My Biopsy Results

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My Biopsy Results

Post by Polly »

RATZ! They were not totally negative as I had hoped they would be. But it is my own stupid fault, I think. SIGH.

Actually, the news was not bad. There were only a few isolated areas of "sparse" lymphocytes, no collagen. Apparently it was "100% improved compared to the original biopsy report", according to my doc. She was delighted!

But I was disappointed. My hunch is that it was totally healed the past few years, and I screwed it up last month with my holiday indiscretions.

Remember I told you that I went off the wagon a number of times and ate no-nos like dairy, corn, tomatoes, etc.? And I did have D at the time -not the first few times I ate triggers, but the effect was cumulative. Eventually I did have D for about 2-3 weeks. At the colonoscopy I told my doc about my dietary indiscretions, and she suggested skipping the biopsies this time, but I still wanted to do them.

Oh well. At least I now have proof of how sensitive I am to my food triggers. I am newly committed to avoiding all of the foods that are bad for me. And next holiday season, when I will again be tempted, I am counting on my good friends here to remind me about this. LOL!

Love,

Polly
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Post by tex »

Hi Polly,

Very interesting that a short term reaction would show up in the biopsies. I agree that getting that information is very enlightening, as far as future plans are concerned.

I've forgotten--was your original diagnosis LC or CC?

One thing that you have demonstrated, is that triggers other than gluten, can cause the diagnostic markers for MC. It seens intuitive that they would, but I've often wondered about that. Thanks for sharing.

Love,
Wayne
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Post by Polly »

Hiya Wayne,

I have LC. Yes, it is interesting that the short term reaction would show up.

I am not sure about the mechanism......are you? I have been trying to reason it out. I know that MC itself is caused by an overgrowth of bad colon bacteria because the body begins making antibodies to its good bacteria. So, do you think that eating known food triggers, which leads to the development of "food" antibodies, somehow "turns on" the mechanism once again that develops antibodies to the good colon bacteria?

Or, could it be that the antibody/antigen complexes formed from eating food triggers actually mechanically damage the colonic mucosa, thus interfering with improper water absorption and causing D?

And then there is the special gluten issue. Apparently gluten IS different from the other food proteins, in that, as far as we know, the other foods don't cause the same kind of damage. But do we really know this? This probably has never been studied extensively. I don't think I ingested any gluten last mo., but since I was eating out a lot, I could have. We know how it can be hidden everywhere.

Put your thinking cap on and give me your thoughts, please.

Love,

Polly
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Post by tex »

Polly,

Well, of course, I'm not sure either. In order to get lymphocytic infiltration, though, the immune system would have to be experiencing a typical MC episode, wouldn't it? (Rather than mechanical damage from a food reaction). An ordinary food reacion can cause ordinary diarrhea, but a true MC reaction involves secretory diarrhea, (though I'm not sure that secretory diarrhea is pressent in 100% of the occurrences).

Also, secretory diarrhea can occur in both the small and large intestine. I would suspect that secretory diarrhea would be more likely to be a problem with gluten, though, than with other food triggers, since gluten damages the villi in the duodenum, whereas, (as far as we know, anyway), other food triggers do not. This raises the question in my mind, whether celiacs ever experience secretory diarrhea? I'm guessing that they do not.

Obviously, certain proteins, (in food), contain the key to turn MC on. If this were not true, then MC would not be controlled by removing those items from the diet, (and by avoiding the ingestion of NSAIDS, and other known triggers). I don't believe the proteins themselves cause the damage, though. Instead, some part of the immune system misinterprets them as a danger signal, and triggers a "corrupt" response, (which causes the immune system to produce antibodies against the body's good bacteria, or possibly against something else, in the mucosa of the colon).

I need to think about this a while.

Love,
Wayne
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by Jean »

Polly and Wayne,

I've had to read this twice!

First, Polly, is this proven or theoretical? "I know that MC itself is caused by an overgrowth of bad colon bacteria because the body begins making antibodies to its good bacteria." I've never completely bought into the bacterial idea. I like the simplest ideas, i.e. that the antibody/antigen complexes do the damage. Of course, I'm open minded.

