Gluten Cross-Reactivity UPDATE: How your body can still think you’re eating gluten even after giving it up.

March 13, 2013 in Categories: , , , , , by

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The Paleo Approach by Sarah BallantyneIn my research for The Paleo Approach, I feel that it is important to provide scientific references for every single statement I make.  This has me doing a great deal of fact checking, scouring the medical literature to verify information often gleaned from other paleo authors and bloggers.  Most of the time what I find out just helps reinforce concepts, filling in blanks, and typically making a strong case for my assertions.  But, every once in a while, I find information that makes me completely reevaluate a concept and sometimes even an aspect of the autoimmune protocol.

The update for this blog post comes from my further examination into the science behind gluten cross-reactivity.  While there are plenty of papers confirming how cross-reactive antibodies can be formed, I could not find any published studies confirming the results from Cyrex Labs (and my motto with the paper is if I can’t cite it, I don’t say it).  I contacted the company to request further information (I was particularly interested in the reported cross-reactivity to tapioca as I was trying to decide whether or not tapioca starch and/or pearls should be included in The Paleo Approach).  Cyrex labs responded quickly and informatively and my level of esteem for that company (which was high to begin with) elevated another couple of notches.  While they were unwilling to share proprietary data with me, they were able to point me to a recent publication that evaluated gluten cross-reactivity and share a summary of their proprietary findings (the paper did not show up on my PubMed searches).  As I devoured the paper (figuratively, not literally), I realized that an update to this post was required.  This is not an excerpt from The Paleo Approach but it is a direct result of my research for the book and much of the information that follows is still presented in it.

For those 20% of us with celiac disease or gluten-intolerance/sensitivity (whether diagnosed or not), it is critical to understand the concept of gluten cross-reactivity. Essentially, when your body creates antibodies against gluten, those same antibodies also recognize proteins in other foods. When you eat those foods, even though they don’t contain gluten, your body reacts as though they do. You can do a fantastic job of remaining completely gluten-free but still suffer all of the symptoms of gluten consumption—because your body still thinks you are eating gluten. This is a very important piece of information that I was missing until recently.

Proteins are made of long chains of amino acids (small proteins may only be 50 amino acids long whereas large proteins may be 2000 amino acids long) and it is the specific sequence of these amino acids that determines what kind of protein is formed. These amino acid chains are folded, kinked and buckled in extremely complex ways, which gives a protein its ‘structure’. This folding/structure is integral to the function of the protein.

An antibody is a Y shaped protein produced by immune cells in your body. Each tip of the Y contains the region of the antibody (called the paratope) that can bind to a specific sequence of amino acids (called the epitope) that are a part of the protein that the antibody recognizes/binds to (called the antigen). The classic analogy is that the antibody is like a lock and a 15-20 amino acid section of a protein/antigen is the key. There are 5 classes (or isotypes) of antibodies, each with distinctive functions in the body. The IgE class of antibodies are responsible for allergic reactions; for example, when someone goes into anaphylaxis after eating shellfish. The two classes IgG and IgA are critical for protecting us from invading pathogens but are also responsible for food sensitivities/intolerances. Both IgA and IgG antibodies are secreted by immune cells into the circulation, lymph, various fluids of the body (like saliva!) and tissues themselves. And both IgG and IgA antibodies are found in high concentrations in the tissues and fluids surrounding the gut (this is part of why the gut is considered our primary defense against infection).

The formation of antibodies against an antigen (whether this is an invading pathogen or a food) is an extremely complex process. When antibodies are being formed against a protein, the antibodies recognize specific (and short) sequences of amino acids in that protein. Depending on how the antigenic protein is folded, certain amino acid sequences in that protein are more likely to be the target of new antibody formation than others, simply because of the location of that sequence in the structure of the protein. Certain sequences of amino acids are more antigenic than others as well (i.e., more likely to stimulate antibody formation). This is also part of why certain foods have a higher potential to cause allergies and sensitivities.

Understanding that antibodies recognize short sequences of amino acids and not an entire protein is key to understanding the concept of cross-reactivity (and molecular mimicry, but that’s a topic for another post). It also is the reason why many different antibodies can be formed against one protein (this redundancy is important for protecting us from pathogens). Many different antibodies can also be formed against one pathogen or, more relevant to this discussion, one specific food.

So what happens in cross-reactivity? In this case the amino acid sequence that an antibody recognizes is also present in another protein from another food (in the case of molecular mimicry, that sequence is also present is a protein in the human body). There are only 20 different amino acids, so while there are millions of possible ways to link various amount of each amino acid together to form a protein, there are certain amino acid sequences that do tend to repeat in biology.

The take home message: depending on exactly what antibody or antibodies your body forms against gluten, it/they may or may not cross-react with other foods. So, not only are you sensitive to gluten, but your body now recognizes non-gluten containing foods as one and the same. Who needs to worry about this? Any of the estimated 20% of people who are gluten intolerant or have celiac disease, i.e., have formed antibodies against gluten.

