That's the topic of chapter 10 in the book. In case you don't have a copy, since it's a relatively short chapter, I'll quote it here:
Chapter 10
An Immune System Quirk
Our immune system may have a programmed hierarchy that determines its focus
While our immune system is always alert to any perceived threats to our health, when confronted with multiple food sensitivities it seems to concentrate on the most significant single issue at any moment in time. That is to say, it appears to focus on the one food sensitivity that is likely to do the most damage to the digestive system and to long-term health.
That doesn’t mean that it will totally ignore secondary food sensitivities, but it suggests that the immune system will concentrate most of its attention on the one that it perceives as the most important threat at the moment, while postponing or minimizing action on the other food sensitivities. That implies that the immune system may have a pre-established hierarchy that it follows, when determining which food sensitivity should be the primary focus of its attention.
As we discovered in chapter six, based on the compiled experiences of hundreds of people who have microscopic colitis, the number one food sensitivity threat as perceived by the immune systems of those individuals is gluten. Casein, the primary protein in all dairy products, appears to rank number two in this hierarchy, while the third-ranking food sensitivity is usually soy. Whether by coincidence or design, it appears that this ranking also correlates with the relative probability of someone with microscopic colitis being sensitive to each of those respective foods. That is to say, gluten is the most common food sensitivity among people with microscopic colitis, casein is the second most likely food sensitivity, and soy is the third most likely food sensitivity.
This information can be very important to someone trying to control their symptoms by diet
Many MC patients who have decided to see if diet changes will reduce or eliminate their symptoms, will start by eliminating only gluten from their diet. In many cases, though not always, after a few weeks, more or less, they will discover that they are feeling much better and the intensity of their symptoms are definitely diminishing. Some will even reach remission. After the passage or more time, though, if gluten is the only food that is being avoided, most people in this situation will experience a relapse of symptoms, and from that point on their symptoms will progressively become worse as time goes by. This very frustrating turn of events inspires many people to make the mistaken decision that they must not be sensitive to gluten after all, since they are back in a full flare of symptoms. However, there is more to this dilemma than meets the eye.
In my opinion, this is simply a real-life demonstration of a quirk of the immune system that causes it to focus its attention on only the single threat that it considers to be the most serious of all those with which it is confronted at any given time. When gluten is withdrawn from the diet, antibody production does not cease immediately. In fact, the immune system will continue to produce antibodies for a very long period of time, at a slowly decaying rate, as it continues to remain at a high alert level, remaining vigilant just in case gluten should reappear in the diet.
Anti-gliadin antibodies have a relatively long half-life (120 days), so it typically takes them months to decay, and to be eliminated from the system. Eventually, a point will be reached where the anti-gliadin antibody level has decayed to below the threshold where a reaction is triggered, and after that point is reached, the clinical symptoms will begin to fade away and remission may occur. At some point, the immune system will cease to focus its attention entirely on anti-gliadin antibodies and it will begin to be responsive to other threats.
The immune system will then turn its attention to the next available food in the hierarchy of food sensitivities with which it is faced, and that will typically be casein, assuming that casein remains in the diet and the individual is actually sensitive to casein. The immune system will begin to aggressively produce anti-casein antibodies, and at some point, the casein antibody level will exceed the minimum threshold level required to trigger a reaction. At that point, the inflammation process will flare out of control again, due to a reaction against casein.
If casein is withdrawn from the diet, then the level of anti-casein antibodies will begin to decline much faster than the rate at which anti-gliadin antibodies decay, and at some point, the immune system will turn its attention to the next item in the hierarchy of potential threats. Experience shows that this cycle will be repeated until no more food sensitivities are present in the diet. Of course, if the person going through this procedure were to eliminate all of his or her food sensitivities at the start of the process, all of the secondary and subsequent reactions could be avoided.
This concept of an immune system hierarchy is strictly a theory and I am not aware of any scientific proof of the concept. However, as evidence that the logic is sound, note that a precedent exists to demonstrate that this concept does indeed have merit. Extensive research has demonstrated that treatment of inflammatory bowel disease and other autoimmune issues by helminth therapy is extremely effective at bringing remission of symptoms.1 In essence, the presence of parasitic worms in the intestines causes the immune system to focus on them, and as a result, the inflammatory reaction causing an IBD or some other autoimmune issue will virtually always disappear, bringing remission of clinical symptoms to the patient. If the helminths are not replaced as they reach the end of their life cycle, the previous symptoms will return as the helminth population in the intestines dwindles. Clearly, helminths are either at or near the top of the hierarchy.
In other words, the immune system perceives the parasites as a more serious threat than whatever is causing the IBD or any other autoimmune reaction. As a result, it withdraws its attention from the perpetuation of the autoimmune disease in order to focus its resources on the helminths. By the same token, the immune system seems to assign a hierarchical rating to various food sensitivities and it tends to address them one at a time, beginning with the one that it perceives as the greatest threat. If that issue is resolved, then it proceeds to the next one in the hierarchy.
Apparently mothers transfer this effect to their unborn babies
More evidence of this effect was demonstrated in a study done in Uganda, published in 2011, in which researchers proved that unborn babies benefited from helminth populations in the digestive systems of their mothers.2 This project studied the effects of treating pregnant women in order to rid them of a helminth infestation that was discovered after they were pregnant. As an apparent consequence of eliminating the worms in the mothers, the babies developed eczema at a much higher rate than controls after they were born, thus indicating that the worms were protective of eczema development in their offspring, even though it was the mothers who had the worms, not the fetuses.
