Celiac Part 2: Destined for a life of suffering and more autoimmune diseases?
In my last blog post (Part 1: Destined for a life of suffering and more autoimmune disease), I looked at how having Celiac Disease makes us susceptible to many other autoimmune diseases and other diseases, in general.
I'ts shocking, and pretty depressing, to say the least!
Here are the stats, in case you forgot...
16% of Celiacs have Pancreatitis, versus 0.7% in the general population
29% of Celiacs have arthritis versus 8.4% in the general population
19% of Celiacs have migraine headaches versus 4% in the general population
36.8% of Celiacs have GERD versus 13% in the general population
Celiacs are diagnosed with IBD (Crohn’s and Ulcerative Colitis) 10 times higher than the general population
8% of people with Type 1 Diabetes are diagnosed with Celiac
Celiac is 20X higher in kids with autism (1)
Upon further investigation, I found out there is a long list of associated comorbidities, or diseases that commonly follow the diagnosis of Celiac such as:
Liver disease (Autoimmune, Chronic Active Hepatitis), Grave’s, Hashimoto’s, Addison’s Disease, lupus, Myasthenia Gravis, Pernicious anemia, Raynaud’s Phenomenon, Scleroderma, Sjogren’s, eosinophilic esophagitis, anxiety disorders, Down Syndrome, MS, psoriasis and autism. (2, 3)
Plus, once you have one autoimmune disease, the chance of acquiring another autoimmune disease is 15% versus 5-8% in the general population. (4, 5)
Across the board, women are affected more than men, generally, 80% of those effected by autoimmunity are women. And, in some AI diseases, the rate is strikingly higher. In Systemic Lupus Erythematosus (SLE), 9 out of 10 cases are women. (6)
So, why does having Celiac Disease predispose you to so many other diseases?
By understanding what's causing this increase, I believe it helps us have the tools to not only reverse chronic symptoms post Celiac diagnosis, but eliminate future diagnoses and suffering.
We don't know, exactly what causes autoimmunity.
But we know 3 things must be in place for autoimmunity to occur:
1. Genetic vulnerability
2. An environmental trigger, such as a significant life stress, the birth of a baby, infection, toxic exposure, etc.
3. Gut permeability or "leaky gut" (7)
Next, I'm going to go through all of the theories as to why we have an epidemic of autoimmune disease, plus why having Celiac predisposes us to so many ailments.
Could it be “leaky gut” and elevated Zonulin?
We know that autoimmunity- ALL autoimmunity- begins in the gut when the tight junctions, the space between the cells of the gut lining, become permeable, or have tiny holes. This allows large food proteins, bacteria and toxins to pass through the intestinal lining into the blood stream. This is bad news because your immune system sees these particles that shouldn’t be there, and it triggers an immune response to the “foreign invader”. Your immune system mounts an inflammatory attack that can spread to include healthy, self-tissue and the inflammatory response can happen in any area of the body from your brain to your joints. (7, 8)
Specifically, with Celiac, gliadin causes Zonulin levels to increase. This opens up the tight junctions, or the cells of the epithelium, causing “leaky gut”. When you have leaky gut, you also have a leaky blood brain barrier, allowing toxins and proteins to enter the brain, causing low level brain inflammation. This, in turn causes inflammatory changes in the central nervous system. This is why so many with Celiac- up to 50%- have neurological symptoms, such as brain fog, memory problems, trouble learning new concepts and problems with concentration.
Research shows that Celiacs have an elevated level of Zonulin, even after adopting a gluten-free diet. High Zonulin is associated with developing other autoimmune diseases, as well as increasing your risk for obesity, high cholesterol, insulin resistance, and metabolic syndrome, among others. (9)
With Celiac, whether you have gut symptoms or not, your body attacks the hair-like projections of the inside of your intestine. This causes not only inflammation and malabsorption, but distinct and dramatic changes to the landscape and function of your intestine. Normally you would have nice folds with "hills" and "valleys" that increase surface area for nutrient absorption.
With Celiac, the lining of the gut begins to flatten out. Since your immune system attacks the gut, and we know health begins (and ENDS) with the health of the gut, it makes sense that you become susceptible to so many other diseases when your gut is such a mess. Furthermore, research shows that eating a gluten free diet, alone, does not heal your gut or change the hyper-sensitive immune response.
Or, is it a hypersensitive immune system?