A recent study evaluated the potential cross-reactivity of 24 food antigens.  These included:

  • Rye
  • Barley
  • Spelt
  • Polish Wheat
  • Oats (2 different cultivars)
  • Buckwheat
  • Sorghum
  • Millet
  • Amaranth
  • Quinoa
  • Corn
  • Rice
  • Potato
  • Hemp
  • Teff
  • Soy
  • Milk (Alpha-Casein, Beta-Casein, Casomorphin, Butyrophilin, Whey Protein and whole milk)
  • Chocolate
  • Yeast
  • Coffee (instant, latte, espresso, imported)
  • Sesame
  • Tapioca (a.k.a. cassava or yucca)
  • Eggs

They did not find cross-reactivity with all of these foods (as is implied by the Cyrex Labs gluten cross-reactivity blood test, a.k.a. Array 4).  But, they did find that their anti-gliadin antibodies (antibodies that recognize the protein fraction of gluten) did cross-react with all dairy including whole milk and isolated dairy proteins (casein, casomorphin, butyrophilin, and whey)—this may explain the high frequency of dairy sensitivities in celiac patients—oats, brewer/baker’s yeast, instant coffee (but not fresh coffee), milk chocolate (attributable to the dairy proteins in chocolate), sorghum, millet, corn, rice and potato.

While not all people with gluten sensitivities will also be sensitive to all of these foods, they should be highlighted as high risk for stimulating the immune system.   Just like trace amounts of gluten can cause a reaction in at least those with celiac disease (the threshold for a reaction has not been tested in non-celiac gluten sensitivity), even a small amount of these foods can perpetuate inflammation and immune responses. This is important when you think of the small amounts of corn used in so many foods and even the trace milk proteins that can be found in ghee.

Beyond this gluten contamination is common in the food supply and many grains and flours that are inherently gluten free may still contain gluten once processed.  Commonly contaminated grain products include millet, white rice flour, buckwheat flour, sorghum flour, and soy flour.  As these are commonly used ingredients in commercial gluten-free baked goods, extreme caution should be exercised.

Cyrex Labs offers a simple blood test that is referred to as their gluten ross-reactivity panel, a.k.a. Array 4.  It tests for reactions to the gluten cross-reactors mentioned above as well as the non cross-reactors evaluated in the paper.  Cyrex Labs reported to me that they see positive sensitivities frequently (many as high as 25%) in many of those foods in people with diagnosed gluten sensitivity.  This may reflect that when you have a leaky gut, food intolerances are quite easy to form.

If you have autoimmune disease (which has a very high correlation with gluten-sensitivity), celiac disease, gluten-sensitivity, or are simply not seeing the improvements you were hoping for by following a standard paleo diet, one or all of these foods may be the culprit. You have the choice of either cutting these foods out of your diet and seeing if you improve or get tested to see if your body produces antibodies against these foods.

When I first wrote this blog post, it made so many pieces of the puzzle come together.  I stopped eating chocolate (I had already given up coffee), fermented foods like sauerkraut and kombucha (because of the yeast content), eggs, and tapioca.  Over the months that followed, I was able to definitely discern that I am very sensitive to chocolate (perhaps because it is extremely high in phytic acid, discussed in this post) and eggs (discussed in this post).  I have successfully reintroduced fermented foods and have not been particularly inspired to test my sensitivity to tapioca (I test by eating a bit and seeing if I have a reaction, most typically my reactions are acne, but sometimes trouble sleeping, mood issues, joint aches, or increased itchiness and redness of my lichen planus lesions).  So, will I give coffee a try now?  Maybe, once in a while as a special treat, but removing gluten cross-reactivity from the list of ways coffee is suboptimal, really only removes one potential problem.  Coffee still has effects on cortisol and still correlates with increased inflammation.  Oh well.  Whether I can drink coffee again or not, I am glad to be able to share this updated information with all of you!

A great overview of proteins and antibodies (and source of protein folding image): http://publications.nigms.nih.gov/structlife/chapter1.html

A fairly technical review of food IgG-mediated food sensitivities: http://www.usbiotek.com/Downloads/information/criticalReview.pdf

Cyrex Labs Array 4: http://www.cyrexlabs.com/CyrexTestsArrays/tabid/136/Default.aspx

Image of antibody binding taken from http://classes.midlandstech.edu/carterp/Courses/bio225/chap17/ss2.htm

A. Vojdani and I. Tarash, “Cross-Reaction between Gliadin and Different Food and Tissue Antigens,” Food and Nutrition Sciences, Vol. 4 No. 1, 2013, pp. 20-32.  http://www.scirp.org/journal/PaperInformation.aspx?PaperID=26626

Thompson T et al. Gluten contamination of grains, seeds, and flours in the United States: a pilot study. J Am Diet Assoc. 2010 Jun;110(6):937-40. doi: 10.1016/j.jada.2010.03.014.

Comments

Thank you for this extremely interesting and informative information. I have been gluten and dairy free for about 5 years, and have such rigorous control over what I eat, that I can quickly tell what my body doesn’t like. But it has seemed so random at times, that it is hard to figure out a pattern. Yours is the first writing that I’ve seen that mentioned fermented foods as possibly problematic, so it was reassuring since I’ve sadly realized I can’t eat fermented cabbage without issues. Strangely, some chocolate is ok, other isn’t, without relation to cacao content. Some wine is ok, other wine isn’t. What I’ve read on that is that perhaps it is certain strains of yeast that one might be more sensitive to over others. But I am now very interested in taking this test; perhaps it will help with some of the mysterys.

Thanks for the excellent article. Regarding the Cyrex slabs study, I notice that while they tested “Coffee (instant, latte, espresso, imported)” per the bullet points, in the ensuing paragraph you note that they only found the anti-gliadin antibodies’ cross reaction to “instant coffee (but not fresh coffee).” Is the culprit the fresh coffee or the “junk” that ends up in the processed instant coffee? Thanks again for the great material!

