HOW DOES IT START?
When I bring up the possibility to certain patients that their problems may be centered around GLUTEN SENSITIVITY, I often get asked why. Why is it that I have become Gluten Sensitive all of a sudden? The truth is, that individual may have been Gluten Sensitive for a very long time, or their problem may have started quite recently. Because so many of the symptoms of Gluten Sensitivity are either NEUROLOGICAL or "extra-intestinal" (THYROID, DIABETES, CANCER, BRAIN, SKIN, NERVES, etc, etc, etc), it's often hard to tell. Fortunately, an academic paper from last month's Journal of Immunology Research (The Interaction among Microbiota, Immunity, and Genetic and Dietary Factors Is the Condicio Sine Qua Non-Celiac Disease Can Develop) from the Institute of Internal Medicine at Rome's Catholic University, helps shed light on the way(s) that Gluten Sensitivity develops.
- CELIAC DISEASE IS AUTOIMMUNE: "CD is considered an autoimmune disorder..." This should come as no surprise considering that we have known about the relationship between GLUTEN AND AUTOIMMUNITY for seventy plus years --- a problem getting progressively worse with the advent of GMO (they cause problems with MOLECULAR MIMICRY / CROSS-REACTIVITY) and ADVANCED HYBRIDIZATION TECHNIQUES. Interestingly enough, this study actually deals with Cross Reactivity, revealing that, "one major hypothesis explaining how infectious components can cause autoimmune reactions is based on the concept of cross-reactivity, also known as “molecular mimicry,” that is the similarity between the epitopes of autoantigens and epitopes of harmless environmental antigens." If this doesn't make sense to you, just follow the Cross-Reactivity link and it will.
- CELIAC DISEASE HAS A GENETIC COMPONENT: "Exposure to gluten is the main environmental trigger responsible for the signs and symptoms of the disease, but exposure to gluten does not fully explain the manifestation of CD." It takes a combination of both genetic factors and epigenetic factors for your body to start reacting to Gluten. Genetically speaking, Gluten needs to be on your radar if you have Gluten Sensitivity in your family (which many people may not even be aware of) or if you are of Western European decent; i.e. blonde, blue-eyed, fair-skinned or most particularly a red-head. The thing to remember is that, "both genetic determination and environmental exposure to gluten are necessary for the full manifestation of CD; neither of them is sufficient alone.... the role of genes in the development of CD is not completely clear." We want to blame genetics for everything, but Epigenetics is a much bigger factor.
- EPIGENETIC FACTORS: We have come to realize that people are not nearly as ruled by their genes as first believed (HERE). Even if you have the right genetic background and makeup, "environmental factors, including infections, alterations in the intestinal microbiota composition, and early feeding practices, might also play a role in disease development." In other words, even if you have a strong genetic predisposition towards Gluten Sensitivity, unless those genes are actually 'turned on' by various and sundry factors, you will not develop the disease. What are these factors? They are many. Follow along as we cover a few of them.
- LEAKY GUT SYNDROME: I have written extensively about Leaky Gut Syndrome (HERE and HERE are my two most popular posts on the subject). This problem is characterized by a propensity to develop "Increased Intestinal Permeability" due to a failure of the Gut's barrier system. "Dysfunction of the innate and adaptive immune systems can conceivably cause impairment of mucosal barrier function and development of localized or systemic inflammatory and autoimmune processes. Initially, paracellular passage of gliadin peptides is due to an increase of gut permeability which, in turn, is due to an upregulation of zonulin, an intestinal peptide involved in epithelial tight junction control... The incomplete digestion of this protein by humans, due to high concentrations of glutamine and proline, results in the formation of residual partially digested peptides. Various complex diseases may occur as a consequence of disturbances of mucosal barrier." In other words, when the protein that maintains "tight junctions" in the gut is degraded via Inflammation, it allows the tight junctions to become "loose". When this happens, any number of molecules that shouldn't get in to the blood stream (Gluten included) are allowed free entrance. Once there, the body mounts an array of Immune System Responses against it (or 'them' as the case usually is), causing a potential nightmare that could only be likened to opening Pandora's Box. The authors themselves admit this by saying that, "The intestinal barrier regulates intestinal homeostasis throughout innate and adaptive immune responses. Unfortunately, in some cases the innate immune system’s attempts to protect the host fail and chronic inflammation and intestinal autoimmunity occur."
