Avoid Gluten with Elevated Antibodies but No Celiac Disease?

Celiac.com 01/09/2021 - Ever stand on a school playground when a very loud siren would go off and feel like it was rattling your brain because it was so loud? If not from the local school ground, perhaps that siren was at the fire station, or other public building in your neighborhood? For the last 40 to 50 years, many of us remember hearing an ‘air raid siren' go off.  In our area, it was on the first Tuesday of the month at 1:00PM.  Air raid drills were a ‘warning system' to let us know that we had to take cover.  From the days of the attack on Pearl Harbor through the dawning of the Nuclear Age, the air raid siren was designed to give us all a chance to ‘take cover' to get ourselves and our families to safety.  Well as it turns out, our bodies have a similar early warning system.

The National Institutes of Health tells us that Auto-Immune Diseases (the immune system attacking our own body tissue) collectively affect more than 24 million people per year in the U.S.(1)  To put this in perspective, Cancer affects nearly 9 million people per year and Cardiovascular Disease affects close to 22 million people.  And we know that only about 1/3rd of the people with an Auto-immune Disease are diagnosed.(2)  That means about 72 million people are suffering with a self-destruction process (the immune system attacking its own body tissue).  That puts Auto-Immune Diseases at the top of the list of the most common diseases in America today.  But it's not screened for.  To most of us, autoimmune diseases are unknown.  Our medical system waits until the signs and symptoms are severe enough with organ failure and irreversible damage before we identify it.  It's not screened for, it's looked at as a ‘last-resort' type of diagnosis.

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In general, autoimmune disorders can be classified as either organ specific or non-organ specific.  In organ-specific autoimmune diseases, antibodies are specifically directed against targets localized in a particular organ and are often detected in the blood.  Examples of organ-specific autoimmunity include Hashimoto's Thyroiditis (thyroid tissue), Type I Diabetes (pancreas tissue), Multiple Sclerosis (brain and nerve tissue), and Myasthenia Gravis (muscle tissue).  

In contrast, the non-organ-specific autoimmune disorders are characterized by the presence of antibodies directed against multiple targets (not specific to a particular organ).  This results in the involvement of several organs or endocrine glands and is often characterized by the presence of specific circulating antibodies.  Non-organ-specific autoimmunity includes diseases such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), and Scleroderma.(9)

A growing number of studies have identified that the body makes these antibodies directed against itself—otherwise known as auto-antibodies—years, and sometimes for a decade before a diagnosis is made.  The antibodies damage tissue slowly and steadily until finally people begin showing symptoms, and eventually receive a diagnosis.  

In Systemic Lupus, for  example, research shows that the progression of auto-antibodies for Systemic Lupus Erythematosous (S.L.E.) begin to present five years before a diagnosis is typically made. The immune system began an ‘early-warning system' (by producing auto-antibodies), and was starting to say "there's a problem here".  At this initial point, the patients did not have symptoms severe enough that warranted seeing their doctor.

Unfortunately, in the vast majority of cases, no one is monitoring this early warning system.  And so the body has to speak a little louder (more and different antibodies begin being produced)—no one is listening.  And then a little louder—no one is listening.  This continues for years until the body has to begin screaming.  And how does the body scream? Pain.  Have you ever stood under the telephone pole on the school playground when that Tuesday 1:00 PM siren went off? It rattles your brain.  That's what is happening in the body when there eventually is enough damage that a diagnosis of an autoimmune disease becomes obvious-it can't be ignored.  Researchers are telling us that autoimmunity appears to be a warning system that has gone beyond ‘early warning' to ‘take cover'.

It takes years from the first identification of antibody presence to the point of ‘clinical onset'—when the symptoms are obvious that something is wrong, and a diagnosis is made.  The levels of up to seven different antibodies may continue to rise for five years or more before the diagnosis.

If patients were armed with such information, they could start fighting the ailment years before the threshold of damage has been passed and a diagnosis is evident, thereby preventing or delaying symptoms.  One just has to look for the evidence.

Arguably, the most common auto-immune disease is also the only one where the ‘cure' is known and uncontested.  For some, gluten causes an ‘alarm reaction' in the immune system with a ‘call out the troops' type of attack response.  (upregulating macrophage pro-inflammatory gene expression and cytokine production).(5,6)

When this allergy to gluten (found in wheat, rye, barley and spelt) stimulates the production of auto-antibodies to the intestinal tissue (anti-transglutaminase or anti-endomysium antibodies), Celiac Disease is the diagnosis.  And this auto-immune disease is readily put into remission and disappears with a life-long avoidance of gluten in any form.(4) 

Are there early warning signs of Celiac Disease? Yes, there are.  We know that Celiac Disease-associated antibodies can be identified up to 5.2 years before a diagnosis of Celiac Disease can be made. (17)

Numerous pain syndromes and auto-immune diseases have been associated with an ‘alarm response' to gluten.  From peripheral neuropathies (numbness and tingling in the arms and legs) to crippling migraines and ataxia, from acute myocarditis (inflamed heart) to chronic pancreatitis, from vitiligo (loss of pigment-white spots-in the skin) to Primary Biliary Cirrhosis (Gall Bladder problems), from Multiple Sclerosis to Rheumatoid Arthritis, from Attention Deficit Hyperactivity Disorder (ADHD) to Epilepsy, in sensitive individuals, gluten may initiate this auto-immune response.(5,14)

So which organ is vulnerable to this auto-immune attack, this calling out of the troops? The target tissue seems to be determined by one's genetics (the blueprint you were born with) and all of the mitigating factors (accumulated exposures we've had in our lives such as toxic chemical accumulation, repeated use of antibiotics or other drugs contributing to intestinal permeability, heavy metal toxicity, excess stress hormone production, poor food choices…).(7)

This response may affect tissue throughout the body and has been identified with brain and peripheral tissue(8), liver epithelial cells, pancreatic beta-cells(8), thyroid tissue (9), bone cells(10), skin tissue(11), skeletal muscle(12), myocardium(13), and the brain and nervous system.  And it does not require the production of auto-antibodies to the intestines-that is, gluten intolerance can occur and be associated with other autoimmune diseases without the diagnosis of Celiac Disease (14).  