Hi, i got my rsults back and am out of range for eggs and several other things. My question about eggs is whether that is to both the whites and the yolks? I left this question for them but havent heard back.

This just in from Cyrex Labs concerning whether their test is for egg yolks or egg whites – they test both so if its a positive result (out of range) then it is for the whole egg. Darn!

My doctor/researcher husband was appalled that they report “high negative” results as low positive or equivocal. He insisted that a negative result is a negative result and that it is bad science to report otherwise. Is allergy testing different? I don’t want to eliminate foods I don’t have to. I guess observing symptoms is the only sure way to know.

My doc explained that Cyrex uses a narrower, functional medicine lab range when interpreting antibodies. This is called “predictive” autoimmune testing because antibodies are flagged as being problematic before they become severe.

Hi Sarah,
Thanks for all your great work!

I started seeing a holistic nutritionist about a year ago. At that time I had been gluten free for about 1 1/2 years (celiac). I was feeling totally fine, but just wanted to make sure I was getting all of the right nutrients, pairing foods together correctly etc. She recommended I do a leaky gut protocol and take the Array 4 test. Lost of foods came back on it, I cut them out for 6 months and reintroduced and then retested. The only food I felt any reaction to was rice (a little bloated). The foods that came back were , most grains (corn, buckwheat and quinoa were fine), whey was equivocal, yeast, and tapioca.

My question is, if I had gone into this and decided to cut those foods out and reintroduce without taking the Cyrex test, I would have thought all of them were ok (except rice) because I had no noticeable reaction. Mood stayed fine, gut reactions, headaches, general inflammation, etc. I didn’t notice anything. I had them back in my system for approx 2 months before retesting. I have omitted all of them after the retesting since mid-December.

I saw a new holistic doctor for a 2nd opinion and he said that those tests were a good start, but that its possible my gut wasn’t really totally healed yet, and that if I healed it all the way, he didn’t see a reason I couldn’t eventually add those foods back in. For my purposes if that were the case, I would do it on a limited and rotational basis, but it sure would be nice to not have to scrutinize everything, and be able to travel internationally again!

Also, speaking of international travel. If I were to travel and ate some of these foods for a week or 2 weeks, and was asymptomatic, would it be ok? But was strict for the rest of the year?

Thanks for all of your help!
Nicole

I agree with the 2nd holistic doctor. As for traveling, it depends on here you are in your healing when you do it, what you eat, how nutrient-dense your diet is, how well your stress is managed, how well you sleep… but, in principle, yes, you might be able to do that.

Hi Sarah, ive found all the info on your blog really helpful. One of my friends has had a lot of success with resistant starch, and suggested I try it. However, potato is out on AIP. I live in the uk and i havent been able to find anyond selling plantain chips or flour over here. I was thinking of trying tapioca starch, but I was a bit confused as to whether it is allowed or not. Thanks Rachel

I thought I knew nearly everything about gluten-free and paleo….but this Xmas when I made a rice pie crust (I only indulge in rice 2x a year) with tapioca instead of arrowroot, I was unprepared for the searing joint pain. I did not know it was a nightshade!(I do not eat tomatoes or white potatoes.) I woke up screaming in pain and just now, one-and-a-half months later, am recovering from pain, brain fog, bloat, constipation, etc…. It has been excruciating.

You can order plantain flour from Amazon UK. I’ve also found plantains in my local greengrocer (Cirencester). Good luck!

Sarah – I love all of your articles and have learned so much. After suffering from almost nightly painful gas, I switched in January to a Paleo diet and probiotic pills and have seen definite improvement. I have occasional relapses with gas when I try new foods that should be Paleo that lead me to question exactly what my issue is – lactose intolerant, celiac disease, gluten sensitive or what. Is there any easy way to get tested for all of this including cross reactivity without all the trial and error? Thanks for your help.

I am not saying that they are not cross reactive – but cassava and tapioca and yams are not nightshades. They are in a different botanical family. I was surprised when I read that here. Why do you believe that they are nightshades?

Thanks for such an informative post. I’ve been on an autoimmune protocol with my naturopath for 3 years now to treat leaky gut and many other symptoms derived from it. It’s been helpful getting testing on every ingredient before I add it to my diet, it’s slow but gradually moving. But one thing I want to add is obviously dysbiosis is a big issue with leaky gut and treating the parasite makes a big difference. It’s been a reoccurring issue for me but one that needs to be addressed if you want the condition to improve.

Thanks Sarah for all your work, you’re my idol!! :)

Are duck eggs and goat milk inc. in this “dairy”
Thank you for some great info my 11 yr old has Crohns and the ELISA test was wonderful. Is there a difference in the test?

Thanks for this informative article. I’ve known about cross reaction for several years, just not the science. This will make it easier to explain to people why I can’t eat any grains etc. I also suspected I should give up chocolate, but have been able to talk myself out of it until now.

Sarah, thank you for this post! We are trying to follow the GAPS diet for our son, 19 mo. He was muscle tested for sauerkraut a few months back and was weak to it. It’s so high priority in GAPS and it’s really bugged me that he tested weak to it, as I don’t want to impede his healing in any way. He has also thrown up after ingestion of quinoa (even soaked and sprouted) – we were trying to incorporate some gluten-free carbs to cut back on our budget. Again, this article explains why this could happen.

You’ve been at this longer than I have – have you heard of Paleo people being able to incorporate properly prepared grains in their diet after a few years of healing? Thanks, Sarah!

