Adventures in Food Allergies and Autoimmune Disease

Karma’s a b. I used to roll my eyes hearing about food allergies in my foolish youth. Then a few years ago, I got a celiac diagnosis. Then last week, a blood test indicated major reactions to dairy, eggs and almonds (which was basically my whole diet since I already had major restrictions). Now, I have been reduced to what one friend called a rabbit. The choices are to eat very restricted or to keep living with chronic inflammation.

At a time when I’m hoping to keep my immune system in tip-top shape, I am trying the first approach. It is, after all, a great time to not be tempted to eat out or with others. In the blog which follows, we’ll cover not only celiac but how allergies and autoimmune responses work in general, and how new science is showing they may share similar genes and pathways. In future articles, I’ll chart my course in trying to give up a whole lot more than just the gluten.

The basics: What are the differences between allergies, intolerances, sensitivities, and autoimmune disease? Why do more people seem to be allergic to more things these days? There’s some evidence that multiple allergies are a sign of a generally over-reactive immune system. Certainly allergies and immunology go hand in hand. A true food allergy can be fatal or cause severe anaphylaxis. Most people know when they have these, because the reactions are so severe. There are three classes of immune responses to food (and other environmental factors): IgE, IgA, and IgG. These are all types of molecules called immunoglobulins which develop when the body’s immune system treats the food as a foreign invader. The healthy immune system reacts only to true threats like viruses or bacteria, but the over-reactive immune system can be triggered by a range of common substances.

IgE produces the severe immediate symptoms like anaphylaxis, and this is the kind of thing you’d need an Epipen for. But IgG and IgA responses are more subtle and slow. These can cause low grade but chronic symptoms. Hives, stomach upset, runny nose, joint pain, a foggy brain or headaches. While not life-threatening, these can contribute to long term systemic inflammation, which has been associated with obesity, heart disease, cancer and more.

Celiac disease is in a class by itself as an autoimmune disease, where the body first attacks the gluten protein, but then also starts to attack itself. And yet, new research shows there may be more overlap than expected between autoimmune disease and multiple allergies. Effectively, the same thing is happening – the body’s immune system is overreacting or misidentifying threats.

My story: I’ve had chronic asthma and bronchitis basically since I was an adult. The basic pattern was I was fine for months at a time and then as soon as I caught a basic cold, it would spiral into months of bronchitis and asthma attacks. Maybe the triggers were being around second hand smoke for all of my childhood, or maybe it was living for months at a time in South Asia (during the SARS outbreak at one point). Or maybe it was the years of undiagnosed celiac. Or all of the above. In the worst of it, I was on a half dozen meditations including twice daily nebulizers and some steroids with some pretty scary potential side effects.

I had read a book called Wheat Belly randomly and it noted how an allergy to wheat can actually trigger a type of breathing disorder called “baker’s asthma.” I kind of put that thought away, but the next time I lapsed into severe asthma, I thought maybe I should see an allergist to rule out the wheat allergy. He drew some blood and I waited for the results. He called back with a real surprise. I wasn’t allergic to wheat, but I did have celiac, an autoimmune disease in which your body reacts to wheat (and a few other grains) like they’re a virus or bacteria. Then, your immune system gets so amped up, it starts to attack your own tissues (the autoimmune component). I was floored.

All the celiacs I knew were skinny, but I was chubby. He said we could confirm the diagnosis with an endoscopy to look at my small intestine (ground zero for the over-active immune response in this case). A normal small intestine is covered with villi, little waving cells which look like a shag carpet and absorb nutrients from food. My small intestine had no villi visible, and a characteristic scalloped pattern showing wear. It had been wiped clean, meaning my body wasn’t getting the vitamins and minerals it needed from food.

When it was first discovered, celiac showed up as classic severe malnutrition: failure to thrive, extremely low body weight, brittle bones. But in modern times, about half of celiacs are overweight. The suspected cause is still the same. We aren’t getting appropriate nutrition. But the body can react to this by storing excess amounts of what it can absorb; fat and carbs. It’s starved for key micronutrients (I was most deficient in zinc and vitamin D), so it holds on to what it can. I was of course hoping going gluten-free would result in some major weight loss, but no luck there.

Still, I saw a nutritionist and when she saw my food diaries, she saw I was generally only eating around 1600 calories a day and working out at least a few times a week. She suggested I may have more allergies and intolerances, and suggested an elimination diet. I also asked my allergist if I should be tested for more food allergies, but I had so many allergens on the environmental panel (dogs, dust, all manner of trees and pollen), he felt I would probably just show up with lots of positives as well, so he concurred that an elimination diet would be better. But I just couldn’t stick with the extreme approach. So I kept sticking to gluten free and gave up the dreams of getting skinny or getting to the bottom of the overall immune picture.

Going gluten free was fairly easy. I had read the literature on how continuing to eat gluten when Celiac causes sharply higher cancer rates. I looked at a piece of toast as a carcinogen on par with a pack of cigarettes. Additionally, I never really cared for bread or pasta. Beer was rough to give up, but there are some decent GF options (Glutenberg is my fave). If you’re going to be a celiac, these are great times to do it in. Labels are everywhere and substitution options abound. I’d be remiss if I didn’t do a product shout out: Nima is a portable gluten testing kit which is a game changer for eating out. There’s also an option for peanut allergies. A celiac friend also swears by these digestive enzymes which can help if you are travelling and accidentally get glutened while eating out (though I find the science a bit shaky).

In the back of my mind, I knew I should probably look more into the possibility of other allergies. I was chronically inflamed, regularly breaking out into hives or having GI troubles even while sticking faithfully to a gluten free diet. One day I saw an ad for a do-at-home allergy test and thought why not see what it says. I couldn’t do the insanely restrictive elimination diet, but maybe if I identified a few problem areas, I’d know where to focus. So I bought the test, poked my finger, and held my breath.

It came back, somewhat expectedly, showing a range of sensitivities. I reacted to about two dozen foods, some only minorly. But far and away, the worst were dairy, egg, and almonds. This was damn-near heart breaking. These were the three things I ate regularly and the things I adored. Many gluten free foods use almond flour instead of wheat. I decided I should try giving these up for a couple of months to see how it would go. I mourned all over again. For ranch sauce and cappuccinos. For palak paneer and ice cream. But it’s a pandemic and being chronically inflamed is not good for the immune system. As I write this, I’m on week two of giving up not only gluten, but dairy, eggs and almonds. I’ll check back in a couple months to see if I could pull it off and if I notice a chance. Wish me luck!

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