Celiac Madness and the Gluten-Free Diet : Exclusive Article by J. E. Williams

Friday Mar 30 | BY |
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Are so many people really allergic to wheat?

Separating medical fact from fiction is one of the roles of any good clinician. It helps to have a knowledge base and a few years of experience. Instilling confidence and inspiring hope that the patient can and will get better is important. The human mind, however, tends toward fantasy and fear. The same things that propel the Hollywood movie industry can work against the patient’s best interests. That’s why every once in a while, we need to step back and take a second look at common conditions to see what the reviewers of the latest “movie” have to say.

The whole issue of gluten and the gluten-free diet is no exception. Let’s explore what I’ve learned from patients and what the most recent research tells us, and then compare the two to find out what’s right for you.

Signs of Celiac Disease
In a review paper in Current Opinions in Gastroenterology, the authors conducted a critical summary of recent scientific and clinical advances in the diagnosis and treatment of celiac disease, which they spell “coeliac”—the British way.
Celiac disease is characterized by a derangement of the mucosal immune response to gliadin peptides. People with this condition have a special gliadin peptide that triggers interleukin-8 release in a manner unique in patients with celiac disease. Gliadin is a glycoprotein found in wheat and other cereals within the Triticum family.

There are no “typical” signs and symptoms of celiac disease. Most people have general complaints, such as diarrhea and bloating. A wide variety of other symptoms are associated with wheat sensitivity, however, including mood changes, fatigue, joint pain and muscle cramps, tingling in the extremities, and rashes. Celiac disease symptoms can also mimic those of irritable bowel syndrome, gastric ulcers, Crohn’s disease, parasite infections, and anemia. Another gluten-related condition, dermatitis herpetiformis—an itchy, blistering skin disease—also stems from gluten intolerance.

There is also an association of celiac disease with sarcoidosis, psoriasis, restless leg syndrome, vitiligo, immune thrombocytopenic purpura, idiopathic dilated cardiomyopathy, primary hyperparathyroidism, and multiple sclerosis.
Just about every thing can be blamed on wheat, right? That’s not fair, however.

Symptoms Don’t Equal Disease
Wheat has sustained humans for thousands of years. The problem seems to be the gliadin molecule in gluten, and modern GM strains of wheat are engineered to have higher percentages of gluten.

Celiac is common around the world. It’s as frequent in Asia, Africa, and Eastern Europe as it is in Western countries. The incidence of “real” gluten allergy, i.e. celiac disease, however, is low: somewhere between 1-3 percent. This tells me that all peoples are susceptible to gluten, and points to an underlying genetic propensity for humans to be sensitive to gluten and gliadins, but also indicates that most people with wheat-sensitive symptoms do not have celiac disease.

That’s not the whole story, however. It’s estimated that between 55-70 percent of Americans have some form of gluten sensitivity. Symptoms are similar to full blown celiac disease, but usually milder: abdominal bloating, distention, discomfort, and changes in stool elimination, compared to the severe reactions of those with celiac disease. Many people don’t have specific symptoms at all, but when on a gluten-free diet, feel remarkably better.

There are many things that make gluten sensitivity worse, including the overuse of NSAIDS (ibuprofen, aspirin). Over supplementation with vitamin A, which exhibits paradoxical proinflammatory activity, can also make celiac symptoms worse. In contrast, vitamin C may be a beneficial supplement in coeliac disease as it inhibits the production of IL-15 and other proinflammatory cytokines in cultured duodenal biopsies.

Testing for Celiac Disease
People with glucose metabolism concerns, like diabetes, have a much higher tendency to be gluten intolerant. If you have diabetes or even if you are pre-diabetic, have IBS, suffer from frequent abdominal bloating and discomfort after meals, especially where wheat is consumed, avoid consuming wheat, and get a blood test for celiac.

A comprehensive celiac test includes gliadin antibodies, endomysial antibodies, tissue transglutaminase (tTG) antibodies; and total IgA. If you really want to get deep into the underlying reason, ask your doctor to do genotyping for HLA-DQ2 and HLA-DQ8.

In my clinical experience, very few people have true celiac disease. They do not test positive for gliadin antibodies. Most have gluten “sensitivity,” IBS, or other food allergies. However, because it’s a multi-layered condition with many overlapping symptoms, I treat “as if” they had celiac, even when the test results are negative for gliadin antibodies.

When a Gluten-Free Diet Doesn’t Help
Despite all the research data and natural remedy promises, the cornerstone of therapy remains the gluten-free diet (GFD). In my clinical experience, however, it causes a dramatic improvement in only about 30 percent of people. Even in people that get some benefit from GFD, a large percentage of them are dissatisfied and look for new ways to treat their condition. One method is to restrict other grains like oats and barley. Sometimes, you also have to remove corn, quinoa, and flax. Allergy tests for other foods like milk and soy, which can be highly allergic to the gut lining, may also be helpful.

