celiac disease

celiacHow many times have you read that celiac disease is the worst form of gluten intolerance? Or perhaps you’ve heard that celiac disease is the potential end-stage of gluten intolerance?

Certainly you’ve probably read that gluten sensitivity isn’t nearly as severe as celiac disease. These statements are often repeated, and they sound fairly logical.

But are they?

To get an accurate handle on what these statements mean we need to clarify the differences between celiac disease and gluten sensitivity. And in order to clarify these differences the first thing that we need to do is to revisit the definition of celiac disease.

To be diagnosed with celiac disease you need one thing, and only one thing. That one thing is called villous atrophy. To explain simply, villous atrophy is a very specific kind of damage that can occur in the small intestine.

If you don’t have villous atrophy, then you don’t have celiac disease. Period. There are various ways to test for celiac disease, but they are all designed to measure one thing–villous atrophy.

A diagnosis of celiac disease is not based on how sick you feel or on how many symptoms you have. It’s not even defined by the type of symptoms that you have, or on how long you’ve had symptoms. The only thing that identifies whether or not you have celiac disease is the presence of villous atrophy. That’s it. (more…)

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A recent article from the Huffington Post (“Why You Need Celiac Disease Awareness”) mostly gets that for millions of Americans (and many more people across the globe) living gluten free is not a fad, but is in fact a necessary health preservation diet.

For people with celiac disease or non-celiac gluten intolerance eating gluten results in health problems that can be slow and outwardly subtle but severe enough to shorten lives and require hospitalization; or can be dramatically damaging immediately after exposure.

We would contend however that the article is inaccurate in saying that experimenting with gluten free is risky.

It is true that tests for celiac disease and non-celiac gluten intolerance require that the patient has been eating gluten. But going gluten free to see how it feels can be one way of deciding to eliminate gluten forever.

We have seen many patients who decided to go gluten free even after a negative celiac disease test because they knew it helped.  Some of these patients have later resumed eating gluten, gotten tested for non-celiac gluten intolerance and found that they were right all along.  Most doctors do not test for non-celiac gluten intolerance so patients need to be their own advocate.

Excerpt from the Huffington Post article:

Many factors play into the low diagnosis rate of celiac disease, but this could very well be one of them. The gluten-free diet has taken on a life of its own. It’s often portrayed as a weight loss diet, and endless athletes and celebrities tout the perceived health benefits of “going gluten-free.” You’ve probably heard all the buzz. You can lose weight fast on a gluten-free diet. Your skin will look so much better if you cut out gluten. Your overall health will improve without gluten.

But those statements are nothing more than just myths.

We are constantly inundated with messages from the media about the “magic” of a gluten-free diet. While some share accurate information with the masses, many irresponsibly perpetuate a cycle of misinformation, leading to the amplification of the gluten-free diet and the silencing of celiac disease.

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High magnification micrograph of celiac disease. (img: commons.wikimedia)
High magnification micrograph of celiac disease. (img: commons.wikimedia)

For a much more detailed examination of celiac disease, wheat allergies, and non-celiac gluten intolerance, please take a look at Dr. Stephen Wangen’s latest book: “Healthier Without Wheat.”

This article reviews the relationship between celiac disease and gluten intolerance (an allergy to grains containing gluten such as wheat allergy).

What Is Celiac Disease?


Celiac disease is a hereditary allergy to gluten that results in damage to the small intestine. Common symptoms include loose stools, fatigue, weight loss and generally poor health. However, symptoms can vary widely and include constipation, weight gain, and a skin condition called dermatitis herpetiformis.

What Is Gluten? 

Gluten is a protein found in wheat, barley, and rye. Gluten is responsible for the springiness and stretchiness of bread. Without it, bread turns out heavy and dense.

How Is Celiac Disease Diagnosed? 


Celiac disease can be assessed by blood tests or by a biopsy of the small intestine performed during an upper endoscopy. The blood tests include the tissue transglutaminase antibody test and the newer deamidated gliadin antibody test. The endomysial antibody test is older and is not as senstive as the newer tests.



How Common Is Celiac Disease? 

The occurrence of celiac disease is much higher than previously thought. A recent study put the prevalence at 1 in every 133 people, making it one the most common genetic diseases known. Once diagnosed, 1 in 22 first degree relatives, and 1 in 39 second degree relatives, is also diagnosed positive.

