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Time to Bite the Hand that Feeds us?

Time to Bite the Hand that Feeds us?
© 2004 by Laurence Harris. All rights reserved.

There is a growing awareness that something is terribly wrong in our healthcare system, that we are facing a healthcare financial crisis of incredible proportions. Here is an amazing but true story about a big chunk of the reasons behind it. We do have a crisis at hand. It is not too late to stem the tide, to significantly pull back from the ongoing terrible losses of financial and human capital. We can stop it now, although for some it is too late. We collectively can make a huge difference!

The story is a complex one of medical technology, food production and history. We are only now coming to a realization of the magnitude of the problem. Hang on to your seats, the ride is wild!

The Immune System

The human body has wonderful ways of protecting itself. The system of interacting parts that defends us from invading bacteria, fungi, viruses and other foreign matter is collectively referred to as the “immune system”. The tale we are telling here is one not of allergies (IgE antibodies), but one of a different, more insidious kind of immune system activity, (IgA, IgG and IgM antibodies).

The immune system includes cells circulating in the blood and lymph and cells in various other places as well. It includes a variety of cell types from those that are self-moving blob-like hunter-killer cells (macrophages) to several kinds of miniature chemical factories with some making destructive toxins and others making specially shaped “antibodies” that match up to and latch onto the fairly unique cell-surface chemicals used by attacking organisms as tools or protective cover.

Blood serum, T-cells, B-cells, macrophages, antibodies, bone marrow, spleen, lymphatic system, and various other organs all work together to detect and destroy invasion forces. It has taken many millions of hours of research and study for us to come as far as we have in our understanding of what happens when a bacterium or virus attempts to invade our bodies. And while we have a lot of the picture we are still learning, still searching for missing pieces to this magnificent puzzle.

Cells

What we do know is that nearly every type of cell in our body encases fluids in a smooth, waterproof, double-layer of stuff we call a cell wall. The cell wall has various special structures embedded in it to transport materials across the barrier. That is how food energy gets in and how waste products get out. Inside each cell are a variety of different structures; some are tiny chemical factories that convert glucose to ready-to-use chemical energy, and use that energy for motion, or to create other special chemicals needed for the cell’s operation. Sometimes the chemicals are to sent out into the rest of the human body for use elsewhere.

Cell Identity Flags – Friend or Foe?

But dotted all around on the outside of this smooth cell wall there are several types of special “identity flags” – specially shaped chemicals that are firmly anchored in the cell wall with a large specially shaped part “waving in the breeze” telling all passing observers who they are - self. It is not really quite that simplistic, but it is actually a combination of several possible types of identity markers that are recognized by cells in the immune system, telling them “Leave me alone! I’m a friend!” And different types of tissue have skightly differently shaped flags, all still self, but not quite all the same.

Woe be unto cells, like bacteria, who don’t know the right combination of markers for “friend” – the immune system learns their surface markers, creates a complimentary shaped pattern and attaches it to special proteins, called antibodies, that hook onto the foes’ flags and tell the immune system “This is a bad guy! Let’s take them out!” Once a particular immune system cell recognizes an invader it can trigger cells whose job is to make antibodies to reproduce and make lots more of these useful chemicals. Immune Responses

Inflammation, created by the fast responders of the immune system, makes the area surrounding a detected invasion become porous, or permeable, so that antibodies and various immune system cells can “get at” the offenders. Even blood vessel walls become rather leaky. This makes surrounding tissues swell and turn red.

So the various parts of the immune system work to penetrate or perforate the cell wall of an invading organism and make its insides all leak out. Some immune system cells pick up the antigens and carry them around with them like flags, telling other cells about the invader’s identity. Some use the antibody’s matching pattern to latch onto the invading cells’ surface features (antigens) and get up against them to unleash little vesicles of destructive chemicals. Others engulf an offender and digest it, or at least they carry away indigestible stuff.

Picture these blob-like macrophages, fairly big as blood cells go, slipping along in the blood stream and encountering a battle site – they send out an amoeba-like tentacle, a pseudopod, and pull themselves over to a marked offender, then they ooze around it and rejoin on the other side. When it is fully engulfed they release chemicals, right up against the bad cell, similar to chlorine bleach, that chemically take apart the proteins and lipids that make up the invader’s structure. Burp.

