The American Autoimmune Related Diseases Association estimates that there are around 50 million people in the United States with an autoimmune condition, and suggests that its prevalence may be increasing. To put that another way, that is 1 in 6 individuals. And although autoimmune diseases and their underlying mechanisms are becoming better understood, what is not often discussed is the link between autoimmune disease and diet.
Many health practitioners believe that avoiding gluten— a protein in wheat, barley, rye, and oats— only makes sense for individuals with Celiac’s Disease. However, evidence suggests that it may be important for anyone with an autoimmune condition to remove gluten from their diet because of the role that cereal grains play in the development of autoimmune diseases. Not just glutenous grains… all grains.
Gluten and Autoimmune Disease
Gluten is one of the most well-known, potentially dangerous proteins in grains. Gluten is made up of two types of proteins: gliadins and glutenins. During the digestion process, gluten is broken down into strings of amino acids, called peptides. However, gliadin and glutenin are poorly degraded by heat or digestion, so it remains an intact, 33 mer polypeptide. When this polypeptide enters into systemic circulation, an autoimmune response may occur if the peptide sequence mimics the three-dimensional structure of an individual’s tissues. In this event, the immune system “confuses” non-self proteins with self-proteins— a case of ‘mistaken identity’ known as molecular mimicry, the pathogenic mechanism of autoimmune diseases.
The immune system has a number of ‘recognition’ or ‘identification’ mechanisms which allow the body to distinguish between its own proteins, and foreign proteins. This identification system allows for foreign bodies to be discovered, identified, and subsequently destroyed. This system enables the body to initiate an immune response to intrusions by viruses, bacteria, etc. When an antigen, or “foreign invader” is presented, immunoglobulins make antibodies to combat them.
This is important to note, as certain antibodies have been linked to the pathogenesis of autoimmune conditions —namely anti-gliadin antibodies— which have been widely accepted as a hallmark for Celiac’s Disease.
However, research has shown elevated levels of these same anti-gliadin antibodies in several autoimmune conditions, not just Celiac’s Disease. This is including, but not limited to:
- Autoimmune Diabetes
- Multiple Sclerosis
- Rheumatoid Arthritis
- Psoriatic Arthritis
- Crohn’s Disease
- Ulcerative Colitis
- Graves Disease
- Antiphospholipid Syndrome
- Pemphigus vulgaris
- Autism (Not exactly an autoimmune condition, but there is autoimmune activity involved.
In light of this information, perhaps it makes sense that those affected by an autoimmune disease should adopt a gluten-free diet. However, a Paleo Vegan Diet suggests avoiding all grains, not just the glutenous ones.
A study entitled “Mucosal recovery and mortality in adults with Celiac Disease after treatment with a gluten-free diet” concludes that “Mucosal recovery was absent in a substantial portion of adults with [Celiac Disease] even after treatment with a [gluten-free-diet]. The study also indicated that immunoreacitvity was still present, meaning, going gluten-free wasn’t enough.
There are a few potential reasons for this. While research is still inconclusive, it’s also hypothesized that impaired intestinal barrier function is required in the development of autoimmunity. Because gliadin and other prolamins are associated with the development of intestinal damage and the release of zonulin (a toxin that compromises tight junction integrity), non-glutenous prolamins from other grains may also be implicated in autoimmunity for susceptible individuals.
In other words, just because a grain is gluten-free doesn’t inherently mean it doesn’t cause immunoreactivity, or is safe for people with autoimmune conditions. For example, the prolamin zein in corn was found to illicit immunoreactivity in individuals with Celiac’s Disease.
Rice has the prolamin orzenin , which is now causing rice to be reevaluated as a hypoallergenic food. Orzenin is recognized as a common and severe cause of food protein-induced enterocolitis syndrome. This is interesting, since enterocolitis is commonly induced by an autoimmune targeting of glial cells. Millet and Sorghum, which are common in gluten-free beers and gluten-free cereals are Panicoid grains with zein-like prolamins— which are notably also resistant to digestion. Panicoid grain prolamins act like zeins, and are also implicated in the process of molecular mimicry which is potentially harmful for people with autoimmune conditions.
This information is rather unfortunate, because people with autoimmunity who purchase gluten-free products don’t realize that they are still causing harm to themselves if the starch is still grain-based.
Did you know?
Approximately 56% of the protein consumed globally comes from wheat, rye, oats, barley, millet, corn, rice, and sorghum*. That should be alarming for the 1 in 6 individuals in the US with an autoimmune condition if the estimates by the American Autoimmune Related Diseases Association hold true. However, perhaps most unfortunately, research indicates that non-Celiac, healthy individuals still experience mucosal changes and damage to enterocytes (gut cells) in the intestines of people who have a high gluten-containing diets.
So if enterocytes are damaged and gut permeability is increased— and prolamins like gliadin get into systemic circulation— you may unknowingly be putting yourself at risk, especially if you have a family history of autoimmune conditions. So for the many who adopt a Paleo Vegan Diet for more than just ethical reasons, but for health concerns too— we encourage removing all grains from the diet and focusing on other sources for protein.
*Stoskopf NC: Cereal Grain Crops. Reston, Reston Publishing Company, 1985