Dear Dr. K: I’ve had a blood test for gluten sensitivity, allergy tests for wheat and even an intestinal biopsy for celiac. All the tests are negative, but I still feel better when I avoid wheat. What gives?
What gives is that wheat is not good for you. No medical test is perfect. Even “gold standard” tests such as chest X-ray for pneumonia or cardiac catheterization for coronary blockage sometimes fail to demonstrate an existing abnormality. The bottom line is to listen to your body – it almost always gives reliable feedback.
I suspect you feel better wheat-free for one of two reasons: 1.) You are wheat-allergic or gluten sensitive, despite negative tests or, 2.) You are feeling metabolic and inflammatory buffeting from wheat.
Regarding the first possibility, the Mayo Clinic published research data from their GI department. They found that 15 percent of their patients with chronic GI problems improved on a wheat-free diet, despite negative tests for gluten sensitivity. They posited that perhaps a better test for gluten sensitivity needs to be invented.
With respect to the second possibility of metabolic and/or inflammatory problems, this case was probably best summed up by Dr. Daniel Lieberman, a Harvard social anthropologist, in his book, The Story of the Human Body. He maintains that the cultivation of wheat, starting 10,000 years ago, was both the best and worst step for humans. He contends the ability to farm allowed humans to move from sparsely populated hunter-gatherers to the burgeoning population of civilized humans who have covered the globe.
The trade-off, he says, is a dramatic increase in the “civilized” diseases of metabolism and inflammation. Ghrelin, leptin, adiponectin and insulin are crucial to proper metabolism and weight management, and all four are adversely affected by wheat. He points out the phytic acid (phytate) in wheat severely reduces absorption of essential micronutrients and vitamins.
With respect to inflammation, gluten is pro-inflammation; in addition, wheat contains the lectin WGA (wheat germ antibody). Lectins are proteins that bind to the glycoproteins and glycolipids found in many cells in the body. These include: skin, respiratory system, GI tract, nerves, cartilage, connective tissues, prostate, kidneys, pancreas, liver, uterus and thyroid. This binding serves as a promoter of inflammation in these tissues. Lieberman draws a direct parallel between the increased consumption of wheat and the appearance of “modern” diseases such as diabetes, heart disease, autoimmune diseases, allergy and cancer.
The most common cause for drug allergy is from IgE-mediated (allergic) reactions, such as having hives from penicillin. New research is discovering a second mechanism for drug reaction being called “drug hypersensitivity,” as it is mediated by T-lymphocytes. The reactions are different from the arch-typical “allergy” in that they tend to be somewhat delayed and different types of rashes. Examples are measles-type bumps, the life-threatening skin condition Steven-Johnson Syndrome or liver irritation.
Of great interest is that there seems to be a genetic predisposition to react to certain individual drugs. Following is a list of certain HLA (genetic) types and the drug that reacts:
|
Genetic Type |
Drug |
|
HLA A 31:01 |
Tegretol |
|
HLA A 33:03 |
Ticlid |
|
HLA A 68:01 |
Lamictal |
|
HLA A 02:06 |
Cold Medicines |
|
HLA B 56:02 |
Dilantin |
|
HLA B 58:01 |
Allopurinol |
|
HLA DRB 1 11:01 |
Statins |
|
HLA DRB 1 13:02 |
Aspirin |
|
HLA C 04:01 |
Viramune |
Because this research is new there are lots of uncertainties. Genetic testing is expensive, and everyone with the implicated gene won’t react to the medicine. It’s too early to recommend across-the-board testing, but an awareness of possibilities, along with finding less expensive ways to do this testing, may soon lead to “genetic profiling” of all of us.
In the early 1900s, German scientist and Nobel Laureate Paul Ehrlich pioneered an antiserum to help combat diphtheria. His anti-serum saved many lives in the pre-antibiotic era. He also popularized the concept in medicine of a “Magische Kugel” (Magic Bullet).
His idea was to find treatments that were so specific that they only worked on their specific targets without any collateral effect or damage to the body. In 1975 Cesar Milstein and Georges Kohler (also Nobel Laureates) invented hybridoma technology which allows the production of large quantities of antibodies specific for a single target also known as monoclonal antibodies.
