Gluten Sensitivity IS a form of Gluten Intolerance

The argument over the existence of gluten sensitivity as a legitimate condition was finally laid to rest recently in a landmark article published in February 2012 in BioMed Central. The authors made up a veritable ‘who’s who’ of the most respected doctors in the gluten research world and the fifteen of them came together last October 2011 to hash out a consensus as regards treatment and nomenclature as it concerned the three major varieties of gluten intolerance: wheat allergy, celiac disease, and gluten sensitivity.

I want to share with you the findings of this article and how you can use it to ensure that you, your family, and friends are properly diagnosed when it comes to gluten intolerance. It has never been argued that true wheat allergies exist, and testing that’s accurate for the diagnosis has been around for a long time – namely a blood test and skin scratch test.

‘Classic’ Celiac Disease vs Celiac Disease

Similarly, celiac disease has never been refuted as a disease, but the criteria for a positive diagnosis has been the subject of hot debate of late.

‘Classic celiac disease’ is a term used to describe the original presentation of the disease when it was first identified over 100 years ago. This includes a patient complaining of digestive bloating, pain, diarrhea, and extreme weight loss.

A patient with ‘classic celiac’ will tend to follow a pattern of being found positive for traditional blood celiac tests as well as an intestinal biopsy (a procedure where pieces of the small intestine lining are removed and then evaluated to see if they are structurally normal or degraded. Small intestinal destruction is the hallmark of classic celiac.)

We now know that non-classic celiac disease is much more prevalent than the classic form and testing for it requires a different approach. Because non-classic often presents with no digestive complaints, the typical tests often show negative, despite the disease being present.

Celiac is known to shorten life span, so missing its diagnosis is a serious matter and one we must remedy soon. Currently, we only diagnose 3 to 5% of all of those suffering from the disease. Here at Root Cause Medical Clinic, we utilize testing that is more broad-based with the intention of diagnosing non-classic celiac more effectively.

A Positive Biopsy is NOT Necessary for a Celiac Diagnosis

A new paradigm was created in this paper that embraces, correctly in my estimation, the fact that an intestinal biopsy does not HAVE to be positive for a diagnosis of celiac disease to occur. This is a large step forward because for too many years patients have been told that they were fine to consume gluten simply because a biopsy was negative, when in fact they did have celiac disease.

Most importantly, this paper officially defines gluten sensitivity as a reaction to gluten that is not a true wheat allergy nor celiac disease. The classic celiac blood tests (tTG and EMA) would be negative in a patient suffering from gluten sensitivity, according to the authors.

I concur. I was also happy to see that the authors mentioned that one of the blood tests we utilize here at Root Cause Medical Clinic (anti-gliadin antibodies – AGA) might be found positive with gluten sensitivity. While they haven’t embraced the AGA test as a conclusive test, they at least mention that it could be a marker.

This is a big step in the field that has, up to this point, categorically stated there is absolutely no lab test available to measure gluten sensitivity.

Personally, here at Root Cause Medical Clinic, we find the AGA test to be quite helpful in diagnosing gluten sensitivity and we use it (along with a larger panel of tests) and a gluten elimination diet to help us identify patients with gluten sensitivity.

Symptoms of Celiac Disease & Gluten Sensitivity DO Overlap

The researchers also stated that the symptoms associated with gluten sensitivity could readily overlap those seen with celiac or wheat allergy patients and those symptoms would resolve with a gluten-free diet.

The authors correctly point out that many symptoms associated with gluten sensitivity are extraintestinal in nature – meaning that they are found outside the digestive tract. This is very true and something that must be disseminated broadly.

I still hear from patients who, almost apologetically, state they are convinced of their gluten sensitivity despite having no digestive symptoms. I quickly let them know they are in a very good company and many many people suffering from gluten sensitivity have no digestive complaints.

This data should hopefully give support to those many people who are denied testing because they don’t fit the criteria of classic celiac disease due to their absent digestive complaints. Specifically, conditions such as eczema or skin rash, headaches, foggy thinking, fatigue, depression, anemia, and bone or joint pain were noted by the authors as common symptoms of gluten sensitivity.

The vast increase of gluten-free food and beverages on the market, to the tune of a 28% compound annual growth between 2004 to 2011, was assumed by the authors to imply that people far beyond those diagnosed with celiac disease were purchasing these products. [Note: this trend of growth shows no sign of slowing in 2012.] In fact, they stated that “the rest of the market is filled either by people who undertake the diet as occasional consumers (no medical necessity) or by individuals affected by maladies that have been claimed to be affected by gluten exposure, including autism spectrum disorder, attention deficit hyperactivity disorder, multiple sclerosis, and irritable bowel syndrome, but for which there is no evidence of the effectiveness of the diet.” I strongly disagree with the above statement.

