Celiac disease is a set of symptoms associated with gluten intolerance.
Celiac disease develops when a person makes antibodies against a wheat protein called gluten such that eating anything containing gluten results in intestinal discomfort and a variety other symptoms including joint pain, skin rashes, and fatigue. Gluten is also present in barley, oats, triticale, and a few other seeds, and is often added to baked goods as a separate ingredient.
Why is gluten intolerance suddenly so common?
You could say gluten is the new cholesterol, in that gluten is being identified as the cause all kinds of illnesses and it has been suggested that nobody should ever eat it anything containing traces of it. But as is the case with cholesterol, pinpointing this single food component as the new universal-scapegoat is misguided. The way I see it, celiac disease is part of a larger epidemic of allergic disorders that include all food allergies, allergic rhinitis, and asthma—all of which are in the midst of a dramatic rise.
Whenever something new like this comes over the horizon, I like to always take a step back and examine the larger picture. When I do, I see the new explosion in rates of gluten-intolerance not so much as the result of anything inherently unhelathy about gluten, but rather as a sign that the processing that renders gluten harmful has lead to widespread immune system confusion. So in that sense, gluten is the canary in the coalmine, warning us of a potential impending explosion in the rates of intolerances to all kinds of processed foods.
When I started out in medicine in the 1990s, the most common food allergies were soy, eggs, peanuts, tree nuts, shellfish, and dairy. Each was far less common then than now. Wheat wasn’t even on the list. While I lived in Hawaii, by some measures the healthiest state in the nation, food allergies were almost non existent among my older patients. As the years went on, I noticed more and more kids coming in with food allergies. Then I moved back to the mainland where the number of young adults and children with foods allergies of all kinds blew me away.
My own experiences are echoed by doctors all over the country and reflected in national statistics which show that rates of food allergies have risen dramatically over the last decade, especially among the younger generations.
Gluten-free recipes are suddenly all the rage
The epidemic has taken the entire medical community by surprise and so far even our top academic practitioners have no good explanation for the recent spread of celiac disease—or the other food allergies. And so, most of my patients have had to educate themselves. They come to me after reading theories on the cause of gluten intolerance propose by a collection of health and wellness personalities.
Here’s a synopsis of the top theories circulating around the net, and my critiques:
Wheat has been bred for high yield, rendering it unsafe to eat.
(All crops have been bred for high yield, and wheat is no exception.)
Man evolved as a hunter-gatherer, and should not eat wheat because it is an agricultural product.
(Ditto: All crops are agricultural products, and wheat is no exception.)
Wheat is a grass, and we haven’t had enough time to genetically adopt to eating grasses.
(Rice is a grass and it doesn’t cause celiac.)
Wheat is a seed, and all seeds contain antinutrients. In the past, people used to sprout and soak seeds to increase their nutrient bioavailability, so we should too.
(While I’m all for increasing nutrient bioavailability, this theory, like the others, still fails to explain why gluten —a protein, and not an antinutrient—causes sickness.)
So far, I have yet to see anyone discuss gluten intolerance in the context of this epidemic of food allergies and allergic disorders. As I said, ALL allergic conditions, from asthma to eosinophilic esophagitis to rhinitis and eczema, are increasing, and not just in the US, or developed nations. We’re experiencing a worldwide epidemic of allergic diseases of all kinds. Why?
I think the answer is inflammation, and the resulting genetic change.
As I explain over several chapters in Deep Nutrition, the consumption of free-radical-causing vegetable oils combined with excess protein glycation from excessive sugar ingestion create a toxic environment for our bodily functions. None of our body’s systems can function normally in this toxic environment, not our hormonal system (which affects reproduction and genes), not our skeletal system, not our nervous system, and not—here’s what inflammation has to do with celiac disease—our immune systems.
The development of celiac disease is an important sign that your diet may be interfering with the normal function of your immune system. I like to help my patents understand that gluten intolerance is not, as we commonly hear, a strictly genetic disease, and supporting this idea is the fact that most people with celiac also have one or more other allergic disorders. Immune dysfunction can have even more serious consequences than celiac, including cancer and neurologic degeneration, and I discuss this below where I talk about molecular mimicry.
Inflammation also interferes directly with gene function and can cause abnormal or imperfect DNA replication, which is another fact that gets overlooked in most discussions of gluten intolerance. Through no fault of their own, women have been following dangerously pro-inflammatory diets during their pregnancies because our culture promotes wrong-headed dietary advice, and these pro-inflammatory foods are cheap and readily available.