How Is Celiac Disease Different from a Gluten Intolerance? 


Although celiac disease is a gluten allergy, it is only one form of gluten allergy. Many react to gluten and may have elevated serum antigliadin antibodies, but they do not have damage to the small intestine. These people have a negative biopsy of the small intestine, as well as negative antiendomysial antibody and tissue transglutaminase tests.

How Common Are Gluten Allergies? 


Although no studies have been done on the prevalence of gluten intolerance, the prevalence of gluten allergies is certainly higher than that of celiac disease alone.

What Is the Treatment for Celiac Disease and Gluten Intolerance? 


The treatment is identical for both celiac disease and gluten intolerance and involves removing all sources of gluten from the diet. This means that a person with a gluten allergy should not eat bread products, pastas, or processed food of any kind that contains wheat, rye, or barley in any form. Individuals require special dietary counseling. Fortunately, many alternative sources for gluten free breads, pastas and other foods now exist and are easier than ever to find.

QUESTIONS? Contact our office.

(photo: commons.wikimedia)

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This study supports what we at the IBS Treatment Center have been saying for years, and even published in Dr. Stephen Wangen’s book “Healthier Without Wheat.” Once you’ve have positive blood testing for celiac disease, the biopsy is superfluous. But not for the doctor, because that is how they make their living.

Patients with positive blood tests for celiac may not be “confirmed” by positive biopsy because the mucosal damage has not yet occurred. But the symptoms may still be present and may come and go despite remaining on a gluten containing diet.  For these patients the best way to maintain and improve health is to cut out gluten (though that is not reported in this paper).

From National Institutes of Health:

Prevalence and natural history of potential celiac disease in adult patients.

OBJECTIVE:
Potential celiac disease (PCD) is a form of CD characterized by positive endomysial/tissue transglutaminase antibodies and a preserved duodenal mucosa despite a gluten-containing diet (GCD); it can evolve into flat, active CD. This evolution is, however, not certain. Our aim was to retrospectively study the prevalence and the natural history of adult patients with PCD.

METHODS:
The clinical notes of all 47 patients with PCD attending our clinic between September 1999 and October 2011 were retrospectively reevaluated. To study their clinical features, patients with active CD, randomly selected and matched for sex and date of birth, served as controls. Symptoms, associated diseases, familiarity, and laboratory data at diagnosis were compared.

(more…)

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What Is Celiac Disease?


Celiac disease is a hereditary allergy to gluten that results in damage to the small intestine.Common symptoms include loose stools, fatigue, weight loss and generally poor health. However, symptoms can vary widely and include constipation, weight gain, and a skin condition called dermatitis herpetiformis.

What Is Gluten? 


Gluten is a protein found in wheat, barley, and rye. Gluten is responsible for the springiness and stretchiness of bread. Without it, bread turns out heavy and dense.

How Is Celiac Disease Diagnosed? 


Celiac disease can be assessed by blood tests or by a biopsy of the small intestine performed during an upper endoscopy. The blood tests include the tissue transglutaminase antibody test and the newer deamidated gliadin antibody test. The endomysial antibody test is older and is not as senstive as the newer tests.

How Common Is Celiac Disease? 

The occurrence of celiac disease is much higher than previously thought. A recent study put the prevalence at 1 in every 133 people, making it one the most common genetic diseases known. Once diagnosed, 1 in 22 first degree relatives, and 1 in 39 second degree relatives, is also diagnosed positive.
(more…)

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The vast majority of those with celiac had not been diagnosed (almost 83%)!

This new study (published in the National Institutes of Health) tested nearly 8,000 persons representing the population of the USA.  They determined which had celiac disease using blood testing alone (which is how we do it at the IBS Treatment Center).  Their conclusion is that the prevalence of celiac disease in the USA as a whole is about .71% (1 in 141 people), but is 1% among non-hispanic whites.

Perhaps the most important finding was that the vast majority of those with celiac had not been diagnosed (almost 83%)!  Celiac disease testing should be more common, and physicians need to understand both the disease and the testing.

The Prevalence of Celiac Disease in the United States

OBJECTIVES:
The prevalence of celiac disease (CD) in the United States is unknown. We sought to estimate CD prevalence nationwide by using a nationally representative sample.

