Celiac disease (CD) or gluten-sensitive enteropathy, is an autoimmune gastrointestinal (GI) and systemic immune disorder. It is characterized by inflammation and tissue remodeling in the small intestine. Immune sensitivity to gliadin, a component of gluten, and its related proteins, present in wheat, rye and barley, and to a lesser extent in other grains. Gluten-free diets (GFD) that reduce or eliminate immunogenic gluten-related proteins leads to a reduction in anti-gliadin and anti-transglutaminase antibodies, coupled with improvement in symptoms of bloating and abdominal pain. The differential diagnosis of CD however includes other affected individuals with so called, non-celiac gluten sensitivity, who also respond to GFD but differ from CD in the absence of systemic allergic and autoimmune features; as well as others with irritable bowel syndrome (IBS) and symptoms induced by dietary Fermentable, Oligo-, Di-, Mono-saccharides And Polyols, collectively abbreviated FODMAPs.
A majority of patients with CD express the HLA-DQ2 and DQ8 MHC class II molecules, involved in the presentation of gliadin to naïve T-cells, which is ultimately involved in the intestinal manifestations of the disease as well as different associated disorders affecting other body organs and systems recently classified as systemic and inflammatory autoimmune. Nervous system involvement leads to disabling brain fog, sensorimotor neuropathy, and dysautonomia with overwhelming fatigue. However, the clinical presentation of CD varies from patient to patient, making it important for clinicians and nutritionists to take into account distinctions between typical, atypical, and silent cases on a case-by-case basis.
In fact, it is the autoimmune or allergic symptoms that bring most people to medical attention seeking a cure from stringent GFD. Keep in mind that properly diagnosed, CD is an uncommon disease, amounting to only 8 new cases per 100,000 persons annually in the US, and no more than 0.17% of the population at any given time in the population. Yet there has been an unwieldy increase in the popularity of empiric GFD management of autoimmune disease in general with an estimated that 100 million Americans consuming gluten-free products each year.
Interest in the interaction between diet and symptoms of IBM was the turning point in the elucidation of so called functional GI symptoms visible by MRI due to short-chain fermentable carbohydrates that increases small intestinal water volume and colonic gas production without gluten allergy yet causing identical symptoms of true CD. At least 10 randomized-controlled trials or comparative studies have shown that the FODMAP diet leads to clinical response in 50%-80% of patients, relieving bloating, flatulence, diarrhea and improving their global well-being. However, the down side of the FODMAP diet are the profound change in the composition of the gut microflora and hence out overall microbiome, that as we know is inextricably related to a sound immune system.
The Autoimmune Fix, developed by the functional medicine practitioner, Dr. Tom O’Bryan, seeks to stop hidden autoimmune damage in a variety of disorders through a two-phase dietary protocol. A 3 week Phase 1 Transition diet removes gluten, dairy and sugar, the autoimmune triggers. One can eat all forms of seasonal fruits, vegetables, and nuts; and non-factory farm-raised meats and fish; and fermented foods. Transition Phase 2 during weeks 4 to 6, eliminates food offenders of allergy and immune-mediated symptoms, beyond gluten, dairy and sugar, including soy, all remaining grains such as corn, rice, and quinoa; nightshade vegetables, FODMAP fresh and dried fruits, nuts and seeds, and vegetables.
With clinicians struggling to make sensible recommendations for individuals desperate to have an answer to their most pressing complaints, one thing rings true, is the importance of providing readers with sound advice based upon individual care, or at the least, a paradigm that separates out the likeliest offenders to their autoimmune ailments.