symptoms(2, 3). 
    And the importance of recognizing this? Unfortunately, too many doctors will tell their patients that if the intestinal symptoms are not severe, or if there is no advanced intestinal damage (total villous atrophy), then the patient does not need to be vigilant in avoiding gluten exposure at all costs(4). Many patients are advised to follow the World Health Organization or Food and Agricultural Organization Codex Alimentarius gluten-free diet, which allow up to 0.3% of gluten per 100 g of protein in foods, whereas others follow a strict GFD with no detectable gluten. However, trace amounts of gluten may be responsible for persistent symptoms in some patients with celiac disease. Up to 75% of patients with persistent symptoms despite a World Health Organization or Food and Agricultural Organization Codex Alimentarius gluten-free diet will improve when put on a ‘‘no detectable gluten’’ diet(5).
    We know that for gluten-sensitive patients, eating gluten will cause inflammation in the intestines, and often in other parts of the body(6, 7, 8, 9).  The importance of ‘quieting down’ the inflammatory cascade from gluten exposure? Mortality in celiac patients is highest (6-fold higher) in those not adherent to a gluten-free diet. Non-adherence to a gluten-free diet was defined as eating gluten once-per-month(10). Vigilance is paramount. You can’t be a little pregnant. There is no convincing evidence that you can have a little gluten if you have gluten sensitivity.
    The ‘conundrum of gluten sensitivity’ is when patients know they have a problem with wheat, their doctors run the standard blood profile, and one of two things happens:
    -IgA anti-transglutaminase or anti-endomysial antibodies come back negative(11), or;  -IgA anti-transglutaminase or anti-endomysial antibodies  come back negative and  anti-gliadin, or anti-deamidated gliadin antibodies come back positive and the doctor tells the patient “it’s okay to eat wheat because the tissue antibodies are negative”. The patient is left in a state of confusion. They don’t WANT to give up wheat. After all, they believe it’s a staple of life. And their doctor says it’s okay to eat it. Yet they know they don’t feel as well when they eat it. So many will rationalize “Oh well, it must be the stress of my life making me feel bad”, and they order their bagel. That’s the conundrum. Where’s the problem? The problem is the test. Gluten sensitivity is a systemic autoimmune disease with diverse manifestations(12). Celiac disease, or gluten-sensitive enteropathy, is only one aspect of a range of possible manifestations of gluten sensitivity. And yet, this enteropathy, ‘one of the most common lifelong disorders in both the U.S. and Europe(13), receives the lion’s share of focus to the point of ignoring other manifestations. Auto-immune disease, the 3rd leading cause of morbidity and mortality in the industrialized world(14), is ten times more common in a gluten sensitive enteropathy than in the general population(15). The correlation is undeniable. The exact mechanisms of how this correlation manifests is being investigated intensively. What we can say, with a good deal of research behind us, is that the toxic peptides of gluten may act as a trigger in the development of the auto-immune mechanism (the immune system attacking our own tissues). Traditionally, doctors do not recognize this connection and wait for the accumulated damage from the immune system attacking our tissue (our thyroid, or our brains, or our skin, or…), they wait until the damage is extensive enough that there are obvious symptoms, and then we receive a diagnosis of an auto-immune disease (celiac disease, Hashimoto’s thyroiditis, type 1 diabetes, systemic lupus, inflammatory bowel disease, inflammatory skin diseases, ….)(16). Thus, the burden on society imposed by gluten sensitivity is difficult to overestimate. Earlier identification might result in earlier treatment, better quality of life and an improved prognosis for these patients(17).
    The diagnosis of gluten sensitivity has been proposed to include not just intestinal damage (celiac disease), but also gluten-reactive patients without intestinal lesions. From the skin (dermatitis herpetiformis, psoriatic arthritis, alopecia areata, dermatomyositis, cutaneous vasculitis,), to the muscles (inflammatory myopathies), to the brain (gluten ataxia, altered neurotransmitter production, schizophrenia, anxiety, depression, attention deficit disorders,…) to the nerves (peripheral neuralgias, carpal tunnel syndrome, idiopathic neuropathies,…),  and beyond. Pathology in response to gluten exposure can occur in multiple systems without evidence of intestinal damage(18-27). 
    Now, what about this conundrum?
    The tests are negative, yet the person feels better when they do not eat gluten. Many studies have validated the sensitivity and specificity using anti-endomysial and/or anti-transglutaminase antibody testing to identify celiac disease(28, 29). This means that the science says these tests are very, very accurate. Then how is there a conundrum? Here’s the problem: the definition of celiac disease requires total villous atrophy(30). Not partial villous atrophy; not increased inflammation without any visible atrophy. The definition of celiac disease requires total villous atrophy. Thus, when researchers look at populations who have celiac disease confirmed by biopsy, and look to see how accurate the blood tests are, they come up with percentages above 95%, because they’re only including people who have total villous atrophy in their study group-because that’s the definition of celiac disease. If we were to expand the definition of celiac disease to include those with partial villous atrophy, or include those who currently show only the mechanism that wears down the villi  (increased intraepithelial lymphocytes), then the sensitivity and specificity of anti-endomysial or anti-transglutaminase goes down, in some studies dramatically down, to as low as 27-32%(31, 32, 33, 34). 
    So do we want to base our health guidance and decisions on blood tests that are limited to identifying celiac disease at its end stage of intestinal deterioration (total villous atrophy)(35, 36)? Or would we want to include testing that has a much bigger picture in mind and identifies gluten sensitivity inside and outside the intestines and at earlier stages?
    If we recognize the fact that gluten sensitivity may manifest as celiac disease, or it may manifest outside of the intestines(37), one of the ways of expanding our diagnostic range is to focus on whether or not our immune system is saying that gluten is a problem. We may know where the problem is manifesting, or we may not. But if our immune system is saying “We’ve got a problem here”, it is likely worth listening to. 