Just wondering if you could please confirm when you mention ‘potato’ on the cross-reactivity list, is this just white potato? Also, when you mention ‘tapioca’ would this include sweet potato as well? I get a little confused between the two as I’ve only seen tapioca in the pearl or starch form… not as a root vegetable.

One last thing, do you know of any reputable testing laboratories in Brisbane, Australia? I have been on the food elimination/trial-and-error for way too many years and wondering if I do the blood testing would it confirm foods that would definitely react with me? Thank you!

This was the case for me and pregnancy! My body was attacking ‘pregnancy tissue’ thinking it was gluten due to similar protein sequence. Very interesting! Having miscarriage or fertility issues, consider gluten being the issue.

I started seeing a Functional Medicine Practitioner around the same time I bought your book – I am slowly reading through it, trying to absorb all of the fantastic science. My Dr. ordered the Cyrex Array 4, and while I was doing more research on it, I stumbled across this article. I am so grateful for all of your hard work, and your commitment to accurate information. I’m looking forward to seeing my results, because I have not noticed a big difference simply cutting out gluten. I have Hashimotos Thyroiditis, and I’m very hopeful that following the Paleo Approach will help alleviate some of my symptoms.

Hello Sarah,
If a person does not have a gluten problem, but is going to adopt this life style due to another autoimmune disorder, Hashimoto for example, is it true that once you go gluten free you can never eat gluten again? And if that is true, can this same person end up with Gluten Cross-Reactivity too? I have ordered your book, thank you for writing it.

Absolutely amazing info here. I can’t tell you how thankful I am to have this all in one place! I have been struggling with understanding the tests I took with Cyrex labs (Cross Reactive Foods and Gluten Sensitivity), and this helps. I found out I have a gluten sensitivity in transgutaminase 3 IgG (mainly effecting the epidermis) and I am still trying to fully understand what that means. While my doc did explain this a bit, there is much I do not understand! I do wish there was info all in one place for that also!!

I’ve been searching for an answer to my question by reading your site and the general internet for a while now but I’ve not been able to find a specific answer. I used to get frequent migraines which have stopped after cutting out gluten. I seem to be more sensitive to it now and get occasional migraines after contamination, however I don’t have GI symptoms, just “low normal” ferritin/B12 levels and hair loss. Does this mean I must have leaky gut or do some people have purely neurological symptoms from the gluten and the hair loss is unrelated? I’ve been trying to do the “right thing” for gut healing by avoiding dairy and rice, taking probiotics, L-glutamine and vitamin supplements but my hair doesn’t seem to grow back as much as I want it to, and I don’t want to bombard my body with supplements if I don’t need to.. I wish I could ask my doctor, but he didn’t even believe me when I told him that gluten was the culprit for my migraines! Any insight would be much appreciated!

Thanks Christina for your reply! I had never even heard of leaky brain (new to this gluten thing) so now I have even more stuff to worry about ha ha!

Have you looked into a sensitivity to free glutamates? A lot of people suffer headaches from it, and experience relief when cutting out gluten and dairy, because they are lightening their protein load. Also, most doctors know very little when it comes to food issues, I’ve found. Good luck!

I have multiple food allergies, the IgE kind, to gluten, wheat, barley, rye, eggs, and a number of other foods. I have diagnosed Eosinophilic Esophagitis via biopsy and I’ve been scoped and blood tested (IgA and IgG) for Celiac disease which came up negative. I suspect I have leaky gut (based on symptoms of depression, lack of energy, etc.) which co-exists with my food allergies. The trouble is I cannot find any material linking IgE mediated allergies to leaky gut. The material I find always discusses IgA and IgG mediated reactions and leaky gut.

Can IgE mediated food allergies also cause leaky gut?

Thank you for your response!

I’ve been trying to clean up my diet for over a year now. It’s a yo-yo. The harder I try, the harder I fall. Binging on carbs and sugary foods when i fall has me extremely frustrated. I know there will be immediate allergic reactions and long-term after effects but the cravings are simply overpowering. And its been getting worse lately.

The whole paleo diet is a bit overwhelming. It’s tough to completely change my processed diet. I’m trying to change my diet slowly, eating more veggies, healthy protiens, healthy fats, and fewer sweets and diet soda. Eventually I hope to have a large enough list of allergy free, healthy food options so I don’t feel too restricted and end up falling back to the same old garbage.

I’m focusing on leafy greens, and other veggies I like. I’m also working my way toward healthy, protien packed meats like fish, turkey, and chicken along with allergy-free carbs like white rice. Of course, I’m also trying to avoid sugar and the foods I’m allergic to. I plan to include pro-biotic and glutamine supplements too, but want to keep it simple.

Are there any other ‘keep-it-simple’, big-ticket items you’d recommend?

I am a celiac, gluten-free for a year and a half. I also have RA and other conditions that have been related to CD. Recently, after 3 rounds of severe abdominal pain (which I never had prior to the CD diagnosis), I have now been diagnosed with an “aggravated” gall bladder with gall stones and my doctor wants to remove my gall bladder. Could this have been caused by celiac disease? Can a paleo diet help reverse this? If not, can a paleo diet help one adjust to the side effects of not having a gall bladder?

I am following the AIP diet. If I did the Array 4 and find that I am not reacting to rice (or any other grain), does that make it a safe food or while following AIP do all grains need to be removed regardless of a sensitivity?

