Could A Gluten Intolerance And Other Immune Reactions To Foods Cause Crohn’s Disease?

I have a close relative with Crohn’s disease. This is another autoimmune disease that causes inflammation and damage in the bowel. Upon diagnosis, he was offered a drug to suppress his immune system and help decrease the inflammation. When he asked about diet, the gastroenterologist told him that diet modification would not help him because Crohn’s disease didn’t appear to be related to diet. I was quite surprised by this guidance because, for me, it seemed logical to suspect that Crohn’s disease could be associated with something in the diet. After all, what is the bowel most exposed to? Food!


Luckily, my relative, a professional engineer, was used to questioning new information and agreed that a change in diet may be needed. He went on the specific carbohydrate diet and was off his medication within 5 months. Further investigation revealed that he reacts to corn and corn derivatives (high fructose corn syrup, dextrose, glucose/fructose, citric acid, etc). Corn is in most grocery store products so this was quite a challenge to remove from his diet. As well, he was surprised to learn that corn can be in milk (1%, 2%, and skim, it carries the vitamin D), table salt (to stabilize the iodine) and it can coat fruit such as apples.

He also has an allergy to almonds, broccoli, cauliflower, chocolate, and legumes. Diet modification has helped him to heal himself. If he accidentally consumes corn or the other foods he reacts to, then the symptoms promptly return. Although he tested negative for celiac disease, he has removed gluten from his diet as well. He hasn’t had the other tests for gluten intolerance, but feels better without these grains in his diet. Currently, he is very healthy with no symptoms. With his last follow-up scope, the gastroenterologist was amazed at the healthy appearance of his bowel.

This story highlights the fact that autoimmune reactions in Crohn’s disease may be triggered by something in the diet. I also met another individual with Crohn’s disease who had the same results. As well, I have met many others who have a underlying gluten intolerance. This strengthens the possibility that diet modification may relieve symptoms in individuals with Crohn’s disease.

Theoretically, I suspect that the ingestion of gluten could be the underlying cause. Some studies have shown that gluten is difficult to digest. This is a problem because undigested gluten can increase the permeability of the bowel (leaky gut effect). Researchers suspect that if the conditions are right and the bowel is is a state of dysbiosis, with some inflammation and low levels of beneficial microbiota, then this along with undigested gluten can trigger the the tight intracellular junctions between the intestinal cells (like gates) to open. This increases the risk for a gluten intolerance because the undigested gluten can gain access to the immune system by entering through the gates. The ever patrolling immune system has a high chance of identifying the undigested gluten as an invader since it appears foreign (it should be digested). The result, an immune reaction can occur leading to a gluten intolerance. Gluten intolerance can present as celiac disease, dermatitis herpetiformis and non-celiac gluten intolerance. It is very elusive and can cause a variety of different types of damage in the body. With Crohn’s disease, it could cause enough inflammation in the bowel to increase the risk for an infection (such as H.pylori and other Helicobacteraceae) and this could potentially contribute to the skip lesions found throughout the bowel.

In developed countries, the risk for dybiosis may be higher due to our increased intake of sugar, highly refined carbohydrate processed diets, and increased use of antibiotics in our food supply (with animals) and for curing infections. This could lead to an imbalance between the health promoting intestinal flora and negative intestinal bacteria further promoting a leaky gut effect.

Once a leaky gut occurs, other undigested food molecules can gain access to the immune system as well. This can increase the risk for other food allergies. Like gluten intolerance, food allergies can cause a variety of symptoms throughout the body and this could further impact the negative effects on health.
If this theory proves true, it may explain why different Crohn’s patients who have used diet modification seem to need their own unique diet to feel well. Gluten intolerance may be the underlying cause, but the associated allergies may be different with each patient. The allergies could be IgE, IgA or IgG mediated. The related allergies may be different for each person and this means that each person would need their own individualized therapeutic diet.

As well, nutrients deficiencies may vary and this can affect the type of supplements needed. Underlying infections could contribute to symptoms as well. Testing for parasites, bacterial infections and fungal infections can help rule this out.

I have met many patients with coexisting celiac disease and Crohn’s disease. Some studies have also identified an association as well. Therefore, I believe it is worthwhile to rule out a gluten intolerance by testing for celiac disease, dermatitis herpetiformis and non-celiac gluten intolerance. Further testing for food allergies (IgE, IgA, and IgG mediated) can help to identify other food reactions. An allergist often only tests for IgE mediated allergies and offers an elimination diet. Naturopathic doctors will generally do blood tests for the other types of allergic reactions. Your physician, allergist or naturopathic doctor may recommend a food log along with an elimination diet if needed.

I wonder, if this approach helps people with Crohn’s disease, why couldn’t it help people with other types of inflammatory bowel diseases?

Lectins

Lectin intolerance may be an underlying cause. Some studies have suggested that immune reactions to lectins can cause bowel changes as well. Antibodies to lectins have been found in people with celiac disease further suggesting that the immune system can react to lectins. A paleolithic diet may provide relief to people with this type of reaction.

Problem With Past Studies

Often, past studies looking at the relationship between food allergies and Crohn’s disease only tested for IgE mediated reactions, totally missing the potential for IgG and IgA mediated reactions to foods.

Future Studies

For a future study, I would like to see a large group of Crohn’s patients tested for the presence of a gluten intolerance (IgA and IgG antibody mediated), lectin intolerance, and food allergies (IgA, IgE, and IgG antibody mediated). This may help to further confirm an association between Crohn’s disease and immune reactions to foods.

Extra Note: Aspergillus, a type of fungus often used to process corn could potentially cause skip lesions as well. Perhaps, this is why my relative feels better without corn and corn derivatives in his diet. He may just have an allergy to corn as well.
Please share this information with your medical doctor, allergist and naturopathic doctor and get advise before making any changes. 

