Alpha Nutrition Health Education

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Foods made with wheat are staples in North American and European diets. Unfortunately, wheat and its close relatives,  barley,  rye and oats have proved to be a problem in the diets of many of our patients. Allergy develops to proteins in these grains known as "gluten". Celiac Disease is the best-recognized form of gluten allergy.

Whole grains are popular foods but there is a hitch. The bad news is that wheat disease ranks second only to milk disease when we review the experience of our patients with celiac disease, irritable bowel, arthritis and other expressions of the delayed patterns of food allergy. 

The four cereal grains, wheat, rye, oats and barley contain similar proteins that are participate in a variety of diseases - the proteins are called "gluten" and act by exciting immune responses in the gastrointestinal tract and downstream in the rest of the body. The significance of other problems in the grain supply remains to be defined. These include contamination with pesticides, preservatives, and molds such as ergot and aspergillus. Alpha Nutrition excludes cereal grains because of the high incidence of observed problems with cereal grain ingestion.

The diseases related to intolerance of cereal grains are Celiac Disease and the skin disorder, Dermatitis Herpetiformis. These disturbances are caused by wheat proteins, collectively called Gluten. 

Gluten

Wheat proteins are collectively called "Gluten". Wheat is closely related to other cereal grains, especially rye, barley, and oats. Enthusiasm for "whole grains" to increase intake of dietary fiber, especially in the past decade, led to increased consumption of whole cereal grains. Relatively unrefined grains, often in combination, as with granola cereals and whole wheat breads fortified with bran, coarse flours, and other additives are now eaten in large quantities.

Gluten is a mixture of individual proteins classified in two groups, the Prolamines and the Glutelins. The prolamine, Gliadin, seems to be a major problem in celiac disease; gliadin antibodies are commonly found in the immune complexes associated with this disease.

We eat the seeds of the grain plants. The seed has a bran casing, a starchy endosperm which contains 90% of the protein, and a small germ nucleus which is the plant embryo waiting to grow. Any flour made from the starchy endosperm contains prolamines and is potentially problematic to the grain intolerant person.

When wheat is the principal problem food- barley, oats, and rye must be excluded as well. Millet is usually an acceptable grain alternative. Corn and rice are usually tolerated when gluten prolamines are the chief and only food intolerance, although corn triggers food allergy for its own reasons.  Triticale is a new hybrid grain with the properties of wheat and rye, and is excluded on a gluten-free diet. The identity and the amount of the prolamine decides the kind of reaction that is likely to occur. It should be noted that there is considerable variability in the prolamine content of various foods made from cereal grains, and this variability is one of the many reasons why food reactions are not consistent.

Rice is used as the staple grain in Alpha Nutrition and gluten-containing foods are excluded.

Janatuinen et al presented evidence that 52 adult celiacs tolerated oats for one year with no evidence of harm. The study period is too short to be definitive since relapses after longer periods have been observed repeatedly in celiac patients who resumed eating grains.  Their study at least raises the question of what foods can be considered safe in the long term. Celiac dogma treats the four cereal grains as equally risky. The older assumptions need to be reviewed by further studies.

Recently marketed grains, Spelt and Kamut, are gluten-containing wheat variants (despite claims to the contrary) and are likely to cause problems similar to other wheat varieties.

The general thesis is that immune responses to proteins found in cereal grains are a common cause of disease. The gastrointestinal tract is the primary target organ; however systemic disease is an important consequence of cereal grain ingestion in many patients. Latent disease may manifest as irritable bowel syndrome with iron deficiency anemia, but little or no diarrhea. Kelly in a clinicopathological review of celiac disease stated that: "...there is increasing evidence that most people with gluten sensitivity have latent celiac disease with such mild manifestations (in the digestive tract) that the diagnosis is never made.  

Celiac disease is associated with a variety of autoimmune disorders, carcinomas of the gastrointestinal tract and lymphomas. These associations suggest a diathesis to immune hypersensitivity diseases and a possible role for food antigens in causing systemic autoimmune disease. Increased incidence of diabetes mellitus, autoimmune thyroid disease, sarcoidosis, vasculitis, pulmonary fibrosis, encephalopathy and cerebellar atrophy have been reported in celiac patients. The prevalence of celiac disease among children with IDDM is 50 times more likely than chance. IgA deficiency is 10 times more common in celiac patients than in the general population.

In their review of these associated disorders, Mulder and Tygart repeated the basic idea of pathogenesis of systemic disease downstream from a disordered gastrointestinal tract. They stated: "Patients with (celiac disease and) selective IgA deficiency often have circulating antibodies to food proteins; they also have circulating immune complexes, suggesting that absence of an intestinal IgA barrier might allow the absorption of antigenic material from the gut. Antibodies to some of the antigens might cross react with the host's self components and might indirectly produce autoimmune disease."

A striking association is that celiac disease predisposes patients to the eventual development of lymphoma. If this relationship is re-stated as "cereal grains cause cancer" the implications are more easily understood. There is evidence that strict adherence to a gluten-free diet long term will reduce the incidence of lymphoma.

Gluten & Arthritis

The mechanisms by which wheat or any other food can cause disturbances are numerous. Painful inflammatory states may be the presentation of wheat allergy. The occurrence of pain in joints, particularly the hands, with slight swelling and stiffness is the early presentation of allergic arthritis; it can occur strictly as a manifestation of gluten allergy. A wheat gluten mechanism has been studied in rheumatoid arthritis patients. Wheat ingestion  may be followed within hours by increased joint swelling and pain. Little et al studied the mechanism, as it developed sequentially following gluten ingestion. The mechanism involves several stages:

The gastrointestinal tract must be permeable to antigenic proteins or peptide fragments, derived from digested gluten. The antigen appears in the blood stream and is bound by a specific antibody (probably of IgA or IgG, not IgE class), forming an antigen-antibody complex, a circulating immune complex (CIC). The antigen-antibody complex then activates the rest of the immune response, beginning with the release of mediators - serotonin is released from the blood platelets. Serotonin release causes "symptoms" as it circulates in the blood stream and enhances the deposition of CICs in joint tissues. Once in the joint, the immune complexes activate complement, which in turn damages cells and activates inflammation. More inflammation results in more pain, swelling, stiffness, and loss of mobility.

While this complex of events is known to occur with gluten antigens, many food allergens can trigger arthritis. Parke et al concurred with this explanation of the gut-arthritis link in their report of three patients with celiac disease and rheumatoid arthritis.