Because of these nearly ubiquitous toxic exposures, however, over the past decades many babies have been born with genes scarred from exposure to inflammatory chemicals during key periods of replication. Today, the younger generations suffer from never-before-seen and sometimes disabling sicknesses because they have very fragile overall systems that will readily malfunction on anything other than a perfect diet.
And few parents are aware of, not to mention ready to provide, that perfect diet.
Real Reason for Hope: Epigenetics and Gene “Intelligence”
Fortunately, however, damaged and malfunctioning genetic material has the potential to regain normal function. This has to do with the fact that most of the genetic damage is confined to the gene regulation system, and does not affect the DNA itself. So if we provide our bodies with a rich variety of healthy foods and keep inflammatory exposures to a minimum, metabolic processes that currently malfunction may be able to repair themselves and begin to function normally again.
Why some people make antibodies to gluten: Immune system confusion
A two-step process triggered your body to make antibodies against gluten.
First, you ate processed foods that contained a distorted form of gluten that alerted your immune system to the presence of gluten. This immune-attraction is called an adjuvant effect. Gluten develops its adjuvant properties during processing when the protein reacts with sugar and distorts into all sorts of configurations, generating compounds that did not exist before processing.
Second, you also ate foods that promote intestinal inflammation. Adjuvant plus inflammation usually means you have an infection, and when you have an infection, your white blood cells manufacture antibodies to attack the invading organism. So your confused immune system mistook gluten for an invader, and you started making antibodies against gluten. Though processed and distorted, gluten, as with the windmills Don Quixote perceived as ferocious giants, does not pose an infectious threat, and the immune attacks are a tragically useless pursuit.
The foods containing proteins most likely to attract the attention of your intestinal immune system, like windmills dotting Don Quixote’s landscape, are those that meet two criteria:
- They contain complex protein molecules and an abundance of sugar molecules
- They are consumed often in processed form.
The most common allergens, wheat, soy, and casein meet both criteria. Eggs, another common food allergen, are included in vaccines and may trigger an antibody responses in some people for that reason.
The foods that promote intestinal inflammation and trick your immune system into thinking there’s a bad bacteria on the loose and launching it’s tragically useless and painful attack also meet two criteria:
- They promote free radical formation, which makes your immune system think you are infected with a pathogenic bacteria.
- They are high in starch, which gets rapidly fermented into sugar and invites overgrowth of bacteria that are borderline pathogenic, like yeast, which further confuses your immune system.
Statistically speaking, if you have one food intolerance, you’re more likely than the average person to have another. For instance, many people with celiac also have problems from dairy because the same sequence of events that played out with gluten also played out with a milk protein called casein, which, like gluten, is added to lots of processed foods. The same applies to soy, if you have soy allergies, eggs, if you have egg allergies, and so on.
So far, I’ve described only the reasons you have antibodies against gluten. People who suffer from celiac also have joint pains and skin rashes because the antibodies against gluten also just so happen to cross react with these tissues. The process is called Molecular mimicry.
From antibodies in the gut to problems in the skin, joints, and nervous system.
I do not believe, as some have proposed, that most people’s joint and skin symptoms are caused by particles of food traveling undigested to reach these tissues where they lodge and promote inflammation. I believe what happens is antibodies against food happen to be shaped so that they also bind to bodily tissues, launching a painful or disabling immune attack against your joints, your digestive system, or even your nervous system. This is the hypothesis proposed by scientists who study Molecular Mimicry.
How Molecular Mimicry Causes Celiac Disease
When molecules of different origin have segments in common, our immune cells may confuse one for the other. This is the accepted explanation for auto-immune diseases like lupus in which the troublesome agents are “auto-antibodies”—antibodies that attack you, rather than invading pathogens. The auto-antibodies bind to your own tissues where they attract white blood cells that can launch an attack. The effects of such an attack against your own body can cause, for instance, the symptoms of Lupus, an “auto-immune” disease.
Why antibodies sometimes attack their host (you).
Unlike cells, which are driven by the intelligence in their DNA, antibodies are mindless. They are large, Y-shaped proteins studded with sugar that the body manufactures after an infection to prevent you from getting sick from the same infection twice. Once you make antibodies to a pathogen, the next time the same organism tries to take root in your body the antibodies recognize it’s molecular fingerprint and bind to it, drawing a white blood cell attack that eliminates the invaders before you even feel sick. This is how it’s supposed to work.
