The only allergy I suffer from is one to cat dander, and
considering what my children do to the house and furniture already, I'm
probably better off without a cat. But I know many people with food allergies
and/or celiac disease. They are all conscientious people who try to eat
healthily. Many people are wondering what is causing the
rise in celiac disease, an autoimmune disease where the body damages itself
after ingestion of gluten and which is related to certain genes and can be
triggered by various events, including childbirth, pregnancy, viral
infections, and stress. I also wonder, hence this hypothesis.
On p. 236 of a
2013 review of celiac
disease (CD) epidemiology, there is a map that shows graphically the reported
prevalence of CD by country. Two countries jumped out at me: Finland, with a
high prevalence (
more
than 1 in 100), and Estonia, with a significantly lower prevalence (and
apparently not increasing, per
this study).
Genetically, the Finns and Estonians are reported to be
very similar. Their
traditional cuisines and geographical situations are also very similar. Why
would they have dramatically different rates of developing celiac disease?
Why would differences in Vitamin D supplementation have an
effect on who develops CD? Our bodies make molecules called Vitamin D receptors
(VDRs) that are also important in maintaining the health and barrier function
of the intestines (see
this,
this,
this,
this,
this,
and
this). Perhaps
by adding Vitamin D to our milk we are overexposing our intestines to Vitamin
D—most Vitamin D is supposed to come from our skin’s production of it, not from
our food—and causing our bodies, in line with homeostasis principles, to
decrease expression of VDRs in our intestines over time. Something similar does
appear to happen with
excess folic acid ingestion and folate receptors in the intestines, but there
is only
one study
out there hinting that this might happen with Vitamin D and VDRs.
This Vitamin D receptor hypothesis might be helpful in
explaining intestinal permeability problems, but it doesn’t explain the
increase in CD seen in many other countries that don’t fortify with Vitamin D
or take cod liver oil. As I looked further into CD incidence, I started to see
a pattern of correlation between dairy intake and CD. Milkfat is a rich source
of Vitamin A, which is also high (rather dangerously so) in cod liver oil. In
the US, lowfat and skim milk are now fortified with Vitamin A to supply a
higher amount than naturally occurs in whole milk.
Why would high Vitamin A intake cause a hyperimmune reaction
to ingested gluten? Well, first off, it’s necessary to point out that CD
apparently involves hyperimmune reactions to more than just gluten;
one study found that
half of CD patients had the same reaction to cow’s milk protein as they did to
gluten, indicating that the
immune system’s
dysfunction is the culprit, not an unavoidable genetic incompatibility with
gluten. After all, people typically eat wheat fairly happily before CD is
triggered. That hyperimmune reaction, it turns out, is connected to Vitamin
A-related processes, for
signaling
related to retinoic acid—a metabolite of retinol, the storage form of
Vitamin A—is a “
keystone
in the development of oral tolerance” (oral tolerance
means “the
capacity of the immune system to recognize substances taken in through the
digestive system and to weaken or suppress the immune response to them”).
At this point, I feel I must widen the discussion a bit to
include all hyperimmune reactions to dietary gluten and other highly allergenic
foods, although I will still occasionally address CD specifically.
Several enzymes are involved in transforming retinol into
retinoic acid. Retinol is first transformed into
retinal,
catalyzed by retinol dehydrogenases and alcohol dehydrogenases. Retinal is then
transformed into retinoic acid, catalyzed by
retinal dehydrogenases
(RALDHs) and retinal oxidases.
RALDH2, one of
the RALDHs, apparently needs to be optimally expressed in order for
intestinal dendritic cells to properly carry out their oral tolerance function.
(This is a very complex field of study that I won’t pretend to fully comprehend
or adequately summarize, so I’ll direct you
here,
here,
here,
here,
here,
here,
here,
here,
here, and
here for more
information on the subject.) But retinoic acid, the product of RALDH2, can make
inflammation worse, not better. This
study, in particular,
is interesting in that it finds that retinoic acid promotes an inflammatory
immune response to dietary antigens in connection with a cytokine that is
greatly upregulated in the gut of CD patients; to me, this indicates that 1)
retinoic acid might be interfering with RALDH2 expression in a way that
negatively affects oral tolerance (it is not unusual for the product of an enzyme to inhibit an enzyme through a process called
feedback inhibition), and 2) RALDH2 might have an important
immunity-related function besides catalyzing the transformation of retinal into
retinoic acid.