Another idea is that once your immune system is stimulated by one autoimmune disease, maybe it remains hypersensitive to other triggers. (1) We know in Celiac, even after adopting the gluten-free diet, inflammatory markers can remain high years later. I see this in my clients where they are diligent with their gluten-free diet, yet serum anti-tTG antibodies remain high or they have continued immune reactivity to various gluten peptide epitopes on the Wheat Zoomer. This can go on for years.
At the Bold Beyond Celiac Symposium in November, 2017, the panel consensus agreed, “up to 50% of Celiacs show ongoing or intermittent Celiac activity while on the gluten free diet and more than 30% of adults Celiacs continue to have intestinal damage 4 years after going gluten free”.
For many people, removing gluten is not enough. We need to take measures to heal the gut and retrain the immune system.
Or, is it because of infections and changes to your microbiome?
Or, maybe it’s the involvement of bacteria, viruses and toxins. Scientists postulate that the antigens of certain microbes resemble self antigens, so they believe autoimmunity occurs due to this "molecular mimicry". In essence, they believe that the immune system begins attacking the microbe and gets confused or goes "haywire" and begins attacking self because they present to the immune similarly.
In contrast, other researchers explain the self tissue attack as "collateral damage". Infectious agents like to hide in human tissue, such as the thyroid gland. Epstein Barr Virus (EBV), for instance, loves to hide in the thyroid. So, it makes sense that your immune system is trying to eliminate EBV and some thyroid tissue gets destroyed in the process. (7)
I see this in my practice all the time. Gut infections and viral reactivation can be one of the initial autoimmune triggers. There is ample research linking early Rotavirus, Campylobacter, Adenovirus (Parainfluenza), and Hep-C infections to increased Celiac risk in susceptible individuals. (10, 11, 12)
In Celiacs who don't get better on the gluten free diet, studies have shown 50% have SIBO, Small Intestine Bacterial Overgrowth. This is a marked change in the microbiome where there is either a bacterial infection with a pathogen or, the normal flora of the colon has traveled into the small intestine, where it shouldn't be, and overgrown. If you've had SIBO, you know how miserable you can feel with symptoms ranging from extreme bloating and gas, to heart palpitations, to brain fog, to overall body pain and more. (13)
If you have Celiac and have been diagnosed with IBS, it would be prudent to get checked for SIBO with a lactulose breath test or combination lactulose/glucose. 85% of IBS sufferers are actually dealing with SIBO.
Infections, as well as prescription medications, toxins and especially Glyphosate (the active toxin in RoundUp) also play a role in changing the microbiome, turning on gene expression. “Fasano believes the explanation may lie in what’s known as the microbiome—the collective genome of all the microbes, such as bacteria, in and on the human body. These bacteria on the skin and in the gut, our internal environment, are important factors in the disease. Fluctuations in these microbes can affect, among other things, the gut integrity, the metabolism and the immune response. That may cause the genes—which have been there all along, not causing a problem—to be turned on.” (14)
Dr. Fasano and Dr. Leonard are currently involved in a study closely tracking changes in the microbiome in Celiac-susceptible infants in the CDGEMM study. They are attempting to pinpoint exactly what the microbiome changes are and looking for ways to prevent the onset of disease.
Or, what about hormones?
There is a link between the male sex hormone testosterone and protection against autoimmune diseases. This would explain why more women have autoimmune diseases. Men are generally more protected than women, who only have one tenth as much testosterone. Furthermore, we are seeing an overall decrease in testosterone levels possibly due to all of the endocrine disrupting toxins in our environment. This could further explain the rise in autoimmunity.
It is believed that Testosterone reduces the number of B cells, a type of lymphocyte that releases harmful antibodies. With less of these specific B cells, you have less autoimmunity.
Researchers looked at blood samples of 128 men, ran numerous experiments on mice and came to the conclusion that the critical connection is the protein BAFF (B-cell Activating Factor, also knows as Tumor Necrosis Factor), which makes the B-cells more active.
"We have concluded that testosterone suppresses BAFF. If you eliminate testosterone, you get more BAFF and thereby more B cells in the spleen because they survive to a greater extent. Recognition of the link between testosterone and BAFF is completely new. No one has reported this in the past," says Asa Tivesten. (15)
Now, before you go out and try to increase your levels of testosterone, it's wise to first test and see where your hormones are at. In the end, it's all about hormonal balance. I don't ever recommend using hormonal therapy without testing because you can do more harm than good.