    As a comparison, if your car is running fine on the highway at 60 miles per hour, do you listen when the immune system of the car (the dashboard gauges) says “we’ve got a problem here”, and the hot light has lit up, or do we say “the car’s running fine-I don’t see or feel any problem”, and keep driving? I think most would agree that is not a very wise move. The same is true for your body. You may ‘feel’ a problem; you may not. We’ll talk more about that in a future article. For now, the point I want to make is that we will benefit from ‘listening’ to what our immune system is saying to us. We just have to be able to hear what it’s trying to say.
    The problem is accurate communication
    The current blood test that every laboratory offers in looking for an immune reaction to the gluten fraction of wheat is elevated antibodies to gliadin or deamidated gliadin - every laboratory. And there are many studies that have shown that looking for elevated antibodies to gliadin is not as accurate in identifying celiac disease as looking for elevated antibodies to transglutaminase or endomysial antibodies. Why? Because sometimes the antibodies to gliadin are positive and the biopsy shows there is no celiac disease. And sometimes the gliadin antibodies are negative and the biopsy shows there is celiac disease. Thus, the consensus in the scientific community is that looking for antibodies to wheat (gliadin) is not sensitive enough when looking for celiac disease. You can’t rely on it. 
    Now that doesn’t make much sense, does it? If the gluten peptide is the problem, why can’t we measure the immune reaction to it when other gauges on the dashboard are hot? Two reasons:
    Researchers tell us it is “inappropriate” to compare gliadin antibodies against transglutaminase or endomysial antibodies because gluten sensitivity can exist without villous atrophy. Thus the gliadin antibodies may be elevated (and often are) without recognizable celiac disease. It’s showing us a bigger problem than just Celiac disease. They’re not ‘false positives’. It’s the immune system saying “we’ve got a problem here” that is not currently manifesting in the intestines-it is likely manifesting somewhere else, such as in the brain or the nervous system(38). Identifying antibodies just against the fraction of gluten called gliadin is not thorough enough in looking for an immune reaction to gluten(39). Amino acids are the building blocks of protein. When we eat protein, any protein, it’s the job of the digestive system to break down that protein into 1, 2, or at most 3 amino acid peptides that are easily absorbed into the blood stream through the ‘cheesecloth’ of the intestines. When someone has gluten sensitivity, the gluten molecules in wheat, barley and rye are not digested into small enough molecules to easily fit through the cheesecloth, be absorbed into the blood stream, and they remain in larger peptides, sometimes very large peptides. These large peptides, called macromolecules, trigger the immune system to say “these are not good for me(40, 41)”. An exposure to a large peptide on a rare occasion would not likely have initially been a problem. But with pancakes for breakfast, a sandwich for lunch, pasta for dinner, toast for breakfast, a sandwich for lunch, croutons on the salad at dinner, day in and day out, eventually you’ve got a hot light on the dashboard that is reaching the critical stage(42). Then ‘boom’ your engine overheats and you begin to notice symptoms-perhaps in the intestines, perhaps in the joints, perhaps in the skin, perhaps in the skull (depression, anxiety, headaches), perhaps fatigue,…..
    So let’s get back to the large peptides left in the intestines due to an inability to digest the gluten molecule. We know there are many peptides of gluten result from poor digestion(43). One study identified over 60 putative peptides of gluten(44). Yet the current blood tests only test for one - gliadin. Studies have said that gliadin is the primary toxic peptide. But, only about 50% of celiac patients have antibodies to the gliadin peptide of gluten(39). The rest of the celiacs don’t. They have antibodies to other peptides of gluten(45). This is the reason for the conundrum-you test for it, the test only looks for antibodies to gliadin, the test comes back negative, and yet you ‘know’ you feel better off of gluten. It’s the test! In that example, the person does not react to the gliadin peptide-they are likely to be reacting to a different peptide of gluten.
    Why don’t laboratories test for other peptides of gluten?
    Good question. I do not know the answer to that. Some of the studies on this go back to the mid 1990’s. Probably a supply and demand issue for commercial laboratories.
    Well, no longer.
    There is a new blood test, looking at 12 different peptides of gluten-not just Gliadin. You can go to www.cyrexlabs.com or to my web site www.theDr.com to read more about this test. Looking at antibodies to 12 different peptides of gluten (including gliadin) will certainly increase the detection rate of the immune system saying “we’ve got a problem here with gluten”. We know celiac disease is due to sensitivity to the peptides of gluten found in wheat, barley and rye, many of the peptides in gluten-not just to gliadin. And now, another diagnostic tool has been added to your doctor’s repertoire assisting in accurately identifying gluten sensitivity with or without the serious end-stage of tissue destruction-total villous atrophy.
    And my personal prayer is that as a result of this expanded test looking for a reaction to gluten, we no longer miss those with earlier stages of celiac disease and gluten sensitivity thus being able to calm down the ‘fire in the belly’, the hot light on the dashboard, before the engine blows up. Before the diagnosis of attention deficit hyperactivity disorder, before the diagnosis of autoimmune thyroid disease, before the diagnosis of type 1 diabetes, before the diagnosis of migraines, before the loss of a pregnancy,…. and doctors will have the tools to truly guide their patients in increasing their health - tuning the engine before it blows up with a diagnosable disease. So our bodies can carry us through life purring instead of rumbling along.
    References:
    1.    Hadjavassilios, M., Gluten sensitivity as a Neurological illness, J Neurol Neurosurg Psychiatry 2002;72:560–563 
    2.    van Heel D., West J, Recent Advances in Coeliac Disease, Gut 2006;55:1037–1046
    3.    Fasano A, Catassi C., Current Approaches to Diagnosis and Treatment of Celiac disease: An Evolving Spectrum Gastroenterology 2001;120:636-651 
    4.    Goddard CJ., Gillett H R., Complications of coeliac disease: are all patients at risk? Postgrad. Med. J. 2006;82;705-712
