by wayne persky
Founder and President of the Microscopic Colitis Foundation
*Note that this article is so long that it is being published in two parts. This is part two.
Our immune system was fine-tuned over a million years, as our paleo ancestors evolved. During that time period, our ancestor's immune system was exposed to most types of threat to which it is exposed today, and more, and it evolved with the capability to protect human life without the benefit of any medical intervention. Consequently, there's no logical reason why it should malfunction now, as long as it's properly nourished.
Food sensitivities originated with the Dawn of agriculture.
And the detection of certain food sensitivities by the immune system proves that the immune system is working correctly. The origin of food sensitivities can be traced back to the domestication and development of wheat. Our digestive system did not evolve digesting wheat, but when the Neolithic period came along, and agriculture was adopted, and developed, wheat suddenly (sudden, when compared to the million plus years during which our digestive system had previously evolved) became a major part of our diet, and wheat (gluten) sensitivity was born.
No human can completely digest wheat gluten.
Prior to the development of agriculture, and the alteration of the wheat genome, to make it more productive, our ancestors' immune systems had never been exposed to any examples of the gliadin and glutenin proteins that comprise the primary proteins in wheat gluten. And because the wheat genome is much more complex than any other grains (or any other foods) to which it had been previously exposed, the human digestive system was incapable of producing any enzymes to completely digest wheat, and to this day, it still hasn't developed that capability.
Consequently, when humans eat wheat, their digestive system is incapable of completely breaking down the molecules in these proteins into the individual amino acids that normally result from digestion, and that are used as fuel and building blocks by the body. Instead, incomplete digestion of wheat results in the creation of hundreds of medium-length chains of amino acids, known as peptides.
Consequently, when humans eat wheat, their digestive system is incapable of completely breaking down the molecules in these proteins into the individual amino acids that normally result from digestion, and that are used as fuel and building blocks by the body. Instead, incomplete digestion of wheat results in the creation of hundreds of medium-length chains of amino acids, known as peptides.
Not everyone can develop celiac disease.
For many people, it doesn't seem to matter that they can't completely digest gluten, and the undigested protein particles simply pass on (harmlessly) through their system. It only matters if a person has leaky gut. But research shows that gluten sensitivity can cause leaky gut. Fortunately, only those who have certain human leukocyte antigens (HLA) alleles (DQ2 and/or DQ8), that predispose to the development of celiac disease, are capable of developing celiac disease, and only a small percentage of those who have those genes eventually develop celiac disease.
And then there's non-celiac gluten sensitivity.
Non-celiac gluten sensitivity can cause basically the same symptoms as celiac disease. Published medical literature proves that the celiac screening blood tests have very low sensitivity, and doctors have absolutely no tests that will detect non-celiac gluten sensitivity. As a result, many, many doctors have mistakenly informed many, many MC patients that they are not sensitive to gluten based on a negative celiac blood test result, and this probably applies not only to virtually all MC patients, but IBD patients, and patients who have any other AI diseases, as well. The vast majority of us have non-celiac gluten sensitivity.
The claim that a negative celiac test result means that a patient cannot be sensitive to gluten is simply incorrect, because doctors have no way to diagnose non-celiac gluten sensitivity. A positive celiac test result can confirm gluten sensitivity, but a negative celiac test result definitely cannot rule out gluten sensitivity. Many doctors mistakenly believe that a negative celiac blood test result rules out gluten sensitivity, but there is no medical justification for making that assumption, it's simply incorrect.
The claim that a negative celiac test result means that a patient cannot be sensitive to gluten is simply incorrect, because doctors have no way to diagnose non-celiac gluten sensitivity. A positive celiac test result can confirm gluten sensitivity, but a negative celiac test result definitely cannot rule out gluten sensitivity. Many doctors mistakenly believe that a negative celiac blood test result rules out gluten sensitivity, but there is no medical justification for making that assumption, it's simply incorrect.
Unfortunately, anyone can develop food sensitivities.
The celiac genes only pertain to the development of celiac disease. Therefore, the development of food sensitivities in general, does not require that a person have one or both of those two celiac genes. Consequently, virtually anyone can develop not only food sensitivities, but IBDs, other AI diseases, and other health issues that are associated with food sensitivities.
If you doubt that food sensitivity issues can apply to all AI diseases,
because they don't appear to apply to every IBD or AI patient, note that medical research proves that many celiac disease patients, for example, are asymptomatic. In other words, although they are gluten sensitive, and the villi in their small intestine are flattened, and unable to properly absorb nutrients from their food, these individuals do not have the clinical symptoms (primarily diarrhea) that typically affect most celiac disease patients.