Second, I wish you'd had a biopsy (easy for me to say LOL) before your indiscretions, then we'd know for sure that is what showed up on the biopsy.

Personally, I think that all of my triggers do the same damage because the reactions are so close. I doubt there are different mechanisms at work. Again, the simplest explanation.

Very interesting. Love, Jean
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Post by Matthew »

Polly

My congratulations. Even if not a complete victory with a clean slate “a few isolated areas of "sparse" lymphocytes, no collagen and a "100% improved compared to the original biopsy report" is a huge step and as far as I am concerned something to rejoice about. Just knowing your incredible results is a further inspiration stay the course. Wowy wow wow.

I have always just assumed because of the damage done by gluten to the small intestine that food was going into the large intestine unabsorbed and in the moist warm environment conducive to bacterial growth that a lot of the problem was bacterial overgrowth. In that grains of any kind have been a big problem for me , along with other carbs like potatoes and the kinds of sugar in tomatoes I thought I had figured it out. Ha! Elaine Gottshall’s expination In “Breaking the Vicious Cycle’ has always been my inspiration in that I have never found anything that explains it any better. As I have said real creative thinking comes from a time of gathering data, questioning it , being confused and questioning it again , gathering more information, questioning it , finding some clarity and then starting all over.

Thanks for a new idea to be confused enough about to be inspired to look for more answers.

In the mean time I feel inspired by such great news and feel ,again, that I am really on the right track.

Love

Matthew
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Post by tex »

Well Jean,

Now that you bring it up, you've got me wondering, also, if that explanation has ever been proven. Maybe the "bad" bacteria are there simply by coincidence, and they're not the primary cause of the reaction. They are opportunists, just taking advantage of the situation. They may well contribute to the damage, but they might not be the primary cause of it.

I've been cogitating on this most of the day, and I've come up with this tentative hypothesis. Now that I've read your post, I lean even more strongly in this direction.

Consider this: What if the effect of the proteins which trigger reactions in MCers, (and celiacs), is as simple as directly promoting the excessive production of zonulin? IOW, instead of zonulin production increasing as a result of an autoimmune reaction, maybe the zonulin overproduction is directly, (or indirectly), triggered by the proteins, and the immune system subsequently responds to the overproduction of zonulin.

When the immune system begins to produce anti-zonulin antibodies, the "good" bacteria are destroyed as colateral damage. The mucosa of the colon is damaged by both the immune system response to the zonulin overproduction, and by the opportunistic "bad" bacteria.

One thing that adds credence to a possibility such as this, is the fact that the zonulin causes leaky gut syndrome in the small intestine, which, of course, causes many of the other symptoms, (besides diarrhea), often present during a reaction, (such as joint pain, general body aches and pain, headaches, brain fog, etc). This would allow for a fairly prompt response to a food trigger, (a matter of minutes, or a few hours).

I would think that if "bad" bacteria were entirely responsible for a reaction, then much more time would be required for them to cycle throgh enough generations to reach the huge numbers necessary to cause significant damage over large areas of the colon. Also, without the LGS, caused by the excessive zonulin production, a reaction would not be accompanied by those other symptoms, until much more time had passed, since it would take much longer for the toxins to get into the bloodstream.

Ok, now you can shoot my theory full of holes. LOL.

Love,
Wayne
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by Polly »

WOW, the brain cells are working fulltime today! Great thinking on this thread.

Jean, I don't think it has been proven in humans that antibodies to the good bacteria result in overgrowth of the bad bacteria and therefore colitis.....studies have only been done in animals so far. At least that's what it says on Dr. Fine's website.

Wayne, interesting hypothesis. Yes, it would make sense that zonulin would play a role. But do we know that naturally-occurring zonulin is "deactivated" by an immune response? IOW, does the body form an actual antibody to zonulin in order to deactivate it? I don't know. I wonder how Dr. Fasano's "peptide" deactivates zonulin?

As Matthew says, it is so good to ask these questions, which on the surface seem simple, but truly could lead to new insights.

BTW, Matthew, thanks for the vote of confidence. You make me feel better despite my dumb timing of food indiscretions.

Love,

Polly
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Post by Lucy »

Celiacs who've been long diagnosed and apparently successfully treated for celiac disease are turning up with M.C. after as much as 30 yrs gf. Wouldn't this seem to indicate that another allergen is involved?

