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Megan Tichy wrote:

>I'm very confused by some recent statements regarding vigilance on 
>the gluten free diet.

Dear List,

I think Ms. Tichy means me, as I am the person who asked about 
vigilance and wrote up the summaries.

I stand corrected: for whatever reason, I had the idea (as must some 
others, because it shows up on this list from time to time) that 
circulating antibodies produce an illusory "protection" and result in 
fewer perceived reactions to accidental gluten hits. I put the 
question to Peter Green, one of the leading Celiac researchers, and 
he set me straight. More on that in a minute.

First though, I apologize for what seems to have been a lack of 
clarity in my use of quote marks around the word "protect." I did not 
mean to imply that antibodies are somehow good for you or that they 
in any way ameliorate intestinal damage. The quote marks were 
intended as a syntactical shorthand meaning "feel like but aren't" 
or, to put it more colloquially, NOT.

>
>
>Anti-gliadin antibodies are not something that one wishes to 
>"retain" and they do not "protect" you, as a celiac,

agreed

Gluten causes harm to the Celiac gut; I never meant to imply 
otherwise. I hope that whatever confusion my original post caused was 
at least limited. I apologize for spreading misinformation and I 
thank Ms. Tichy for pushing me to re-examine my erroneous assumptions 
about the cause of the oft-reported increased sensitivity among gf 
diet-compliant Celiacs.

>
>On the contrary, with an autoimmune disease, more antibodies = a 
>worse reaction.

This is not supported by the research.

In Peter Green's book, which I recommend, (Celiac Disease: A Hidden 
Epidemic) he says "Inflammation, mainly through the increased level 
of circulating cytokines, makes people feel unwell." This statement 
draws a distinction (as I intended to) between the reactions many of 
us associate with accidental gluten and the myriad health and 
symptomatic consequences of gut damage and malabsorption.

So does the degree of new inflammation process correlate with the 
degree of reaction?

Green says: "There have been no studies of sensitive versus 
nonsensitive Celiacs....(but reactions are) not related to the level 
of inflammation in the biopsies of the duodenum."

(Apologies in advance, but I have to restrict this discussion to the 
biopsy-diagnosed because that is the basis of the research evidence.)

Most of the people on this list probably know that at the time of 
diagnosis, some people, even with bad damage, have symptoms so mild 
that they recognize them only in retrospect. Others are truly 
asymptomatic.

However, more antibodies mean more gut damage. IgA Endomysial 
Antibodies (EMA) correlate with the degree of villous atrophy.

The current state of research shows, then, that antibodies are a 
nearly invariable (nothing is 100%) correlate to villous atrophy, 
present in proportion to the amount of gut damage. But reactions to 
gluten are extremely varied and sometimes even absent. More 
antibodies do not mean a worse reaction.

One more thing: Dr. Green's book has a good explanation of the 
various ways in which gluten can cause gastro-intestinal problems for 
a Celiac. Cytokine production (part of the inflammation process) is 
only one of the relevant physiological phenomenon. The others he 
cites are essentially by-products of continuing gluten assault and 
damage.

Mary B.
NYC
-- 

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