    5.    Green PHR, Stavropoulos SN, Panagi SG, et al. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gasroenterol 2001;96:126–31.
    6.    Olesen M, Eriksson S, Bohr J, Jarnerot G, Tysk C. Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993-1998. Gut, 2004; 53:346-350.
    7.    Gillet HR, Freeman HJ. Prevalence of celiac disease in collagenous and lymphocytic colitis. Can J Gastroenterol, 2000; 14: 919-921.
    8.    Koskela RM, Niemelä SE, Karttunen TJ, Lehtola JK. Clinical characteristics of collagenous and lymphocytic colitis. Scand J Gastroenterol, 2004;39: 837-845.
    9.    Dickey W, Celiac disease and the Colon, PRACTICAL GASTROENTEROLOGY • SEPTEMBER 2008
    10.    Corrao G, Corrazza GR, Bagnardi V, et al. Mortality in patients with coeliac disease and their relatives: a cohort study. Lancet 2001;358:356–61.
    11.    Hill I Salem W, Dirks M, Liptak G, Colletti R , Fasano A, Guandalini S, Hoffenberg E, Horvath K, Murray J, Pivor M, Salem W, Seidman E, Guideline for the Diagnosis and Treatment of Celiac disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, J Pediatr Gastroenterol Nutr, Vol. 40, No. 1, January 2005
    12.    Hadjavassilios, M, Gluten sensitivity: from Gut to Brain. Lancet Neurol 2010; 9: 318–30
    13.    Fasano, A, Celiac disease-How to handle a Clinical Chameleon, NEJM 348;25 June 19,2003
    14.    Arnson Y, Amital H, and Shoenfeld Y, Vitamin D and autoimmunity: new aetiological and therapeutic considerations, J of Immunology, 2005, 175: 4119–4126.
    15.    Alaedini A, Okamoto H, Briani, C, Wollenberg K, Shill H, Bushara K, Sander H,  Green P, Hallett M, Latov N, Immune Cross-Reactivity in Celiac disease: Anti-Gliadin Antibodies Bind to Neuronal Synapsin I, The Journal of Immunology, 2007, 178: 6590–6595.
    16.    Bland J., Understanding the Origins and Applying Advanced Nutritional Strategies for Autoimmune Disease, Metagenics Seminar Series, 2006
    17.    Green P, Alaedini A, Sander HW, Brannagan III TH, Latov N, Chin R, Mechanisms underlying celiac disease and its Neurologic Manifestations Cell. Mol. Life Sci. 62 (2005) 791–799
    18.    Marietta E, Black K, Camilleri M, Krause P, Rogers RS 3rd, David C, Pittelkow MR, Murray JA., A new model for dermatitis herpetiformis that uses HLA-DQ8 transgenic NOD mice, J Clin Invest. 2004 Oct;114(8):1090-7
    19.    Lindqvist U, Rudsander A, Boström A, Nilsson B, Michaëlsson G., IgA antibodies to gliadin and coeliac disease in psoriatic arthritis, Rheumatology (Oxford). 2002 Jan;41(1):31-7.
    20.    Humbert P, Pelletier F, Dreno B, Puzenat E, Aubin F, Gluten intolerance and skin diseases, Eur J Dermatol 2006; 16 (1): 4-11
    21.    Selva-O’Callaghan A, Casellas F, de Torres I, Palou E, Grau-Junyent JM, Vilardell-Tarrés M., CELIAC DISEASE AND ANTIBODIES ASSOCIATED WITH CELIAC DISEASE IN PATIENTS WITH INFLAMMATORY MYOPATHY, Muscle Nerve. 2007 Jan;35(1):49-54.
    22.    Hadjivassiliou M, Grünewald R, Sharrack B, Sanders D, Lobo A, Williamson C, Woodroofe N, Wood N, Davies-Jones A., Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics, Brain. 2003 Mar;126(Pt 3):685-91.
    23.    Hadjivassiliou M, Aeschlimann D, Grünewald RA, Sanders DS, Sharrack B, Woodroofe N, GAD antibody-associated neurological illness and its relationship to gluten sensitivity, Acta Neurol Scand. 2010 Apr 15
    24.    Eaton W, Mortensen PB, Agerbo E, Byrne M, Mors O, Ewald H., Coeliac disease and schizophrenia: population based case control study with linkage of Danish national registers, BMJ. 2004 Feb 21;328(7437):438-9
    25.    Hadjivassiliou M, Grünewald RA, Chattopadhyay AK, Davies­Jones GAB, Gibson A, Jarratt JA, et al. Clinical, radiological, neurophysiological and neuropathological characteristics of gluten ataxia. Lancet 1998;352:1582­5.
    26.    J Neurol Neurosurg Psychiatry. 2006 Nov;77(11):1262-6., Hadjivassiliou M, Grünewald RA, Kandler RH, Chattopadhyay AK, Jarratt JA, Sanders DS, Sharrack B, Wharton SB, Davies-Jones GA, Neuropathy associated with gluten sensitivity.
    27.    Gluten sensitivity: from gut to brain., Hadjivassiliou M, Sanders DS, Grünewald RA, Woodroofe N, Boscolo S, Aeschlimann D, Lancet Neurol. 2010 Mar;9(3):318-30
    28.    Hopper A., et.al., Pre-endoscopy serological testing for coeliac disease:evaluation of a clinical decision tool, BMJ. 2007 Apr 7;334(7596):729
    29.    Hill ID., What are the sensitivity and specificity of serologic tests for celiac disease? Do sensitivity and specificity vary in different populations? Gastroenterology. 2005 Apr;128(4 Suppl 1):S25-32
    30.    Memeo L, Jhang J, Hibshoosh H, Green PH, Rotterdam H, Bhagat G., Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis, Mod Pathol. 2005 Aug;18(8):1134-44
    31.    Abrams JA, Diamond B, Rotterdam H, Green PH. Seronegative celiac disease: increased prevalence with lesser degrees of villous atrophy, Dig Dis Sci. 2004 Apr;49(4):546-50
    32.    Tursi A., Seronegative Coeliac Disease: a Clinical Challenge. BMJ 26 April, 2005
    33.    Rostami, K., Unforgiving Master of Non-Specificity and Disguise, BMJ 27, April 2005
    34.    Lebwold, Green P., Screening for Celiac disease. N Engl J Med Oct.23 2003,1673-4 
    35.    Freeman HJ., Pearls and pitfalls in the diagnosis of adult celiac disease. Can J Gastroenterol 2008;22(3):273-280.
    36.    Bonamico M., Serologic and Genetic Markers of Celiac disease: A Sequential Study in the Screening of First Degree Relatives, Journal of Pediatric Gastroenterology and Nutrition 42:150–154
    37.    Fasano A., Catassi C., Current Approaches to Diagnosis and Treatment of Celiac disease: An Evolving Spectrum, GASTROENTEROLOGY 2001;120:636–651
    38.    Hadjavassiliou M., Grunewald R., The Neurology of Gluten sensitivity:Science vs. Conviction  Practical Neurology, 2004, 4, 124–126
    39.    Camarca, A., et.al., Intestinal T Cell Responses to Gluten Peptides Are Largely Heterogeneous: Implications for a Peptide-Based Therapy in Celiac disease, J. Immunol. 2009;182;4158-4166
    40.    Meresse B., , Ripoche J., Heyman M., Cerf-Bensussan N., Celiac disease: from oral tolerance to intestinal inflammation, autoimmunity and lymphomagenesis, Nature Vol 2 No 1, JANUARY 2009 
    41.    Bethune M.,Parallels Between Pathogens and Gluten Peptides in Celiac Sprue, Plos Pathogens Feb 2008 Vol 4: 2;e34 
    42.    Ehrhardt G., et.al. Discriminating gene expression profiles of memory B cell subpopulations JEM VOL. 205, August 4, 2008
    43.    Martucci S., Corazza G., Spreading and Focusing of Gluten Epitopes in Celiac disease GASTROENTEROLOGY Vol. 122, No. 7, 2002
    44.    Pastore L., et.al., Orally Based Diagnosis of Celiac disease: Current Perspectives, J Dent Res 87(12):1100-1107, 2008
    45.    Vader W., et.al., The Gluten Response in Children With Celiac disease Is Directed Toward Multiple Gliadin and Glutenin Peptides, GASTROENTEROLOGY 2002;122:1729–1737