As an example, 57% of patients with neurological dysfunction of unknown cause have elevated antibodies to gliadin (a protein in wheat).  Only 35% of this group also have evidence of intestinal damage (Celiac Disease).  The remaining 65% have gluten sensitivity and elevated antibodies to the brain (cerebellum) or the nerves in the arms and legs, a situation analogous to that of the skin in Dermatitis Herpetiformis.(14) It appears that wheat can directly stimulate an auto-immune attack on the brain and nervous system in sensitive individuals without the diagnosis of Celiac Disease.

Elevated antibodies to gliadin and gluten (the protein in wheat) are the immune systems way of saying "this food is not good for me".  Many researchers take the position that if there are elevated antibodies to wheat, but there is no evidence of Celiac Disease, there is no evidence of value to avoiding wheat.  This position is historic and is in the process of changing.  The idea that until the sirens are screaming, it's ok to eat wheat, even if the immune system is saying "this is not good for me", is a position that more and more doctors are realizing is causing unnecessary suffering.

Many doctors and health care practitioners believe that even in the absence of indicators of outright Celiac Disease-that is with normal transglutaminase or endomysial antibodies, or a normal biopsy, we are best served by heeding the message our body is giving us, and avoiding these foods.  The concern is that if we ignore the actions of our immune system (elevated antibodies to wheat), the auto-immune process of the body (attacking its own tissue), may years down the road leave us standing under that telephone pole with the siren going off rattling our brains, or thyroid, or pancreas, or heart…

Dr. Thomas O'Bryan is a graduate of the University of Michigan and the National College of Chiropractic.  He is a Diplomate of the National Board of Chiropractic Examiners, a Diplomate of the Clinical Nutrition Board of the American Chiropractic Association, and a Certified Clinical Nutritionist with the International and American Association of Clinical Nutritionists.  He is a Certified Applied Kinesiologist.  He is a Certified Practitioner in Functional Biomechanics from the Motion Palpation Institute.  He is a member of the Institute of Functional Medicine, the International and American Association of Clinical Nutritionists, the American Chiropractic Association, the International Academy of Preventive Medicine and numerous other professional organizations.  

References:

• 1.    National Institutes of Health.  Autoimmune Diseases Coordinating Committee.  Autoimmune Diseases Research Plan. Accessed 1/18/07.
• 2.     Bland, J, Understanding The Origins and Applying Advanced Nutritional Strategies For Autoimmune Diseases.  March 2006.
• 3.    Notkins, A, Predictors of Disease, Scientific American, March 2007, 72-78.
• 4.    Murray, J, The Widening Spectrum of Celiac Disease.  Am J Clin Nutr 1999;69:354–65.
• 5.    Betterle C., Update on autoimmune polyendocrine syndromes (APS), ACTA BIOMEDICA 2003; 74;9-33.
• 6.    Zanoni,G, In Celiac Disease, a Subset of Antibodies against Transglutaminase Binds Toll-Like Receptor 4 and induces Activation of Monocytes, PLoS Med. 2006 Sep;3(9):e358.
• 7.    Kumar,V,Celiac Disease-Associated Autoimmune Endocrinopathies, Clinical and Diagnostic Labortory Immunology,July 2001, p.  678–685.
• 8.    Alaedini,A, Immune Cross-Reactivity in Celiac Disease: Anti-Gliadin Antibodies bind to Neuronal Synapsin 1,J Immunology,2007,178:6590-6595.
• 9.    Freeman HJ.  Hepatobiliary and pancreatic disorders in celiac disease.  World J Gastroenterol 2006; 12(10): 1503-1508.
• 10.    Moreno, M,The IL-1 gene family and bone involvement in celiac disease, Immunogenetics (2005) 57: 618–620 .
• 11.    Abenavoli L, Cutaneous manifestations in celiac disease.  World J Gastroenterol  2006;12(6): 843-852.
• 12.    Kozanoglu, E, Proximal myopathy as an unusual presenting feature of celiac disease, Clin Rheumatol (2005) 24: 76–78.
• 13.    Frustaci,A, Celiac Disease Associated with Autoimmune myocarditis, Circulation, 2002;105:2611-2618.
• 14.    Hadjivassiliou, M, Gluten Sensitivity as a Neurological Illness.  J Neurol Neurosurg Psychiatry, 2002;72:560-563.
• 15.    Sategna-Guidetti C., Prevalence of Thyroid Disorders in Untreated Adult Celiac Disease Patients and  Effect of Gluten Withdrawal: An Italian Multicenter Study, AJG—Vol.  96, No.  3, 2001.
• 16.    Oderta G., Thyroid Autoimmunity in Childhood Coeliac Disease, .  J Paediatr Gastroenterol Nutr, 2002 Nov;35(5):704-5.
• 17.    Salmi,T., Immunoglobulin A autoantibodies against transglutaminase 2 in the small intestinal mucosa predict forthcoming coeliac disease Aliment Pharmacol Ther 24, 541–552