I don't think we can assume that all of these folks are getting hidden gluten, particularly since some of the ones in our local celiac group are very strict and still they're turning up with M.C.

It's my understanding that the relevant parts of gliadin are very similar to the relevant parts of prolamines in other of these common "allergens" we tend to have the most trouble with. Also, that the "interacting areas" on these relevant parts of the prolamines are like the same on the proteins of some of the bacteria the body reacts to, and even the tissue protein of the body itself, like that of the villi, for instance. Think this is called genetic mimacry or something. Wayne or anyone familiar with this? It's been so long that I'm no longer able to remember where I read it.

As an aside, what do you think is the adaptive purpose of zonulin in increasing the permeabililty of the gut in the first place? Same goes for zonulin's kissin' cousin that controls the permeability of the brain?
(The two are simliar, remember, and the gut is the largest producer of the neuroleptic, serotonin. Does this give anyone any ideas?)

Guess you all already know this, but it's been demonstrated that zonulin production is increased in mice with increased stress, so it must be nature's way of adapting to stress.

What would happen under these conditions in order for the serotonin to be useful? Would increased permeability enable serotonin from the gut to be better utilized by the brain, perhaps? Otherwise, it's hard to imagine how the increased permeability would help the organism experiencing stress.

Just thought I'd throw in another what if, in case anyone thinks it's relevant. Would any other substances benefit the organism in a state of increased permeability like this?

Obviously, from my experience at least, stress isn't a factor while I'm gf, etc. Why is this? I never have diarrhea now while under stress. Before gfness, stress would increase the severity of a reaction. This has to be due to the increased zonulin production in response to stress, just like with those lab mice, right?

Now, those of you familiar with the biochemistry of the body's reactions to stress should by now have come up with an airtight theory for what all this means! Ha!

Interesting thread. Too bad I'm too sleepy to think it through tonight. You guys let me know when you've figured this all out, ok.

Yours, Luce
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Post by artteacher »

My brain hurts.

My email to Dr. Fine dealt with some of the issues you're talking about, coincidently. I asked him if one of the reasons that Pepto Bismol helps some people, even if it's for a short period, is maybe that some of them have h pylori infections. He emailed back and said that Pepto Bismol has an antibacterial effect that suppresses bacterial overgrowth, which is the cause of inflammation with MC. And that he doesn't expect to ingest orange juice or rice again, either, and that's just the way it is. That's almost word for word, except that I'm not sure now if he said that bacterial overgrowth is a cause, or the cause.

I was hoping he would tell me that a gluten free diet would allow the damage to heal, and like celiacs, other foods like dairy or orange juice, could some day be digested normally.

I'm glad this topic came up . . . Marsha
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Post by tex »

Polly,

I can't speak for Jean, but my question about "bad" bacteria overgrowth was realated to whether or not it has ever been convincingly demonstrated that MC is actually caused by bacteria, rather than, for example, changes in the structure of the gut, caused by chronic LGS, and its resulting effects. I never questioned the subsequent replacement of good bacteria by bad bacteria, in the event that populations of good bacteria take a nose dive. I think that's a given.

Either the anti-zonulin antibodies that the immune system produces cannot successfully deactivate the zonulin, or it cannot produce antibodies fast enough to keep up with the production of zonulin, during an episode. If this were not true, then we wouldn't have LGS, and the resulting auxillary symptoms. I believe that the body's immune system produces antibodies to zonulin, in a futile attempt to regain control, but only succeeds in damaging the gut, in the process. This article, from the University of Maryland Medical Center, supports the claim that the immune system produces those antibodies:

http://www.umm.edu/news/releases/zonulin.html

In paragraph number six, this sentence addresses the antibody issue:

"Patients with active celiac disease showed higher levels of zonulin and anti-zonulin antibodies compared to non-celiac patients and patients in remission, who were eating a gluten-free diet."

I'm convinced that LGS, (and therefore zonulin production by the body), is the key to MC reactions, just as it is with celiac reactions, (in fact, I'm not totally convinced that celiac sprue and MC are separate and distinct diseases, but that's another issue). Once Dr. Fasano perfects a way to regulate zonulin levels, then LGS will be preventable, and MC will no longer be a problem.