    Dr. Tom O'Bryan
    Celiac.com 01/09/2020 - Research indicates that having additional medical conditions is associated with a lower quality of life. One study looked at the combined influence of having a chronic disease and their perceived quality of life and wanted to see if it had an impact on suicide-related ideations or suicide attempts. Depression was clearly linked to both. The people who had a lower quality of life had more suicide-related ideation and suicidal attempts than those with a higher quality of life.
    With the strong association between people with celiac disease and depression, we need to have plenty of tools at hand to support this at-risk population. Intervention techniques, prevention methods, and treatment strategies should be considered for anyone with celiac, even if you do not currently have a diagnosis of depression.
    There Are Several Factors That May Feed Into Suicide Statistics
    Hypoperfusion - There is a strong gut-brain connection. People diagnosed with celiac already have villous atrophy in their gut. 73% of people with a sensitivity to wheat have hypoperfusion, a lack of blood flow to the brain. This can be caused by any food sensitivity.
    Low Levels of Neurotransmitters - Neurotransmitters like dopamine and serotonin are produced in the gut. A lack of both of these feel good chemicals is associated with depression and anxiety. In fact, 90% of your serotonin levels reside in the gut where it also serves the critical role of helping to stimulate contractions that push food through your intestines.
    Dysbiosis - Dysbiosis has been linked to major mood disorders. A gluten-free diet starves your body of some much needed nutrients. Nearly 80% of the prebiotics in our diets comes from wheat! These prebiotics are fuel for the probiotics that reside in your gut microbiome. When you take away the primary food supply (wheat) from your beneficial bacteria, you starve the probiotics. They die off unless you replace the prebiotics you’ve been getting from wheat, with other prebiotic foods. As good bacteria dies off, the bad bacteria continues to flourish and reproduce. This creates dysbiosis (an altered microbiome), an environment out of balance.
    Financial Concerns - Even your finances can have an impact on your mental well being. Several studies have shown finances impact the ability to adhere to a gluten-free diet. A study in Nova Scotia looked at 56 different gluten-free foods and compared them against their counterparts. Across the board, the gluten-free food was more expensive. Financial worries become an additional burden on a person already taxed with other serious concerns. A higher mortality rate is associated with the lack of  adherence to a gluten-free diet. Studies show that people who are wealthier are able to comply with the dietary protocol more easily. The lack of adherence may stem from the depression, or it may be a contributing factor toward becoming depressed. 
    Social Engagement Participation - Studies support a reciprocal relationship exists between an engaged lifestyle and cognitive function. People who are actively engaged in social activities, do better cognitively. Also, if you are functioning better cognitively, you are more likely to participate in mental, social, and physical activities. It revealed that they mutually influence each other.
    Isolation, depression, and high rates of suicide make it imperative that you don’t let a restrictive diet stand in the way of meeting the human need for socialization.
    Restrictive Diets Restrict Social Life (if you let them)
    You are faced with a lifetime of family celebrations, weddings, birthday parties, fraternity or sorority parties, festivals, and workplace events while living gluten-free. There is no, “I can’t wait until this is over” moment. Life on a gluten-free diet is from here on out. 
    Food is such a focal point of celebrations for the majority of people, but it can be a source of disappointment and frustration for people with gluten-related disorders. Events can become less and less enjoyable when met with the same predictable frustration. You can’t have what everyone else is having - gluten-laden snacks, drinks, and entrees. 
    You don’t know if that innocent looking side dish is gluten-free, and odds are the person that made it doesn’t either. Asking questions can wear you (and others) down, until you finally throw in the towel. Either you give up asking and eat it against your better judgement despite the impact it will have on your health, or you give up going out altogether in order to control your environment. Over time you may find others pulling away from inviting you to things, or you may pull away from social engagements. It can lead to isolation with Gloom and Doom as your new lifelong companions.
    Treatment and Intervention
    Unfortunately, people with celiac find the requirement of living gluten-free restricts their social life. This can lead to either abandonment of your gluten-free protocol (which is an absolute necessity for anyone living with celiac disease), or it can lead you to becoming isolated and lonely. Neither are good.
    You must adhere to a strict gluten-free diet. Like it or not, it is what your body needs. If you choose to dismiss your body’s need for that, you will see other chronic conditions pop up. They may be more serious and life threatening, or it may simply be more of a nuisance that you have to deal with. But your body will be sending out autoantibodies that attack your own cells, every time you eat even the littlest amount of gluten. Eventually, an autoimmune condition will be diagnosed that reveals what your body was up to. Let’s not do any further damage. Stick to the diet.
    Find a good therapist. This is especially important if you do not have a built in network of support. It is critical if you have depression. Venting to someone can really help take the weight off of the burdens you carry.
    Actively work to heal your gut, so it can better support you. You want to make sure that your microbiome is brimming with diversity. It should contain approximately 80% of what we would call good bacteria and 20% of what we might consider bad. Since that gut is sending messages to your brain directing it to how it feels and what it wants, be sure your brain is being steered by the good guys.
    Reach out for help. If you or a loved one are in crisis and feeling like you want to harm yourself, reach out for a lifeline and call the National Suicide Prevention Lifeline at  1-800-273-8255. You are not alone, and they are there to listen. Talk to them and find out how they can best support you during your darkest hours.
    Thanks to your ancestral design as a species, you function better with a support network to help you survive, and that is still true today. We all need others in our lives. 
    Connect with others. Finding ways to reconnect with lost friends and family or connect with total strangers can be helpful in preventing feelings of loneliness and isolation, which can make depressive thoughts more present.
    Many celiacs suffer from isolation and exclusion. As their world becomes smaller, it makes suicide prevention even more challenging. So we need to find ways to keep people socially engaged and improve their quality of life.
    Practical Solutions for Maintaining Social Contact
    Plan to be spontaneous. I know that sounds like a contradiction, but when you want to continue living spontaneously, you need to be prepared for whatever life may throw at you. 
    Carry a digestive enzyme with you at all times. Choose digestive enzymes that help to break down minor exposures to gluten within approximately an hour. This timing is critical because you want to make sure it is broken down before gluten proteins exit the stomach. That is when the autoimmune response gets triggered. This is not permission to eat foods with gluten, just protection against trace amounts of gluten that you may encounter in a restaurant setting or at a friends house - wherever life may take you.
    Adhere to that gluten-free diet. Higher mortality rates are associated with the lack of a gluten-free diet. Make sure that you address your gut health wholly, not just the absence of gluten, but the replacement of nutrients lost in the process - like prebiotics and probiotics. Improving your gut health will improve your overall health, including addressing issues surrounding depression and anxiety.
    Install a gluten-free restaurant locator app on your phone. Wherever you are, when you and your friends or family are ready to eat, find out which restaurants offer food friendly options. To be safe, take a digestive enzyme. One study provided a NIMA Sensor to 804 people. Out of the 5,600+ samples labeled gluten-free in restaurants, almost one-third came back as containing gluten. 27.2% of “gluten-free” breakfast items tested in the study came back as containing gluten. Dinner came in at 34%, with pizza and pasta coming in at skyrocketing numbers. Gluten-free pasta dishes in restaurants contained gluten 50.8% of the time, and gluten-free pizza served in restaurants contained detectable gluten 53.2% of the time.
    Carry a NIMA Sensor with you. A NIMA Sensor can detect trace amounts of gluten. If you order gluten-free food in a restaurant and it comes back “glutened,” know before you take that bite. 
    Always carry some goodies with you, so you have something to eat. If you end up at a friend’s house, and it looks like almost everything they have is infected with gluten, rather than go home, eat a little something to carry you over or supplement it with the little bit that they do have that is gluten-free, like a piece of fruit.
    Find alternative opportunities to socialize in places that do not involve food. For instance, enroll in yoga, art classes, or a dance class.
    Don’t restrict yourself more than necessary. If chronic pain or sickness has you bedridden, talk to your friends and family on the phone. Facetime them or skype. Ask a friend over to watch a movie. Vary the friends a little, so you don’t restrict your world to one friend. Don’t be too embarrassed to ask friends to take you to appointments. You would do it for them if you could. Let them help you.
    Become the "hostess with the mostest." If you are one of those who loves a good party, show them how it is done with a 100% gluten-free buffet. Have those recipes ready to share with friends and neighbors, so that they can retrieve it for their future events when they are looking for a great recipe or a gluten-free recipe. Let people know that all of the recipes will be gluten-free beforehand, so that anyone with any concerns leaves them at home. 
    Create and provide a list of gluten-free approved snacks for a weekly gathering like book club or game night. If others have food sensitivities, work this into the gluten-free list. It doesn’t matter if you end up with a list of only 5 things. This is just snacks and drinks that everyone can enjoy. This eliminates worries for everyone about what people can or can’t eat, and reduces the competitive urge to keep up with or outdo the person that brought food before them.
    Find ways to improve your quality of life. A lower quality of life is associated with a higher risk of suicide and a lower adherence to a gluten-free diet. Life may be very different from what you used to dream about, but that doesn’t mean you have to stop dreaming. Create a dream list and modify anything that is food-related to include or address those needs. You may find that most things that would improve your quality of life, have nothing to do with food. Dare to dream.
    Remember your now is not your future. Don’t cling to where you are now. Figure out where you want to be and how you can get there. Then live out loud.


