Still Eating Grains With An Autoimmune Disease?
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. One in Six— the same odds in Russian Roulette, the potentially lethal game of chance played with a standard revolver.
Now, it seems to me that most people are under the impression that abstaining from glutenous grains only makes sense for individuals with Celiac’s Disease. However, I believe that it may make sense for all people who have autoimmune conditions because of the role that cereal grains play in the etiology of autoimmune diseases. Not just glutenous grains… all grains.
First, let’s discuss gluten as it 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 not degraded well by heat or digestion, so it remains an intact, 33 mer polypeptide, and if it 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 makes perfect sense evolutionarily speaking, enabling 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. 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:
In light of this, does it makes sense that we (as in the 1 in 6 of us with autoimmune conditions) should consider avoiding gluten altogether? Probably. But should we avoid all grains like the plague, and does having an autoimmune disease really justify adhering to a diet like the Paleo Diet? After all, most of the grains on the market are gluten-free…
Unfortunately, the answer might be ‘yes.’ 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 presented. Going gluten-free wasn’t enough. But why?
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.
Also, 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.
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.
The following chart gives the type of prolamin each grain contains, and its respective percentage of protein the prolamin has in relationship to the entire grain.
Fun fact: 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. (There has been some question over whether these figures are accurate)
Though there are other factors that could cause molecular mimicry (like rotovirus , and certain types of bacteria) it should be no wonder that so many people with previous autoimmune conditions report such drastic improvements adhering to a diet devoid of grains, like the Paleo Diet.
Now you may have read all of that and thought to yourself that you’re Scott-free because you don’t have an autoimmune condition. Unfortunately, research still indicates that non-Celiac 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 and you’re just lucky enough to be 1 in 6 with a genetic predisposition for an autoimmune disease… I’ll let you postulate what could potentially happen next.
And since family history of autoimmune disorders, and certain ethnicities can increase your chances of getting an autoimmune disease significantly (click here for my theory as to why that is), one could easily justify going grain-free even if you’re healthy, just as a preventative measure.
*Stoskopf NC: Cereal Grain Crops. Reston, Reston Publishing Company, 1985