Love,
Wayne
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Post by Carrie »

Hi everyone. Jean, you really have me wondering again about the possibilities of "bad" bacteria being formed to combat the "good." Even if not yet proven in humans, I think it certainly is worth looking into. My husband has a theory on what caused my LC: I was consuming far too much active-culture yogurt beginning about 30 days before and up to the day my LC erupted. Taking his theory to the next level, can there can be too much good bacteria? I don't have the answer. If anyone can find any information about an oversupply of "good bacteria" and its effects I would be very interested!

Love,
Carrie
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Post by tex »

Luce,

I believe that the reason why celiac patients turn up with MC after decades of gluten abstinance is, as you have suggested, because of other allergens, and because celiac disease, and MC, are linked.

I'm not familiar with genetic mimicry, but I do know that the polymer chains of certain offending gliadins, and many of the other other triggers, such as casein, and zen, (the protein in corn), for example, are very similar

Zonulin's reason for existence, is to regulate permeability. Without it, there might be no permeability, (and therefore no nutrient absorption). Regulation of permeability is probably a rather complex preceedure, in order to optimize the absorption of various necessary nutrients, into the bloodstream. The article that I cited above, also discusses this issue, where it says:

“Zonulin works like the traffic conductor or the gatekeeper of our body’s tissues,” says lead author Alessio Fasano, M.D., professor of pediatrics and physiology at the University of Maryland School of Medicine, and director of Pediatric Gastroenterology and Nutrition at the University of Maryland Hospital for Children. “Our largest gateway is the intestine with its billions of cells. Zonulin opens the spaces between cells allowing some substances to pass through while keeping harmful bacteria and toxins out,” explains Dr. Fasano.

It is apparently zonulin itself, and not a cousin, that regulates the permeability of the blood-brain interface, as per this quote, from the same article:

Earlier research conducted by Dr. Fasano discovered that zonulin is also involved in the regulation of the impenetrable barrier between the blood stream and the brain, known as the blood-brain barrier.


Increased permeability under stress serves many purposes, not the least of which is increased absorption of the additional epinephrine, (adrenalin), which is produced, increased nutrient apsorption, etc. In extreme stress situations, it serves to curtail digestion, and make the energy that would otherwise be used in digestion, available for other purposes, such as "fight or flight".

You don't have diarrhea with stress now, because by removing gluten from your diet, you removed a large, and chronic cause of extra zonulin production. Therefore your threshold for LGS has been raised a notch or two.

At least this is the way I see it.

Wayne
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Post by tex »

Carrie,

Since it appears that no one has ever documented a problem with excessive populations of "good" bacteria in the gut, I seriously doubt that this is ever likely to be a problem. I would be very surprised to learn that too much yogurt caused your LC. A developing intolerance for casein might have contributed, though.

Still, that's quite a coincidence, isn't it. It kinda makes one wonder if maybe the immune system might have a potential to become alarmed about high populations of gut fauna, regardless of whether they are "good" or "bad".

Love,
Wayne
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Post by Lucy »

Wayne,

That last statement made me think that a while back, I remembered something about
our immune systems attacking our good bacteria. It seems as though the relevant protein parts are similiar in configuration to the relevant prolamine parts of our "allergens." Further, since these bacteria are in the tissue, it seems that this is how the antibodies end up attacking the tissue itself, as in the case of anti-endomesium, for example.

These pairings of similar antigens to corresponding antibodies are what I believe is referred to as "mimicry." It's almost as if one finds a key somewhere along the street, and trys it on a lock at home, and lo and behold, it opens a door. Of course, this can happen if a key has the right spots on it's surface to correspond to the lock, but by no means does it have to be of the exact same shape.

I believe that there is a difference in the "form" of zonulin that is at work in the gut vs the one that works in the brain, but they are so similar as to be almost the same thing. Perhaps the doc is just lumping them both together for simplicity's sake, unless this is some new discovery or something.
Point is that once the zonulin blocker thing is figured out, the other should be simple to apply the same findings.

Need to go back and read the links, Wayne. You always find the most interesting ones!
Thanks!

Yours, Luce
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