- MICROBIOTA & DYSBIOSIS: The first thing you'll have to understand here is DYSBIOSIS --- the name given to the imbalance of one's MICROBIOTA towards "bad" or pathogenic bacteria. For those not aware, fostering GUT HEALTH in your children is one of the single most important things you could possibly do for them. The authors also mention the benefits of breast feeding on the Microbiota. "The period in which the human host is most acutely influenced by the microbiota is the postnatal period, during which the germ-free neonate moves from the sterile environment of its mother’s uterus into a world full of microorganisms and during which the neonate’s mucosal and skin surfaces become gradually colonized. The composition of main bacterial populations does not stabilize until after the first few years of life. In this period, the microbiota gradually colonizes the mucosal and skin surfaces of the neonate and exerts the greatest effect on the development of the immune system. Components of the intestinal microbiota play a crucial role in the postnatal development of the immune system. During the early postnatal period, the intestinal microbiota stimulates the development of both local and systemic immunity, while later on these components evoke inhibitory regulatory mechanisms intended to keep both mucosal and systemic immunity in check." In other words, anything that is potentially destroying your family's Microbiota, is, via our understanding of something called THE HYGIENE HYPOTHESIS, destroying their overall health. But what does any of this have to do with Gluten?
- MORE MICROBIOTA & DYSBIOSIS: After talking about the detriments of a "germ free" environment and the need to be exposed to an array of beneficial bacteria from birth, the authors discuss "germ-free mice" (mice that are genetically engineered with no bacteria in their guts). When lab-raised "germ-free" mice are then exposed to microorgainsms, this tends to adversely, "influence the gut barrier function". Can anyone say Leaky Gut? "In some cases, impaired function of the intestinal barrier leads to an increase in antibodies directed against antigens present in the intestinal lumen. It was recently shown that the appearance of these antibodies or/and autoantibodies in individuals lacking clinical symptoms may have important predictive value for the development of inflammatory and autoimmune diseases." In case the staggering implications of this statement are not registering, go back and take a look at the first bullet point in this post.
"A principal function of the microbiota is to protect the intestine against colonization by exogenous pathogens and potentially harmful indigenous microorganisms. However, in certain conditions, some species of bacteria are thought to be capable of causing disease by producing inflammation, infection, or increasing cancer risk for the host. Infectious agents are considered possible environmental factors triggering autoimmune diseases. Particular bacterial populations that are typically found in very low abundance can acquire pathogenic properties. These conditions include inherent immune defects as well as changes in diet and/or acute inflammation and can result in the disruption of the normal balanced state of the gut microbiota, which is referred to as dysbiosis. Dysbiosis involves the abnormal accumulation or increased virulence of certain commensal populations of bacteria, thereby transforming former symbionts into 'pathobionts' [the best example of this phenomenon is H. PYLORI INFECTIONS / ULCERS]. Pathobionts are typically colitogenic and can trigger intestinal inflammation. The breakdown of the normal microbial community contributes to increase in the risk of pathogen infection and the overgrowth of harmful pathobionts and inflammatory disease. In addition to dysbiosis, infections may also disrupt the intestinal homeostasis leading to chronic inflammation and tissue damage, which could eventually contribute to reduced gluten tolerance."
- STILL MORE MICROBIOTA & DYSBIOSIS: Why are you not going to solve this problem simply by taking PROBIOTICS of some sort? "The complexity and interindividual variation of the gut microbiota composition in humans represent a confounding factor in the efforts to determine the possible significance of individual commensal microbial organisms in disease pathogenesis." In plain English, this means that depending on how sick you are and whether or not you have (successfully) undergone a Gluten-Free Diet, you had better start seriously thinking about something along the lines of a FECAL MICROBIOTA TRANSPLANT.
- INFLAMMATION: INFLAMMATION is (along with the body's 'barrier' systems) one of several "innate" Immune System Responses, and is intimately linked (i.e. it causes) virtually every non-genetic disease we care to list (click the link above for 20 of the most common). I am not going to spend inordinate amounts of time on this aspect of my post, but suffice it to say that Inflammation and the various chemical / molecular components that make it up are widely discussed throughout this study. The problem is (you'll see this clearly in a moment) that Big Pharma is using the information from studies like this one in order to engineer funky drug-based "cures" for any number of health problems, including various forms of Gluten Sensitivity. "The evidence that pediatric and adult patients have a similar inflammatory profile will encourage treatment of both with the same immunological therapy in the future."
- ANTIBODIES: There are two parts of what are known as 'adaptive immune responses': humoral immunity, regulated by antibodies made by B lymphocytes, and cell-mediated immunity, which has to do with T lymphocytes (killer T's, helper, T's, Tregs, etc). This is the portion of your Immune System that sits quietly in the shadows, biding its time until it's needed. When exposed to various forms of antigens that are getting into the blood stream (for instance, Gluten coming in through a 'Leaky Gut), the body mounts rapid, vicious, and sometimes, all-out attacks against these 'invaders' in order to 'overcome' them. The problem is, in the case of things like Gluten that are not really antigens to begin with, the response is way overblown. The resulting IMMUNE SYSTEM STORM and subsequent explosion of Systemic Inflammation, further drives and perpetuates the cycle. Things under this point get quite technical. If you are into this sort of detail, simply read the study. I will, however, leave you with this. "In summary, the disease develops as a result of an abnormal CD4+ T-cell-initiated immune response to gluten. Generally, gluten gains access..... during periods of increased epithelial permeability......"