Even the lowly virus has chemical patterns that the immune system uses to identify them. Virus surface coat chemicals are really tools to make the virus stick to the surface of a human cell so they can get inside that cell. And as a virus drills through the human cell wall it leaves behind various parts of its surface coat, sort of embedded in and floating on the human cell wall. These too are sensed by the immune system and used to identify cells that are being taken over by a virus. These human cells then, are mercilessly destroyed. And the methods work. Takes about two weeks for the immune system to detect the invasion, learn the cell-surface markers left by the viruses, make enough antibody factories ( B-Cells and others ), and do the search and destroy job. When it is all done, and the antibody production shuts down, there are extra of these chemical factories circulating in the blood, sort of on standby, in case the same invaders come again. They would be able to attack and destroy them before they ever get a foothold again. That is learned immunity.

Immunity

Learned immunity is what we try to induce with a vaccine. A vaccine is just a whole lot of these cell surface markers without the offending bacterium or virus still attached, or at least if the cell is still there it has, hopefully, been killed. Seems to work pretty well most of the time. So we make a mixture of water with pieces of surface marker protein in it and inject it into the inside of the body. The immune system sees the invading stuff and sets up new antibody manufacturing to fight it off. Since there are no real invaders, it is easy to clean up the debris, but the result is that the immune system now has standby troops for that particular type of invader. It is much better to learn immunity without having to suffer through a full scale invasion.

The Flags are Proteins

So the cell surface markers are mostly bits of protein, which are really just interconnected amino acids, which have shapes unique for that kind of organism. Amino acids are some of the basic building blocks of the human body. We get amino acids from eating and digesting meats and plant materials, although some of them can be made by our own cells. Amino acids also serve as a source of food energy when needed. Depending on what order you string the amino acids together, and what other chemical bits you hook onto the chain at various places, the whole thing folds into a three dimensional shape. These proteins are sometimes referred to as “peptides”. (A peptide, then is just a piece of protein.) And shape is what is used by antibodies to “recognize” a cell surface marker.

The other hugely important basic building block material, the stuff of cell walls, is called lipids. Lipids are mostly made up of fatty acids, which are mostly just some simple short chain hydrocarbons with one end hooked onto a three-position “backbone” chemical called glycerol. You’ve probably heard of “triglycerides” – that is another name for lipids. Cell walls, however, consist of a different sort of specialized lipid made by the human body or obtained from food, called cholesterol. The human body can make most of the lipids it needs, but there are a few lipid pieces that it can’t make, so they must be eaten, digested and absorbed – these are called essential fatty acids. As you might guess we get them by eating and digesting fat. Lipids also serve as a food energy source since they can be taken apart and turned into glucose. And of course the human body can create lipids from glucose as a way of storing food energy. Ugh. Fat.

So now you have a basic picture of the immune system. It is marvelous, seems almost magic, and keeps most of us alive long past our ability to pass on genetic material to another generation, that being the goal of DNA – to ensure its own survival.

Complexity – an Asset and a Liability

The immune system is a lot of cooperating parts that all play together to protect us from invaders. But it is a pretty complex world out there, and it seems to be full of endless surprises. One particular virus, an adenovirus, of which there are many types, is suspected of triggering one of the surprises.

An adenovirus, like other viruses, leaves behind characteristic cell surface debris as it bores into a human cell. It intends to commandeer the inner workings of the cell to have it make more copies of itself. The cell surface debris is pretty much unique to each sort of virus. The immune system sees this peptide debris ( referred to as an antigen ) learns its shape, and proceeds to launch all defenses to fight off the virus. And part of the immune system’s reaction is to make a lot of B-cell antibody chemical factories that circulate in the bloodstream just waiting to be activated when an invasion occurs.

That is all as it should be but here is the nasty surprise. The virus coat pieces accidentally have a huge similarity to the “self” cell surface markers in some humans. Not similar to the markers for all tissue, but just for certain tissue types. So the immune system does a little bit of damage to “self” while it is fighting off the adenovirus. But when the infection is cleared, the immune system activity sort of calms down, and the damage is repaired. So far so good.

But the real trouble comes from a “double-whammy” coincidence: There happens to be a short, indigestible, peptide sequence in a certain type of food that is a pretty close match with the adenovirus antigen debris and can thus trigger the immune system to crank out antibody chemicals so that the offenders can be destroyed. Unfortunately the match is close enough that when the food peptide triggers a wholesale attack, the antibodies are a close match to certain kinds of the human cell self surface markers. too. So while the immune system is attacking the supposedly offending peptide sequence it also unfortunately finds and destroys the similarly labeled self cells. Some of these cells are found in a part of the intestinal epithelium, the mucosa lining the small intestine.