    Dr. Tom O'Bryan
    Celiac.com 02/07/2020 - Gluten sensitivity during pregnancy can profoundly impact fetal brain development. Gluten is a protein found in wheat, rye, and barley. 
    Many people who have a gluten intolerance may also have other food sensitivities to common antigens like corn, soy, dairy, and sugar. Many times, without a histamine response like hives, people can be blissfully unaware of their food sensitivity. 
    Studies have shown gluten sensitivity destroys brain and nervous tissue more than any other tissue in the body, and is linked to a number of other neurological disorders. (Read my blog Gluten Intolerance Testing for more information about this.)
    Eating Gluten During Pregnancy May Potentially Put Your Child At Risk
    Beginning before birth, the left and right hemispheres of the brain develop in stages according to a very sophisticated schedule. Each hemisphere depends on the other to meet its developmental goals within a precise window of time. While in-utero and in early childhood, viruses, infection, and inflammation (such as that from a gluten sensitivity), can throw a wrench in this intricate timing and hinder proper brain development. This sets the stage for a wide range of neurological disorders, attention-deficit/hyperactivity disorder (ADHD), autism, Tourette's syndrome, depression, anxiety, and other childhood brain disorders. 
    Childhood mental disorders now affect one in five children, and the rates are increasing.
    Wheat Can impact Brain Function
    There are at least 13 different ways I know of that a gluten sensitivity can impact the brain. Let's look at a couple of the big ones.
    One mechanism is that there can be elevated antibodies to wheat and the cerebellum and GAD-65. Your cerebellum controls your muscle movements. After years of your body attacking this brain tissue, the brain may shrink.
    People with GAD-65 antibodies indicate a high trigger for anxiety and ADHD.
    Another common mechanism is hypoperfusion, a lack of blood flow going to the brain. 73% of people with a sensitivity to wheat have hypoperfusion. Just like your cells need hydration, your brain needs to be saturated.
    So many people go undiagnosed with a gluten-related disorder for years. Imagine what we are doing to our children (and ourselves) when we eat that bowl of cereal or toast before school or work. We are not able to function optimally. This is why "brain fog" is the most common symptom for people with a sensitivity to wheat.
    In 2006, a study looked at 132 people with symptoms of ADHD who had a wheat sensitivity. When they put them on a gluten-free diet, the researchers reported markedly  significant improvement in all behavioral markers within six months.  
    Gluten sensitivity may also more than double your child's risk of developing schizophrenia later in life.  
    The first study to reveal food sensitivity was linked to a greater risk for psychosis, autism and other brain disorders in the child. Researchers looked at blood samples of nearly 800 individuals born in Sweden between 1975 and 1985. 
    What did they find? People with schizophrenia had high levels of gluten antibodies in their blood at birth - meaning a gluten sensitivity was passed from mother to child.
    You Might Have an Undiagnosed Gluten Sensitivity
    Awareness is growing as rates of celiac disease, an intestinal autoimmune disease caused by gluten, have quadrupled in the last 50 years. 
    The numbers could be much higher. In fact, it's estimated that 95 percent of those with celiac disease go undiagnosed. 
    Researchers also estimate the numbers of people with gluten sensitivity — a non-celiac inflammatory reaction to gluten — range from 10 to 30 percent of the population. 
    During Pregnancy, Mom's Gluten Sensitivity May Affect Her Baby's Brain 
    If you look at the current explosion in inflammatory disorders today, the rise of these brain-based disorders is less of a mystery. Immune-activated mothers are giving birth to immune-activated babies. 
    If you can, don't wait until pregnancy to look into food sensitivities. Every woman needs to consider a screen for gluten sensitivity. Look for anti-gliadin antibodies and, if that test comes back positive, go on a gluten-free diet. 
    We don't know at which point during pregnancy a mother's gluten sensitivity impacts the fetal brain, but we do know the baby's brain and nervous system begin developing in the first trimester. Although the association between a mother's gluten sensitivity and the baby's increased risk of psychosis as an adult is not yet fully understood, it makes sense to err on the side of caution. 
    "During My Pregnancy, I Didn't Get Nauseous. I Must Not Have Gluten Sensitivity, Right?" 
    Not Necessarily. A lack of gut symptoms doesn't mean you're in the clear. Everyone reacts differently to gluten sensitivity. One person can have chronic skin rashes, another may have joint pain, and a third brain fog. In fact, research suggests the majority of people with gluten sensitivity have no gastrointestinal symptoms whatsoever. 
    For every person with gut symptoms caused by gluten, there will be eight who have none, despite there being a gluten sensitivity present. 
    An undiagnosed gluten sensitivity during pregnancy is in no way a guarantee that your child will develop schizophrenia or other brain disorders either. However, when an expectant mother produces autoimmune antibodies to brain tissue, 86% of their children are on the autism spectrum. 
