Immunoglobulin A, Aflatoxin and the Celiac Screening Test

The Celiac Disease screening test most commonly used is IgA-anti-tTG, and it should be used with an IgA deficiency test, both together.  If IgA is high enough, it means the anti-tTG (tissue transglutaminase) test is valid.  Yet in some cases it is too low and then an IgG-anti-tTG may be used (again with a check for deficiency in IgG).

But what does it mean, in general, if IgA is low?  IgA deficiency (or at least functional deficiency) is a possible explanation, for some of the complications of Celiac Disease, including the development of certain cancers like Non-Hodgkin's Lymphoma.  The mechanism would be that a lowered IgA leads to chronic immune insufficiency and erratic immune activation.  After a period of time, it could lead to a disordered immune response that looks a lot like autoimmune disease.  It's so simple, it's almost simplistic.  But we must begin at the beginning, at aflatoxins.  
This post is long and very dense.  If you're not into the sticky details of Celiac science, feel free to skip it and I'll get back to something more fun later.  But when I'm seeking answers, I often wander a path very much like this post.  Sometimes I go to websites that aren't reputable, and seek ideas, then try to validate them with Pubmed, or refute them.  When I stumble on a coherent collection of ideas that seems to make sense, I'll present it and I would welcome your input on these thoughts. 

Aflatoxins are a ubiquitous low level toxin in nearly all food.  In first world countries, the level is very low and is assumed to be harmless, but not zero.  In developing countries it can reach such high levels that people develop serious illness from it, and some die.  It starts entering the food web when Aspergillus species (fungus) grow on crops such as wheat, soy and corn.  Human exposure happens when we either eat the crops, or when we eat animals who have eaten such crops.

Grain storage often perpetuates a cycle of contamination with aflatoxin in the developing world.  In the developed world, we assume that our storage practices are adequate to prevent too much aflatoxin generation.  However, we continue to publish such hubris as this, which at one point says basically that although the Hispanic population is affected by aflatoxin, it's not as bad as in Ghana, so we're OK.  It's double duplicity because most people, regardless of race, in the southern US enjoy Mexican food on a regular basis.  One of the most frequent requests in the gluten free community down here is for Celiac safe Mexican food.  

So we're all being exposed and there's no safe level for aflatoxins. Assumptions that only certain groups are affected aren't helpful because, if you're not looking to your right, you won't see the bus moving toward you on the right.

Aflatoxins are created by fungus that grows on grains, nuts and legumes.  The most famous, occurs on peanuts and corn. The most surprising might be that Tempeh is NOT contaminated with the toxin, although it is inoculated with a harmless type of Aspergillus fungus.  It's mostly discussed in relation to lifetime exposure and cancer (if at all).  Although aflatoxin is mainly a worry of farmers and food producers, there are a few things you can do to protect yourself. We'll get to that later, for now, take a look a the slides, coming up next.

Let's look at an aspect of aflatoxin, that's more relevant to "mystery illness" and Celiac disease.  Its lowering effect on IgA and possibly other immune markers.   The idea for this article grew from reading this article and the supporting PDF file with slides from a presentation.  Please take a moment to read just the slides at least.  Perhaps the most worrying conclusion is that lifetime exposure to aflatoxins causes cancer, often liver cancer. Perhaps the most unusual remedy is the use of edible clay to mitigate the harm that aflatoxins do.  Some animal feed already incorporates this strategy.  As late as 2003, the ingestion of kaolin clay was commonplace for stomach problems (kaopectate). 

I've mentioned Tunisia before.  It's surprising how often it comes up when doing research into Celiac disease.  It's an interesting place to do such research because the prevalence of Celiac is high, and compliance with the gluten free diet is low for various reasons.  In this case, they've drawn the conclusion that aflatoxin can cause a drop in IgA.  I hope this study will be duplicated and verified because if this is true, then using the typical Celiac screening test in a developing country would be a huge waste of money.  If true, we should assume that tTG will not be a valid marker and use others from the start. 

From the article, "The results indicated that rats treated with AFB1 (80 μg/kg BW) alone had significant decreases in lymphocytes in their blood (including B-lymphocytes, CD3+, CD4+, and CD8+ T-lymphocyte subtypes, and NK cells), immunoglobulins (IgA and IgG) and pro-inflammatory cytokines; these rats also had altered oxidative stress status. In contrast, in rats treated with LP + MT (2 × 109 cfu/ml [∼ 2 mg/kg] + 0.5 mg MT/kg BW) for a total of 7 days before, concurrent with or after AFB1 treatment, there was a significant blockade/mitigation of each AFB1-impacted parameter."

Wow that's a lot of acronyms and words with numbers!  Boiled down, it means Aflatoxin B1 (one of the types of toxins produced by Aspergillus fungus) can cause a drop in immune function, and this drop includes IgA.   What is that?  Well first it's an antibody "Antibodies are proteins made by the immune system to fight antigens, such as bacteria, viruses, and toxins."  And there are many types... this is type A.
Immunoglobulin A (IgA), found in high concentrations in the mucous membranes, particularly those lining the respiratory passages and gastrointestinal tract, as well as in saliva and tears.
Well how interesting.  IgA protects the gut, lungs and the saliva glands.  If it drops, infections in these areas are going to be more common and response to infection will be slow. Even more interesting, this connects Sjögren's syndrome with Celiac.  They were already likely to occur together, but here's a possible reason why.