Roughly 10 years later the first therapeutic antibody was made: monoclonal antibodies (muromonals), with a target of the CD-3 receptor on T -lymphocytes. You see, by inactivating CD-3, it prevents rejection of organ transplants, and it revolutionized transplant medicine by allowing better survival with less need for high-dose steroids.
Since 1985 the floodgates have opened up with more than 35 monoclonal antibodies that have been approved by the Food & Drug Administration (FDA) for use in medicine. Hundreds more are being researched. These antibodies are used to treat a variety of diseases. Some examples which include the antibody, the target and the disease follow.
|
Drug |
Target |
Condition |
|
Infliximab |
TNF-a |
Rheumatoid arthritis |
|
Adalimumab |
TNF-a |
Crohn’s disease |
|
Omalizumab |
IgE |
Asthma |
|
Rituximab |
CD20 |
Lymphoma |
|
Abciximab |
Gp11b/111a on platelets |
Prevent clots after coronary stenting |
|
Trastuzumab |
HER2receptor |
Breast cancer |
Two other strategies being worked on are using monoclonal antibodies as vaccines and making an antibody-drug conjugate. The idea is to couple an antibiotic or an anti-cancer drug to the “magic bullet” so only the target receives the medicine. This would allow high concentrations of the drug to be used.
As far as vaccine therapy goes, there actually is one already in use: palivizumab, which targets the F protein found on RSV (Respiratory Syncytial Virus). It is given once a month to high-risk infants to prevent their catching RSV.
Similar efforts are underway to develop a vaccine for HIV, and also one for influenza.
Over the past five years this newsletter has offered numerous articles about the health benefits of probiotics.
We have learned that because 80 percent of the immune cells in the human body are found lining the GI tract, it is critical that these cells see a normal, healthy microbiome (like a micro-ecosystem in the body.) Altering healthy gut flora leads to both a pro-inflammatory and a pro-allergic state, predisposing to auto-immune and allergic disorders.
Ingesting healthy microbes in the form of probiotics has proven to help. Now, new research is extending this approach to the use of prebiotics — foods that contain oligosaccharides (certain carbs with a few simple sugars) and fiber. These promote the establishment and flourishing of healthy gut bacteria. Some of the best in this category are:
dandelion greens chicory root
asparagus garlic leeks beans
banana berries artichokes
Interesting research on aboriginal peoples in New Guinea and Australia, whose diets are replete in prebiotics, shows almost no problems with autoimmune or allergic diseases.
Recent research done at St. Jude Children’s Research Hospital in Memphis led to an unusual discovery!
Rapamycin, a drug normally used to suppress the immune system was found to bolster the powers of the flu vaccine.
Rapamycin was originally discovered in a soil sample taken on Easter Island (whose Polynesian name is Rapanui; hence, “rapamycin).” Early on it was found to have antifungal properties, but additional research revealed it to also have immunosuppressant and anti-tumor properties. Giving low doses to healthy mice, it actually increases their life span.
Its main use in humans is to prevent kidney transplant rejection. Taken in small amounts with the flu vaccine, it allows the immune cells in experimental animals to make high-level and broad-spectrum antibodies.
If human results prove similar, we may all end up taking a small amount of Rapamycin prior to our then once-every-10-years flu shot.
We are obligate aerobic creatures requiring constant, good oxygenation. Allergic individuals sometimes have less than ideal oxygen delivery because of nasal obstruction or asthma.
If, in addition, they are anemic, then oxygen delivery to the tissues is reduced for a second reason.
Iron deficiency anemia is fairly common, especially in growing children and menstruating females. The usual therapy for this is oral iron supplementation. Until recently, this was recommended on a daily basis. However, recent research published in the Journal Blood is altering this advice.
It seems that within a few days of starting oral iron therapy our bodies make a peptide called hepcidin which inhibits intestinal iron absorption. And so the very act of taking iron can put on the brakes, so to speak, of absorbing it. Trying twice or thrice a day dosing only increases the hepcidin levels more.
Luckily the researchers found a simple solution: take the iron every other day. This keeps hepcidin levels low and iron absorption high.