    If mom has an autoimmune mechanism going on inside her body, it can affect the baby. One of the most common food sensitivities associated with neurologic problems is wheat. Only a fraction of people who have a problem with wheat have celiac. Many more have gluten sensitivity. 
    Many women —and men—may be better off on a gluten-free diet even though they do not have celiac disease. 
    How do you reduce antibodies?
    First, screen for antibodies against the brain. Two great tools for screening are the Cyrex Array #5 and the Neural Zoomer. 
    If you are producing antibodies, you need to eliminate the trigger(s). The goal is to stop the autoimmune cascade, particularly during pregnancy when the fetus is developing its entire body and establishing its own immune system that will set him or her up for life.
    Bacterial Colonies Change in the Vaginal Tract During Pregnancy
    In the last trimester of pregnancy, the bacterial colonies in the vaginal tract change completely to the point that there's a very high count of prevotella [bacteria]. 
    Most of the time, there are practically no prevotella that are measurable in the vaginal tract at all. The change in the last trimester occurs because the prevotella is the substance that coats the baby as it comes down the birth canal. Prevotella migrates through the baby's nasal cavity and its mouth and goes down to turn on the genes in the gastrointestinal (GI) tract. These genes say, "Okay, this is the mammal that is going to start feeding you. Here are the codes for the protein that's about to come to you for food." 
    The baby's digestive tract then starts turning on the digestive enzyme production capability for the specific proteins that are encoded in the prevotella bacteria. 
    My Personal Story
    When we were first married, my ex-wife and I, despite all efforts, could not get pregnant. I was an intern at the time, and I called the seven most famous doctors I'd ever heard of, holistic doctors, and asked, "What can we do?" 
    Because I was an intern, they asked, "Do you know this?" "Do you know that?" I'd say, "No." 
    And they would respond: "Learn." 
    So I put a program together, and we were pregnant in six weeks.  A lot of people know that this began my study of gluten and the many effects it has on the body.
    Since then, I've helped hundreds of couples with infertility, recurrent miscarriages, and hormonal imbalances. There's not much in medicine that's all or every, but this is an every. 
    What we learned early was that every person with hormone-related symptoms, whether it was infertility, miscarriages, estrogen dominance, testosterone deficiency, all of them, when tested properly, had a sensitivity to foods that they were eating — foods that they did not know were making them sick. 
    When you eat a food that you're sensitive to, it triggers inflammation in the body. The immune system responds to try to protect you from something it considers an invader, and it creates an inflammatory reaction.
    I have said this so many times over the years: "Ms. Patient. If you pull at a chain, the chain always breaks at the weakest link. So, the first thing to do is to learn what's pulling on the chain." 
    We found out something amazing...
    Food Sensitivities Were a Component Every Time
    Often there were more, but it was an important component. I found that the most frequent food sensitivity was wheat. So I started reading the literature on wheat way back in 1980. Our daughter was also born in 1980, and I started talking about it shortly thereafter because the studies were blowing me away.
    By 2004, I was lecturing professionally onstage about wheat sensitivities with or without celiac disease. That progressed and progressed until 2008, when a nutritional company called Metagenics sponsored me to go around the world. I went to 26 different cities and gave full eight-hour presentations on wheat sensitivity. The presentation dropped everybody's jaw. No one had ever seen these studies about different types of spondyloarthropathy, rheumatoid arthritis, psoriasis, multiple sclerosis, attention deficit disorder, autism, or Alzheimer's and how it would benefit some of those people just by getting off of wheat. They started to get better, sometimes dramatically, but often to some degree.
    In 2009, I did the same 26 cities for a full eight-hour presentation on the development of autoimmunity. 
    What triggers the development of autoimmunity? And what do you do to address autoimmunity? 
    It was infertility, successfully addressed by looking at food sensitivities and a couple of other things that led me into learning about wheat sensitivity; gluten sensitivity; and the trigger of intestinal permeability.
    For example, in the United States, 78% of the prebiotic diet is wheat. If you take wheat out of your diet, which is a very important thing, what you're also taking out is the major source of your prebiotics. And prebiotics feed probiotics, which are the good bacteria in your gut.
    If you take wheat out of your diet without the right education or mentorship, you lose the main prebiotic source, and, as a result, probiotics in your gut (the good bacteria that need that food) start starving. Some probiotics begin to die off, and the bad guys in your gut that have been kept in check to some degree by those probiotics now become opportunistic and rear their ugly heads. 
    This is why it is so helpful to find a certified gluten-free practitioner or nutritionist when you are on a gluten-free diet: This is especially important before and during pregnancy. You want to prepare your body to be free of antibodies prior to conception, and you want the proper nutrition to support both you and a developing baby.


