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There’s no denying that celiac disease (CD) is more prevalent now than ever. In the US, rates of CD have increased at least 5-fold over the past few decades, and prevalence in Finland has doubled. (1, 2, 3) The incidence of CD has also increased four-fold in the UK and three-fold in the Netherlands in the past 20 years, and the incidence of pediatric CD in Scotland has increased 6.4-fold. (4, 5, 6)

So naturally, everyone is wondering – why? We know that there’s a strong genetic component to celiac disease (and our ability to detect the disease has vastly improved), but the rising rates have occurred too quickly to be explained by a genetic shift in the population.

Besides, the genes that predispose an individual to CD are actually relatively common in the population, but only a very small percentage of those people actually develop the disease. In other words, genetics appear to be necessary – but not sufficient – for someone to develop CD.

Can the overuse of #antibiotics trigger celiac disease?

Antibiotics can cause intestinal dysbiosis and infection

Clearly, something has changed in the environment to trigger celiac disease in a higher proportion of genetically susceptible people. Multiple factors probably play a role, but evidence indicates that one big factor is the intestinal microbiota. And a major contributor to disordered intestinal microbiota is antibiotic overuse.

In my previous article on the effects of antibiotics, I reviewed several studies that demonstrate how drastically antibiotics can alter the gut microbiome. Just a single course of antibiotics can reduce the richness and diversity of the intestinal microbiota, and in many cases, people never completely regain the diversity they lost.

Even if a person doesn’t develop an overt, clinically-diagnosable infection such as C. difficile, imbalances in the types of bacteria that colonize the gut can still cause serious problems. But to understand how antibiotic-induced gut dysbiosis could trigger celiac disease in genetically-susceptible individuals, it helps to first understand some of the basic mechanisms behind celiac disease.

Celiac disease involves an immune reaction to both gliadin and tissue transglutaminase

The biological mechanisms behind celiac disease are complicated and still not fully understood, but the general idea is that gluten – a group of proteins found in wheat, rye, and barley – triggers an autoimmune response that results in severe damage to the epithelial lining of the intestine.

Gliadins and glutenins are the two main components of gluten, with gliadins being the primary trigger for celiac disease. These proteins are very difficult for the body to digest fully, but in most people, this isn’t a problem. However, in people with celiac disease, certain cells (known as “antigen-presenting cells”) get a hold of these large, undigested fragments of protein and present them to T-cells, triggering an immune response. (7, 8)

An enzyme called tissue transglutaminase (TG2) is also important in the development of CD. This is because antigen-presenting cells only bind certain types of proteins, and they don’t usually bind normal gliadin fragments. (9) On the other hand, TG2 readily binds gliadin, and actually modifies it to make the gliadin much more attractive to antigen-presenting cells. This vastly increases the likelihood of an immune response.

Once this happens, the body starts creating antibodies against gliadin. But because the gliadin is usually bound to TG2, the body also creates antibodies against TG2, its own enzyme. This attack of “self” is what earns CD the classification of “autoimmune.”

Intestinal dysbiosis and infection can lead to up-regulation of tissue transglutaminase

In healthy individuals, TG2 plays a role in tissue repair, as well as in other processes such as regulation of cell death; it’s not an enzyme that’s “supposed” to interact with gluten. (Interestingly, TG2 also plays a role in other diseases, such as Parkinson’s and Huntington’s, by modifying proteins that it isn’t supposed to modify.) (10)

Most TG2 appears to be either stored safely inside cells or inactive under normal conditions, and is only activated in the event of tissue injury, bacterial or viral infection, or another source of inflammation. (11, 12) This indicates that tissue damage or inflammation in the intestine (and subsequent TG2 up-regulation) might actually be necessary for the development of CD.

Without substantial TG2 activity, it’s unlikely that the antigen-presenting cells would bind and present enough gluten fragments to provoke a major immune response. But a bacterial or viral infection could create inflammation and tissue damage that would activate TG2, and thus trigger the cascade of events eventually leading to celiac disease.

Intestinal dysbiosis and infection can contribute to leaky gut

Another factor to consider is the location of tissue transglutaminase. Nearly all TG2 is found in the sub-epithelial region of the intestine, a place that gluten shouldn’t have access to. This means the intestinal barrier would need to be compromised in some way for gluten proteins to significantly interact with TG2. (13)

This fits with previous work done by researchers such as Alessio Fasano, who have hypothesized that a person cannot develop an autoimmune condition such as CD if they don’t have leaky gut. If the intestinal barrier is intact, the immune system will never “see” the antigens, so it won’t mount an immune response.

