what is 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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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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drwangenIn this week’s Digestive Health Smartbrief, self proclaimed experts on gluten sensitivity are acknowledging that there is a lot more gluten sensitivity than there is celiac disease. That is good news. But…they are still confused…

I (Dr. Stephen Wangen) have been writing about and studying gluten sensitivity for over a decade, however I was not included as an expert on this article. This is just as well, as the experts are also saying other things with which I don’t want to be associated with.

Among other things, they point out that before you diagnose gluten sensitivity that you should first rule out an allergy and auto-immune causes. This makes no sense for two primary reasons.

First, gluten sensitivity, just like celiac disease, is an allergy.

Secondly, gluten can cause auto-immune reactions, not the other way around. Celiac disease itself is an auto-immune reaction. If you did have an auto-immune disease, then you’d want to be looking for the cause, which might be gluten.

Sadly, the medical system is so warped that it often can’t understand the difference between a symptom and a cause.

It’s not the first time, but will it never end?

Excerpt from Digestive Health:

Experts such as Dr. Alessio Fasano, Director of the Mass General Center for Celiac Research and Treatment, estimate an incidence of gluten sensitivity of up to 7 percent of the population. The causes are under study, but hypotheses include intestinal inflammation, changes in the gut microbiota, and high-gluten wheat.

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Study Explores Potential Celiac Disease in Adults

(img from facebook.com)
(img from facebook.com)

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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Villous atrophy is a sign of celiac disease. Villi are small finger-like extensions of the lining of the intestine that are visible only under the microscope.

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.

For more information on the proper testing, contact our office with questions at Info@IBSTreatmentCenter.com.

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(image thanks to kelownaceliac.org)c

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.

(more…)

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If you are allergic to gluten, then the result of removing gluten from your diet is generally a reversal of your health problems.

Symptoms very often resolve, some faster than others, and you gain a new definition of optimal health. Even celiac disease is reversible, usually resulting in complete recovery of the damage to the small intestine.

Gluten Intolerance Case #1

27 year old male with loose stools, gas, Irritable Bowel Syndrome, inability to gain weight, acne on back, poor endurance, and hypoglycemic/needing to eat every 2-3 hours. Patient was very athletic and in most respects would be considered extremely healthy. Allergy testing demonstrated a severe allergy to gluten. Removal of gluten from his diet resulted in complete resolution of his Irritable Bowel within 2 days. Over time acne cleared, endurance improved dramatically, and he is no longer hypoglycemic.

Gluten Intolerance Case #2

24 year old female with a long history of sinus infections including two sinus surgeries, asthma, diarrhea, headaches, chronic fatigue, and dizziness. Food allergy testing was positive for allergies to gluten, dairy, and eggs. This patient also tested positive for hypothyroidism and iron deficient anemia. Removal of these foods from the diet and treatment of hypothyroidism and anemia has resulted in significant improvement in energy and the resolution of diarrhea and dizziness. Sinus infections have been greatly reduced, as have headaches, and her health continues to improve with time.
(more…)

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Villi are small finger-like extensions of the intestinal lining which have been damaged in celiac disease.

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.
(more…)

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Biopsy of small bowel showing celiac disease. (image 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.
(more…)

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(image thanks to medicalsymptomsguide.com)

The following study comes thanks to National Institutes of Health.

OBJECTIVE:
Persistent villous atrophy in patients with celiac disease (CD) on a gluten-free diet (GFD) is reported with increasing frequency. The aim of this study was to evaluate a possible association between persistent damage of the villi and “atypical” gastrointestinal symptoms in CD patients on a GFD.

MATERIAL AND METHODS:
Sixty-nine CD patients on a GFD were divided into two groups: Group A included 42 patients (6 M, 36 F, age range 17-62 years) undergoing esophagogastroduodenoscopies (EGDs) due to the presence of symptoms; Group B included 27 control patients (6 M, 21 F, age range 24-71 years) who were asymptomatic at the time of the study. Both groups underwent EGDs and a duodenal histologic study.

RESULTS:
Persistent endoscopic lesions were more frequent in Group A (30/42) than in Group B (12/27; p=0.01). Villous atrophy was significantly more frequent in Group A than in Group B: 85% versus 33% (p<0.0001; odds ratio (OR)=12; 95% CI 3.7-38.9). Gastrointestinal symptoms in the Group A patients were different from those present at CD diagnosis: anemia/diarrhea/weight loss in 6 cases; gastroesophageal reflux disease (GERD)-like symptoms in 12 cases; abdominal pain/constipation in 24 cases. In Group A there was no difference in gender distribution, age and duration of GFD between subjects with normal villi and those with persistent partial villous atrophy. Patients with persistent symptoms showed a higher intraepithelial eosinophil count (p=0.005) than the asymptomatic patients (p=0.01).

CONCLUSIONS:
Persistent intestinal villous atrophy in CD patients on a GFD is associated with gastrointestinal symptoms considered “atypical” for CD and not present at CD diagnosis.

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Source
Department of Internal Medicine, University of Palermo, Hospital of Sciacca (AG), Italy. acarroccio@hotmail.com
Carroccio A, Ambrosiano G, Di Prima L, Pirrone G, Iacono G, Florena AM, Porcasi R, Noto D, Fayer F, Soresi M, Geraci G, Sciumè C, Di Fede G.
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Image thanks to medicalsymptomsguide.com

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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 karlloren

Celiac disease is traditionally diagnosed with a positive biopsy of the small intestine. The biopsy will demonstrate damage to the intestine known as villous atrophy. Villi are small finger-like extensions of the lining of the intestine that are visible only under the microscope.

People with celiac disease and other conditions 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 the poor digestion and absorption of many nutrients.

Biopsies are done in a hospital on an outpatient basis, but require strong medication due to the invasive nature of the procedure. An endoscopy is performed, which involves a tube being placed into the mouth, down the esophagus, and past the stomach. A tissue sample can then be taken from the small intestine.

Although the small intestine is extremely important to our health, in most cases the value of the biopsy in diagnosing celiac disease is highly questionable. About 98% of people with a gluten allergy or celiac disease can be diagnosed as being allergic to gluten with a blood tests alone. There is no added benefit from performing the biopsy. The results of the biopsy do not change the form of treatment nor the outcome for the patient. Only if the blood tests are negative can a biopsy potentially provide useful additional information.

Image thanks to karlloren