    Dr. Tom O'Bryan
    Celiac.com 04/25/2020 - Do you know or suspect that you may have a sensitivity to wheat (or gluten)?
    According to the European Journal of Endocrinology, 43% of people with gluten sensitivity will manifest a form of thyroid dysfunction. (1)
    The American Journal of Endocrinology reports 30.3% of people with celiac disease will have thyroid dysfunction. (2)
    If you have a gluten sensitivity, a common manifestation is that it impacts your thyroid. In fact, thyroid dysfunction is four times higher in people with celiac disease than in the general population. (3)
    Your thyroid is a butterfly shaped gland located in your neck. The two main hormones produced are triiodothyronine (T3) and thyroxine (T4). The most common types of thyroid dysfunction are related to the levels of hormones. For instance, hyperthyroidism is an overproduction, as seen in conditions such as Graves disease. Hypothyroidism is when you are not producing enough or your thyroid is underactive, as seen in conditions such as Hashimoto’s. 
    Hormones get into the cell through receptor sites specific to that particular hormone. Estrogen goes into an estrogen receptor site. Testosterone goes into the testosterone receptor site. Thyroid hormone will only go into a thyroid receptor site. There is a thyroid receptor site on every single cell of your body. It is an incredibly important hormone.
    Have you ever turned the thermostat down in your home on a winter night when everyone goes to sleep to save fuel? And in the early morning, turn it up to warm your home before everyone wakes up? Your thyroid is the thermostat that controls the temperature inside every cell of your body, otherwise known as your metabolism. And your metabolism is how fast or slow every function in your body occurs. 
    Because the thyroid regulates the level of function of every cell in your body, any symptom in your body can be the result of thyroid dysfunction. 
    The most commonly recognized symptoms of thyroid dysfunction are: 
    Cold hands and feet Lack of vital energy Brain lacks clarity of thought Difficulty losing weight Depression Hitting snooze multiple times in the am Physical symptoms that may suggest a thyroid condition:
    Distal third of the eyebrows are thinned out Dry, cracked skin, such as the bottoms of your feet Brittle hair Fatigue Increased sensitivity to cold Constipation Dry skin Weight gain Puffy face Hoarseness Muscle weakness Elevated blood cholesterol level Muscle aches, tenderness and stiffness Pain, stiffness or swelling in your joints Heavier than normal or irregular menstrual periods Thinning hair Slowed heart rate Depression Impaired memory Enlarged thyroid gland (goiter) Medication Warnings for People with Thyroid Dysfunction
    Of course, if it is determined that you need medication, always follow your doctor’s advice. But at the same time, investigate. ‘WHY’ does my body need medication right now? The FDA warns that some thyroid medications may cause serious consequences, including liver disease, liver dysfunction and death. (4) Although uncommon, if you are taking medications and are not seeing improvement, discuss concerns with your doctor before stopping any medications. Try eliminating gluten from your diet to see if you notice any improvement with your thyroid-related symptoms. 
    People with a sensitivity to gluten who still eat wheat require 49% more thyroid hormone to ‘get the job done’  compared to when they stop eating gluten. (5) That means that IF gluten is a problem for you, when you stop being exposed to gluten, your thyroid begins working better, requires less ‘outside help’ - thus less medication, and less risk of side effects from the medication.
    If you improve on a thyroid healing protocol, some people find antidepressants are no longer necessary. But before going off any medications, you should first check with your doctor on how to safely do this and confirm it is advisable.
    Thyroid function is critical to your sense of well being. Whatever it takes to improve its function so you can feel good, keep digging away to discover what may help you. You may be among the many people who have a sensitivity to gluten, and it is triggering an autoantibody response. If so, eliminate gluten from your diet. If gluten is not your trigger, you will need to identify what the trigger(s) are. There is often more than one thing. For example, once BPA, a chemical used to mold plastic found in our food and drinks gets into our bloodstream, it is notorious for binding to thyroid and causing chaos. (6) 
    Removing substances (foods and chemicals) offensive to the thyroid,allows this very important gland to function more normally. Testing is advisable to drill down and uncover the source of the problem. 
    What can impact the thyroid negatively?
    Chlorine is a common one that binds to the receptor sites. (7) An easy ‘base hit’ is to add a chlorine shower filter to your shower head. It may also improve your skin and hair.
    Bromine - Overexposure to bromine can cause hypothyroidism. (8) Bromine can be found in baked goods, carbonated soft drinks, hot tubs, and even your car upholstery. Your thyroid relies on iodine for hormone production. Bromine tricks those receptor sites into thinking it is binding with iodine. Ultimately, this results in an iodine deficiency and likely thyroid dysfunction.
    Fluoride - Some people benefit from choosing fluoride-free toothpaste or fluoride-free water. Fluoride effects appear to be more severe in people with iodine deficiencies and is more closely associated with hypothyroidism. (9) 
    Goitrogenic foods - Goitrogenic means they may inhibit thyroid function. The following are very good foods for you but it is worth seeing if any of them may be inhibiting thyroid function. This would include cruciferous vegetables like broccoli, cabbage, or cauliflower. If you have thyroid problems, screening these foods, keenly observing how you feel and function may be of value.
    Gluten Sensitivity with or without celiac disease - A recent 2019 study of 34 women with thyroid disease was performed to examine the impact of a gluten-free diet. After six months, the results showed that the group on a gluten-free diet had significantly less antibodies affecting thyroid globulin (TG) and thyroid peroxidase (TPO). (10) 
    Rapid weight loss - When you lose a lot of weight or starve yourself, your thyroid slows down its metabolic activity. Ancestrally, this is your body’s way of protecting you for those times when food is scarce, to prevent death from starvation. When your gas gauge says empty and the nearest station is a few miles away, you slow down to burn less fuel and hopefully you’ll make it to the station for a fillup (your next meal). Responsible weight loss is slow and steady.