Since so many more women have autoimmune diseases, it begs the question, "what about estrogen"? According to Michael McEvoy, estrogen plays a role in autoimmune disease in multiple ways:
Estrogen has the ability to reduce CD8 lymphocytes, making you more susceptible to viral reactivation or infection.
Viruses such as Epstein Barr have shown to be able to increase aromatase (an enzyme catalyst), causing testosterone to convert into more estrogen. Now, you've lost testosterone's protective effect and increased estrogen's triggering effect.
Again, thanks to our toxic environment, we are exposed to ever-increasing estrogen-mimicking compounds, adding to estrogen dominance.
Can you see how this goes round and round? Viruses increase estrogen, and estrogen decreases your ability to fight off viruses. Epstein Barr virus was found in about 85% of Hashimoto's patients and 65% of Grave's patients.
Again, before you go find a clinic that will give you hormone injections, test and see where you are at. There are many safe ways to find hormonal balance.
Could it be genetics?
New study looked at genetic variations among men and women. Researchers identified 661 genes that were expressed differently in men and women. Many of these genes regulate immune function and some have been linked to autoimmune disease. The findings suggest that the difference in genetic expression not only increases the risk of developing an autoimmune disease, but will change the severity of the symptoms. Furthermore, the researchers identified a protein called VGLL3, which plays a large role in regulating inflammation and autoimmunity.
When looking at health skin samples, they noticed VGLL3 was only active in women. However, when they looked at skin samples from men with lupus, they found it had activated.
“In this context, we note that being female is the strongest risk factor for the development of autoimmunity, and it dwarfs the identified autoimmune genetic risk variants.” -Liang (16)
Recently, researchers at National Jewish Health found a new group of B-cells, called ABC’s (Age-Associated B-Cells). These cells can make auto-antibodies. By down-regulating these cells, researchers stipulate we might be able to turn off autoimmunity. These new cells could help explain the onset of autoimmunity or they could help us “turn off” autoimmunity.
These ABC’s need to be activated by TLR7 (Toll-Like Receptor 7), a cell surface receptor involved in the innate immune system. And, the gene for TLR7 is carried by the X chromosome, and since women have 2, X chromosomes, it might explain why women have a higher incidence of autoimmune disease. (17)
Many Celiacs have had their Celiac genes mapped. Most Celiacs either have HLA-DQ2 or HLA-DQ-8 (HLA stands for Human Leukocyte Antigen). But, we also know that the HLA haplotype is involved in many autoimmune diseases, such as Ankylosing Spondylitis, Rheumatoid Arthritis, reactive arthritis, psoriasis, narcolepsy, Type-1 Diabetes, and Multiple Sclerosis. (18)
Changes in these gene complexes alter the MHC, or the Major Histocompatibility Complex and cause a “confusion” in the immune system where it begins attacking self-tissue. Since we know some autoimmune diseases can be “triggered” by infections, some researchers believe the immune system is going after infectious agents that like to hide in host tissue, such as Epstein-Barr Virus or Lyme Disease.
“Rose adds that some autoimmune diseases share heritable components, such as variations in the gene that codes for human leukocyte antigen (HLA). HLA is the human version of a major gene family called the major histocompatibility complex (MHC), which plays crucial roles in immunity in vertebrates. One MHC variation in particular, he says—known as the HLA-A1-B8-DR3 haplotype—is implicated in several autoimmune diseases. Indeed, most autoimmune illnesses can be tied to HLA variations of one kind or another, he adds. “So this tells me they’re fundamental to autoimmune disease etiology."(19)
Or, is it the toxins in our environment?
We live in a toxic soup.
Babies are born with 200 + toxins in their body.
The average woman is exposed to 168 chemicals in her beauty regimen each day. (20) Women tend to use more body care products than men. We also tend to have more fat on our body and guess where most toxins are stored?
You guessed it! In fat.
We are exposed to toxins in our air, water, food, furniture, clothing, beauty care products, pots and pans and even food storage containers.
Glyphosate, the active ingredient in RoundUp has been found at high levels in numerous food products, whether organic or not. It is a water-soluble super antibiotic! It selectively kills off your beneficial gut bacteria, leaving pathogenic species to take over.
