Gluten Sensitivity, Celiac Disease, Wheat Allergy, and Cancer
When we think about gluten sensitivity, we immediately think about celiac disease. Scientists are finally beginning to realize what those of us who are sensitive to wheat have known for years – there are many manifestations of wheat sensitivity, with celiac disease being only one form.
Celiac disease was first described in 1887 by Dr. Samuel Gee. A Dutch pediatrician, Willem Dicke, discovered in the 1940s that when he removed all wheat products from the diets of children with celiac disease, their symptoms completely resolved. In the 1950s biopsy of the small intestine confirmed the location of the problem. In 1966 the association of gluten sensitivity with skin disease was noted. In 1966 a paper was published on the association of gluten sensitivity with neurologic disorders.
And some doctors are still telling their patients that a gluten-free diet is not only unnecessary, but even deleterious, harmful to their health and the health of their children, because they are unable to confirm a diagnosis of celiac disease based on standard testing.
And why is gluten-associated disease so difficult to diagnose? Remember if you want to make anything – a bookcase or an apple pie or a diagnosis – it is much easier if you have the right tools.
— Celiac disease affects approximately 1% of the population of European descent. How often have we heard “You don’t have celiac disease, therefore you can eat all the wheat you want without worrying about it.” How is celiac disease diagnosed? Typically with blood tests and an intestinal biopsy.
• If IgA is present in sufficient amounts, we see anti-tTG (tissue trans-glutaminase) antibodies.
• If IgA is present, we see anti-endomysial antibodies
• If IgA is not present, but IgG is present in sufficient amounts, we see DGP (deaminated gliadin peptides) – good test for children under the age of 3
• Small intestine biopsy will show characteristic changes – increased intraepithelial lymphocytes, some atrophy of the intestinal villi
But what if we don’t show any of those changes, and yet we feel bad whenever we eat wheat or gluten-containing products? Since the early 1980s we have seen literature about a wide range of proteins in wheat to which people may be sensitive or allergic. Only ONE of these proteins is tested by standard laboratories. No wonder we can’t make the diagnosis of wheat sensitivity – we are not testing the right antibodies.
Cyrex Laboratories, in Scottsdale, AZ, under the direction of Aristo Vojdani, PhD has an excellent panel called “Wheat/Gluten Proteome Reactivity & Autoimmunity” that measures many of these commercially untested antibodies in a sample of saliva. The test can even be used with very small children – they love to spit!
Wheat IgG, Wheat IgA, Wheat Germ Agglutinin IgG, Native + Deamidated Alpha-Gliadin-33-mer IgG, Native + Deamidated Alpha-Gliadin-33-mer IgA, Alpha-Gliadin-17-mer IgG, Alpha-Gliadin-17-mer IgA, Gamma-Gliadin-15-mer IgG, Gamma-Gliadin-15-mer IgA, Omega-Gliadin-17-mer IgG, Omega-Gliadin-17-mer IgA, Glutenin-21-mer IgG, Glutenin-21-mer IgA, Gluteomorphin+Prodynorphin IgG, Gluteomorphin+Prodynorphin IgA, Gliadin-Transglutaminase IgG, Gliadin-Transglutaminase IgA, Transglutaminase-2 IgG, Transglutaminase-2 IgA, Transglutaminase-3 IgG, Transglutaminase-3 IgA, Transglutaminase-6 IgG, Transglutaminase-6 IgA.
So if we can just measure the right antibodies, we may be able more easily to diagnose many of the following wheat-associated conditions.
— Wheat dependent exercise induced asthma – we may see recurrent wheezing whenever someone engages in any kind of exercise. The allergist or pulmonologist gives them some kind of bronchodilating inhaler to use before exercise, but may never think to inquire about their diet.
— Dermatitis herpetiformis – skin rash caused by gluten sensitivity. The microscopic appearance on biopsy of the skin lesions is quite characteristic. There is blistering under the epidermis (top layer of the skin) with inflammatory cells (neutrophils and eosinophils) in the dermal papillae found at the base of hair follicles.[8,9] IgA deposits are found within the skin.
— Gluten-associated cardiomyopathy. The Chinese first noted some 3500 years ago an association between the heart and the small intestine (Shao Yin Tai Yang meridian). More recently, we have read reports of gluten sensitivity associated with autoimmune inflammation of the heart and heart failure.[11,12]
— Autoimmune diseases – thyroiditis, rheumatoid arthritis, ankylosing spondylitis, even type I diabetes mellitus have all been associated with antibodies to wheat-derived peptides. The incidence of autoimmune disease is increased up to 30-fold in patients with celiac disease.
Table II. Detection of antibodies against different antigens in 3 representative
patients with celiac disease and gluten intolerance expressed by index.
— Osteoporosis – the blood of slightly more than 50% of gluten sensitive patients has antibodies to structures crucial to the formation of bone. Think of how many people could have avoided hip fractures and humped backs had they known to avoid gluten in their diets.
— Neurologic illness – diseases as diverse as cerebellar ataxia (inability to keep one’s balance), seizures, neuropathy, dementia, chronic headache, and even infertility have been reported to be associated with gluten or wheat sensitivity.
M Hadjivassiliou quotes the “modern” definition of gluten sensitivity as written by MN March in 1995 and published in the QJM: International Journal of Medicine:
“…a state of heightened immunological responsiveness to ingested gluten in genetically susceptible individuals.
It does appear that the marked upsurge in chronic inflammatory diseases, autoimmune diseases, osteoporosis, autism and cancer parallel the increase in manifestation of gluten sensitivity in our population. Is it possible that those dermal papillae could be involved?
Dermal papillae contain stem cells – cells which can multiply and turn into a multitude of epithelial-derived organs like hair follicles, sweat glands, sebaceous cysts, new hair… One wonders about the possibility of their also turning into less helpful organs like skin cancer, or other solid tumors derived from epithelium, and whether there might be similar stem cells in other parts of the body associated with ectoderm and/or endoderm, like the lungs, pancreas, stomach, colon, breasts…
There is some evidence of increased incidence of lymphomas and gastro-intestinal cancers in people with celiac disease.[22,23] Fortunately there is also some evidence that going on a gluten-free diet can improve the situation.
So… gluten or no gluten? If we eat bread addictively, we are going to have a hard time giving it up, to be sure. But if we can avoid that intolerable itch, explosive diarrhea, brain fog, wheezing, autoimmune disease, and a host of other symptoms, it might just be worthwhile.
We have the choice.