Re: Hmm... Dr. Lazoff

[Guest guest]

> When I said increased GI permeability I was referring to abnormal

> uptake of food peptides from the gastrointestinal tract that may

> elicit an adverse immune response with consequent immunological

> effects, or incomplete metabolism of such peptides that may have

> either immunomodulatory or direct effects on the cellular level.

Right, Eliza, but my point was that all that can be caused by

*normal* GI permeability.

> Strong humoral immune responses to food antigens, most commonly

> cow's milk, wheat or egg, have been seen in patients with gluten

> enteropathy (celiac disease), which may be an indicator of

> increased or abnormal gastrointestinal permeability and subsequent

> immune exposure, but this is just a theorical link.

I read your words, but I'm not understanding your underlying

principles. Let's review: we know the pathophysiology of celiac

disease involves some kind of abnormal immune-mediated response to

gluten products. Keep in mind that the classic presentation of

celiac sprue is malabsorption, not food allergies.

There is a sub-clinical form of celiac disease, one where the overt

gluten hypersensitivity is subtle and non-specific system symptoms

predominate. This is not a theory -- since the 1970s and 80s, we've

known that many people have some of the immune markers of celiac

disease, and some non-specific symptoms of gluten-related

indigestion. For a number of reasons it's important to diagnose such

people whenever possible, but the treatment is the same as with

classic celiac disease -- dietary control.

Regarding milk products, I *think* what you're referring to is not

celiac disease but the sometimes-associated selective IgA deficiency

that accompanies a proportion of patients with either full-blown or

sub-clinical celiac disease (although IgA deficiency is much more

common as an isolated disorder or in association with some

medications (nothing rosaceans would use)). Among other problems,

these patients also lack secretory IgA's protective mucosal barrier,

which results in increased incidence of GI infections and food

intolerances, exactly by the mechanism you described about. Lack of

IgA can be tested for, and presents with symptoms beyond the GI

tract.

> It is being researched

> currently trying to find a link between autisim and food antigens.

From what I recall, that research was first conducted in the mid-late

80s. It's an interesting theory, but it hasn't panned out. There is

one well-respected physician in England who has a related theory,

which may be what you're referring to. But specifically, what does

this have to do with what we're talking about?

> I respect that you don't appreciate the link between food and

> rosacea, but I like to dare to think differently even if I have it

> wrong.

As a medical student, think however you like. Right now you're

bicycle riding with training wheels, you're not going to tip over no

matter how you ride/what you think.

> I continue to read your posts and learn from them, maybe

> someday I will learn " the hard way " that you are right. But then,

> maybe I will learn that you were wrong.

Medical students always think practicing physicians are wrong and

unhip, just as teenagers always think their parents are wrong and

unhip. I thought like you did, but I learned the truth over time.

> " You're just looking for an easy fourth-year elective that will

give

> you some research experience for your residency applications. You

> know I'd be an easy Honors grade for you " .

>

> Maybe the first part is true, but about the easy Honors grade, I

> doubt that.

Naw, just because I wouldn't let you get away with " sloppy thinking "

doesn't mean I'm not a pushover for a good grade (if your learning

curve is steep and you end up deserving it. )

Marjorie

Marjorie Lazoff, MD