Dangerous Grains - The Gluten Sensitivity Conundrum

Dangerous Grains - The Gluten Sensitivity Conundrum
by Jackie Burgess

I Introduction
II Checklist – signs and symptoms
III The Identification Problem
IV The Inflammation Factor
V Hidden,Unsuspected, Elusive Sources of Gluten
VI Exposure to the Gluten Molecule
VII Intestinal Permeability
VIII Treatment
IX Genetic Susceptibility
X Genetic Testing
XI Microscopic Colitis
XIII References


I. INTRODUCTION
Gluten sensitivity is a very big deal for a wide variety of reasons…much more so than you probably realize. The mainstay of most diets, bread and other wheat-containing foods, has surfaced as the culprit in many adverse health conditions. Bread, the staff of life, has played a cruel trick on a very large majority of people and is taking away health at a rapid clip. This is very serious stuff!

Compounding the problem is the fact that many people including physicians incorrectly think that gluten sensitivity relates specifically to officially-diagnosed Celiac Disease. Not so.
They also think that gluten sensitivity is mainly a gut issue… Also not true. The major system affected is neurological – the brain. Not the gut.
Some think there must be painful symptoms; also not true; silent symptoms are very common.

Almost daily, I see references to the dangers associated with gluten sensitivity. A recent newsletter article by Mark Hyman, MD, is titled:
“Gluten: What You Don’t Know Might Kill You” He says about 99% people who have a problem with gluten don’t even know it. They attribute their symptoms to something else.

This month’s AARP magazine talks about diagnosis shortcomings for various ailments. After reading the introductory case symptom description, I immediately pegged that as gluten sensitivity, which it was.

Hans just published in the current Afib Report the gluten sensitivity connection to afib.

There just so much information to share, it’s difficult to condense into a reasonably-sized post and although I’ve tried, this one is still lengthy because everything I have to share is critically important and cutting edge.

So this then begs the question:

What’s your gluten sensitivity I.Q.?
You may be surprised to learn what you think you know is not correct or is, at the very least, outdated. You are not alone. Misinformation is rampant.
Very significant health consequences manifest as a result of inflammation caused by gluten sensitivity. Gluten sensitivity is often referred to as an “iceberg syndrome” because so much lies hidden beyond the obvious.

Confusion is widespread regarding the term, gluten sensitivity, wheat sensitivity, and the auto-immune disorder, Celiac Disease. There is the auto immune disorder (Celiac) manifesting inside the intestinal tract and also non-celiac, manifesting outside the intestine. Either way, the gluten connection can be overlooked or misdiagnosed and treated incorrectly. Until now that is, because new tests are available that eliminate the guesswork. More later on the new Cyrex Lab tests.

Inflammation from gluten sensitivity is dangerous because of the damage it can cause…..often long before testing reveals a progression to intestinal villous atrophy as in true Celiac Disease or in other health problems not celiac-related. It’s well recognized that inflammation is the root of all chronic illness.

Silent Celiac manifests outside the intestine. There is an entire world outside the intestine dealing with gluten sensitivity. Most physicians and clinicians don’t have that understanding at all. Even medical students graduating today are pretty much thinking of celiac disease and gluten sensitivity as a GI disorder, solely, which is surprising because there is so much literature out there. Of the people who have some sort of gluten sensitivity or gluten reactivity in the body, only one third manifest with typical inflammatory changes in the GI tract. (O’Bryan)

• Gluten, Celiac Disease & Cancer -Lancet, April 1997
Malignancy may be the first manifestation of subclinical (silent) celiac disease. There are many areas of concern with gluten sensitivity.