METHODS:
This study included 7,798 persons aged 6 years or older who participated in the National Health and Nutrition Examination Survey 2009-2010. Serum samples from all participants were tested for immunoglobulin A (IgA) tissue transglutaminase antibodies and, if findings were abnormal, also for IgA endomysial antibodies. Information about prior diagnosis of CD and use of a gluten-free diet (GFD) was obtained by direct interview. CD was defined as having either double-positive serology (serologically diagnosed CD) or a reported diagnosis of CD by a doctor or other health-care professional and being on a GFD (reported clinical diagnosis of CD).

RESULTS:
CD was found in 35 participants, 29 of whom were unaware of their diagnosis. Median age was 45 years (interquartile range, 23-66 years); 20 were women and 29 were non-Hispanic white. The prevalence of CD in the United States was 0.71% (95% confidence interval (CI), 0.58-0.86%), with 1.01% (95% CI, 0.78-1.31%) among non-Hispanic whites. In all, 55 participants reported following a GFD, which corresponded to a prevalence of 0.63% (95% CI, 0.36-1.07%).

CONCLUSIONS:
The prevalence of CD in the United States was 0.71% (1 in 141), similar to that found in several European countries. However, most cases were undiagnosed. CD was rare among minority groups but affected 1% of non-Hispanic whites. Most persons who were following a GFD did not have a diagnosis of CD.

Am J Gastroenterol advance online publication, 31 July 2012; doi:10.1038/ajg.2012.219.

Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE.

Source
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

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Biopsy of small bowel showing celiac disease manifested by blunting of villi. (img thanks to wikipedia.org)

What is celiac disease?

You may have never heard of celiac disease, but it is actually a fairly common problem. In fact, 1 out of every 133 people has it. That is over 2 million people in this country. It is really more of an allergy than a disease, although it is typically called an intolerance to gluten.

What is gluten?

Gluten is a protein found in wheat, barley, rye, spelt, kamut, triticale, and couscous. People who have celiac disease cannot eat any foods made out of these flours. Gluten is the thing that makes bread, well, bread. It allows bread to rise and keeps it together with lots of nice little air pockets, making your bread light and spongy. Without gluten it is difficult to make bread that is not heavy and dense.

What are the symptoms of celiac disease?

The symptoms vary widely. Celiac disease is typically thought of as a condition that causes diarrhea, abdominal pain, gas and bloating. However, many people do not experience these symptoms at all. They may experience constipation, weight gain, fatigue, headaches, heartburn, skin problems such as eczema and acne, or any number of health problems.

What exactly happens to the body in celiac disease?

In people with celiac disease, eating gluten leads to damage of the small intestine. Damage is specifically done to the villi of the small intestine. Villi are tiny finger-like extensions of the surface of the intestinal tract. They can only be seen under a microscope. In celiac disease the villi are in essence worn down, or blunted. This is known as villous atrophy. It’s something like the difference between holding your hand open with your fingers out, and having your hand clenched into a fist. The fist represents the blunted villi.

Why does this happen?

In people with celiac disease, their immune system is triggered by gluten to not only attack gluten, but to attack their own intestinal tract. This leads to villous atrophy. It is not known exactly why this happens, but it appears to be a genetic response to gluten.

How is celiac disease diagnosed?

Celiac disease is diagnosed by measuring the damage to the small intestine. The presence of villous atrophy can be determined by a biopsy taken during an endoscopy (a procedure to scope your esophagus, stomach and the upper part of your small intestine) and seen under the microscope. The blood test for tissue transglutaminase antibodies has also been shown in scientific studies to be equally effective at determining whether or not there is villous atrophy.

Endomysial antibodies and reticulin antibodies are older blood tests that are not as reliable as the transglutaminase antibody, but if these tests are positive then they are also diagnostic for celiac disease.

What is the treatment for celiac disease?

The treatment for celiac disease is to stop eating gluten. That is easier said than done, but many thousands of people find that they are capable of completely removing gluten from their diet. Of course, it does take conscious effort. Gluten is found in almost all bread products, pastas, soy sauce, and many, many processed foods. However, there are many companies now producing gluten free alternatives, and more are coming out every month.

What is the long term outcome for people with celiac disease?

Fortunately, removing gluten from the diet usually reverses the damage that had already been caused. Significant improvement is usually noticed within weeks if not days, and continued improvement and healing may go on for 1-2 years.

Contact the IBS Treatment Center for more information on testing and treating celiac disease.