Recently, a treatment of 10 days of the antibiotic rifaximin (1,200 mg/day) has been touted as a cure. At least one double-blinded randomized-controlled trial of patients with biopsy-proven coeliac disease and GFD-resistant symptoms, however, concluded that rifaximin did nothing to improve symptoms. Other treatments to consider are a raw or fermented food diet, moderate fasting, supplementing with probiotics, colon hydrotherapy with ozone, and fecal implants. Very good results have been reported after implantation of stool culture from healthy, non-celiac individuals.

Celiac disease is a serious condition. It occurs worldwide, influences all races and cultures, and appears to be getting more common. Modern Western people have a high occurrence of digestive symptoms that mimic celiac. This is likely due to wheat intolerance combined with other factors. All cases will benefit from a 3-month trial of GFD. Avoid vitamin A if you have celiac-like symptoms. If GFD is not sufficient to reduce symptoms, talk to a doctor experienced in celiac and wheat sensitivity about other options.

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Source:
Matthew J. Armstrong; Vinod S. Hegade; Gerry Robins, “Advances in Coeliac Disease, Curr Opin,” Gastroenterol. 2012;28(2):104-112. © 2012 Lippincott Williams & Wilkins, http://www.medscape.com/viewarticle/759778_print.

Picture courtesy pierrotsomepeople via Flickr.com.

Dr. J. E. Williams

J. E. WILLIAMS, OMD, FAAIM

Dr. Williams is a pioneer in integrative and functional medicine, the author of six books, and a practicing clinician with over 100,000 patient visits. His areas of interest include longevity and viral immunity. Formerly from San Diego, he now resides in Sarasota, Florida and practices at the Florida Integrative Medical Center. He teaches at NOVA Southeastern University and Emperor’s College of Oriental Medicine.

Visit Dr. Williams’ Website: https://drjewilliams.com/

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6 COMMENTS ON THIS POST

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  1. Jana says:

    Thank you for this article. I’ve been toying with going gluten free for a long time now. I seem to have separation anxiety every time I think about it.

  2. Samantha says:

    Thank you for sharing! I’m definitely passing this along. I know a few people who have “self-diagnosed celiac disease”. It went something like, “I feel X-symptoms after eating Y-wheat containing food, so I think I’m celiac”. I keep urging them to at least talk to a doctor and get some testing done so hopefully this helps them!

  3. Anne says:

    Thanks for the article. I have two questions. One is relating to Vitamin A. I take spirulina (1 TBS) and chlorella (1 tsp) daily. Would the Vitamin A contained in these food affect gluten intolerance? Also I wonder about flax. Why would flax not be recommended. Is it just that it can irritate the lining of the intestine or does it in fact contain any gluten?

  4. Carole says:

    Even though I’ve been gluten-free as much as possible for over ten years, I have not regained good health. Then I came across the book “Wheat Belly”. I’ve often had a distended belly, and other stomach discomfort. I was very impressed by this book,and actually shocked by the information revealed. Since then, I have done what I was never able to do before, gone totally grain-free, and the results were immediately apparent. I have been feeling more alert and energized than I have in a long time. I have been recommending this book to everyone I know, and am working on changing my family’s diet as well. Lots of cooking for me, but since I’m a housewife it’s doable and worth it.

  5. Maia Alpern says:

    Interesting. As someone with Celiac disease I found the article to be eye opening with respect to the figures he quoted for the population that reacts to gluten in some way. As a health coach specializing in gluten-free lifestyle management, I know many people have a sensitivity but didn’t realize it may go as high as 70%.

    The only problem I had with this article is his recommendation to stop eating gluten and then get tested. That might be ok if not much time has elapsed but to get an accurate test you must still be consuming gluten at the time you are tested. If you go gluten-free, start the healing process before the tests, you may get false negative test results. In addition, when gluten is reintroduced, often the reactions are much worse than when you were consuming it regularly.

    If you, or someone you know, might have issues with gluten, please go to http://www.gotglutened.com for my free 5 step program to get information regarding symptoms, suggested medical tests, educational video on the difference between celiac and gluten sensitivity, and more.

    Maia Alpern
    Founder of Nutrition-Tools.com

  6. Julia says:

    Wow, I’m surprised at this article as it is very incomplete. You make no mention of Dr. Haas who long long ago was the first to discover the cure for Celiacs in the Specific Carbohydrate Diet (SCD). You really should research more. The GAPS diet would work, too. Please see Elaine Gotchsall’s book, “Breaking the Vicious Cycle”, and Dr. McBride’s book, “Gut and Psychology Syndrome”, they’re an absolute must for anyone with any digestive problems. Bottom line, it’s not just about gluten.

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