It's Curious Role In Crohn's, Behcet's, Celiacs and Autoimmunity
As with all of my posts, if you want to get right to the research and skip my babble, just scroll down. I am not a doctor, I draw stuff for a living. This blog is my interpretation of the research. Please research these things on behalf of your health that of your loved ones, and discuss them with your doctor or nutritionist.
It seems as though Gluten and Casein are getting alot of attention these days. This is great news. Many folks have been suffering months, years, decades with mysterious afflictions only to find out it was something they ate. There are many reports that children with Autism and ADHD seem to have trouble with at least one of these. Both of these have also been known to be genetic in some families, but not always.
For years the traditional medical community has strictly considered "allergies" to consist of hives, redness, swelling of the face or throat, and involve something called IgE antibodies produced by the immune system. Allergists would usually use skin prick tests to find these allergens. Researchers, however, would sometimes wind up scratching their heads (no pun intended). Some foods, or other items, where clearly causing a negative reaction in some people, but they were not able to get a response to a skin scratch test. They knew something else was going on. We now know that IgG antibodies were probably involved. They are an immune response with a different type of antibody, and tend to can cause more internal grief that can sometimes take a few days to develop, making them difficult to track down, or even suspect. IgG responses can cause a runny nose, chronic inflammation, migraine headaches, reflux, joint and muscular pain, digestive problems, canker sores, behavior problems, and the list goes on.... and you can develop IgG allergens to almost anything. They cannot be detected on a typical skin scratch test, but IgG's to food can be detected with a very simple blood test called an ELISA IgG Food Panel. One vial of blood can be run against 80 to 120 foods, depending on which labratory is used.
In 2007 Austrian researchers studying metastic renal cell carcinoma, a.k.a.kidney cancer, wanted to see if any cereal grains may be causing problems for these patients. They did an ELISA IgG Food panel for 113 foods and found one ingredient that stood out from the rest, and it wasn't a grain at all. Those with anti-Saccharomyces cerevisiae mannan antibodies (ASCA), a.k.a. bakers yeast allergy, had their median survival rate cut in more than half. The study concluded that ASCA alone was a source of "immune deviation and impaired immunosurveillance in predisposed RCC patients".
Although it does not have the notoriety of casein and gluten, bakers yeast allergy, known as anti-Saccharomyces cerevisiae mannan antibodies (ASCA), justly deserves a spotlight all it's own. In 1999 the commercial test for IgG ASCA became available. Since then researchers have been finding it in lots of places, especially in autoimmunity, and it's not always an innocent bystander. ASCA can be especially destructive in the GI tract. Just as a banana allergy can cross react and cause an allergy to latex, ASCA can cross react and make an individual allergic to yeast found in their own intestinal flora. ASCA appears to be one of the markers for Crohn's disease, an inflammatory bowel disease. While not all Crohn's patients have ASCA, studies have found up to 65 to 80 percent of them do. What's more, numerous studies have found that early age of onset plus having ASCA makes a patient at high risk for a severe course of the disease and a high chance of surgery. A 2003 study from John Hopkins School of Medicine, found that "ASCA titer was significantly associated with stricturing and penetrating CD".
ASCA has also been showing up in other bowel disorders as well, including Ulcerative Colitis and Celiac's Disease. Many researchers have come to the conclusion that anytime blood work reveals ASCA,and the patient has any gi tract issues, further testing for Inflammatory Bowel Disease, needs to be done.
Behcet's disease, an autoimmune disorder with chronic canker sores, vasculitis, and sometimes gi tract involvement, also tends to have ASCA. Another condition also plagued by canker sores is called
Reccurent Aphthous Stomatis (RAS). Unlike Behcet's and Crohn's patients, RAS folks typically have canker sores and usually no gi involvement. Researchers, looking for a way to distinguish between Behcet's and RAS looked into ASCA, but found it in both. What's interesting is that Crohn's and Celiac's patients can be prone to canker sores and throat ulcers as well. Anyone plagued by frequent canker sores may want to consider the possibility of a bakers yeast allergy (or just get an ELISA IgG Food Panel to find any other food culprits).
ASCA is also showing up in other areas, although it's role may not be as clear: cystic fibrosis, acute myocardial infarction, autoimmune hepatitis, primary biliary cirrhosis, ankylosing spondylitis, infertility. It can also show up temporarily during a bacterial or viral infection in healthy individuals.