But one big risk factor for developing leaky gut is intestinal dysbiosis or infection. Bacterial components such as lipopolysaccharides can induce inflammation and increase intestinal permeability, which would allow gluten into the sub-epithelial region of the intestine where it could be modified by TG2 and trigger CD. (14)

Candida infection may trigger celiac disease through cross-reactivity

So far, we’ve been talking about dysbiosis in a general sense, but there’s evidence that specific microbes could trigger celiac disease as well. A recent study (hat tip to Questioning Answers for the find) found that an overabundance of the yeast Candida albicans could contribute to the development of CD, and unfortunately, antibiotic use is a big risk factor for developing a candida infection. (15)

Candida is a normal part of the intestinal microbiome of healthy individuals, but problems can arise when it overgrows relative to other inhabitants of the intestine. Remember how tissue transglutaminase (TG2) readily binds gliadin? Well, it turns out that candida expresses a protein named Hwp1 that also binds TG2, potentially leading to immune activation and cross-reactivity with gluten.

The study found that people without CD who had candida infections produced anti-gliadin antibodies, as well as the expected anti-Hwp1 antibodies. People with CD produced antibodies to both proteins as well. This means that in theory, a person who is genetically susceptible to CD but who doesn’t have the disease could develop the disease in response to a candida infection.

So, what does this mean for you?

As you can see, there are several ways in which antibiotic overuse and subsequent intestinal dysbiosis or infection could lead to the development of celiac disease. As I’ve said before, antibiotics can be lifesaving and are necessary in some situations, but that doesn’t mean they’re free of consequences.

It’s becoming more and more clear how vitally important it is to use antibiotics responsibly, whether that’s not using them at all, or properly rehabilitating the gut during and after a course when they’re deemed necessary.

Now I’d like to hear from you. If you have Celiac disease, do you have a history of antibiotic use prior to the expression of the disease? What do you think about this theory? Share your opinion in the comments below.

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One of my favorite strategies for saving money on food costs is stocking my pantry and freezer to serve me all year long. Packaged foodstuffs generally last for many months, which means I can stock up on a great sale and use those items far past their typical “season.”

Also, learning a few tricks in food preservation allows me to extend the shelf life of seasonal produce and enjoy summer fruits in the dead of winter. Here are few of the seasonal deals I look for throughout the year.

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One way to subvert the usual lettuce narrative is to do something wholly unexpected with it, as in the baked lettuce and onion tart we shared with you yesterday. Another way is to expand the idea of lettuce itself — as in this crisp, bitter chicory salad from the bright minds behind Bar Tartine in San Francisco.

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This kitchen violates not one but FOUR reader rules. Can you guess what they are?*

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In my many years covering kitchen design and organization for The Kitchn, I’ve incited my fair share of reader outrage at some of the kitchen designs we’ve showcased on the site. From white subway tile — you love it or you hate it, and if you hate it, you really hate it — to rugs in the kitchen (cozy or a hazard?), some features just really rile readers up, but none quite as much as the following five.

So, dear reader, steady your fingers over your keyboard and prepare to type in a wild rage, because I’m about to show you the five kitchen features that drive many of you crazy … and also why you’re probably overreacting. (Yeah, I said it.) Ready, set, go!

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Q: Growing up, I remember my grandparents used to send me out to get potatoes and carrots out of “the storage box.” This box was full of sand that had been heated up to kill bacteria (I believe). Once cooled, the potatoes and carrots were buried for later use during winter months.

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About a month into my marriage, my husband and I took a yoga class together with a fairly well known and respected teacher. Halfway into the class, the teacher, who was male, straddled over me in bridge pose and lifted my hips.

This created an amazing opening in my shoulders and I let out a sound – a sound my husband later described to me as a moan. This, along with other sexual innuendos the instructor made throughout the class, made us both uncomfortable.

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Originally Posted At: https://breakingmuscle.com/feed/rss

About a month into my marriage, my husband and I took a yoga class together with a fairly well known and respected teacher. Halfway into the class, the teacher, who was male, straddled over me in bridge pose and lifted my hips.

This created an amazing opening in my shoulders and I let out a sound – a sound my husband later described to me as a moan. This, along with other sexual innuendos the instructor made throughout the class, made us both uncomfortable.

read more

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Summer is right around the corner, and with it comes grilling season. You’ve probably grilled the usual suspects — chicken, steak, fish — but what about lettuce? This grilled romaine, with corn and avocado salsa, will make a lettuce-grilling believer out of you.

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We’ve had our fair share of savory ice creams, but until today we’ve never thought of a burrata ice cream. Leave it to the creator of the Cronut to come up with this savory masterpiece.

Ansel launched the flavor last Friday at his new outpost, Dominique Ansel Kitchen, along with a Gianduja-flavored soft serve.

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First off, let’s make no mistake. Americans are still binging on junk food. No one is declaring the end of fast food. Financial trends show as much, as does a casual look around. That said, there’s plenty to suggest that we find ourselves at an interesting junction these days when it comes to the food economy.

We’re seeing big packaged food giants, who lost four billion dollars of the market share last year, initiate “healthy” or sustainable changes they hope will drive consumers back to their product lines. Several fast food chains are doing the same. It’s all part of a “Big Food versus Granola Startup” movement, as described by a recent Fortune Magazine analysis of the food industry, a review that highlights the increasing role of health goals and smaller sourcing as well as questions the ability of large food companies to maintain their market share, particularly without heeding the alternative writing on the wall.