Research Supports Association between Gluten & Autism

Why do I disagree? Simply because there is ample research (plus my own clinical experience) that directly opposes it. Here are the facts:

1. In October 2011, I personally shared the stage with Dr. Fasano in Indianapolis at a gluten intolerance conference for the lay public of that area. In his lecture, he stated that while autism and celiac disease occur at the same time in only 2-3% of children, for those who did have celiac disease, 95% were cured of their autism symptoms with a gluten-free diet. Even more importantly, he went on to state that he found that 20% of autistic kids are actually gluten sensitive and have a leaky gut.

I think you’ll agree that there does seem to be some strong evidence that a gluten-free diet can be effective in treating children with an autism spectrum disorder. Clinically, I have seen very good success with a gluten-free diet in certain autistic children, as well as those suffering from ADHD.

Research Supports Association between Gluten & MS

2. In BMC Neurology 2011, in an article titled “Prevalence of celiac disease in multiple sclerosis”, the authors found an increased prevalence of the celiac disease in multiple sclerosis patients (11.1%) and also in their first-degree relatives (32%).

They stated: “Therefore, increased efforts aimed at the early detection and dietary treatment of celiac disease, among … multiple sclerosis patients, are advisable.” Obviously with an incidence of celiac disease in the general population of 1%, finding it in multiple sclerosis patients at a prevalence of 11% is worth noting.

It is well known that gluten affects the nervous system and it is also well documented that autoimmune diseases tend to occur together – celiac and MS are both autoimmune diseases. Clinically, I personally have seen improvement in multiple sclerosis in my patients who have undertaken a gluten-free diet.

Research Supports Association between Gluten & IBS

3. In the American Journal of Gastroenterology March 2011, a study that aimed to determine if patients with IBS (irritable bowel syndrome), but without confirmed celiac disease, legitimately improved on a gluten-free diet was conducted.

The individuals in the study were already using a gluten-free diet to control their IBS symptoms, but they did not have celiac disease and the authors wished to confirm if they ‘really’ were better gluten-free when a double-blind placebo study was undertaken. Note: double-blind randomized placebo-controlled studies are considered the ‘gold standard’ when it comes to research. This study met those criteria.

The patients were very compliant. 68% of those being fed gluten (unbeknownst to them since it was a double-blind placebo study) reported that they felt worse. They were found to be significantly worse within 1 week of beginning the gluten-containing diet. Symptoms such as pain, bloating, fatigue, and stool consistency all worsened.

The control group not receiving gluten did not suffer these symptoms. The authors concluded that non-celiac gluten sensitivity may very well be a legitimate condition although they admitted that they didn’t fully understand the mechanism behind it. [Note: they are not alone and that is why more research needs to be done.]

In my personal 20+ years of clinical experience, there are few cases of IBS that I and my fellow clinic doctors have treated that were not helped with a gluten-free diet. Typically the elimination of gluten from the diet resolved most if not all symptoms. Therefore, looking at the study above, I think it is safe to say that a gluten-free diet has shown ample effectiveness when it comes to IBS.

The Value of this Report is Vast – Share it with your Doctor

Hopefully, I have defended the reason for my disagreements with ample research support. However, those disagreements are not the important takeaway from this landmark report. What I feel is most important and valuable is that this study revealed the following:

1. It fully embraced gluten sensitivity as a legitimate condition
2. It acknowledged the AGA test as a potential marker for gluten sensitivity
3. It stated that gluten sensitivity often accompanies symptoms outside the digestive tract and they range from skin issues to behavioral, to joint pain, and more
4. It points out that an intestinal biopsy does not have to be positive for a diagnosis of celiac disease
5. And lastly, that much more research needs to occur to fully understand the mechanism that underlies gluten sensitivity and appreciate the percentage of the world population affected.

You can now show this study to your doctor (it is not written for laypeople) and this blog to your friends. No longer does anyone need to believe that gluten cannot possibly be affecting their health simply because they have negative celiac blood tests or biopsy or because they don’t have digestive complaints.

With this data, you can educate your doctor that gluten sensitivity does not require the devastating digestive symptoms and loss of weight associated with classic celiac disease.

Quite the contrary, gluten-sensitive patients are frequently without digestive complaints altogether and suffer, rather, from symptoms outside the digestive tract. And finally, patients with symptoms from fatigue to schizophrenia, from joint pain to depression, and from seizures to skin problems, can insist on finding out whether their symptoms are caused by an intolerance to gluten.

We now know there is a vast array of symptoms and diseases (over 300) associated with gluten intolerance and they are far beyond what many doctors are aware of.

We CAN Increase Awareness & Help our Friends & Community

I hope this was helpful to you. Please share this information with your doctor, your family, and friends. It is only through increased awareness that we will begin to diagnose all those patients with celiac disease and gluten sensitivity who remain undiagnosed or misdiagnosed and suffer terrible health consequences as a result.

I am happy to answer any questions you may have and am delighted to assist you with your health should you require help.