Additionally, Glyphosate interferes with cytochrome P450 Enzymes, making you less able to detoxify these toxins. It also makes you less able to make Vitmain D3, less able to break down Vitamin A and inhibits bile acid production so you can't digest fats and absorb fat soluble vitamins. It is a known chelator, meaning it binds to minerals, making them unavailable to YOU. (20)
Glyphosate is in every fluid of your body and even in your honey. It is classified as a "probable carcinogen", yet, it's in your child's breakfast cereal at high and dangerous levels.
Dr. Stephanie Seneff and Anthony Samsel, pioneers in the research of glyphosate and the connection to the rise in Celiac Disease, feel there is an undeniable link. When you graph the increase in use of Glyphosate and the rise of Celiac Disease, the lines match almost perfectly. The chart, below is from “Glyphosate, pathways to modern disease II: Celiac Sprue and Gluten Intolerance”, 2013. (22)
So, what about plastics? When you store your food in plastic or microwave food in plastic, endocrine disrupting chemicals are leaching into your food.
You might be thinking, “well, I don’t use plastic anymore, so I’m safe, right?”.
Or, "I only buy BPA-free plastic, so I'm safe, right?".
Scientists are now finding tiny plastics in our water, in our salt and in our food.
BPA has been replaced with an alphabet soup of Bisphenol-B, -F, -S, and BHFP. Plastics are a known endocrine disruptor, causing estrogen dominance and a drop in testosterone. Do you see the link to hormones, here?
“Our gene sequences aren’t changing fast enough to account for the increases,” Miller says. “Yet our environment is—we’ve got 80,000 chemicals approved for use in commerce, but we know very little about their immune effects. Our lifestyles are also different than they were a few decades ago, and we’re eating more processed food.” (23)
This study was from 2011. Do you know how many more chemicals have been approved for the American market? We all know our chemical exposure has increased and we are already seeing an autoimmune epidemic with over 50 million suffering. Miller says autoimmune diseases will play a major role in healthcare costs in the US, and it already is.
Many scientists have noted the real rise in chronic disease, including Celiac, in the last 30-40 years. The change in rates are happening much too fast to be explained by genetic changes. So, it makes sense that there must be some environmental influence. Jill Norris, a professor of epidemiology at the Colorado School of Public Health, adds, the prevalence of celiac disease—an autoimmune affliction of the small intestine triggered by exposure to gluten, a protein found in wheat, barley, and rye—also appears to be rising dramatically in the United States.” (24)
Or, is it a problem with food additives?
Food additives have become ubiquitous in our food supply. It’s easy to think that the companies making your food would have your health and best interests in mind. I’m here to tell you, if you didn’t already know, that is NOT the case. It’s the opposite. Food manufacturing companies have one thing in mind... bottom line!
They want you to love their product. To become addicted to their product and feel that you can’t live without it. Also, they want to make their product as cheaply as possible and have it last on the shelf for as long as possible. All to increase their profit.
We’ve seen the addition of sugar, table salt, emulsifiers (such as polysorbate-80 and carboxymethylcellulose), solvents (like Hexane), gluten, Microbial Transglutaminase, and nano-particles. All of these additives have either a direct effect on the relative “leakiness” of the gut or destroy the protective mucous layer, allowing toxins, pathogens and proteins into your bloodstream. (25)
“They (tight junctions) regulate the trafficking of macromolecules between the environment and the host through a barrier mechanism. Together with the gut-associated lymphoid tissue and the neuroendocrine network, the intestinal epithelial barrier, with its intercellular TJs (tight junctions), controls the equilibrium between tolerance and immunity to non-self antigens.” (26)
We’ve also seen an increase in Advanced Glycation End Products or AGE’s in fast food and a change in cooking methods. These AGE’s increase inflammation in the body and promote a Th2-dominant immune system, increasing allergic response. These AGE’s will additionally alter your microbiome in a negative way, creating further inflammation. We know where there is chronic inflammation, autoimmunity is more likely to develop. These AGE’s also destroy the mucous layer that lines the inside of the gut. This mucous is protective and keeps the food particles and bacteria away from the blood stream. It is also the first line of defense in your gut when you accidentally ingest a pathogen like a parasite, infectious bacteria, yeast or virus. Without this mucous layer, you become more reactive to foods, in general and more susceptible to pathogenic infections, along with increased inflammation and autoimmunity.
So, what is causing this rise in autoimmunity and increased rates of disease prevalence among Celiacs?
I wish I had the answer.