No. The best way to determine sensitivity is to remove foods and then reintroduce them. Also, the Array 4 may not pick up sensitivities to any foods you have already been avoiding. – Christina, Sarah’s assistant

This article changed my life. I read it a while ago before I knew for sure that I was celiac and cut out almost all of the cross reactive foods mentioned. Now, since I got dermatitis herpetafomis (gluten rash) for the first time I KNOW I am celiac and I am being even more careful than ever. Baby steps! I hope to get Cyrex Labs testing done for Array 4 if I can figure out a doctor who has an account (I am in NY and looking to go to VT since Cyrex is not allowed to test here). Thank you so much for all that you do sharing this valuable info with everyone!!

Hello! I understand the milk issue in chocolate, but what about dark chocolate & cocao powder? Should these be avoided? Thanks for your time!

My daughters and I had Cyrex Array 4 performed. Our doctor said we should never add back Rye,barley spelt,polish wheat, Cow’s milk, oats, yeast, millet and corn. We diligently avoided all problem foods for a year and have successfully healed leaky gut. Of the list of
24 items on array, why do we have to avoid oats, yeast, millet and corn? Are these just considered more problematic for some reason, or should we just see how each of our bodies responds to each allergy? Should we avoid kombucha because of the yeast, and should all yeast be avoided? Lastly, my hair is thinning and falling out despite so many positive lifestyle changes over the year. So many things are moving in the right direction but the hair is a problem? Any thoughts?

Well, there are lots of ways that grains can be a problem that won’t show up on tests, but there’s still individual variation in responses. However, I think that if your hair is falling out (could be hypothyroid or alopecia, both things you should talk to a doctor about), that’s probably a sign that your gut has not yet healed.

I, too, have had the Array 4 done and am now, in addition to wheat, avoiding milk protein, and soy (all positive). I feel SO much better in every way, but am also experiencing increased hair shedding and am extremely frustrated. I was taking an iron supplement after my last doctor told me I had low iron, then stopped iron as my new doctor (who did the Array 4) told me my iron was high (Ferritin 40; Serum Iron 187 which was the high one). So I stopped taking iron supplements and started the Gut Repair Diet, at which time my hair loss and shedding increased dramatically, so it’s hard to know if it was the diet, or stopping taking iron which has contributed. I will start iron again after seeing this post, thank you!. It looks like an optimum range is 60 for ferritin anyhow, so I had a little ways to go even before I stopped taking it.

Thank you for this information. I took array 4 last December and also discovered I had a strong reaction to eggs. Also some reaction to oats, soy and coffee which i didnt use anyway.
It has been easy to eliminate eggs. I had the question about yolks and whites and saw it answered above.
However, were these tests done on pastured eggs? grain free chickens that is?
and
is the only way to test for sensitivity to duck or goose egss (to which I have access) , at this time, by eating and awaiting symptoms?
For the strong reaction to eggs shown on cyrex, I felt almost nothing in my body. I have determined now that it was causing a ‘hot brain’ feeling that came periodically but not directly correlating to the timing of eating the eggs. Being on WAPF and having done GAPS, I had been eating 2+ eggs daily for about 3 years. I am horrified to imagine what I had been doing to my blood brain barrier.
Looking forward to getting and using your book very soon.
Thank you!
Meredith

I’m not sure what type of eggs were used. It’s true that many people who do not tolerate conventional eggs do well with pastured eggs. The best way to determine sensitivity to any food is to eat it and see how you do. – Christina, Sarah’s assistant

I don’t think that this makes sense. Pastured eggs, conventional eggs, duck eggs all have the same kind of protein. Isn’t the test looking for sensitivity to the protein?

Eggs have been shown to contain the protein of foods the hens were fed (like soy), so those with soy sensitivity may not be able to tolerate soy-fed eggs. In that case, a person who does not tolerate conventional eggs may tolerate pastured eggs because the sensitivity has nothing to do with the actual egg proteins. – Christina, Sarah’s assistant

Thanks so much for the helpful blog and The Paleo Approach. I’m 2/3 through the book and want to share it with so many folks. We have autoimmune illness in our family and are so grateful to hear the helpful truth-do miss the nightshades tho! We’ve been gluten free for a few years and paleo for five months, except for occasional goat milk yogurt and cow’s milk butter. The info in your book has convinced us to go AIP in a few weeks–wish your recipe book was already published! I love the wonderful lists you have for all the varieties of food and have enjoyed trying new vegetables. I’m especially grateful to know that fish is safe to eat.

I have a strange question and I thought if there’s been any research on it, you would probably know about it. We have a small goat herd, part dairy (wondering if we will even be able to use the milk!) and part meat. I’ve read about a forage called sun hemp that is supposed to have a good fatty acid profile and be very healthy for goats. It is supposed to be easy to grow and seemed like a good alternative to the grains we feed in winter and year round for our milking doe. When we stopped grains, we started questioning grains for our livestock too. Seeing hemp on the list makes me wonder if that would translate into the meat/milk and possibly cause a cross reaction. Also, do you think hemp clothing, rope or paper would present a problem?

Also, I read an article on Mercola.com once about problematic antigens being present in Holstein milk but not Jersey and Gurnsey. I’m wondering if our goat milk might be an option for us because of that or if the mechanics of dairy effects on the intestine should be enough for us to cross it off our list post AIP. Seems a shame to go to the trouble and expense of milking if we can’t have any of it–but we have a great doe and I don’t want to part with her if we can still incorporate some dairy into our diet.