Image thanks to wikipedia.org

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Celiac or gluten sensitivites? Does it matter? (image thanks to NIH.gov)

A recent article titled, “Irritable Bowel Syndrome and Gluten Sensitivity Without Celiac Disease: Notes from the Front Lines” raised an interesting issue and I wanted to share it here. The article suggests that gluten sensitivity tends to be less severe than celiac disease.

Based on this, it’s suggested that gluten sensitivity might be thought of as “celiac light.”

The article correctly points out that there are people with gluten sensitivity who have very severe symptoms. And in my experience there are many of these people.

However, the fundamental principle of this whole concept is that those with celiac disease are experiencing severe symptoms. This assumption is not based on the facts of celiac disease. The symptoms of those with celiac disease vary just as widely as those with gluten sensitivity. And the data on this topic clearly indicates this. Many celiacs have essentially no symptoms at all. 

The subjective experience of reacting to gluten does not provide any indication about whether or not a person is celiac or experiencing a non -celiac gluten sensitivity. The only true difference is that celiacs have villous atrophy in the small intestine. Therefore it is not accurate to think of gluten sensitivity as celiac light.

Excerpt from Celiac.com:

Should gluten sensitivity be thought of as “celiac light,” as just one of the milder manifestation within the wider spectrum of celiac disease? Some doctors and researchers think so.

Over the past several years, there has been increasing discussion concerning gluten sensitivity as a possible cause of irritable bowel syndrome (IBS) symptoms in patients for whom celiac disease has been excluded. 

This is undoubtedly because gluten sensitivity, like IBS, is a symptom-based condition of diverse pathogenesis. As discussed, some have argued that gluten sensitivity might be best thought of as “celiac light,” representing the milder domains of the celiac disease spectrum.

More information on Celiac disease here.

Image thanks to NIH.gov

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(image thanks to mambosprouts.com)

With all of this news lately about Domino not-so-gluten-free pizza, we thought that this would be a good time to remind people what Celiac disease and Gluten intolerance is and is not.

What Is Celiac Disease?


Celiac disease is a hereditary allergy to gluten that results in damage to the small intestine. Common symptoms include loose stools, fatigue, weight loss and generally poor health. However, symptoms can vary widely and include constipation, weight gain, and a skin condition called dermatitis herpetiformis.

What Is Gluten? 


Gluten is a protein found in wheat, barley, and rye. Gluten is responsible for the springiness and stretchiness of bread. Without it, bread turns out heavy and dense. 



How Is Celiac Disease Diagnosed? 


Celiac disease can be assessed by blood tests or by a biopsy of the small intestine performed during an upper endoscopy. The blood tests include the tissue transglutaminase antibody test and the newer deamidated gliadin antibody test. The endomysial antibody test is older and is not as senstive as the newer tests. 



How Common Is Celiac Disease? 


The occurrence of celiac disease is much higher than previously thought. A recent study put the prevalence at 1 in every 133 people, making it one the most common genetic diseases known. Once diagnosed, 1 in 22 first degree relatives, and 1 in 39 second degree relatives, is also diagnosed positive.

How Is Celiac Disease Different from a Gluten Intolerance? 


Although celiac disease is a gluten allergy, it is only one form of gluten allergy. Many react to gluten and may have elevated serum antigliadin antibodies, but they do not have damage to the small intestine. These people have a negative biopsy of the small intestine, as well as negative antiendomysial antibody and tissue transglutaminase tests. 

How Common Are Gluten Allergies? 
Although no studies have been done on the prevalence of gluten intolerance, the prevalence of gluten allergies is certainly higher than that of celiac disease alone. 



What Is the Treatment for Celiac Disease and Gluten Intolerance? 


The treatment is identical for both celiac disease and gluten intolerance and involves removing all sources of gluten from the diet. This means that a person with a gluten allergy should not eat bread products, pastas, or processed food of any kind that contains wheat, rye, or barley in any form. Individuals require special dietary counseling. Fortunately, many alternative sources for gluten free breads, pastas and other foods now exist and are easier than ever to find.

Testing?

The first step is to get proper testing for Celiac disease and gluten intolerance. Contact the IBS Treatment Center for details.

Image thanks to mambosprouts.com

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A very interesting study was recently published by Scottish researchers on the relationship between celiac disease and bone density. They looked at 15 celiac patients and found that 3 of them had an autoimmune reaction against a bone protein called osteoprotegerin. This means that their own immune system was attacking their bone.