It is likely a complex interplay between all of these factors. As many of us have experienced, our autoimmune disease was diagnosed after a "perfect storm" of events.
What I do know is this.
Conventional medicine is great at emergency medicine. If I’m in a car accident and badly hurt, you bet your ass I want to go to the ER and the team of doctors will take great care of me.
In conventional medicine, the problem arises with chronic illness. When there isn’t a pill for your ill or the pill they give you doesn’t work or makes you feel worse, it’s time to look outside of conventional medicine. In the realm of autoimmunity, conventional medicine is failing. There aren't adequate answers and solutions because I believe chronic disease must be addressed holistically.
As a Functional Practitioner, I get to innovate. I get to take the latest research and apply safe strategies based on that research… NOW, not 18 years from now.
Unlike your doctor who has a limited toolbox, I have an ever-expanding toolbox of strategies that have been proven to work. My hands are not tied by what insurance will allow. Also, unlike your doctor, I will not diagnose or treat a specific disease. I look at where your body has lost function and what factors are blocking healing. By removing these blocking factors, your body knows exactly what to do to get back to health.
So, taking all the evidence of what might be causing autoimmunity, in the first place, plus the propensity toward being diagnosed with another autoimmune disease or other diseases, what can be done to not only heal and feel well after Celiac diagnosis, but reverse the autoimmune path and prevent other disease diagnoses?
At the end of the day, this is the most important question.
As a Functional Health Practitioner, I have the luxury of combining cutting-edge lab testing with a detailed health history. I also get to spend ample time getting to know you and your unique situation.
Together, we ask these questions:
Why did YOU develop an autoimmune disease in the first place and what do we need to do to restore balance to your body and reverse autoimmunity? How many of the above factors are contributing to your symptoms?
Check back in for Part 3, where I'll outline how you can find answers as to why you developed Celiac, plus ways to not only heal your body and reverse the autoimmune process, but prevent future diagnoses.
You can get your life back!
Allana McKinnon, FDN-P is not only highly trained in Functional Health Practices, she has lived through chronic illness and reversed her own Celiac Disease and other health challenges such as asthma, allergies, hypothyroidism, a half dozen gut infections, and CIRS from mold and Lyme. She is a Certified Functional Diagnostic Nutrition Practitioner ® and a Certified Gluten Practitioner, with additional training in histamine intolerance, hyperoxaluria (oxalate metabolism issues), Celiac Disease, detoxification, hormone balancing, SIBO, the Autoimmune Paleo Diet, the microbiome and stealth infectious disease. Allana works one-on-one with clients via telemedicine, using Functional Lab Testing, along with meaningful interventions in the realm of nutrition, movement, sleep, mindset and supplementation. Many of Allana's clients enjoy working with her because they feel truly understood and truly heard. They feel her compassionate nature and she provides her clients with the answers they are so desperately seeking.
Click here for a 30 minute Zoom video consultation for $30 to see if she can help YOU heal from Celiac.
Gluten Free and More
Gluten Free and More
Moreno-Navarrete JM, Sabater M, Ortega F, Ricart W, Fernández-Real JM. Circulating zonulin, a marker of intestinal permeability, is increased in association with obesity-associated insulin resistance. PLoS One. 2012;7(5):e37160. doi: 10.1371/journal.pone.0037160. Epub 2012 May 18. PubMed PMID: 22629362; PubMed Central PMCID: PMC3356365.
Stene L, Honeyman M, Hoffenberg E, Haas J, Sokol R, Emery L, Taki I, Norris J, Ehrlich H, Eisenbarth G, Rewers M. Rotavirus Infection Frequency and Risk of Celiac Disease Autoimmunity in Early Childhood: A Longitudinal Study. The Americal Journal of Gastroenterology. 2006, pp.2333–2340, doi:10.1111/j.157241.2006.00741.x
Troncone, Riccardo; Auricchio, Salvatore. Rotavirus and Celiac Disease: Clues to the Pathogenesis and Perspectives on Prevention. Journal of Pediatric Gastroenterology and Nutrition: May 2007 - Volume 44 - Issue 5 - p 527–528. doi: 10.1097/MPG.0b013e31804ca0ec
Plot L, Amital H. Infectious Associations of Celiac Disease. Autoimmunity Reviews: Volume 8, Issue 4, February 2009, Pages 316-319. doi.org/10.1016/j.autrev.2008.10.001