    Estrogen - Yes, estrogen is needed for both men and women, but you can have too much of a good thing. Many studies have been done on the association between estrogen and your thyroid levels. Estrogen dominance produces thyroxine binding globulin (TBG) which binds to that thyroid receptor site, reducing your available thyroid hormone availability. 
    A Case of Mistaken Identity
    The primary offensive gluten molecule is 33 amino acids long. It’s a long molecule. If your immune system is searching (antibodies) for the food you are sensitive to it may attack other molecules that look like the food. The surface of your thyroid is made up of proteins and fats. The proteins are made up of many amino acids, which can include a section that looks like the gluten molecule. Now the immune system may go after the thyroid damaging your thyroid cell. The ‘geek’ term for this is Molecular Mimicry.
    Once the immune system goes after the thyroid damaging your thyroid cell because of Molecular Mimicry (in this example), now your body needs to make thyroid antibodies to get rid of that damaged cell. If you have a sensitivity to gluten, every time you eat gluten, your body creates antibodies to gluten. These may also go after the thyroid where it looks like it (if that is your genetic weak link). Eventually, over time, your body develops the mechanism where it starts making antibodies to the thyroid ongoing. Some celiac patients or people with gluten sensitivity find that when they go on a gluten-free diet, the thyroid antibodies also go down. Sometimes dramatically, full remission. Thus, sometimes you can reduce the antibodies to your thyroid just by removing the irritating foods.
    Foods That Contain Gluten
    Many foods contain gluten, but the concerning ones (to everyone) stem from wheat, rye, and barley. These are toxic forms of gluten that nobody is able to digest, and it is one of the most common foods people eat. In general, when referring to a gluten-free diet, this means avoidance of foods containing wheat, rye, and barley. Now there is gluten in many other grains, corn, rice, quinoa,... But it’s the toxic family of glutens in wheat, rye and barley we’re talking about here. You may be sensitive to corn. Or rice, or quinoa, or any other food. If you are, stop the food. But it would not be included in the family of gluten sensitivity. That term is allocated to wheat, rye and barley.
    And remember these grains are used as fillers in many different foods as well as hidden sources, such as sauces, cosmetics and shampoos (which can be inhaled). You want to eliminate all forms of gluten to reap the benefits.
    A recent study on women with Hashimoto’s showed that a gluten-free diet may offer clinical benefits. (11) And it isn’t just hypothyroidism that seems to show improvement. People with Graves are also reporting improvement. (12) Why? Gluten is a common trigger for a lot of people. You may be one of them and not even realize it.
    If you are struggling to manage your thyroid symptoms, try a gluten-free diet for a few months. You should notice symptom improvement relatively quickly if gluten is the only trigger making your condition worse.
    Scientific References
    Valentino, Rossella & Savastano, Silvia & Maglio, Maria & Paparo, Francesco & Ferrara, Francesco & Dorato, Maurizio & Lombardi, Gaetano & Troncone, Riccardo. (2002). Markers of potential coeliac disease in patients with Hashimoto's thyroiditis. European journal of endocrinology / European Federation of Endocrine Societies. 146. 479-83. 10.1530/eje.0.1460479. Sategna-Guidetti, C & Volta, U & Ciacci, Carolina & Usai, Paolo & Carlino, A & Franceschi, L & Camera, A & Pelli, A & Brossa, C. (2001). Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: An Italian multicenter study. The American journal of gastroenterology. 96. 751-7. 10.1111/j.1572-0241.2001.03617.x. Baharvand P, Hormozi M, Aaliehpour A. Comparison of thyroid disease prevalence in patients with celiac disease and controls. Gastroenterol Hepatol Bed Bench. 2020;13(1):44–49. fda.gov Virili, Camilla & Bassotti, Giulia & Santaguida, Maria & Iuorio, Raffaella & Duca, Susanna & Mercuri, Valeria & Picarelli, Antonio & Gargiulo, Patrizia & Gargano, Lucilla & Centanni, Marco. (2012). Atypical Celiac Disease as Cause of Increased Need for Thyroxine: A Systematic Study. The Journal of clinical endocrinology and metabolism. 97. E419-22. 10.1210/jc.2011-1851.  Gore AC, Chappell VA, Fenton SE, et al. EDC-2: The Endocrine Society's Second Scientific Statement on Endocrine-Disrupting Chemicals. Endocr Rev. 2015;36(6):E1–E150. doi:10.1210/er.2015-1010 Bercz JP, Jones LL, Harrington RM, Bawa R, Condie L. Mechanistic aspects of ingested chlorine dioxide on thyroid function: impact of oxidants on iodide metabolism. Environ Health Perspect. 1986;69:249–254. doi:10.1289/ehp.8669249 Allain P, Berre S, Krari N, et al. Bromine and thyroid hormone activity. J Clin Pathol. 1993;46(5):456–458. doi:10.1136/jcp.46.5.456 Malin, Ashley & Riddell, Julia & Mccague, Hugh & Till, Christine. (2018). Fluoride exposure and thyroid function among adults living in Canada: Effect modification by iodine status. Environment International. 121. 667-674. 10.1016/j.envint.2018.09.026.  Krysiak, Robert & Szkróbka, Witold & Okopien, Boguslaw. (2018). The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study. Experimental and Clinical Endocrinology & Diabetes. 127. 10.1055/a-0653-7108.  Gier, Dominika. (2019). EVALUATION OF THE PREVALENCE IgG-DEPENDENT FOOD INTOLERANCE IN WOMEN PATIENTS WITH THYROID DISORDERS.  Joshi AS, Varthakavi PK, Bhagwat NM, Thiruvengadam NR. Graves' disease and coeliac disease: screening and treatment dilemmas. BMJ Case Rep. 2014;2014:bcr2013201386. Published 2014 Oct 23. doi:10.1136/bcr-2013-201386


  • Popular Now


  • Celiac.com Sponsors (A19):


  • Member Statistics

    • Total Members
      95,053
    • Most Online
      6,255

    Snookie
    Newest Member
    Snookie
    Joined

  • Celiac.com Sponsor (A20):


  • Forum Statistics

    • Total Topics
      116,623
    • Total Posts
      975,788

  • Celiac.com Sponsor (A21):


  • Who's Online (See full list)


  • Celiac.com Sponsor (A22):


  • Popular Articles

  • Recent Activity

    1. 6

      Head ache after eating

    2. 23

      Allergist recommendations? Anyone?

    3. 7

      3 yo daughter possible celiac, my Mom hear just needs some clarity! Help!? Scope Wednesday

    4. 69

      are you going to take the vaccine

    5. 69

      are you going to take the vaccine

×
×
  • Create New...