• One of the most common and lifelong disorders in this country and Europe has double the mortality even if you have no markers that you can identify with it. NEJM June 2003

• Excess mortality was observed independent of histopathology JAMA, Sept, 2009

• Less than half of patients with celiac disease on a gluten-free diet have complete normalization of intestinal biopsies, intestinal permeability defects, and antibody levels (after a mean of 9.7 years on a GFD)..Dig Dis Sci (2010)

• Every time the disease is clinically diagnosed in an adult, that person has had for decades, disease in a latent or silent stage. N Engl J Med Oct. 3003

• To prevent the extensive tissue destruction and increased mortality associated with Gluten Sensitivity and CD, one of the benefits of testing should be to identify this as early as possible (at the Subclinical or Latent Stages) BMJ JULY 1999

This is a ‘heads up’ informational report gleaned from the very latest findings by well-known and acknowledged leading experts and explores current thinking, new identification nomenclature and cutting-edge lab testing not available until very recently. Recently, I collected three news articles published as “current gluten information” quoting physicians and a dietitian. They are incorrect, misleading and dangerous. By way of this report, I hope to give you an educational edge over those who aren’t informed.

Because this topic is enormous and workshops on just one facet can take a full day to explain, this report is, out of necessity, merely a snapshot or overview of the overwhelming amount of science showing the detrimental effects of gluten sensitivity. Information from three teleconferences (6.5 hours- courtesy Designs for Health) and the book, Dangerous Grains, constitute the majority of facts provided.

James Braly, MD Allergist, and co-author Ron Hagan, MA,
“Dangerous Grains”… both gluten sensitive.

Kenneth Fine, MD, Board Certified Internal Medicine and Gastroenterologist.
Founder and current director of the non-profit Intestinal Health Institute, Dallas, TX. and EnteroLab.

Thomas O’Bryan, DC, CCN, DACBN
Dr. O'Bryan is an internationally recognized speaker and workshop leader specializing in Gluten Sensitivity and Celiac Disease.
Dr. O'Bryan is a practicing graduate of the Institute for Functional Medicine's hallmark program Applying Functional Medicine in Clinical Practice. Dr. O’Bryan closed his practice almost 2 years ago to do the lecture tour full-time because he wants everyone to know we have to consider gluten for every condition that walks in the door.

CONFUSING TERMINOLOGY
There is much confusion in trying to ‘language’ this condition. Doctors have always thought of celiac disease as a disease of the intestines and many of the textbooks refer to it that way. The Latin word, celiac, comes from the word stomach. But the disease can manifest outside the intestines. Either way, sensitivities can be dangerous.(Braly)

An article in Gastroenterology titled “The Iceberg Commeth” (2004) said that celiac disease found outside of the intestine was more frequent than celiac disease within the intestine. A 2002 article, “Gluten Sensitivity as a Neurological Illness” (Journal of Neurology and Neurosurgery), said.. patients with an enteropathy (disease of the intestinal tract) represent only a third of patients with neurological manifestations of gluten sensitivity. That really puts it in perspective. Only a third of the patients that have neurological complications will demonstrate an enteropathy along with it.(O’Bryan)

People who have inflammation of the gut have double the risk of mortality. (O’Bryan)

“Gluten sensitivity is actually an autoimmune disease that creates inflammation throughout the body with wide-ranging effects across all organ systems including your brain, heart, joints, digestive tract, and more. It can be the single cause behind many different “diseases.” To correct these diseases, you need to treat the cause–which is often gluten sensitivity–not just the symptoms.” (Mark Hyman, MD)

Diagnosing gluten sensitivity accurately and conclusively has been elusive and obscure in many instances. Patients have been misdiagnosed and suffered the consequences. Exciting results from new, highly-specialized testing and a large collection of supporting science provide conclusive evidence that gluten sensitivity is not just a “celiac-related” disorder.