Antibodies recognize bacteria by “feel” the way you feel around for keys in your purse.
Antibodies seek invading bacteria by “feeling” for matching patterns of protein and sugar (the molecular fingerprint) as they circulate through the blood and through the spaces between your cells. When the antibodies identify a fit, they slip around the matching molecular fingerprint like a glove around a hand, and then snap on tight. Once snapped on, patrolling white blood recognize the snapped-on antibody as a signal of trouble, and release chemicals that call for more white blood cells to rush in and destroy the invader.
The antibody-making system is not absolutely perfect. Sometimes your body will make antibodies that happen to match the molecular fingerprint of one or more of your own tissues (molecular mimicry). Fortunately, your body has several checks and balances in place that are designed to result in the destruction of these “auto-antibodies.” This process of destroying antibodies is called “tolerance.”
But those checks and balances fail when your immune system is not functioning normally, for example under times of extreme stress, sleep deprivation—or when eating a pro-inflammatory diet. Under these difficult conditions, your immune system is less likely to properly complete all of its checks and balances, “tolerance” never develops, and the auto-antibodies can end up misleading your white blood cells into launching an attack against your own tissues.
The exact tissue affected depends on the exact shape of the antibody. Celiac sufferers often make an antibody to a protein called tissue transglutaminase, which is located in the joints and skin, as well as the GI tract. Another common antibody is called “anti-gliadin” and this antibody is thought to be responsible for nervous system inflammation and neurologic disability associated with celiac. But there are probably many other antibodies associated with celiac disease that scientists have yet to identify and so we can not yet test for any of them.
To cure celiac symptoms, auto-antibody levels must drop and you must develop “tolerance”
The results you get from cutting gluten from your diet depend on how far your antibody levels drop. The reason some celiac patients feel better after stopping gluten is that the antibody levels have already dropped. The reason others don’t is that the antibody levels have not dropped.
To get auto-antibody levels to drop faster, farther, and potentially even permanently, you have to eliminate not just gluten, but all foods that cause inflammation. And again, the most common are vegetable oils that promote random free radical formation, and carbohydrate-rich foods that promote random tissue glycation.
While the idea that a person with celiac may someday even be able to eat gluten again is so-far untested, I have reason to believe it is at least theoretically possible.
We know that, thanks to the built-in “intelligence” of the immune system, auto-antibodies can be recognized as unnecessary and deleted. So a person who once used to make, for instance, IgA antibodies to tissue-transglutaminase, no longer makes these antibodies and auto-immune attacks stop for good. Though this presents reason for hope, I have to say that at this point I would not recommend anyone diagnosed with celiac by antibody testing or who has definite joint pains or rashes after eating gluten take the risk of re-exposing themselves.
A Healthy Diet To Recover From Celiac: Three Steps
As I’ve said, avoiding gluten is an essential step in recovering from celiac, but it is not enough. You also need to avoid factors that caused the faulty antibody production associated with celiac (and other food allergies) in the first place. The first two-steps for making a full recovery from celiac are:
Step One: Avoid vegetable oils, and keep your total carb consumption under 100 gm per day.
Step Two: Retreat to ‘safe” starches
The antibodies that cause gluten intolerance and celiac were made by mistake and you must eliminate them to eliminate symptoms of celiac. Avoiding gluten is an essential step. Many gluten free recipes make use of so-called “safe starches” (a term first coined by the authors of The Perfect Health Diet).
I define safe starches differently for celiac sufferers, or anyone with persistent digestive difficulties that could represent celiac, than I do for people without these health challenges. Safe starches for the general population are high-carb foods with one or more of the following traits:
- They contain a relative abundance of anti-oxidants (i.e. carrots or beets)
- They are low in protein (ie potatoes, rice)
- They are not commonly used in infant formulas or other processed foods.
Even if you do not have celiac, these kinds of starches will still be better for you. For celiac sufferers, or anyone with persistent digestive difficulties that might represent celiac, I add the fourth trait:
- They are gluten free.
Step Three: Promote healing.
For optimal recovery, I advise my patients to eat superfoods that promote rapid digestive recovery into their diet. Two of the four pillars of world cuisine defined in Deep Nutrition promote optimal digestive health, and these are collagen-rich bone broths and probiotic-containing live-cultured, fermented foods like yoghurt, kimchee, real pickles and sauerkraut.
I am working on a third book which will provide a program for adapting an anti-inflammatory optimal diet of traditional foods that are delicious, fast, and affordable. Stay tuned.