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Celiac disease needs two genes and virus to switch on

Celiac disease needs two genes and virus to switch on

It has been known for some time that two HLA genes (DQ2, DQ8) predispose to celiac disease. What was recently discovered, and reported in The New England Journal of Medicine, is that is seems to take a virus to activate these genes that leads to the disease.  The research focused on the interplay between viruses and genes causing celiac disease, with its gluten sensitivity. The genes alone don’t cause celiac disease.

The virus that appears to be the culprit is a Reovirus that infects the intestines, but is otherwise innocuous, in that is doesn’t cause any symptoms or illness. But in people who inherited HLA-DQ2 or DQ8, the genes are “switched on” and the auto-immune gluten sensitivity develops.

This is very compelling research because development of a viral vaccine could prevent millions of cases of celiac disease.

Dear Doc: Wheat, gluten, inflammation — baffling!

Dear Doc: Wheat, gluten, inflammation — baffling!

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.

Hookworms highlighted again: hitches and hopefulness this time

Hookworms highlighted again: hitches and hopefulness this time

Do you remember a previous newsletter article about a crazy British physician with asthma? He was able to put his asthma into total remission by ingesting hookworms. The worms end up living in the GI tract and for some strange reason, they switch the body from the allergy-promoting TH-2 mode to TH-1, which eliminated allergy (See Promising New Asthma Drug this issue.)

Now his crazy Australian brethren are doing research on celiac disease and hookworms. The Australian scientists found that by inducing an experimental hookworm infestation in patients with celiac disease, and at the same time giving them small amounts of gluten, they were able to induce a state of gluten tolerance.

As well as the hookworm treatments work, the downside is that the worms cause the patients to become anemic and, thus, are not a viable long-term treatment. The researchers, however, hope these experiments will lead to a safe method of switching TH-2 to TH-1. One never knows where research can lead.

Dear Doc: Explain sprue/celiac disease immune reactions

Dear Doc: Explain sprue/celiac disease immune reactions

Dear Dr. K: My gastroenterologist said that my blood pressure pill, Benicar, caused me to develop sprue. Can this be true?

To answer your question in a broad sense: “Yes;” but in a strict sense, “No.”

To better understand this yes/no scenario a few definitions would be helpful.

Sprue (also known as celiac disease) is a form of GI upset with diarrhea caused by an immune reaction to gluten. The immune reaction leads to inflammation in the intestinal wall, with resultant atrophy of the villi.

The villi are critical for properly digesting food (due to enzymes found on the villi), and for properly absorbing food (due to increasing absorptive surface area).

Benicar (Olmesartan) is one of a family of anti-hypertensives known as angiotensin receptor blockers. It has been implicated in a number of cases of chronic diarrhea, with biopsies that show villous atrophy.

However, unlike in sprue, there is no inflammation and also unlike in sprue, the illness does not improve with avoiding gluten. It does however, improve with going off the Benicar which allows the villi to regrow.

The Mayo Clinic has had a keen interest in this issue, and has even found some patients on Benicar with mild villous atrophy, but no symptoms.

What is reassuring about this research is that treatable conditions are being discovered for a large group of individuals previously labeled with “IBS” (Irritable bowel syndrome). The term syndrome means no known cause, but does not imply a cause can’t be found.

Celiac disease control helps thyroid patients absorb meds

Celiac disease control helps thyroid patients absorb meds

 The American Journal of Medicine had an intriguing article about people with difficult-to-regulate thyroid disease.

Researchers at the University of Vermont studied patients with hypothyroidism (low-functioning thyroid) who were on thyroid replacement therapy. In many people it is easy to dial in the proper thyroid hormone regimen, but in some this can be very difficult.

When the Vermont researchers looked at this latter group they discovered a large number had previously undiagnosed celiac disease.

Since celiac disease alters absorption of nutrients it can also lead to poor absorption of medications.

Once the celiac disease was treated, the patients’ thyroid condition came under smooth control.

Celiac disease and gluten may not be good combo

Celiac disease and gluten may not be good combo

A recent article in the Journal of Pediatric Medicine has this interesting title:  “The Complexity of Celiac Disease”.

The reason for the title surfaced when the researchers were testing the validity of the standard approach to diagnosing celiac disease.  The current gold standard for diagnosis consists of having a positive blood test and having an intestinal biopsy that shows villous atrophy (shortening of the absorptive “cilia” in the gut).

This study was conducted in Finland where this disease is quite common.  In the study group of patients who had a positive blood test but a normal biopsy, half went on a gluten-free diet, and half continued to eat gluten.

After a year the gluten avoiders not only felt better, but their blood tests had become negative.  The group that ate gluten continued to have symptoms and most of them developed a positive result on a repeat biopsy.

Their editorial conclusion was that a positive blood test warrants at least a trial of gluten-free diet.