Saturday, March 08, 2008

Gluten and rheumatoid arthritis

The quote below comes from Dr Freed, written in an editorial for the British Medical Journal, to commemorate the public sacrifice of Dr Arpad Pusztai on the altar of GM agribusiness (see the last line of the editorial). Dr Freed:

"Lectins stimulate class II HLA antigens on cells that do not normally display them"

Wheat germ agglutinin is a lectin and sections of gliadin (in gluten) are "lectin like". If you have an auto immune disease the quote is quite important. What is a class II HLA antigen?

If you really really want to know you can have a look here, which explains what MHC class I and class II molecules are. It's the simplified version, including the sausage in a hot dog metaphor which made my wife laugh. Sort of. EDIT: You probably need to know she's an immunologist to understand that last comment.

Here's a rough translation.

Class II molecules sit on the surface of cells, holding out a fragment of foreign protein (in this case a short fragment of gluten). Only certain sub families of immune cells should do this, certainly it should never be done by tissue cells of organs like the pancreas or thyroid as cited by Freed. I would add joint cells in the case of rheumatoid arthritis.

Class II expression is different from MIC expression but just as bad, if not worse.

Waving around a class II molecule on your cell surface is a direct invitation to a subset of white blood cells (in particular a sub group of lymphocytes, ie those with a certain molecule called the CD4 molecule on their surface) to come and interact with the cell displaying the Class II marker. CD4 molecules generally "talk to" class II molecules.

The class II marker molecule has to be holding out a gluten fragment and the CD4+ cell has to be able to recognise that fragment for them to interact. Given this situation, things happen. The CD4 positive cell does several things, one of which is that it starts producing lymphokines. That is it causes inflammation. Note that antibody production is not needed for this to occur.

Of course once the CD4+ cell has seen gluten it may well trot off to get antibodies produced. Or it may not. The immune system is frighteningly complex. If the CD4+ cell does interact with an antibody producing lymphocyte you get this.

Avoiding gluten helps. Forget the vegan bit, it's a failure to control variables in the study and not remotely needed. The gluten avoidance is essential.

LC is very helpful too. I'll post the refs some time but basic premise is that the inflammatory soup production in response to class II/CD4 interaction is controlled to a large extent by NF kappa B, which is controlled by insulin which is controlled by carbohydrate in the diet. Insulin per se is anti inflammatory, chronic hyperinsulinaemia is pro inflammatory.

There are also non specific effects of PUFA in propagating the free radicals generated by the inflammatory response. Suet and dripping contain far more stable fats than vegetable oil does and these highly saturated fatty acids are almost immune to free radical attack in an inflammatory soup.

Vitamin D modulates the irritablity of most cells in the immune system so supplementation or serious sun bathing, without sun burn, probably has an effect to diminish all auto immune problems.

If you read the whole vegan paper you will see there was no radiographic improvement, though patients felt better. Too much carbohyrate, too many PUFA and there are several other plant sources of lectins beyond gluten. Anecdotally nightshade lectins (also mentioned by Freed) can be a potent trigger for rheumatoid arthritis in much the same way as gluten.

That's without going on to Ebringer's work on bacterial proteins and rheumatoid disease....

This aspect is probably also amenable to LC eating. Anyone with a degree of insulin resistance may well be transiently glucosuric on occasions while eating a normal diet. Bacteria love glucose. LC eating should starve any Proteus in the urinary tract because it stops any glycosuria. Proteus also lives in our gut and starving it here too, this time by fiber avoidance, would probably help.

So there are a few factors involved in rheumatoid arthritis. A serious LC, high saturated fat and minimal lectin diet should help.

As would an all over tan.



Anonymous said...

I've been reading some abstracts on how refined carbs (sugar, fructose, and HFCS) cause lipid peroxidation, high blood pressure, reduced alpha- tocopherol, and impaired longevity.

The interesting thing is that honey does not seem to have these harmful effects, nor does starch. I'm using unprocessed honey - unheated honey, comb honey, or honey spread. As for starch, potatoes and rice seem like the safest bets from an allergy and digestion standpoint.

Substituting Honey for Refined Carbohydrates Protects Rats from Hypertriglyceridemic and Prooxidative Effects of Fructose

Peter said...

