Why Gluten and Yeast Can Trigger an Endless Cycle of Reactivity for Mold Sufferers
by Dr. Susan Tanner, MD, and Eric Hosford, RN
Gluten and yeast overgrowth (mostly Candida albicans) are often mentioned together in relation to immune dysfunction and mold illness. But if yeast is able to propagate on a variety of substances in the gastrointestinal tract, what is about gluten, a single group of proteins attached to certain grains, that seems to make yeast become pathogenic? As is typical in the realm of integrative medical treatment, several causative factors are at play. In this article, we plan to touch on some of those factors to help explain why gluten can sometimes extend or worsen symptoms for those suffering from sickness triggered by environmental mold exposure.
Filling the Bucket
Broadly speaking, increased hyperimmune activity–from mold exposure, viral load, high stress, or anything else–may yield additional inflammatory reactions to other substances. As mentioned in previous articles, total body load can also be a significant factor in the development of new inappropriate immune responses. Ergo, if a person is experiencing either gluten intolerance or heightened reactivity to mold, and the metaphorical “bucket” of the immune system then “overfills” due to allergen exposure, another disordered condition may develop as well or cause stronger symptoms if already present.
A Positive Feedback Loop (to Negative Effect!)
The specifics of gluten’s role in yeast overgrowth are much more than its prevalence as an allergen or in the fact that it is found in foods that Candida albicans (yeast) consumes. Gluten itself is difficult for the body to break down and, simultaneously, has a relatively large molecular structure. Supposing GI damage has already occurred via yeast overgrowth (sometimes because of the presence of mycotoxins from mold in the GI tract–either from environmental mold exposure or from consuming mycotoxin-laden foods) in the intestines, absorption of these oversized and undigested glutens can be a process that is further destructive to the intestinal lining.
On the subject of molecules, gluten’s molecular structure happens to be very similar to that of a protein contained in the Candida albicans cell, one which the immune system uses to identify it as a pathogen. The result is that, when the immune system engages to fight the yeast and keep it in check, it may also begin to recognize gluten as a harmful invader and begin reacting to and attacking it as well. This inflammatory immune reaction to gluten can effectively create an intolerance even if a person was not bothered by dietary gluten before. Similarly, if gluten sensitivity is present, the body’s reactivity to Candida can be heightened (again due to the “joys” of molecular mimicry), which then can exacerbate the subsequent attack on gluten, and so on. This cycle of reactivity is known as a “positive feedback loop,” which will continue to increase the size of the disturbance unless both substances can be sufficiently diminished or removed to allow the body the chance to return to equilibrium or homeostasis.
Mycotoxins and Gluten Sensitivity
Whether inhaled from a moldy indoor environment or ingested in food, mycotoxins (the toxic byproducts created by mold) enter the body and negatively affect gut health by impairing several functions within the digestive and immune systems. Mycotoxins are poisonous chemicals, so if the exposure is ongoing or if a person has a genetic inability to properly excrete the toxins, they circulate with the bile through the gastrointestinal (GI) tract multiple times each day. The body continues to sense the threat, so cytokine production and inflammation increase. With inflammation comes an increase in the production of a protein called zonulin. Zonulin is responsible for modulating the permeability of tight junctions between epithelial cells on the intestinal wall. When zonulin is elevated, the tight junctions in the intestinal cell wall expand and remain loose, and there is a loss of barrier function in the gut. Thus, the door is now “open” for molecules that should remain in the digestive tract to leak into the bloodstream to create more inflammation and immune system reactivity. Then, when a person consumes gluten-containing foods, even when they are not diagnosed as celiac, gliadin, a protein found in gluten, releases additional zonulin, allowing the gliadin to move through the intestinal wall and into the blood. At this point, both gluten and the toxins are tagged as invaders, and the inflammation continues, because the body is having the same autoimmune response to the gluten as it does to a moldy indoor environment. It happens often that mold patients must also stop eating gluten to allow their bodies to fully heal.
What About True Celiac Disease?
A form of gluten intolerance is called celiac disease, formerly known as tropical sprue. This is a genetic condition and is not connected to mold-related illness in its purest form. It appears that celiac disease is most prevalent in those of Scottish/English/Irish ancestry, hence many of us Americans contain at least some of the genes involved in celiac disease. What has been postulated is that certain recessive genes may spring into expression when the body burden becomes great enough, and that certainly involves mold exposure. There are certain blood tests that can be done to determine the presence of the genetic expression of celiac disease. The most reliable of these is serum transglutaminase and is easily obtainable from commercial laboratories.
