Well, hysteria from Old Theresa and Eddie not withstanding, it looks like the mechanism for leaky gut and the autoimmune response gets clearer by the day. Pedro sent me this paper which describes the association pretty clearly. It has a few gems which we will get to in  a moment. The study involved the analysis of 33 people with Type 1 diabetes, all of whom had normal intestinal architecture. I emphasize this point because theoretically, a biopsy is the “gold standard” test for Celiac, which appears to be the only clinically acknowledged form of gluten intolerance. The more common method of diagnosis is a blood anti-body test which is less than worthless IMO. Here are a few interesting lines from the paper:

Mounting evidence suggests that the gut immune system is involved in the development of autoimmune diabetes. An inflammatory state has been demonstrated to be present in the structurally normal intestine of patients with type 1 diabetes, and the abnormal intestinal permeability that has been found in these patients could represent a contributing factor.

What this means is these people had an active autoimmune disease but appeared to be negative on the conventional diagnostic tests such as biopsy and serum antibody. Most doctors and those who dismiss a role for grains in autoimmunity would have stopped here. But when we dig a little deeper we find some interesting things:

Immunofluorescence studies showed that 11 of 14 type 1 diabetic children with elevated levels and 11 of 19 with normal serum levels of anti-TG2 antibodies presented with mucosal deposits of such autoantibodies. The phage display analysis technique confirmed the intestinal production of the anti-TG2 antibodies

So almost every single kid with serum positive anti-gluten antibodies showed a positive response in the gut tissues (not too surprising even for those who think gluten only affects 1 in 125 people, but keep in mind, all of these kids were STILL negative on the gold standard of intestinal villi damage) but the really surprising thing was the kids who had no serum antibodies showed significant response in gut tissue. Here is all that stated again, plus some more fun:

These subjects with signs of a deranged immune response to gliadin may be considered potential celiac disease patients; in fact, some of the type 1 diabetic patients who are negative for celiac disease–associated autoantibodies may later become seropositive and may eventually develop frank enteropathy.

It has recently been shown that specific celiac disease autoantibodies against TG2 are deposited in the normal jejunal mucosa before they can be detected in the circulation and that their deposition precedes the gluten-induced jejunal lesion. This finding raises the possibility that the anti-TG2 antibodies might be located only at the small mucosal level in some type 1 diabetic patients.

I know it’s kinda thick, technical stuff but what this paper indicates is when a doctor (or anyone else) sits back and dismisses the gut autoimmune connection for Type 1 diabetes (or any other autoimmune disease) they are really missing the boat. At one time it was assumed celiac only affected 1 in 15,000. then it was 1 in 1,500 now the official story is something like 1 in 125. This is all bullocks, this issue affects everyone, it just manifests differently in different people. One of the main antibodies they talk about in the paper, TG2, (trans glutaminase) is an enzyme that alters EVERY PROTEIN IN THE BODY. This is why one pathological vector (leaky gut) can manifest in so many different ways (all the autoimmune diseases known and unknown).

The gold standard in all this should be: remove grains, legumes and dairy and see if the individual improves, lab work be damned.

Interestingly, weighing and measuring gluten containing foods does not mitigate it’s effects…so much for Nutritional Astrology.

Normal vs. Abnormal (celiac) intestinal mucosa

]]> http://robbwolf.com/2009/11/09/type-1-diabetes-the-gut-connection/feed/ 18 http://robbwolf.com/2009/10/19/type-1-diabetes-update-and-progress/ http://robbwolf.com/2009/10/19/type-1-diabetes-update-and-progress/#comments Mon, 19 Oct 2009 22:08:35 +0000 Robb Wolf http://robbwolf.com/?p=837

Just got this update from Joanne aka “MomOFType1″:

Robb –

Just checking in to let you know our little girl is still going strong! We visited with the new endo on Friday. He reviewed her last few weeks of blood sugar readings from her glucose meter on his computer (very cool how he jacked it in with a USB connection. I need that cable and software!).

He saw that she was almost completely in optimal range (70-140) with only a couple of outliers (a couple lower, a couple higher) and a mean of 96. He concurs that she needs NO insulin at this time. I was happy to have a Doc say that to me!

He did a blood draw in order to do the 4 antibody tests that the first doc did not do. He wants her back in two months but will call us when the results of the tests are back from the lab.

I don’t think the lab results will change anything we are doing, but it will be nice to know a little more about what we are dealing with here.

Thanks for the support everyone! Most regular people think grains and dairy are a MUST, especially where young kids are concerned. I know I am considered somewhat of a heretic in many circles.

-Mom

First, a HUGE thank-you to Joanne for sharing these experiences. All of this would just be theory if we did not have folks share what they are trying and what the results are.

Under ideal circumstances Joanne’s daughter shows no antibodies in the followup blood work. This would mean the immune system has really stepped down it’s attack on the pancreas and her daughter may have dodged a disease she would likely have contended with for life. Short of this, they have found a management strategy that keeps her numbers within normal values. To some degree the long term management is the same: gluten free, dairy free, low-ish carb paleo diet.  This may seem an austere solution to some people but I think most folks who have wrestled with the complications inherent in this disease would argue to the contrary.

I’m sorry if I beat this into the dirt, but I’ve just got to point a few things out here:

1- This REVERSAL of a life-threatening autoimmune disease is being mediated by a focus on food quality (paleo).

2-For the folks for whom the paleo diet does not reverse their condition (due likely to the complete destruction of ALL pancreatic beta cells) it does confer the BEST blood sugar control and best insulin management strategy of anything they have tried. This is likely due to the effects grains have on insulin signaling via leptin.

3-We can not proportion crap foods in any way and see the results reported above. This is trying to marry food to numerology.

4-The same mechanisms which underlie the reversal of Type 1 diabetes underlie ALL autoimmune disease. In the case of these other autoimmune conditions however, we do not see the confounding issue of pancreatic dysfunction. If we can just get folks to try a paleo diet for about a month they typically see a remarkable improvement in symptoms.

Immune attack of Pancreatic Beta Cells