Since the offending peptide comes from a food, much of the initial immune response takes place at the inner layers of the intestine, closest to the offending stuff. Here it causes inflammation. Inflammation makes the tissue more permeable so that immune system cells and antibodies in the blood serum can get through to the trouble zone . But when you do this to the gut, you make the gut more permeable in both directions. Oops. That starts letting the bad peptide pieces through! More inflammation, more immune system response, causing intestinal urgency and leaking of partially digested food right into the abdomen (outside the intestine!) causing bloating,.

And the more times we eat of the offending food, the more attack there is. When the attack really gets out of hand we call this an “autoimmune disorder”. There is a whole laundry-list of autoimmune disorders. And there appear to be several offending foods that, of course, contain different peptide sequences, and so probably correspond to different trigger viruses or bacteria. And there may also be invaders that can trigger an attack on self without a food being involved, but there is no certainty.

The lucky part of all of this is that the intestinal wall self-markers do not seem to be, by themselves, enough to keep antibody production going. It apparently takes the stimulus of a peptide antigen material from the offending food to maintain the attack. But before that, it takes a viral invasion, a trigger event, to start the whole process going. So some people who might some day have the problem, because they have the “right” self cell surface marker types, don’t have the problem yet because they have so far missed out on the trigger infection. But it can happen at any age. Some infants seem to pick up the problem early, other people get the problem later.

But the longer the offending food is consumed, the more accidental variations in the offending peptide sequence are encountered. Perhaps there is also variation in the way the B-cells replicate – through cell division – creating slight variations of the original antibody. So whole new waves of B-cell chemical factories are created and as time goes on, sometimes a new type of human tissue falls prey to its own immune system. And in many cases the immune system keeps up a permanent attack on the particular self tissue – sometimes critical parts of organs are destroyed. The prime example of this is Type I Diabetes, while another organ that seems to suffer permanent attack is the thyroid.

And as you repeatedly churn the whole immune system with this continual challenging with peptides it sees as bad, it even leads to an elevated risk of intestinal cancers, and lymphomas. Some are fairly treatable, although not all of them. But researchers have found that if you stop consuming the bad food before the cancer strikes, the risk goes back down to normal. So perhaps the theory about needing a trigger infection to start autoimmune disorders only applies to some, while most might be triggered by accidental variations in the antibodies being made as slightly different antigens are encountered.

The worst peptide offender is from the seed of a particular type of grass. In this seed there is a little bit of protein that acts like a rubbery, gluey material. Pretty neat stuff! Egyptians discovered its properties some five thousand years ago, and began using it to make bread. Modern cultures, appreciating stretchy dough and springy bread, learned about the protein, called gluten, and selectively bred varieties of this grass that had fatter seeds with a higher proportion of gluten, so that they could make better breads more easily. These grasses have become known as wheat, barley and rye.

Unfortunately, in the gluten protein of wheat, barley and rye, there is a peptide sequence, of about thirty-three amino acids in length, that triggers an immune system response in susceptible individuals. Phooey! Bread for cryin’ out loud! Apparently in most people it happens at such a low level that they never have pronounced enough symptoms to go after medical care. There are various names for the most severe form of the resulting medical condition, including celiac disease, celiac sprue and gluten intolerance. But it is most definitely not a disease, rather it is a slow poisoning.

So the only way to slow down and eliminate the immune system attack on self is to prevent encounters with the offending material. Don’t consume gluten protein. There is a growing suggestion in the medical literature that eliminating all wheat, barley and rye from the diet may actually prevent the triggering of a large number of other sorts of disorders, including type I diabetes, thyroiditis and rheumatoid arthritis. All of these are what are collectively referred to as “Autoimmune Disorders”. These are not allergies, but are something significantly different, much more insidious. That is a rather amazing finding, but it is supported by medical studies!

Another substance that can act like gluten, to trigger an immune response in some people, is bakers’ yeast. Different peptide sequence, different effects, but similar process. And there are apparently others as well.

