I often recommend lab work for my patients to make sure there are no hidden medical problems that need attention. Sometimes I come across elevated liver enzymes. After ruling out hepatitis, and getting an ultrasound; I will check for gluten allergy.

So what is the relationship between having a gluten allergy and the liver?
Well, there are toll-like receptors (TLR) on the surface of many cells which participate in the immune system. These receptors sense molecules that are present in pathogens but not the host. When the immune system senses these molecules, chemicals are released which set off inflammatory and anti-pathogen responses. One class of molecules recognized by TLRs and common to most pathogenic bacteria is something called lipopolysaccharides (LPS).
Gluten increases the permeability of the intestine in those with celiac disease. The disruption of the intestinal barrier allows endotoxins, such as LPS, from gut bacteria to reach the portal vein of the liver triggering a TLR response from immune cells in the liver. Inflammatory mediators are released that triggers more chemicals to flow in tissues that leads to inflammation and liver damage. Gluten itself could also trigger a liver immune response where the Kupffer cells in the liver initiate a T-cell response to gluten within the liver.

Pretty interesting stuff!
You can find out more by logging into www.celiac.com.

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