Following decades of momentum toward increasing convenience, artificial additives, and industrial farming, pushback movements are gaining ground and building awareness around food quality and farming practices in the public consciousness. The result? We’re witnessing an expansion of markets (and their suppliers) for organically raised produce and naturally raised (e.g. pastured, grass-fed) livestock and for less heavily processed alternatives for other kinds of food products and restaurant offerings. (Hooray!)

The last few months have seen a slew of corporate announcements. Chipotle is going GMO-free (not in terms of animal feed, however). Tyson will no longer use poultry that’s been raised with human antibiotics. McDonalds has committed to the same phase-out, which fits given Tyson is a supplier for the fast-food chain. The fast-food giant also agreed to stop using milk from cows treated with the rbST hormone. Panera Bread won’t be using artificial ingredients in their menu. Likewise, Pizza Hut and Taco Bell are reportedly going “all natural,” removing artificial ingredients from their line-ups. Dunkin’ Donuts has agreed to discontinue use of titanium dioxide in its powdered donuts. (Sorry to anyone who’s eaten one – ever.)

On down the list…Nestle is discontinuing the use of artificial flavors and coloring, a move that impacts the processing of 250 products. Hershey, for its part, followed up with a pledge to cut many artificial ingredients in its formulations. Pepsi is dumping aspartame (and replacing it with sucralose). Coca-Cola has eliminated brominated vegetable oil, which, by the way, is used as a flame retardant. After being besieged by a major campaign that spanned social media, Kraft Macaroni and Cheese will not longer include artificial coloring in its U.S. products and will use the natural coloring agents it uses for European versions.

Sure, it’s stating the obvious when I say that most people who read this blog aren’t exactly these companies’ biggest fans and loyal customers. I can’t remember the last time I had soda. Hershey? I do enjoy some quality high cocoa content dark chocolate now, but I’ve found much, much better, thank you. Fast food – not on the radar screen anymore.

Still, the general trend here intrigues me. Big Food is scrambling to shift their product ingredients in a healthier direction – not to mention buy out genuinely natural and organic brands to diversify their lines and maximize their profits.

As Fortune magazine’s insider discussions with food execs demonstrated, companies are concerned about the growing trends toward “shopping the perimeter” and preferring labels with fewer ingredients. Some 64% of people surveyed through a Fortune Magazine-Survey Monkey partnership were very concerned about pesticides. Fifty-six percent were concerned about hormones, and 52% were concerned about the use of antibiotics in livestock. A whopping 85% believed GMO products should be labelled. This doesn’t bode well for many in the industry.

Consumers, it seems, aren’t only more health conscious but more experimental in their health related choices. The top label claims to draw consumers to new products between 2011-2015 were gluten-free and organic. All but obsolete are “diet” and “low fat” labels. Even the concept of diet has changed in the population as a whole, with over 36% of survey respondents saying they’ve tried a low carb diet (and another 6.5% citing their experience with the paleo diet). As the head of Nestle’s U.S. business observed the interest of consumers to experiment with “new of trends ‘is at its highest level, probably, ever.’”

Big Food switching out some ingredients – no, it’s not like the world is going Primal. We’re a long way from healthy, but there’s some reason to appreciate the news. I like a game that’s up for grabs, and the more players the better in my mind. Sure, the biggest dollars are still going toward the biggest companies, but I agree there’s a different energy these days. The old rules (like the old labels) are falling by the wayside. Trends are shifting faster than large corporations can neatly manage. The public, as bad as many of their choices are, in some ways knows more or at least wonders about what they think they know. The older CW messages are slowly falling away, and many consumers are looking for new rules and are open to new shopping sources.

Once upon a time, Whole Foods was a specialty store that few had heard about let alone shopped in. These days, they’re struggling against the competition from big companies’ organic lines as well as increasing co-op, farmer’s market, direct-to-consumer options – not to mention the online healthy warehouse newcomer Thrive Market. The landscape is changing, and consumer interests are driving those changes at a faster pace and in novel directions.

You may have nothing to do with certain companies or whole sectors of the food industry as a result of your Primal choices or personal values. Many people in the Primal community I know shop solely from small local suppliers (or grow/raise/hunt their own), which means they’ve cut themselves entirely (or almost entirely) out from the reach of large food corporations. No matter what companies or growers we support, the fact is, where we put our dollars has an impact. When a large number of us steer our money away from certain businesses or kinds of products and begin to support others, it has an even greater effect.

We’re not only making a choice for ourselves and our families, but we’re helping to shift the trajectory of the food industry as a whole. Each of us matters in this equation, but imagine the subtle but very tangible and gradually transformative power of the full Primal community – and the greater movement of ancestral health/eating. We’re helping decide which businesses stay open, which will grow and which will be forced to change. What starts as a commitment to ourselves becomes an influence on greater economic and societal forces. Our dollars help determine the future of food in this country.

What message or action do you hope your purchases support? How have you (by word or example) influenced others’ food choices or shopping routines? Share your thoughts, and have a great week, everyone.