Unfortunately it is only recently that the problem of immune reactions to food has been receiving any attention in the US. There are only a tiny fraction of those presently suffering from a severe immune reaction to gluten who have been diagnosed with celiac disease ( 97,000 out of about 3,000,000 ), since until quite recently it was thought to be an extremely rare condition in the US. And the official diagnosis of celiac relies on a biopsy of the inside of the small intestine showing a “flattening of the villi”. Unfortunately some people with intestinal damage occurring have it happening in an area past where the doctor’s probe can reach to get a tissue sample. And there are also the others who are not reacting strongly enough to show serious damage, so the potential numbers could be much larger. But it seems that these people are still reacting to gluten strongly enough to keep the immune system churning and causing other autoimmune disorders.

The biggest problem is that most American doctors haven’t been expecting Americans to have the condition. One recent journal article said that if you don’t believe a problem is likely, you will never look for it, and it will never be found. Some in the medical community are referring to the small number of diagnosed celiacs as “The tip of the Iceberg”. So unsuspecting doctors attribute all the inexplicable symptoms people have as being part of some otherwise untreatable condition. Usually they make it sound like a person’s lifestyle or mental condition must be the root of the problem, as in Irritable Bowel Syndrome. Or just that, for no understandable reason, the body’s immune system has decided to attack itself.

There are many medical people who fail to realize the profound magnitude of the real problem, while there are a very few that believe, on the basis of various clinical research studies, that as many as two thirds of Americans may be affected. Part of the problem seems to be that very few people (if any) have put the whole picture together. It seems to be that the real problem is not untreated celiac condition, but that celiac is just an indicator of a very strong immune response to gluten.

People who aren’t initially reacting very strongly to gluten may go for years without experiencing strong enough symptoms to send them to a doctor. Or if they do go to the doctor when the symptoms first appear, they are told some glib story about how nobody knows why some people have an irritable bowel, but they do. Just eliminate stress, coffee, alcohol and … learn to live with it.

But during all those years the immune system is constantly responding to the imagined attack of the gluten peptide, and trying to build variations of the antibodies, until finally one matches up with a self marker and there you have the onset of a “mysterious” autoimmune disorder. Autoimmune disorders altogether affect at probably fifty million, perhaps many more, Americans. And it seems that many of the troubles of old age hit people with celiac disease at a much younger age. But there are a lot of those not diagnosed with celiac disease that also suffer these old age degenerative conditions. This is pathetic. Do we not have our eyes open, our heads on straight?

The gluten-associated immune response problem is apparently quite widespread. The diverse health problem effects have been characterized as being part a whole host of supposedly unrelated diseases and disorders. But because these disorders now increasingly appear to have a common root cause, there should be a new name, an umbrella term used to logically tie together all the symptoms and troubles. The benefit of this will be a faster recognition of the problem, which can prevent the more serious and damaging medical sequelae that seem to follow. I propose “Gluten Autoimmune Reaction Damage Syndrome” (GARDS).

Once you have ANY of the autoimmune disorders your physician should presume a diagnosis of GARDS. There are not yet any really reliable ways of testing for the problem, but used as an indicator “any autoimmune disorder” seems to be pretty specific. And the consequences, in terms of personal health, public health costs, the tremendous life-long suffering and consequences of the sequelae from unrecognized GARDS are staggering.

GARDS is NOT a digestive system disorder, although there are subtle and sometimes profound upsets to the operation of the small intestine. Gluten intolerance should not remain the province of only the gastroenterologists, who seem only to care about the appearance of biopsies. The evidence is mounting that GARDS is the underlying cause of a vast expenditure of medical care dollars and is the root cause of incredible ongoing human suffering.

Whatever made the Egyptians eat ground up cooked grass seed with yeast, it turns out to have been a terrible idea. There is no really good reason that we should trust mankind to have made wise food choice decisions five or ten thousand years ago. We do think we know that people were omnivorous, eating both meat and plants. But we can not know what plants were evolutionarily compatible with human existence. But it appears that triticum species of grass were not a normal part of the diet as our immune systems evolved.

For humans to be safe in continuing to make and consume breads, cakes, cookies crackers and cereals, we are going to have to either redesign wheat, barley and rye or remake the people. Meanwhile, to stem the tide of human suffering we should be dropping these grains from our list of "Generally Recognized As Safe" food ingredients, and perhaps even add them to the list of carcinogens. Perhaps we could substitute oats and some sort of vegetable gum to simulate gluten. Fortunately food technology has made wonderful advances along with medicine.

Meanwhile, perhaps we need to be examining other items in our diet and developing more sensitive methods of testing human immune responses to the foods we consume.

Cheers!