Interesting abstracts. People are now starting to replicate the work that Yudkin and Cohen did in the 1970s and getting the same results. You can cross out hypertension and substitute diabetes according to Yudkin. Same disease. Very strange that honey doesn't do the same to free radical generation. Yudkin was equally down on sugar and honey in all forms, but I don't think he did research specifically on honey vs sucrose. Starch wasn't a problem.

When I went LC I briefly used sucralose, dropped to saccharine for a while then used some carb allowance for cane sugar before having several years on low dose honey. Now it's just the low dose glucose, so I don't have to consider whether I'm getting good fructose or bad fructose. I still use some honey for some desserts as the taste is so good. Like last night's cheesecake...


Lee said...

I have had intermittant arthritic-like pains in my left ankle for about 15 years. It got a bit better on 5000iu vitamin D. Reading your post on Vit D a few weeks ago, gave the courage to go to 10,000iu . The pains have completely gone now. Many thanks.

Anonymous said...

I have never liked those artificial sweeteners - from a taste or health perspective. Fresh honey with cream cheese tastes like a cheesecake and gives stable energy and mood.

Also, the last study I cited has an option for full text (free). I read about Yudkin in Taubes's book. What type of diet does he advocate? Just one without refined sugars?

I think honey protect against free radicals and other problems caused by processed sugars, and even some types of fruit. I'm keeping an eye out for more research on this. And also I think it's important to get honey that is unprocessed.

Peter said...

Hi Bruce,

Yukin was completely anti sugar and equivalents for everyone and used full carbohydrate restriction for medical problems in people with carbohydrate intolerance. I get the impression he felt that people varied in their predisposition to insulin resistance and that starch intake was not a promoter of IR, while sugar was. He was active in the 1970s and died about 10(ish) years ago. His classic book is Pure White and Deadly, which I read as a young adult and which probably kept me reasonably helathy for long enough to rediscover LC in middle age. He collaborated a lot with Cohen. Most of their papers are just pre pubmed abstracts.


Anonymous said...


"Yudkin was equally down on sugar and honey in all forms, but I don't think he did research specifically on honey vs sucrose. Starch wasn't a problem."

This is an example of biases in the low-carb community. If you don't do studies comparing sugar with honey, then why should honey be condemned, based on sugar studies? By the same token, there are infinite varieties of honey, and some are more or less processed than others.

We must work to overcome biases and interpreting studies with "low-carb glasses" on is not very beneficial, IMO. I like Dr. Eades's book review for "Mistakes Were Made (but not by me)". I got it the other day at the library. We need to guard against a type of thinking like "sugar's bad, so honey must be bad too." To prove that honey is bad would be far more difficult, because there are vastly more variables to consider. But you suggest this is what Dr. Yudkin did and the other gurus in the low-carb world do much the same.

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Anonymous said...

The most common form, osteoarthritis (degenerative joint disease) is a result of trauma to the joint, infection of the joint, or age. Other arthritis forms are rheumatoid treat arthritis, psoriatic arthritis, and autoimmune diseases in which the body attacks itself. Septic arthritis is caused by joint infection. Gouty arthritis is caused by deposition of uric acid crystals in the joint, causing inflammation. There is also an uncommon form of gout caused by the formation of rhomboid crystals of calcium pyrophosphate. This gout is known as pseudogout.

Alex said...

I strictly avoided gluten afer my RA diagnosis. But it did not much help, except to better my digestion a lot.
What helped was and is a strict ketogenic diet. A low FBG and a high BHB switched my symptoms off. I am not healed but I AM in control without any drugs.

So, I agree with the LC diet as a nutritional therapy but I think the reasons are connencted to the glycolytic pathway of active immunecells which might loose fuel priority once the blood glucose remains low. They can not activate and proliferate without sufficient glucose (glucose threshhold) and insulin. They die off when the body fasts. BHB on the other hand, is stongly anti-inflammatory. Lipopoteins detox endotoxins.
I think that is why fasting therapies in RA & Co work but fail in the long run: blood glucose and insulin get back to privious status and the auto-immune response rebuilds itself in a few weeks or months.

I agree that antigens from foods and the gut might aggrevate the immune reactions but I am not convinced leaving them out without a concomitant reduction in blood glucose would change much. Not significantly anyway.

Best regards

I like your understanding of physiology! The little bits that link the big bits! Awesome.

adamkern8 said...
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