My key point in the paragraph above is that we want to
optimize expression of RALDH2 in order to avoid hyperimmune reactions to our
food. I have come across four ways to do that:
#1 Magnesium Chloride –
Magnesium
Chloride (MgCl2) is a salt that naturally occurs in the ocean and briny
lakes, most notably the
Dead Sea, the salt
content of which is fully half MgCl2. Until recent times, the salt people
ingested typically contained some magnesium chloride, but we now commonly
consume nearly pure sodium chloride as our regular table salt. Perhaps, in
light of MgCl2’s ability to activate RALDH2, this shift to pure sodium chloride
has been detrimental to our ability to orally tolerate some common allergens.
It is interesting to note that Japanese people still consume magnesium chloride
widely, both in sea salt and as a tofu coagulant, and that celiac disease is
nearly unknown in Japan even though Japanese cuisine today includes regular
consumption of wheat noodles. There is at least one study
finding an apparently
protective role for magnesium in acute allergic reactions. Also, a little
magnesium chloride looks like it
might help bring down
abnormally high triglycerides, so it seems a good idea to sometimes use sea
salt or drink mineral water containing magnesium chloride. The push to lower
salt intake is just to
lower
sodium intake, not all forms of culinary salt.
#2 Citral –
Citral is present in many lemony oils—
per wikipedia, in lemon myrtle
(90-98%), Litsea citrata (90%), Litsea cubeba (70-85%), lemongrass (65-85%),
lemon tea-tree (70-80%), Ocimum gratissimum (66.5%), Lindera citriodora (about
65%), Calypranthes parriculata (about 62%), petitgrain (36%), lemon verbena
(30-35%), lemon ironbark (26%), lemon balm (11%), lime rind (6-9%), lemon rind
(2-5%), and orange rind—and used as an additive in flavorings (including as a
“natural flavor” in soda pop) and perfumes. Citral is recognized to be a
highly sensitizing substance.
#3 Prostaglandin E2 –
In light of prostaglandin E2’s connection to childbirth and
fever initiation, it is intriguing that it inhibits RALDH2. Birth and viral
infections are both associated with onset of CD. Perhaps we really should
“starve a fever” a bit, at least at the beginning. And it probably wouldn’t
hurt to give women who are genetically-susceptible to CD a hypoallergenic diet
around childbirth, especially if
prostaglandin E2
(Cervidil) is being used to soften the cervix.
#4 Excess Vitamin A –
And we end back on Vitamin A, which is easy to overdose on
over the long-term because it is a fat-soluble vitamin that our bodies store. A
mere teaspoon of cod
liver oil contains the daily RDA of Vitamin A. Beef liver is even higher in
Vitamin A, and it does appear to be a significant part of the cuisine in many
places that are notable for CD prevalence.
There are
8 major
food allergens—shellfish, eggs, cow milk, fish, peanuts, tree nuts, wheat,
and soy—the first four of which are amongst the
highest
food sources of retinol (pre-formed Vitamin A, found in animal products).
Retinol is what the body breaks down in the enzymatic pathway that includes the
RALDH enyzmes.
The other four major allergens—at least if one means wheat
to include whole wheat, which still has the germ—are all sources of Vitamin E
(tocopherols), which appear to
increase
the synthesis of retinal and retinoic acid from beta-carotene, especially if
there is also Vitamin C present. If someone is eating lots of beta-carotene
(orange and yellow fruits and vegetables) and Vitamin C along with whole wheat,
soy, peanuts, or tree nuts, that appears to have a similar effect on retinol
metabolism as eating animal products that are high in retinol. Unfairly, it
would thus appear that
many people trying to eat healthily and get all their vitamins regularly are more likely to develop food allergies from RALDH disturbances than someone
who consumes a diet that is sometimes deficient in Vitamin A, C, or E.
In support of a retinol-celiac link, I note that China has
long eaten wheat in noodles, dumplings, and buns. Yet as China grows wealthier
and increases its intake of dairy and other animal products, it is seeing an
increase in CD.