I am dedicating this post to my grandmother, Alma, who died from complications associated with Crohn’s disease when I was in my early teens. Her daughter (my mother), my daughter and I all have celiac disease.

References

1. Curtis WD, Schuman BM, Griffin JW Jr. Association of gluten-sensitive enteropathy and Crohn’s colitis. Am J Gastroenterol. 1992 Nov;87(11):1634-7.
2. Karoui S, Boubaker J, Hamzaoui S, Ben Yaghlene L, Filali A. Association of asymptomatic celiac disease and Crohn’s disease. Ann Med Interne (Paris). 2000 Sep;151(5):411-2.
3. Cheikh I, Maamouri N, Chouaib S, Chaabouni H, Ouerghi H, Ben Ammar A. Association of celiac disease and Crohn’s disease. A case report. Tunis Med. 2003 Dec;81(12):969-71.
4. Malmusi M, Manca V, Girolomoni G. J Am Acad Dermatol. Coexistence of dermatitis herpetiformis, gluten-sensitive enteropathy, and ulcerative colitis. 1994 Dec;31(6):1050-1.
5. Schedel J, Rockmann F, Bongartz T, Woenckhaus M, Schölmerich J, Kullmann F. Association of Crohn’s disease and latent celiac disease: a case report and review of the literature. Int J Colorectal Dis. 2005 Jul;20(4):376-80.
6. Koninckx CR, Giliams JP, Polanco I, Peña AS. IgA antigliadin antibodies in celiac and inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 1984 Nov;3(5):676-82.
7. Rajendran N, Kumar D. Role of diet in the management of inflammatory bowel disease. World J Gastroenterol. 2010 Mar 28;16(12):1442-8.
8. Rijnierse A, Redegeld FA, Blokhuis BR, Van der Heijden MW, Te Velde AA, Pronk I, Hommes DW, Nijkamp FP, Koster AS, Kraneveld AD. Ig-free light chains play a crucial role in murine mast cell-dependent colitis and are associated with human inflammatory bowel diseases. J Immunol. 2010 Jul 1;185(1):653-9. Epub 2010 May 26.
9. Brown AC, Roy M. Does evidence exist to include dietary therapy in the treatment of Crohn’s disease? Expert Rev Gastroenterol Hepatol. 2010 Apr;4(2):191-215.
10. Freeman HJ. Celiac disease (gluten-sensitive enteropathy). Minerva Gastroenterol Dietol. 2010 Jun;56(2):245-9.
11. Triggs CM, Munday K, Hu R, Fraser AG, Gearry RB, Barclay ML, Ferguson LR. Dietary factors in chronic inflammation: food tolerances and intolerances of a New Zealand Caucasian Crohn’s disease population. Mutat Res. 2010 Aug 7;690(1-2):123-38. Epub 2010 Feb 6.
12. LM Solid, J Kolberg, H Scott, J Ek, O Fausa, P Brandtzaeg. Antibodies to wheat germ agglutinin in coeliac disease. Clin Exp Immunol. 1986 January; 63(1): 95–100.
13. K. Fälth-Magnusson, K.-E. Magnusson . Elevated levels of serum antibodies to the lectin wheat germ agglutinin in celiac children lend support to the gluten-lectin theory of celiac disease. Pediatric Allergy and Immunology. Volume 6, Issue 2, pages 98–102, May 1995.
14. Ceri H, Falkenberg-Anderson K, Fang R, Costerton JW, howard R and Barnwell JG. Bacteria-lectin interactions in phytohemagglutinin-induced bacterial overgrowth of the small intestine. Canadian Journal Of Microbiology 34, 1003-8, 1988.
15. JH Ovelgonne, JFJG Koninkxa, A Pusztaib, S bardoczb, W Koka, SWB Ewenc, HGCJM Hendriksa, JE van Dijka. Decreased levels of heat shock proteins in gut epithelial cells after exposure to plant lectins. Gut. 2000 May;46(5):679-87.
16. Lammers KM, Lu R, Brownley J, et al (July 2008). "Gliadin induces an increase in intestinal permeability and zonulin release by binding to the chemokine receptor CXCR3". Gastroenterology 135 (1): 194–204
17. Hausch F, Shan L, Santiago NA, Gray GM, Khosla C. Intestinal digestive resistance of immunodominant gliadin peptides. Am J Physiol Gastrointest Liver Physiol. 2002;283(4):G996–G1003.
18. Shan L, Qiao SW, Arentz-Hansen H, et al (2005). Identification and Analysis of Multivalent Proteolytically Resistant Peptides from Gluten: Implications for Celiac Sprue. J. Proteome Res. 4 (5): 1732–41.
19. Bodinier M, Legoux MA, Pineau F, et al. (May 2007). "Intestinal translocation capabilities of wheat allergens using the Caco-2 cell line". J. Agric. Food Chem. 55 (11): 4576–83.
20. Kaakoush NO, Holmes J, Octavia S, Man SM, Zhang L, Castaño-Rodríguez N, Day AS, Leach ST, Lemberg DA, Dutt S, Stormon M, O’Loughlin EV, Magoffin A, Mitchell H. Detection of Helicobacteraceae in intestinal biopsies of children with Crohn’s disease. Helicobacter. 2010 Dec;15(6):549-57. doi: 10.1111/j.1523-5378.2010.00792.x.
21. Man SM, Zhang L, Day AS, Leach S, Mitchell H. Detection of enterohepatic and gastric helicobacter species in fecal specimens of children with Crohn’s disease. Helicobacter. 2008 Aug;13(4):234-8.