At last we have undisputable results from newly-available tests that conclusively identify who is at risk for tissue damage as a result of sensitivity to the gluten protein molecule, gliaden. No longer will there be misdiagnoses, false negatives and false positives and those with sensitivities can be treated and spared the adverse effects from unrecognized and untreated gluten sensitivity. It is critically important to understand why this is of such enormous concern. Elevated antibodies must be addressed. It is never ‘okay’ to allow antibodies to go untreated.
(O’Bryan)

Since both celiac and non-celiac gluten sensitivity are involved in a wide range of adverse health conditions and symptoms, you’ll probably be shocked when you run down the list that follows. Could gluten be contributing to your chronic illness? Or, possibly be the cause of obscure symptoms yet undiagnosed? The inflammation factor involved with consumption of gluten-containing grains… wheat, rye, barley, triticale, kamut, spelt and oats and especially the new, hybridized or GM strains of wheat. Ignoring the facts can be deadly.

FACING THE DENIAL FACTOR
Because gluten-containing foods-- bread, cereal, pasta, bagels, pretzels, pizza, wraps, crackers, baked goods – pie, cake, cookies and such are mainstay items in most Western diets and are consumed at every meal and snack every single day of our lives, a typical reaction to reading about gluten avoidance is that of intense resistance and denial because it’s unthinkable that a food so firmly entrenched in our daily routine could be the root-cause our illness. Just thinking about giving up these foods is overwhelming. Impossible, we say! But, the facts speak for themselves.

At the very least, you owe it to yourself to read with an open mind for the understanding as to why you need to be aware….if not for yourself; then, family or friends.

Scan the following list of nearly 200 illnesses or symptoms – many of which we see mentioned frequently in posts by afibbers. Mark those related to your health history and genetic/familial history as well. This list did not formally include atrial fibrillation, but knowing what we do about associated conditions that contribute to AF and because Paleo-style eating frequently reverses afib, I’m placing it at right at the top. In this regard, we are among those elite, progressive thinkers who have isolated primary contributors to the AF puzzle including gut disturbances, the inflammation caused by gluten sensitivity along with malabsorption issues that cause critical mineral/electrolyte deficiencies. In this regard, we are way ahead of the pack.

Conference Room Session 54 (Sept.2006) examined the positive influence for afibbers as a result of Paleo eating (grain and dairy avoidance) which brought about improvement from GI problems and associated inflammation. Now, there is much more expansive and conclusive evidence that needs to be known so this elaborates on that initial report. Gluten sensitivity is not just a “celiac-related” disorder. This is important knowledge for everyone – not just afibbers.

The reduction of symptoms as a result of Pale-style eating (no grains, no dairy) indicates that often people are sensitive to both gluten and dairy proteins. This is called cross-reactivity. Additionally, there are at least 24 other known cross-reactive foods for people who are also gluten sensitive so the solution may not be as simple as just avoiding gluten. Typically, doctors treating gluten sensitivity will have patients go both gluten and dairy free.

Bottom line: If you check any of the symptomatic complaints from the following list and they have not been addressed by your current remedies or drugs, at the very least, it would be well worth going on a strict gluten-free, dairy-free diet for at least a month and documenting what changes occur. Most often, the first is the absence of muscle and joint pain along with fatigue or a lifting of mental fog and other allergy symptoms. To prove to yourself you need to remain totally gluten free, you have only to reintroduce gluten (and/or dairy)and document what happens. Ideally, the new testing would be most appropriate but lacking that, at least initially, going completely and strictly gluten free is an important start.

If something you read in this report or see on this list gets you thinking about your own chronic health complaints, you absolutely MUST continue to follow up with your own research on the potential for a gluten sensitivity connection. It could save you from serious health consequences.