That suggests the possibility that some patients who have other AI diseases may well be gluten sensitive, but asymptomatic to the clinical symptoms. And because non-celiac gluten sensitivity is much more widespread than the gluten sensitivity associated with celiac disease, it's more likely that many IBD and other AI patients, have a form of non-celiac gluten sensitivity, so that the celiac screening tests used by doctors are worthless for detecting their gluten sensitivity. Consequently, research articles concluding that only a moderate or relatively low percentage of IBD patients are gluten sensitive (which includes virtually all of them that consider the issue), are based on confounded data, and therefore, their conclusions are inaccurate and misleading.
That suggests the possibility that some patients who have other AI diseases may well be gluten sensitive, but asymptomatic to the clinical symptoms. And because non-celiac gluten sensitivity is much more widespread than the gluten sensitivity associated with celiac disease, it's more likely that many IBD and other AI patients, have a form of non-celiac gluten sensitivity, so that the celiac screening tests used by doctors are worthless for detecting their gluten sensitivity. Consequently, research articles concluding that only a moderate or relatively low percentage of IBD patients are gluten sensitive (which includes virtually all of them that consider the issue), are based on confounded data, and therefore, their conclusions are inaccurate and misleading.
What does the medical literature reveal?
A search of the medical literature on the Internet produces links to numerous studies showing that food sensitivities are closely associated with many AI diseases, such as inflammatory rheumatism (rheumatoid arthritis [RA], spondyloarthritis [SpA], and psoriatic arthritis [PsA]), multiple schlerosis, IBD, and diabetes, for example. (Raffier, 2023, March 24; Fakih, etal., 2019; Feuille, Ceballos, Benkov, and Nowak-Wegrzyn, 2015; Ottawa Hospital Research Institute. 2009, August 31).1, 2, 3, 4 Articles such as these cause curious minds to wonder if food sensitivities might possibly be associated with all AI diseases, although (as pointed out in a previous paragraph) this hasn't yet been verified by published medical research.
Researchers in Australia
recently published a study that shows how a proinflammatory diet increases relapse rates for multiple sclerosis patients (Saul, Taylor, and Ausimmune/AusLong Investigators, (2023).5 But a search of the Internet fails to locate similar research studies for various other AI diseases, suggesting that researchers are not actively pursuing studies of the effect of proinflammatory diets on other AI diseases.
And even more recently,
researchers have shown that patients who have some form of inflammatory arthritis, such as rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis, have altered gut microbiomes (Thompson, et al., 2023).6 Other published research verifies that gut microbiome changes are associated with increased intestinal permeability (a.k.a. "leaky gut") (Chakaroun, Massier, and Kovacs, 2020).7 As most of us are well aware, "leaky gut" is the primary cause of food sensitivities.
Interestingly, in the past, associations with food sensitivities have been confirmed by medical research for all of the major AI diseases. Only the less common AI diseases have not yet been shown to be associated with food sensitivities. But that's very likely because researchers simply haven't done the research for the less common AI diseases — not because they're not associated with food sensitivities. Medical research is very expensive these days, so that financing research regarding food sensitivities and the less common AI diseases may not have been done because the financing hasn't been available.
Interestingly, in the past, associations with food sensitivities have been confirmed by medical research for all of the major AI diseases. Only the less common AI diseases have not yet been shown to be associated with food sensitivities. But that's very likely because researchers simply haven't done the research for the less common AI diseases — not because they're not associated with food sensitivities. Medical research is very expensive these days, so that financing research regarding food sensitivities and the less common AI diseases may not have been done because the financing hasn't been available.
Food sensitivities do not cause classic allergy reactions.
Note that most researchers incorrectly refer to food intolerances as though they were the same as food allergies, when in fact, the two types of reactions are completely different. Food allergies provoke IgE reactions (typically within the respiratory system), whereas food intolerances provoke IgA reactions (typically centered in the intestines).
Most gastroenterologists don't mention food sensitivities when discussing treatments.
Anyone who has consulted with their doctor lately, regarding the treatment of an AI disease, is well aware that most doctors typically fail to adequately inform their patients of the implications of the association of food sensitivities with the control of their AI disease. And according to surveys, this communication failure is quite common, despite the fact that food sensitivities have become a relatively popular topic among patients (who have one or more AI diseases).
And an article published in the Journal of the American Heart Association,
describes a study showing that if doctors properly prescribed dietary treatments for diabetes, the United States could save at least $40 billion on medical expenses (Caputo, 2023, June 30).8 Obviously, there's plenty of incentive to justify making major treatment changes that more realistically reflect the dietary effects of specific foods on AI diseases, and probably many other health issues.
Why does this (resistance to change) continue to happen?