There are different ways folks can acquire a bakers yeast allergy. In Celiacs disease it seems to go hand in hand with the amount of intestinal damage one has acquired, and it seems to lessen on a gluten-free diet. A Finnish study noted "that serum levels of ASCA correlated with the grade of mucosal morphology, as the ASCA serum levels declined in accordance with mucosal healing". Researchers have also found that infections from another strain of yeast,
Candida albincans, can also cause ASCA, perhaps due to cross reaction. Candida is normally present in a healthy gi tract in small amounts, but can become pathogenic when given the opportunity. Modern day diet and medications have contributed to thriving Candida. The healthy bacteria in our intestines keep the Candida in check, but when antibiotics kill off these bacteria, there is nothing to stand in the way. Combine that with the modern high sugar and processed diet (a buffet for yeasts) and liken it to feeding stray cats...they multiply and poop all over your flower beds.
ASCA can also be inherited, much like a gluten allergy is inherited in Celiacs. There appears to be a genetic predispostion in Crohn's and Behcet's disease. There have been several studies finding ASCA in healthy relatives of these patients. What's more, the genetic mechanism that may be responsible is something called Mannan Binding Lectin (MBL) deficiency.
Mannan Binding Lectins are a part of the Innate Immune System. They look similar to bouquets of tulips. The tulip portion is designed to latch on to the carbohydrate surface of yeasts and certain bacteria. Once latched on they can sweep the particle away or call out to other components of the immune sytem to help with disposal. Roughly 55 percent, or so, of the population has adequate MBL, about 40 percent of so are lower on MBL and roughly 5-10 percent are deficient. When an individual is low, another part of the immune system steps in to take up the slack, and it's usually antibodies that do this. And if I understand correctly (again, I just draw stuff for a living) this may also put one at a higher risk for autoimmunity. MBL sweeps the particles away, where as an antibody may just charge on the spot, also attacking the tissue (again, I might not be getting the correct jist, just my interpretation). MBL deficiency is found in Crohn'patients and their healthy relatives. Swiss researchers concluded "enhanced mannan exposure stimulates specific immune responses in a subgroup of CD patients with genetically determined low MBL concentrations. This enhanced exposure contributes to the generation of ASCA."
Low MBL is also found in Lupus, otitis media, and a slew of other health issues. (I will devote a future post to MBL's).
Research points to avoidance of Bakers Yeast as a good thing to do for those with ASCA's. But as with most food allergies, you may have to read between the lines to find out where it's hidden. First of all it's in most yeast breads. Sourdough breads, however, can have different strains of yeast, which some folks with ACSA can tolerate and some cannot. Bakers yeast also tends to show up in crackers and many other "flat" baked goods (
I found this list). Many broths, gravy and sauce mixes, marinades, frozen dinners, etc will also have
yeast extract as an ingredient, this has been shown to cross react with ASCA's. There is also another source of bakers yeast that, surprisingly enough, even some doctors are not aware of: the hepatitis B vaccine given to newborns, and at six weeks of age and again at six months. The two brands of hep B vaccines used are Merck
"RECOMBIVAX HB"! and the GlaxoSmithKline
"ENGERIX-B" While it is not my intent to discuss vaccines, from a food allergy stand point it does raise some cause for concern, as ASCA seems to play a curious role in autoimmunity. There has also been some interesting research on untreated Celiacs and a non-response to this vaccine. Here's an interesting article link at
Celiac.com I have a few links at the end pertaining to the Heb B virus.
Sometimes just avoiding Bakers Yeast is not enough and one can have problems with many yeasts. Avoiding sugars that feed intestinal yeasts and avoiding fermented foods that harbor other strains of yeast might be required. This is often known as a
Yeast-Free diet. The
Specific Carbohydrate Diet is highly recommended for rebalance of intestinal flora.
Research:
Serum antibodies against Saccharomyces cerevisiae : a new prognostic indicator in metastatic renal-cell carcinoma
Antibodies to Saccharomyces cerevisiae in Crohn's disease: Higher titers are associated with a greater frequency of mutant NOD2/CARD15 alleles and with a higher probability of complicated disease
IBD serological panels: Facts and perspectives
Anti-Saccharomyces cerevisiae antibodies in patients with Crohn's disease
Anti-Saccharomyces cerevisiae antibody (ASCA) positivity is associated with increased risk for early surgery in Crohn's disease.