- GLUTEN FREE DIET & GMO: Because, "Gluten peptides activate T-cells to produce inflammatory cytokines leading to tissue destruction..... the only approved treatment for CD is the lifelong complete exclusion of gluten from the diet." If you want to understand how to do this properly (yes, it's very possible to do it incorrectly), simply CLICK HERE. In fact, HERE is a basic recipe for solving any number of chronic health problems. In going Gluten Free, you need to be aware that not only can most Gluten Free food be considered to be "NUTRITIONAL CRAP," but it (dealing with Gluten Sensitivity), along with everything else, is going increasingly GMO. "Modifications of gluten antigenicity may be achieved in several manners, from the selection of natural cereal cultivars [ancient or "heirloom" varieties] to the genetic modification of gluten peptide sequences or more likely producing genetically modified organisms, in which toxic sequences are deleted or silenced." As long as the FDA is still in control of our food supply, rest assured that the solution will be GMO. It is also critical to understand that once you are Gluten Sensitive, ancient varieties of wheat (like Spelt) are not going to make any difference (HERE).
- VACCINES: In a move that would never happen in an American study (this paper was from Italy) the authors talked freely about research that, "demonstrated a possible protective role that infections with EBV, CMV, and Rubella may have on susceptible individuals; it seems that encountering certain infections may establish a particular immunological background that disfavours the evolution of autoimmune conditions." What does this really mean? It deals with something I have been trying to show my readers and patients for a very long time. There are some potentially severe consequences of Vaccines (HERE and HERE) that have much greater implications that simply exposing people to MERCURY, ALUMINUM, HALOGENS, or other known toxins. Then, after telling us that, "we need novel strategies, targeting various factors at different levels in CD pathogenesis," they reveal that this is one of the current areas where Vaccine Research is taking place. Big Pharma is actually making vaccines against the parts of the Immune System that attack Gluten. "A therapeutic vaccination constructed with the panel of most immunodominant gluten epitopes." If you want to better understand this concept, as well as the fact that it is essentially creating a "physician-induced" Autoimmune Reaction, all you need to do is take a look at the post I did a few weeks ago on the new HIGH BLOOD PRESSURE VACCINE.
One of the single biggest things you have to grasp when reading a paper on Celiac Disease is that for the most part, the same things said about Gluten are true of NON-CELIAC GLUTEN SENSITIVITY as well. According to the National Foundation for Celiac Awareness, gluten sensitivity is not as severe as is Celiac Disease because there is no intestinal damage associated with. Bullship! If you think you're safe just because you are not one of the 3 to 4 million Americans who has Celiac Disease, you had better think again. A study published in the April issue of Clinical Nutrition puts it thusly. "NCGS can be diagnosed in those patients with gluten intolerance who do not develop antibodies that are typical neither of CD nor of WA and who do not suffer from lesions in the duodenal mucosa, which is characteristic of CD. The gluten-free diet leads to complete regression of symptoms".
In other words, you can have any number of the myriad of symptoms associated with Gluten (neurological, digestive, extra-intestinal, etc, etc, etc) but if you are not having an autoimmune reaction against your own small intestine (even though you could be making antibodies against virtually every other tissue or organ in your body) you don't have Celiac Disease. All that a diagnois of Celiac means is that there are autoantibodies against your own Small Intestine present. This is why NCGS can, in some cases, be every bit as bad or worse than Celiac Disease --- and harder to find. If treating physicians are not using labs like Cyrex, or having patients do an Elimination Diet, NCGS can be extremely tough to diagnose.
And as to how many people have the Non-Celiac form of Gluten Sensitivity; the authors reveal that, "The overall prevalence of NCGS in the general population is still unknown, mainly because many patients are currently self-diagnosed and start a gluten-free diet (GFD) without medical advice or consultation. The disorder seems to be more common in females and in young/middle age adults. Some authors think that the incidence of NCGS seems to be higher than CD." And why would this last sentence be true? Because the the study lists a number of studies in its bibliography estimating the incidence of NCGS from as low as 6% all the way up to nearly two thirds (63%) of the population. I've seen estimates even higher than this, which is why physicians who deny this problem exists (HERE), not to mention lay-persons (HERE) are putting a huge roadblock to health in the path of the people who are putting their trust in them.
"The gut microbiota has been studied for more than a century; however, we have only recently begun to understand the ever-expanding roles for these microscopic organisms in health and disease. Despite the complexity of the gut microbiota, there is a delicate balance in bacterial populations such that any disruption in this balance leads to dysbiosis and, consequently, to decreased resistance to pathogen colonization, to the favoured growth of pathobionts, and to pathological both innate and adaptive immune responses. So, in genetically predisposed individuals, gluten in association with microbial antigens can stimulate and modulate innate and adaptive immune response, sustaining a chronic mucosal inflammation, underlining this chronic disease."
As you can see in a post I wrote back in 2012 (HERE), this paragraph is not much different than the way most chronic diseases develop.
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