Interesting question! There’s no evidence to show that proteins ingested by a ruminid make it unmodified into milk or meat, so you should be good there. The casein in goat is A2, so many people tolerate that when they’re sensitive to A1. But, there’s no good way to know without trying it and seeing how you do.

As for the paper etc., the concern would be if any can get ingested or otherwise internalized. Some celiacs are sensitive to gluten in beauty products like shampoos and this is probably due to a small amount getting aerosolized in a hot shower. And certainly some people do have violent skin reactions to allergens. That being said, I don’t see a compelling reason to stop using hemp products unless you have a diagnosed allergy or known sensitivity to them.

Great post, thanks. I’m a tad confused since my Array 4 results. I was on GAPS and now AIP for a short time. I see some similar questions here but the answers don’t seem to apply to me since I don’t have noticeable reactions to food.
I know my body is reacting to gluten (thanks to Array 3) but my problem with gluten is brain related and my reactions and symptoms (memory related so far) are not quickly apparent. I’m pretty sure I have some degree of leaky gut although I have no discernible digestive trouble with any food.
If Array 4 says I am not cross reacting to anything, and I won’t overtly manifest a reaction, is it OK to believe that my body is processing them normally and therefore I don’t need to avoid them on AIP? Hope this makes sense. Let me put it another way – since I won’t have any discernible reaction to any food I eat (so omitting and reintroducing doesn’t help me) and I know my body does not see foods on Array 4 as gluten, can I consume them without harm?

Sarah still recommends eliminating all non-AIP foods in addition to any foods you have tested positive for a sensitivity to because false negatives are common. Any change in your health, not just digestive trouble, can indicate a reaction to a food. For example, I get hiccups when I eat dairy. Eliminating these foods makes it a lot easier to notice if they affect you adversely. – Christina, Sarah’s assistant

How about if you don’t notice reactions to cross reactive foods? My constipation has resolved after many years after eating a Paleo diet with plenty of sweet potato and butternut squash, and homemade kefir with raw potato starch, green powder and psylium. When eating eggs, chocolate, Half & Half, for instance, I don’t notice any changes. My eczema seems to come out when washing dishes in very hot water over time. Any thoughts?

Not everyone cross-reacts with every cross-reactive food. The best way to determine your tolerance would be to eliminate them for a time and then add them back in one by one. Very hot water would certainly be enough to aggravate any AI skin condition. Have you considered dish-washing gloves? – Christina, Sarah’s assistant

I take that back. I get bloating and some discomfort from the Half & Half. Are there any options for a dairy-like substance to put in coffee? I can’t seem to eliminate the Half & Half. I keep saying I’ll do it, but fail every morning.

Canned coconut milk mixed with a pinch of sea salt and vanilla makes the BEST creamer for coffee and tea. The saturated fat in coconut milk mimics half and half better than almond or soy milk (which aren’t paleo approved anyhow).

Oh, that’s very interesting. Do you keep the mixture in a jar in the refrigerator to use when needed, or add these ingredients to each cup? I’m not familiar with coconut milk at all. Thank you!

You can do either! Sometimes I keep an opened jar of coconut milk in the fridge (make sure to shake it first), and yes, add the sea salt and alcohol free vanilla extract to each cup. OR you can mix it up beforehand and store in a jar in the refrigerator. Whatever your preference. I think this system works better and is creamier and richer than the coconut milk you can buy in a carton, which is very watered down.

See what PaleoMom says, but I like to make coconut kefir (from a can of coconut milk or light coconut milk with added kefir grains and let sit room temp for 3-4 days). However, some people are allergic to the yeasts in kefir culture. If you are not sensitive to yeast or dairy (dairy and yeast are part of the Array 4 gluten cross reactivity test, I myself am only positive to dairy) then you can make kefir from cow or goat’s milk.

Well, I tried the coconut milk. I just can’t enjoy it enough to forgoe the H&H. I have a feeling I AM reacting to it – and possibly my kefir too. I think the reaction – slight stomach cramping – isn’t strong enough for me to do what I have to do. Yet.

Make a “coconut cream half and half” by combining fresh or canned coconut milk (full fat), or light coconut milk with a tablespoon of coconut oil, a dash of sea salt, alcohol free vanilla extract (or vanilla bean), into a blender, then refrigerate and use for up to one week. You can also add the ingredients without blending straight into your coffee (except the whole vanilla bean, obviously!) The reason to avoid dairy on the auto-immune paleo protocol is not just for the tummy discomfort, it could be making your whole immune system go hay wire, and triggering auto-immune illness, so it is very worth it to find an alternative!

My mother is a Celiac (diagnosed 40+ years ago). Over the years she’s found that she reacts to dairy, soy, corn, potato, etc. She has good days and bad days even now that she’s paleo. After reading his article, we were talking and I found out she takes a lot of prescription meds. All are gluten free, but they all have something else in them.. cornstarch, dairy, etc.

What is one suppose to do about their prescription meds?

Thanks!

Most doctors won’t have a clue. Talk to the pharmacist and read the active and inactive ingredients. A lot of drugs use lactose as an inactive ingredient. Beware of anything made by Bayer as they will not guarantee their products to be gluten free. You can also call the company.

I remember Dr. Tom O’Bryan saying that the ALCAT testing was what you could do outside the U.S. I do not know how it compares to Array 4 specifically though. Seems to me that is unique still. Not sure.

I have been having problems lately and I have been wondering what that problem may be but I have recently added fermented foods to my diet to heal my gut. That would make sense but how do I get my probiotics? Can I take probiotic supplements? If so what brand do you suggest? Thank you!

Hi Sarah,
Thanks for the interesting article. I have been diagnosed as celiac for 14yrs. For the last year I have been feeling like I have been getting glutened, although milder symptoms than usual. When my gastroenterologist performed a scope he congratulated me on how healthy my gut was and how well I must control my diet. Would cross reactivity result in damage to the villi in the same way gluten would, therefore ruling out cross reactivity for me? Also, if your immune system recognises these other proteins to be the same as gluten, why is there a need for the array 4 test? Wouldn’t the antibodies in your blood just be the same as if you had been exposed to gluten? Also do you know if the Array 4 test is available outside the US? I’m in Australia.
Thanks. :)

The antibodies aren’t the same in everyone. So the antibody you make against gluten could be different than the one I make against gluten and that changes what they might or might not cross react with. The array 4 test is helpful if you’re having trouble figuring it out with an elimination diet. I believe it is availably outside the US, but I don’t know any more about how to get it than that.

Yes, is can damage the villi, but only very extensive damage is observable by scope.

I understood from a talk given by Dr. Tom O’Bryan last October (Gluten Summit) that the Cyrex testing is only available in the US. (that could have changed since then). Also, he recommended the ALCAT test for those outside the US.

In your book you mention that fermented foods and kombucha can exacerbate yeast infections because of a specific probiotic strain. It’s interesting because I was guzzling kombucha and fermenting foods, and have had no luck ridding myself of yeast infections for the last two years despite repeated antifungal treatments. I am currently 3 days in on AIP with FODMAP adjustments, and have a couple of questions:

– Would this Cyrex test reveal a yeast cross-reactivity? I already had ALCAT test but don’t remember seeing anything like that, other than moderate reaction to Candida.
– Does this mean fermented cod liver oil and raw apple cider vinegar could be a potential triggers for yeast, and an alternative cod liver oil supplement should be used?
– Is it possible to heal enough on AIP to eventually reintroduce these delicious foods?

Thank you for all that you do!!

Um, it’s the other way around. Fermented foods and kombucha can help control candida infections because the strain that’s in fermented foods (s. boulardi) suppress candida growth. But, fermented foods that contain yeast can be a problem if you have a yeast sensitivity (different than having a yeas infection).

This test would tell you whether antibodies you are making react with s. cerevisiae, the strain of yeast used in Baker’s and Brewer’s yeast as well as nutritional yeast.

I do not know if any yeast strains are present in FCLO. But, yes, vinegars can be triggers if you’re allergic/sensitive to yeast.

Yes, it is possible to heal enough with AIP for food sensitivities to diminish and disappear.

This thread is so interesting! Thanks for the helpful information!! Do you know specifically which ferments might contain s. cerevisiae (i.e. sauerkraut, fermented garlic cloves, etc.)? Our son with allergies seems to do fine with probiotics (GutPro and Prescript Assist), but we’re suspecting that our homemade sauerkraut (made in Pickl-It Jars) might cause a reaction in him – we think we’ve linked hiccups – perhaps a food intolerance to wild strains of yeast – in our sauerkraut and fermented garlic juice. We are hopeful we can increase doses with him – even 5 drops of sauerkraut juice cause a reaction! Any insight? Thank you!!

In comments you mentioned about eggs and their feed? I assume this would be the case with cows’ feed, soy and corn? I am allergic to soy, but can’t afford grass fed meats.

Thanks for very informative write up. Its more useful as you have experienced it. I am 42 and had developed sudden severe urticaria 2 years back, which bought me here on your page. for last one year i am on hypothyroid med and have to take a levocetrizine almost daily. My IgG, E and other values are fine. Now I stopped taking hypothyroid med for last one week and no wheat or dairy, but i am taking legumes, fruits, almonds and rice. I am feeling better in energy levels and rest of things except my urticaria. Its certainly better but still i am on antiallergics daily. My hair have become thin and rough. I am thinking to start paleo diet now. But its very difficult sometimes to control cravings. Do you have any suggestions?

This information has been great! I have Celiac Disease and in fact react to many of the items in your list, including milk. Now my question is, am I safe to eat cheese? It doesn’t (so far) seem to trigger a reaction but I wonder… and also what about yogurt and sour cream?
Thanks for any help with this.

Okay, thanks for the response. It doesn’t seem to be a problem now but since milk is, cheese bears close watching at the very least. I suppose it will be the next thing to go.

It is interesting all of these connections. For me, I have gluten sensitivity (non-Celiac) with 2 genes purportedly responsible for my sensitivity (according to Enterolab). When I went gluten free 5 years ago, I was NOT eating chocolate. I was on a very clean diet (so I thought). I have earned a Phd in Holistic Nutrition in my quest for health. Anyway, going 100% gluten free did help me immensely. My trips to the bathroom went from 10 times a day to 3 after about 6 weeks. In essence that gave me a good part of my life back. But I still had loose BM’s (sorry about TMI). When I added CHOCOLATE back into my diet, my BM’s became normal for the first time in my life. To test it, I would stop eating it periodically and loose always returned. Eating it always set me right. I only eat cooca powder with a little stevia. I am SUGAR & DAIRY FREE. So I decided that it was something good for my body, but I didn’t know why. Then I happened upon some research that showed that CHOCOLATE increases the friendly bacteria in your gut. And recently, new research shows that your gut bacteria actually turn cooca powder into anti-inflammatory compounds. http://www.npr.org/blogs/thesalt/2014/03/18/290922850/chocolate-turns-into-heart-helpers-by-gut-bacteria http://www.bbc.com/news/health-26626507 Because this newer research is dominating Google at the moment, I cannot find the earlier research on it increasing good bacteria. Will look later. So it lends credence to the old adage that one man’s meat is another man’s poison. I am currently on the AIP with the exception of cocoa powder (2 tlb per day in divided doses and 2 servings of stevia). If I have to give those up at some point I will, but at this moment, I feel they do my intestines and body good.