Serologic testing with ANCA, ASCA, and anti-OmpC in children and young adults with Crohn's disease and ulcerative colitis: diagnostic value and correlation with disease phenotype.
Diagnostic role and clinical correlates of anti-Saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (p-ANCA) in Italian patients with inflammatory bowel diseases.
Antineutrophil cytoplasmic antibodies, anti-Saccharomyces cerevisiae antibodies, and specific IgE to food allergens in children with inflammatory bowel diseases.
Anti-Saccharomyces cerevisiae antibodies in inflammatory bowel disease: a family study.
Clinical significance of anti-Saccharomyces cerevisiae antibody (ASCA) in Korean patients with Crohn's disease and its relationship to the disease clinical course.
Anti-Saccharomyces cerevisiae antibodies status is associated with oral involvement and disease severity in Crohn disease.
Predictive value of serologic markers in a population-based Norwegian cohort with inflammatory bowel disease.
Familial expression of anti-Saccharomyces cerevisiae mannan antibodies in affected and unaffected relatives of patients with Crohn's disease.
Seroreactivity against Saccharomyces cerevisiae in patients with Crohn's disease and celiac disease
Diagnostic value of anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic antibodies for inflammatory bowel disease: high prevalence in patients with celiac disease.
Elevated serum anti-Saccharomyces cerevisiae, anti-I2 and anti-OmpW antibody levels in patients with suspicion of celiac disease.
Serological responses to microbial antigens in celiac disease patients during a gluten-free diet.
Anti-Saccharomyces cerevisiae antibodies in coeliac disease.
Anti-Saccharomyces cerevisiae antibodies in Behçet's disease--a familial study.
Comparison of Behcet's Disease and Recurrent Aphthous Ulcer According to Characteristics of Gastrointestinal Symptoms
Anti-Saccharomyces cerevisiae antibodies - A novel serologic
marker for Behçet’s disease
Frequency of ASCA seropositivity in children with cystic fibrosis.
Anti-Saccharomyces cerevisiae antibodies in acute myocardial infarction.
Anti-Saccharomyces cerevisiae IgA antibodies are raised in ankylosing spondylitis and undifferentiated spondyloarthropathy
Yeast Antibodies Predict More Severe AS
Anti-Saccharomyces cerevisiae as unusual antibodies in autoimmune hepatitis.
Anti-Saccharomyces cerevisiae antibodies in primary biliary cirrhosis.
Autoantibodies and prediction of reproductive failure.
Autoantibodies in nonautoimmune individuals during infections
ASCA: genetic marker, predictor of disease, or marker of a response to an environmental antigen?
Candida albicans is an immunogen for anti-Saccharomyces cerevisiae antibody markers of Crohn's disease.
Colonization of mice by Candida albicans is promoted by chemically induced colitis and augments inflammatory responses through galectin-3.
Candida albicans is an immunogen for anti-Saccharomyces cerevisiae antibody markers of Crohn's disease.
Microbial mannan inhibits bacterial killing by macrophages: a possible pathogenic mechanism for Crohn's disease.
Pathogenic agents in inflammatory bowel diseases.
The dyspeptic macrophage 30 years later: an update in the pathogenesis of Crohn's disease
Association of Deficiency for Mannan-binding Lectin with Antimannan
Antibodies in Crohn’s Disease: A Family Study
Food-induced immune responses as origin of bowel disease?
Serum mannose-binding lectin levels are decreased in behcet's disease and associated with disease severity.
Association of HYPA haplotype in the mannose-binding lectin gene-2 with Behçet's disease
Association of mannose-binding lectin gene variation with disease severity and infections in a population-based cohort of systemic lupus erythematosus patients.
Genetic variants of the mannan-binding lectin are associated with immune reactivity to mannans in Crohn's disease.
Mannose-binding lectin deficiency is associated with early onset of polyarticular juvenile rheumatoid arthritis: a cohort study
Concurrent HLA-related response factors mediate recombinant hepatitis B vaccine major adverse events.
The development of rheumatoid arthritis after recombinant hepatitis B vaccination.
Humoral response to recombinant hepatitis B virus vaccine at birth: role of HLA and beyond