On a personal level, I used to bounce back from even the worst flu in three days, but after my illness in 2006 I started to have more lingering colds.  By 2011, colds routinely lasted more than a week.  And yet, my IgA wasn't even in the "low" range when tested.  I think it shows that, when I say "low IgA" I mean functionally low, it's affecting my function.  But when a medical tests says I'm low in IgA, it means low enough to risk life or permanent health damage.

So IgA is not just a test to see if tTG values are valid.  IgA is the first line of defense in certain organs of the body.  If aflatoxin can make it drop (and other immune markers), that begins to explain the connection between cancer and lifetime exposure to aflatoxin.  Nobody should be eating food contaminated with aflatoxin, or meat contaminated with it.  However, for many, it's impossible to avoid it.  And even in the first world, we worry about the hubris of assuming that our food is better protected and cared for, in the face of a general unwillingness of USDA/FDA to strictly enforce regulations.

So what can you do about this?  For obvious reasons like lead content, eating clay is probably not an optimal idea.  Another consideration is the sudden use of a lot of different flours, especially nut flours.  Almonds are only inspected if they're destined to be shipped to the EU.  As someone who is sick right now, should I temporarily limit my use of almonds to those purchased FROM the EU?  I'm just not sure.  Luckily there are a few IgA boosting ideas on the internet.

Two Tips from Self-Hacked

Women who take control of their health go on a "health journey" and men who do the same become "biohackers." I suppose the phraseology amuses me because I used to work in IT.  The author of that website has a very deep interest in functional medicine and shares a lot of it for free.  I appreciate his contribution, and I think anyone with even just a casual interest in health would find many interesting ideas there.

Idea 1

Ferment anything you suspect of being contaminated with safe yeast.  S. cerevisiae is not the same as Candida yeast. In fact it can be used to tame a mild Candida infection.  You should be evaluated by a doctor if you think you have a Candida problem, though.  Nutritional yeast is sold by various vendors and most of them are gluten free. Some of the benefits of yeast are found in inactive yeast, but for the aflatoxin to be degraded, the food must be fermented with it, therefore, for this purpose, your best bet is some gluten free (live) baking yeast.

Warning about using nutritional yeast as a "cheese flavoring" in dairy free diets: I have a type of fatigue syndrome, and as a result, I can't take certain B supplements such as folate or biotin in large doses.  If I do, I have symptoms of encephalitis (swelling of the brain envelope with pain, cognitive effects and light/sound sensitivity).  Since nutritional yeast is high in folate, I am very sparing in how much I use.  If I have had more headaches than usual, I forego it.  I suggest you do the same.

Fatigue syndrome (ME/CFS) is a very underdiagnosed and understudied illness, so sometimes the patients are the best experts on it.  In fatigue syndrome forums, people talk about "overmethylation" and possibly it could explain some of these effects.  One thing is for sure, if you have headaches and fatigue regularly, then nutritional yeast may be a challenging food for you.  It's also possible that the antiviral effects are directly triggering a "herxing" reaction, or that your body is sensitive to "high histamine" foods.  You know your body best, so be cautious and don't make your first taste of it too large.

Idea 2

Lactobacillus Paracasei has a direct increasing action on IgA.  It, and other probiotics (named here) deactivates a form of aflatoxin.  It's important to note in the latter document that the presence of digestive enzymes (but not heat) deactivates the protective qualities of probiotics against aflatoxin.  Therefore, it's important to have the aflatoxin-risk food in direct contact with the probiotic (possibly directly mixed with yogurt).  This starts to explain why yogurt has been regarded as a health food for, probably millennia.  If you have to remain dairy free, the best strategy might be to buy a live probiotic with these strains, and mix it with food before eating it.

Another Idea 

My strategy when looking at "not official" websites is to be cautiously credulous and never embrace anything they say completely (this is in addition to basic scam avoidance).  After all, while modern medicine is resistant to valid new ideas, that doesn't mean that all new ideas are valid.

The benefit of alternate medical websites, even if they're a bit energetic in their recommendations, is that they highlight forgotten research (I would say hidden research).  Life Extension is an old website that grew out of the old health food store system which fell apart after gourmet food stores like Whole Foods and Fresh Market took over.  L. E. takes the time to reference many of their claims, which is more than I can say for some websites.  So the last idea comes from there.  

 Life Extension's advice on how to stop the flu is focused on the phenomenon of low IgA and gives various advice for how to increase it.  Even if you decide that low IgA isn't a problem for you, the document is an interesting read because it gives so many ideas for improving immune function and is referenced. I haven't double checked the quality of the references though.

There may be more ideas out there for dealing with low IgA.  I hope I've shown its importance, not only in Celiac testing, but also for general health and wellbeing.   I've chosen those strategies which are aplicable for most people in this local area. The ideas will need to be adapted to your location, but now you have a better grasp of what you're looking for.  If you'd like to contribute more ideas, please feel free to comment. 


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