Although it appears that doctors prefer to write prescriptions for drugs, rather than recommending dietary changes, they probably continue to choose to withhold dietary information that might prove to be very beneficial for most of their patients for a very simple reason — they don't understand food sensitivities and the health consequences that result from them. They don't feel comfortable even discussing the topic, because they don't have the training they need.
Doctors aren't solely responsible,
because the entire medical community seems to share their reluctance to incorporate dietary considerations into treatments. Most major medical websites offer suggestions regarding diet changes that might help when treating certain AI diseases, especially IBDs, but their doctors typically don't incorporate the suggestions into their treatment recommendations.
Medical schools need to get their act together.
This problem is probably continuing because doctors are not adequately trained (in med school, or anywhere else) to offer competent dietary advice to their patients. Doctors receive regular treatment updates from their drug reps, but obviously pharmaceutical companies are not likely to update doctors on any treatment options that might involve treatments that do not require pharmaceutical products. If inadequate training is the primary problem, surely it could easily be corrected by the proper selection of curriculum choices offered by med schools
Summarizing:
Although conventional medical wisdom dictates that autoimmune diseases are caused by a complex interplay of genetic, environmental, and immune system factors, it can be argued that autoimmune diseases may simply be symptoms of vitamin, mineral, or other nutrient deficiencies, combined with stress, or the food sensitivities that are associated with the increased intestinal permeability associated with those issues. Published medical research shows that the immune system requires adequate nutrition in order to function properly, and proof has been published, showing that chronic inflammation caused by food sensitivities can trigger and perpetuate many autoimmune diseases.
The primary obstacle preventing healthcare professionals from providing proper dietary advice to AI patients appears to be inadequate training by med schools. This problem needs to be corrected as soon as possible, because it's costing patients and governments billions of dollars every year in unnecessary drug expenses.
The primary obstacle preventing healthcare professionals from providing proper dietary advice to AI patients appears to be inadequate training by med schools. This problem needs to be corrected as soon as possible, because it's costing patients and governments billions of dollars every year in unnecessary drug expenses.
References
1. Raffier, N. (2023, March 24). Managing Inflammatory Rheumatism With Diet and Nutrition. Retrieved from https://www.medscape.com/viewarticle/990107?ecd=wnl_infocu8_broad_broad_persoexpansion-algo_20230325&uac=95382HN&impID=5277386
2. Fakih, R., Diaz-Cruz, C., Chua, A. S., Gonzalez, C., Healy, B. C., Sattarnezhad, N., . . . Chitnis, T. (2019). Food allergies are associated with increased disease activity in multiple sclerosis. Journal of Neurology, Neurosurgery & Psychiatry, 90(6), 629-635. Retrieved from https://jnnp.bmj.com/content/90/6/629
3. Feuille, E., Ceballos, C., Benkov, K., and Nowak-Wegrzyn, A. H. (2015). Inflammatory Bowel Disease and Food Allergies. Allergy and Clinical Immunology, 135(2), AB251. Retrieved from https://www.jacionline.org/article/S0091-6749(14)03541-6/fulltext
4. Ottawa Hospital Research Institute. (2009, August 31). Type 1 Diabetes Linked To Immune Response To Wheat. Science Daily, Retrieved from https://www.sciencedaily.com/releases/2009/08/090820124038.htm
5. Saul, A. M., Taylor, B. V., and Ausimmune/AusLong Investigators. (2023). A pro-inflammatory diet in people with multiple sclerosis is associated with an increased rate of relapse and increased FLAIR lesion volume on MRI in early multiple sclerosis: A prospective cohort study. Multiple Sclerosis Journal, 29(8). Retrieved from https://journals.sagepub.com/doi/10.1177/13524585231167739
6. Thompson, K. N., Bonham, K. S., Ilott, N. E., Britton, G. J., Colmenero, P., Bullers, S. J., . . . Huttenhower, C. (2023). Alterations in the gut microbiome implicate key taxa and metabolic pathways across inflammatory arthritis phenotypes. Science Translational Medicine, 15(706), eabn4722. Retrieved from https://www.science.org/doi/10.1126/scitranslmed.abn4722
7. Chakaroun, R. M., Massier, L., and Kovacs, P. (2020). Gut Microbiome, Intestinal Permeability, and Tissue Bacteria in Metabolic Disease: Perpetrators or Bystanders? Nutrients, 12(4), 1082. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230435/
8. Caputo, J. (2023, June 30). Produce prescription programs for patients with diabetes could save billions in health care costs, study shows. Medical Xpress, Retrieved from https://medicalxpress.com/news/2023-06-prescription-patients-diabetes-billions-health.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter
