Cereal Grain Proteins
Increased GI Permeability & Systemic Disease
The idea of excessive Gastrointestinal (GI) permeability to food proteins, such as gluten, has been developed by many studies. Coombs and McLaughlin summarized the problem: "Food proteins in the gastrointestinal tract and their absorption into the body as antigenic molecules have immunologic significance both in (i) initiating an allergic state and (ii) in the subsequent challenge(s) where, by a variety of mechanisms, they may cause some form of 'food-allergic disease'."
Increased intestinal permeability to food antigens can be thought of as a generic explanation of systemic food allergy aka "autoimmune diseases". The association of Crohn's and celiac disease, for example, with psoriasis, arthropathies, sacroileitis and ankylosing spondylitis suggests that increased uptake of food antigens can be the mechanism of systemic inflammatory disease. The absorption of antigenic molecules that originate from food and/or gut microbes may initiate and then maintain inflammation in target organs.
Gardner stated, stated that: "There is still a tendency to regard the intestinal epithelium as an absolute barrier preventing egress of macromolecules... to the systemic circulation. However, there is now overwhelming evidence that this concept has become untenable." The absorption of short-chain amino acid peptides can have profound biological significance since receptors to peptides abound in the body and peptides of about 8 or 9 amino acids and longer can act as antigens. Lutenizing hormone, a decapeptide, is active orally as is thyrotropin-releasing hormone, a modified tripeptide. Great numbers of different peptides can be produced by digestion. There are 400 possible dipeptides, 8000 tripeptide and 160,000 tetrapeptides and so on. Peptides are absorbed by intestinal epithelium and most are hydrolyzed, but some are resistant to hydrolysis and can pass through intact.
Pathological entry of peptides and even intact proteins may occur through a paracellular route, especially if the junctional seals between cells are disrupted. In a later review, Gardner summarized evidence of GI absorption of intact proteins, cited evidence of increased intestinal permeability in many disease states, and acknowledged the possibility of food antigens playing a role in systemic disease. Walker et al have shown that "intestinal anaphylaxis can lead to increased uptake of nonspecific intestinal allergens, which in turn can evoke an IgG-mediated reaction leading to further propagation of disease. This secondary process occurring with classic IgE-mediated disease may be important in converting a self-limited process into a chronic disease state." Sharander et al demonstrated IgE- producing plasma cells in the lamina propria of the duodenum in infants with cow's milk protein intolerance. These children had colic, diarrhea, rhinitis, bronchitis, eczema, and urticaria. The study showed that Intestinal mucosal IgE plasma cells can be found in the absence of positive skin tests or serum IgE RAST.
Castro and Powell reviewed evidence that antigen is absorbed by the gut epithelium, by enterocytes, and by bulk-flow via paracellular pathways. Specialized epithelial cells (M-cells) overlie the lymphocytic nodules in Peyer's patches and act as antigen sampling devices. They stated that: "... the possibility must be entertained that antigens are passively absorbed against tight junctions into the sub-epithelial compartment on a regular basis; that is, there may be routes of antigen permeation across the epithelium in addition to uptake by M cells and enterocytes."
Van Der Meer et al found that in 87 children with recurrent abdominal pain the small bowel permeability was increased with Cr-EDTA. Pain often means that inflammation is occurring in the bowel wall, leading to antigenic macromolecules being absorbed, leading to systemic hypersensitivity reactions. Increased permeability leads to progression of the disease process. The author suggests that a hypersensitivity reaction to certain food antigens is the cause of the increased intestinal permeability. Permeability is a constantly varying feature of the gastrointestinal tract. Many food factors are likely to influence permeability and a number of important adverse factors have been identified. Non-steroidal anti-inflammatory drugs (NSAIDs) cause gastritis and small intestinal inflammation, bleeding and increased permeability. Other agents that increase permeability are alcoholic beverages, detergents, gold compounds, chelators, ischemia, radiation and cytotoxic drugs.
Elemental Formulas Solve Permeability Problems
Elemental nutrient formulas are designed to solve the problem of increased GI permeability. By excluding potential antigens from Alpha Nutrition formulas, nutrients are provided in a safe context. All proteins and peptides are excluded. Hydrolyzed proteins are not used so that there is no risk of peptide effects. Instead of proteins or hydrolyzed proteins, free l-form amino acids are provided. The individual amino acids fall into two groups: the essential AA's, which must be ingested, and the non-essential AA's, which can be synthesized in the body and need not appear in the food. Nine amino acids are considered essential nutrients, while another eleven or so can be synthesized from the essential amino acids. All 19 nutrient amino acids are included in the Alpha Nutrition Formulas as individual amino acids rated at 100% purity, with the highest solubility attainable.
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