Previously it was commonly thought that low bone density in celiac disease was due to the malabsorption of nutrients required to build bone. Although this likely still plays an important role the development of osteoporosis, it is certainly not the only factor.

Few people appreciate the role of the immune system in building healthy bone, but more research will likely come out in the next few years regarding this relationship. I attended a conference a couple of years ago where I heard a fascinating presentation about the role of inflammation bone density and the ability of inflammation to interfere with the process of building bone. And as most researcher in the healthcare world recognize, inflammation is the thread that underlies most health issues. This is just another example of this, even with regard to bone density.

Unfortunately the study did not note whether or not this autoimmune reaction resolved once the celiac patients discontinued ingesting gluten. It also isn’t known how commonly this autoimmune reaction contributes to osteoporosis in celiac disease. Regardless, keep eating healthy foods and taking your vitamin D, calcium, magnesium and other vitamins and minerals that are good for your bone health. If you’d like to read the abstract for the study, click here.

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If you are already avoiding gluten but not feeling much better, you are not alone. This is far more common than most people realize. Maybe avoiding gluten has solved some of your problems, but not others. Or maybe it hasn’t solved anything at all.

This can happen whether or not you’ve been diagnosed with celiac disease, non-celiac gluten intolerance, or simply cut gluten out of your diet as an experiment. Regardless, there is a logical explanation, and it isn’t necessarily as simple as saying that you must be getting some gluten contamination.

Avoiding gluten can provide wonderful results, but when it doesn’t, or leaves a lot of room for more improvement in your health, it’s important not to give up. Of course you want to thoroughly evaluate you diet for hidden gluten. But you also need to consider other causes.

For example, gluten may not be your only food intolerance or allergy. It is common for people who are gluten intolerant to react to one or more other foods. It’s also common to have an imbalance in the ecosystem of your digestive tract. This can involve bacterial overgrowth, yeast overgrowths, deficiencies in good bacteria, and even parasites.

This is a very large topic and an extremely important one, which is why I dedicate an entire chapter in Healthier Without Wheat to discussing it. If you or someone you know is avoiding gluten but has yet to experience the full benefits that others might expect, then this book will give you the information that you’ve been looking for.

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If is often assumed by those who recognize that celiac disease is not the only type of gluten intolerance that at least celiac disease is the end stage of gluten intolerance. This is one of the big misconceptions about gluten intolerance.

This has never been studied, and there is no evidence to suggest this, much less prove it. Studies have clearly shown that many celiacs, and even a majority of celiacs, do not suffer from any noticeable health effects and have no idea that they have celiac disease.

This is not to say that they wouldn’t be much better off over the long run if they avoided gluten. But it does help put things into perspective.

It is well understood that celiac disease can affect people of any age. Therefore you may develop villous atrophy as a young child, or maybe not until you are 70 years old. It does not follow a logical pattern of progression.

However, most of the memorable stories surrounding celiac disease are about people who are very ill and have gone through many years of a long ordeal trying to get help. Then a doctor finally thinks to look for celiac disease, and Shazam! The testing is positive and they get all better.

Those make for very powerful stories. Therefore the impression is given that celiac disease must be the most severe form of gluten intolerance. Sometimes it is severe, but other times it’s not.

And sometimes non-celiac gluten intolerance is very severe. Stay tuned.

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If you haven’t already heard, I’ve been working on a new book titled “Healthier Without Wheat: A New Understanding of Wheat Allergies, Celiac Disease, and Non-Celiac Gluten Intolerance.” It’s taken a lot longer to finish than I had hoped, but it’s nearing completion and I thought that you might be interested in learning a little bit about how a book is made.

I finished the book a few months ago, but then it went to my editor, who kindly pointed out that there were many problems and mistakes, in fact, thousands of them. This is common in the publishing world, par for the course, so I wasn’t too disappointed. I then worked it over again and sent it back to my editor, who then found more mistakes. Then it came back to me, and then back to my editor, etc. You get the idea.

The good news is that I’m finally done with it! The bad news is that it is still a ways from being officially published. It now goes to the interior designer, who will format the text and illustrations and make it look good. This process will take another month or so.

As things progress I will keep you informed. And occasionally I’ll give you some hints about what it is in it. You can already tell quite a bit just from the title. For those of you who have a wheat allergy or any form of gluten intolerance, I think that you’re really going to like it.