This hierarchy effect often reaches well beyond the digestive system
Many of us with microscopic colitis notice that before we are able to achieve remission of symptoms, our conventional (classic) histamine-based allergies seem to disappear, or at least diminish in intensity. And conversely, after we are able to attain remission from MC and our intestines have had time to heal, our histamine-based nuisance allergies once again return, and in many cases we may begin to react to additional allergens as well. This implies that these nuisance allergies may be secondary to food sensitivities.
Some people produce antibodies to certain foods, but have no clinical symptoms
In chapter nine we discussed how some individuals who have food sensitivities may eventually develop a tolerance for certain foods and become asymptomatic. As we learned there, some people with microscopic colitis produce antibodies to certain foods but remain clinically asymptomatic, a phenomenon that seems to parallel a similar situation that has been documented with celiac disease. Some celiacs may produce antibodies to gluten in their intestines, but they show no significant damage to the villi of their small intestine upon biopsy, and they suffer no clinical symptoms. In most cases of MC where antibodies to certain foods are produced but clinical symptoms are absent, if such individuals will exclude the food from their diet for a few weeks or longer, and then challenge their digestive system by reintroducing the food into their diet, they will virtually always show a very pronounced reaction to it, that serves as convincing evidence that they are indeed, sensitive to that food.
Again, I am unaware of any scientific research that might explain why this procedure works, but the experiences of many MC patients who use diet to control their symptoms suggest that it appears to be a reasonably reliable method for verifying a food sensitivity in many asymptomatic cases. And, of course, it’s well documented that many people who have celiac disease are asymptomatic, even though they have extensive small intestinal damage. This is probably a variation of the same diet-induced tolerance phenomenon.
Don’t add to the stress by worrying about a balanced diet when reacting
Many people who have MC worry that such a limited diet will affect their health because of missing nutrients. But the truth is, we’re usually not absorbing nutrients very well anyway when we have active microscopic colitis. The absorption of nutrients that takes place in the intestines can’t possibly proceed very efficiently when we have so much inflammation and such rapid transit.
To begin with, poor digestion causes many of the nutrients to not even be digested well enough to be available for absorption in the first place, and even if they were, when they pass through the intestines so rapidly, there simply isn’t sufficient time for a normal level of absorption to take place. When we also consider the fact that the inflammation at the surface of the intestinal lining further tends to limit the absorption of nutrients, it’s a wonder that we’re able to derive any benefits at all from our food.
Because of the dilemma that can result from malabsorption issues, together with the health risks associated with dehydration that so commonly occurs with MC, it behooves us to try to control our symptoms as quickly as possible and postpone worrying about balancing our diet until after we are in remission. Whether we eat a balanced diet or not is a moot point when our digestive system is so severely compromised that it’s unable to extract more than a small fraction of the nutrients in the food that we ingest. We’ll usually regain our health much sooner if we eat a bland, non-reactive diet designed to stop the inflammation as quickly as possible.
Virtually all herbal products should be avoided during this phase of our recovery while we’re trying to attain remission, and most vitamin and mineral supplements should either be avoided, or very carefully selected because many of those products contain ingredients that can cause us to react. The labeling laws for pharmaceutical products require an accurate disclosure of the active ingredients, but there are no requirements about listing the inert ingredients in pharmaceuticals (they are specifically exempt from the food labeling regulations). Most manufacturers do list inactive ingredients on the label, but since that’s strictly a voluntary listing and not an FDA requirement, we can’t always assume that all ingredients will always be correctly listed.
There are safe vitamin and mineral supplements available, but we have to be very careful when selecting them because many of the mainstream products contain ingredients that can cause us to react. The point is, after we are in remission, we will have the luxury of time and better health to allow us to do a much better job of figuring out how to eat a balanced diet, based on the foods that are allowed by our new dietary needs. Until we get our symptoms under control, the main priorities are to be sure that our electrolyte levels are adequate and that we drink enough water to prevent dehydration. If the diarrhea has been ongoing for a relatively long period of time, then vitamin B-12 may become depleted, in which case a vitamin B-12 supplement, preferably in sublingual form, to be dissolved under the tongue, may be beneficial.
For reasons that will become clear in chapter 15, where we will consider the areas of current research that may have an impact on future treatments for microscopic colitis, I personally feel inclined to avoid the synthetic form of retinol ( vitamin A) whenever possible, or at least I try to use vitamin supplements that contain minimal amounts of retinol. Instead, I prefer to use the beta-carotene form because the body can make all the vitamin A it needs from beta-carotene, and this will by-pass the risks associated with retinol for anyone with an IBD. Another problem with retinol is that it appears to block the benefits of vitamin D, and as we will see in chapter 14, most people who have microscopic colitis or any other IBD, typically need more vitamin D, and all the effectiveness they can get from it, rather than reduced vitamin D benefits.
Summary
In this chapter we explored evidence that the immune system tends to focus on the single problem that it perceives as the most significant challenge that it is facing, at any given time. We considered how this disease often leads to problems with the absorption of certain nutrients and why it is usually desirable to do whatever is necessary to control the symptoms of the disease before attempting to eat a more balanced diet.
I'm sure I will still need questions answered even if my MC is looking pretty classic at this point. I also want to be a positive voice for anyone needing it too. I'm learning boundaries, and realistic needs, whereas I once felt like a Super Mom, I don't put myself out there as frequently as I used to.