Hi Sharon, my experience is similar to yours – chocolate/cocoa really help me with bowel movements, and when I stop eating it I become more constipated and have pale stools.
I was thinking perhaps it’s the theobromine in the cocoa acting in a similar manner to caffeine to stimulate bowel evacuation.

The only downside for me is that too much cocoa can be too stimulating and cause me anxiety, but then I am anxiety prone naturally anyway.

I’m a little confused. I just had the Cyrex Array 4 done, and I tested out of range on almost everything except rice. So does this mean I can eat rice now (still being in the elimination phase), or should I wait until later? And the foods I am out of range on and producing antibodies to, should I never eat them again, or can I try reintroducing them sometime in the future? Thanks for your help!

I’d like to propose an additional theory to this cross-reactivity that might more fully explain what is going on, and if true, would also explain gluten’s involvement in a number of serious illnesses that it is only just now being linked to anecdotally or incidentally through other research.

Specifically, that gluten may act as a catalyst for the misfolding of proteins into amyloids during the digestion/metabolic process. The auto-immune reaction described here may not be against proteins in their natural state, but against their misfolded state when mixed with gluten. In other words, it may not be cross-reactivity of the immune system to other proteins, but to the amyloids created by gluten. Even if gluten-free, the existing amyloids which have not yet been removed by autophagy a might be catalyzing more amyloids from the same proteins. So, even after going gluten-free, other effects will linger until the body has a chance to remove the amyloids. In extreme auto-immune cases, like Type-1 Diabetes, the damage may be too great to heal, or the body may not be able to remove the amyloids.

If such a process is proven, it would explain the cross-reactivity described in this article, and why it may take weeks to months to end, even after going gluten-free. It would explain why many people who go gluten-free show an improvement in other allergies and food intolerances. It would explain Peter Gibson’s research showing that gluten itself wasn’t causing IBS in some NCGS patients during a study, but FODMAPS were, though not to the extent during his previous study. (I’m so tired of reading articles about his short, limited research).

More importantly, it would explain why removing gluten shows improvement in so many amyloid related illness: both Type 1 & 2 Diabetes, Alzheimers’, Celiacs, Parkinson’s, etc.

I’ve run across several research articles which hint at this. I’ll provide a couple of the links for your review:

http://pubs.acs.org/doi/abs/10.1021/bm201005k
http://pubs.acs.org/doi/abs/10.1021/bm401815u
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323203/
http://www.ncbi.nlm.nih.gov/pubmed/14655066
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0066474#s3

I’m also waiting excitedly for this research team to release their next study, as they’re claiming an even greater understanding of the T1 Diabetes process, which should also provide insight into the T2 Diabetes process, since they are so closely related as amyloid auto-immune reactions:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740688
While this research makes no connection to gluten, it wasn’t being looked for. The peptides PPI15-23 seem to be the specific agent sparking the auto-immune reaction, but the genesis of PPI15-23 is not described, and may be unknown. I hypothesize it’s a gliaden caused misfolded protein, perhaps similar to the 33-mer peptide described in some of the other research linked above.

I hope this gives you new ideas to look for in your quest for understanding. I’ll be the first to admit it’s thin, but new research I find keeps pointing in this direction. Hopefully the new 2D IR Spectroscopy process that is capable of showing amyloid formation will answer some of these questions, if there are any scientists interested in looking.

Also, if anyone’s interested after all that: I’m a proud gluten-free anecdote with my diabetes in reversal: http://truecolorings.blogspot.com/2014/08/gluten-free-3-months-lab-results.html

But I love cheese too much to do full Paleo.

Thank you for this terrific post. You were one of the first sites (people) that helped me when my Cyrex lab results came back positive for gluten sensitivity a few years ago. I also share many of the symptoms that you do, and it was great affirmation for me as I read about your experiences. Science is catching up to gluten! Best to you.

Hi all! I just got my results back and came back with an egg white allergy, and then high reactivity to wheat and gluten. I came back non-reactive to corn and potatoes (sweet and white). My question is…if I’m following the Paleo diet but have no reaction to corn on paper, and the corn product comes from a certified gluten free facility, would it technically be safe to eat? Thanks!!

False negatives are always a possibility (especially if you haven’t eaten that food lately), so it’s still recommended to avoid non-Paleo foods whether you test reactive to them or not. – Christina, Sarah’s assistant

hello,

I have been following the Paleo Mom for over a year now and love all the advice!

I have also been on a gluten and grain free paleo diet for over a year. lately, i just can’t seem to control digestion issues. My GI doctor wants to test a number of things but has told me to start eating gluten in order to see if i have celiac disease or sensibility.

I am of course petrified at the idea of consciously eating gluten. in this situation, what would you recommend?

Thank you so much for all that you share with us !

Getting an accurate Celiac diagnosis does require having been exposed to gluten, according to Dr. Fasano, for several months or even years. Whether or not its worth knowing is a personal choice. – Christina, Sarah’s assistant

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