gluten sensitivity

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…)


Dr. Stephen Wangen of the IBS Treatment Center.
Dr. Stephen Wangen of the IBS Treatment Center.

There have been several articles and blogs published lately that claim that gluten sensitivity non-celiac gluten issues are a fad and have no medical validity.

This is an unfortunately common response. It is easy to make fun of the gluten-sensitive population. They are different.  They are setting a new standard.

While some people avoiding gluten have no legitimate reason for doing so, and don’t know what gluten is, there are many people who have measurable immune system reactions to gluten and/or other chemicals in wheat – Non-celiac gluten sensitivity: literature review.

These people can have a wide variety of symptoms, or no noticeable symptoms. This is not different than celiac disease, where many people do not have noticeable symptoms. Let me state that again – many people with celiac disease don’t report having symptoms. Celiac disease: risk assessment, diagnosis, and monitoring.

Either way, avoiding gluten still has benefits that are important: Benefits of a Gluten-free diet for Asymptomatic Patients with Serologic Markers of Celiac Disease.

Don’t let these comments about it being a fad go unchallenged. Running was once a fad too. That didn’t make it bad.

Just because some people are avoiding gluten for the wrong reasons does not mean that others can’t have real health problems caused by eating gluten grains. They do. We’ve seen it hundreds of times.


Dr. Stephen Wangen of the IBS Treatment Center.
Dr. Stephen Wangen of the IBS Treatment Center.

Do you know what gluten sensitivity is? Do you know how it differs from Celiac Disease? Maybe you don’t even know what gluten is.

Here is a gluten definition refresher: Gluten is a protein that is found in many different grains, including wheat, spelt, rye, and barley.

If you are sensitive to gluten, then you are sensitive to all of these grains, and to anything made from any of these grains.

Celiac disease is a very specific kind of gluten sensitivity. Celiac disease occurs when there is a very specific kind of damage that occurs to the villi in the small intestine. This damage is called villous atrophy.

This damage may be seen on a biopsy of the small intestine, which is taken during an upper endoscopy performed by a gastroenterologist. It can also be diagnosed with a blood test.

However, other than the villous atrophy, there is often very little difference between celiac disease and other forms of (non-celiac) gluten sensitivity in terms of symptoms or reactions to the ingestion of gluten. Non-celiac gluten sensitivity can cause just as many problems as celiac disease, and be just as severe. (more…)

Could It Be Gluten?

DrWangenPressPicWeb-199x300This article was written by the IBS Treatment Center’s Dr. Stephen Wangen and originally published at

Think that your problem couldn’t be caused by gluten sensitivity? Think again. If you’re still under the impression that people who react to gluten always have diarrhea, then you’re still old school. If you think that it has to involve any digestive symptom at all, you’re behind the times.

Gluten sensitivity comes in all shapes and sizes. For example, take celiac disease. Celiac disease is a specific kind of damage in the small intestine known as villous atrophy. This is a symptom associated with gluten sensitivity. It just happens to be a symptom with its own disease name.

With or without celiac disease, it’s clear that gluten sensitivity is associated with all kinds of health problems. Got fatigue? That could be your gluten sensitivity. Brain fog? That too. Insomnia? Ditto. Poor recovery from exercise? Poor endurance? All can be due to gluten sensitivity.


Do we want to do true preventive medicine, or are we just putting out fires? 

A huge percentage of celiacs don’t experience symptoms and therefore would not be classified under this article’s (Q&A with Leading Celiac Experts on Gluten Sensitivity, Schizophrenia, and Nutritional Deficiencies) definition as being gluten sensitive. But of course they ARE gluten sensitive. We need to be a lot smarter than the lab work. This is not bad science. But it is a very poor thought process and bad medicine.

Excerpt from

“As an example, the detection of antibodies against the enzyme tissue transglutaminase (tTG test) in the blood is used to detect the presence of celiac disease. In gluten sensitivity, research has not identified any biomarkers. What this means is that we have currently no objective parameter on which to base our diagnosis of this condition. Some say anti-gliadin antibodies (AGA) are a marker for gluten sensitivity. However, while about 50% of patients with gluten sensitivity may have elevated AGA, it turns out that up to 20% of healthy individuals have this same finding. Hence, one cannot rely on this as a biomarker. In fact, not only do half of the gluten sensitive patients have normal AGA, but, if we consider the prevalence of gluten sensitivity to be about 2%, this means that out of 100 people, 21 will have high AGA. Of these 21, only 1 however will be gluten sensitive! As you can see, there is no value of AGA as a biomarker.”

But if we consider that as many as 20% of the population considered “healthy” may be gluten sensitive, despite very limited symptoms, we find that all of those with elevated AGA are gluten sensitive and may experience health benefits they didn’t expect by cutting gluten out of their diets.

Remember to think objectively when reading information online. What/who is the source? What is their motivation, experience, etc. Your health is up to YOU!


(image thanks to

May is National Celiac Disease Awareness Month and a great time to educate people on gluten sensitivity.

 The term gluten sensitivity comes from the increased attention to the clinical importance of those who do not have celiac disease but respond symptomatically to the gluten-free diet.

Gluten is a protein found in wheat, barley, and rye, and is responsible for the springiness and stretchiness of bread. Allergies and intolerances to gluten have been the subject of intensive research over the past decade. Much of this research has focused on celiac disease, which is a special form of gluten intolerance. It is a hereditary response to gluten that results in a very specific type of damage to the small intestine. Common symptoms, which can mirror those of IBS, include loose stools, constipation, or both; fatigue; weight fluctuation; dermatitis; and more.

Celiac disease is diagnosed by measuring damage to the small intestine, either by blood testing or, traditionally, with a biopsy of the small intestine. A positive biopsy means that the villi, or small finger-like extensions of the intestinal lining, have been damaged; this is known as villous atrophy. However, recent studies have shown blood testing to be as accurate as a biopsy.

People with celiac disease will show a marked reduction in their villi, almost as if the villi have been worn off. Damage to the villi causes a dramatic reduction in the surface area of the small intestine, resulting in both poor digestion and the poor absorption of many nutrients.

Celiac disease is not the only form of gluten intolerance or allergy. Many people react to gluten by producing elevated IgG antibodies to gluten or wheat, but they do not have damage to the small intestine. Their test results for celiac disease are negative. They become quite frustrated with traditional medicine, with its narrow focus on celiac disease, because they are told that their negative test results meant that they are not allergic or intolerant to wheat, barley, or rye.

Yet when they eat a piece of bread they become sick.

Gluten is found in nearly all bread products and all pastas, as well as in most breakfast cereals, cookies, muffins, cakes, soy sauce, pancakes, waffles, soups, sauces, and gravies. Beer, ale, lager, and stout contain gluten. Malt, malt extract, and caramel flavorings, which are used to add flavor to a wide variety of foods, contain gluten.

The treatment for celiac disease and for a gluten intolerance or allergy is identical. It means removing all sources of gluten from the diet. This is not an easy task, because so many of our foods contain gluten. Dietary counseling, such as that provided at the IBS Treatment Center, can make the job easier.

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