When true celiac disease is found to be present, a very strict gluten-free diet must be followed life-long. Even very small amounts of gluten can set off both physical and physiologic problems. This includes gluten absorbed through the skin; there are quite a few products containing ingredients derived from gluten so all labels must be read carefully.
Non-celiac gluten sensitivity may be detected by blood tests for IgG sensitivities, through specialty labs offering such tests. The vast majority of patients that I have seen with mold-related illness show at least some level of gluten sensitivity based on the mechanisms described above. A big question is whether or not one may be able to resume gluten in the diet at some point. The answer to that is “maybe” and it all depends on the degree of recovery to the immune system, which varies widely among individuals. In general, the heavier and long-lasting the exposure and illness, the less likely it is that gluten will be tolerated without setting off more symptoms and more immune sensitivity.
A Word (or Two) on Gluten Enzymes
Before discussing the use of gluten enzymes, it is important to be very clear: no current supplement or medication is known to enable gluten-sensitive individuals to deviate from their diets without consequence (especially when yeast is in the picture). Celiac disease and gluten intolerance are widespread enough problems that, should an effective pill or antidote ever be developed, it would take the world by storm. For now, though, the only viable option for sufferers of either condition is to remain strictly gluten-free with food intake as long as the sensitivity remains active.
All this being said, supplements have been produced to break down gluten, and these products are not totally without merit. Occasional, unintentional gluten consumption is entirely likely, particularly via accidental cross-mixing in restaurants. For some people, even minuscule amounts of gluten have the potential to cause a reaction; this is when gluten enzymes may be helpful. Most beneficial is taking these supplements preemptively at meal settings when you are more likely to incur accidental exposure; they can add an extra layer of protection from the traces of gluten that may “fall through the cracks”.
Should you decide to pursue this adding gluten-specific digestive enzymes to your plan, make sure to read the ingredient list carefully. Even some reputable brands manufacture these enzymes with sugar alcohols, which are inconsistent with an anti-yeast diet–remember the positive feedback loop? You don’t want to be avoiding gluten, but feeding the growth of yeast; your efforts will be for naught. To make sure sugar alcohols are not slipping in, avoid products made with any ingredients containing the suffix “-tol” at the end, such as maltitol or sorbitol. (Erythritol and Xylitol seem to be the exceptions to this; fungi do not consume them, but they can cause stomach upset for some people, so take care if trying them for the first time.) I recommend the Integrative Therapeutics product Gluten Manager, which contains both of the needed enzyme blends to break down gluten and is also vegetarian-friendly.
As stated above, gluten-specific enzymes can be helpful, but MOST helpful to any autoimmune issue, created by mold, candida (yeast), or gluten where the immune system is becoming hyperactive is to avoid exposure to aggravating factors. This means doing your best to breathe clean air, drink clean water, and to eat clean food. If you suspect mold may be a triggering factor, test for it in your home or office. If you seem to be getting frequent yeast infections or yeast-related symptoms, avoid sugar and gluten as both increase inflammation and act to make the other less hospitable for your body. It can also be helpful to work with a skilled practitioner who will test you for mycotoxin exposure, yeast overgrowth issues, and food allergies/intolerances.
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About the Authors: Susan Tanner has practiced medicine for over 33 years, concentrating primarily on chronic illness and the impacts on the individual, the family, and the community. Her formal education was completed at Emory University in Atlanta, the Dominican Republic, Brooklyn, NY, and Atlantic City, NJ. After starting her family practice, a driving curiosity into why people are made ill caused her to pursue education in Environmental Medicine, completing coursework, exams, and necessary practice years to earn board certification in this area in 2009. Her own struggles with mold-related illness drove her desire to teach those similarly affected. While in clinical practice, Dr. Tanner wrote and contributed to a number of publications on environmental health, prepared narratives for understanding in legal matters, and researched new techniques for modulating the body’s ability to clear toxins and infections. Now, Dr. Tanner continues to research and learn. She now has a fitness and health website www.thebodynexus.com, where she writes articles and shares education on utilizing the various body systems to improve overall health.
Eric Hosford is the son of Susan Tanner, MD. A theater major at FSU, he found that the healing path held a special pull for him, leading him to complete his RN degree at Emory University in December. He has observed and experienced many interventions for mold-related illness and shares his mother’s passion for finding the root causes of illnesses.