Healthy regards,
Jackie

II.CHECKLIST…
SYMPTOMS/CONDITIONS ASSOCIATED WITH GLUTEN SENSITIVITY
Source: Dangerous Grains (Braly) EnteroLab, various weblinks

From a list of nearly 200 illnesses, following are some that we often see referenced in posts by afibbers commenting on having various health issues and certainly, we all know people struggling to treat these ailments but have no clue about a gluten connection.
[As an example, I know two people treating thyroid issues. One had part of the thyroid removed but was never cautioned about gluten sensitivity; the other has elevated thyroid antibodies not being addressed and she has not been told by her endocrinologist to avoid gluten. She is becoming progressively worse and now has osteoporosis. I know another who undoubtedly developed intestinal cancer as a result of undiagnosed gluten sensitivity. She suffers from the arthritic symptoms, has osteoporosis, severe hair loss, had hip replacement and eventually bowel resection for cancer… the gluten sensitivity connection has never been discussed. J]

There are undoubtedly many surprises here. The various listings may seem redundant but are useful to identify the various designations for the same disorder. This is not a totally comprehensive list…just many examples of the most typical symptoms by various identifications.

BROAD CATEGORIES
Cancer
Autoimmune disease
Osteoporosis
Brain disorders – any psychiatric disorders
Intestinal disease
Chronic pain
Digestive disorders
Infertility and problematic pregnancies.

EXPANDED LIST WITH SUBGROUPS:
Autoimmune Diseases or disorders – any.
Arthritis, Autoimmune thyroid (Hashimotos’s), Auto-immune hemolytic anemia, Celiac disease, Cirrhosis, Crohn’s, Diabetes, Fibromyalgia, Hypoparathyroidism, Microscopic colitis, Multiple Sclerosis, Nephropathy, optic neuritis, oral canker sores, sarcoidoisis, Lupus (SLE), Trigeminal neuritis, vasculitis, Inflammatory Bowel Disorders, Idiopathic Addison’s, Vitiligo, Chronic Hepatitis, Primary Biliary Cirrhosis, Dermatomyositis, Sjogrens, Berger’s disease, Myasthenia gravis, Auto immune liver disease

Atrial Fibrillation
Arrhythmia is not formally listed in this extensive identification of symptoms related to inflammation caused by food sensitivity such as gluten or casein, but we (afibbers) know there can be a significant connection in sensitive individuals. We also know gluten can cause GERD and similar gastric upset that acts as a trigger for AF.

Gluten-associated medical conditions or symptoms…many of which have 6 or more sub-categories…

Abdominal bloating/distension, pain
Elevated alkaline phosphatase-- serum and bone
Addison’s disease
Alopecia areata (hair loss) esp. in celiacs
Alcoholism
Alzheimer’s
Amyloid plaque
Anemia, folic acid deficiency and iron deficiency and elevated liver enzymes.
Apthous ulcers/canker sores.. 25% of celiacs
Arthropathies –including arthritis, undifferentiated, arthralgia, myalgia, polyarthritis, juvenile and rheumatoid arthritis, gout, gouty arthritis
Asthma
Atopic disorders including allergic rhinitis, asthma, eczema, chronic urticaria, psoriasis, keratosis pilaris, and acne
Autism, ADD, ADHD, dyslexia, Down syndrome, Asperger’s
Elevated antibodies
Insulin-dependent diabetes mellitus
Autoimmune disorders
Bone diseases – osteoporosis, osteopenia, osteomalacia, bone pain, bone fractures, elevated bone alkaline phosphatase, Elevated serum osteocalcin, hypocalcemia, hypocalcuria, hypoparathyroidism- magnesium-deficiency induced.
Calcium deficiency
Cancers – Adenocarcinoma of small intestine, B-cell lymphoma, bladder, brain, prostate, squamous cell of pharynx and esophagus, T-cell lymphoma of small intestine… more frequent in celiac and non-Hodgkin’s lymphoma, testicular cancer.
Cerebellar ataxia
Cerebral atrophy, cerebellar syndrome, calcification, and syndromes such as epilepsy, cerebral calcification, headache, mental deterioration, visual disturbances.
Chest pain, non cardiac…esophageal symptoms
Cirrhosis
Elevated Cholecystokinin (CCK)
Colitis, Crohn’s
Chronic fatigue
Dementia, intellectual impairment, brain plaques,
Depressive illness – depression is the most common symptom of gluten intolerance
Dermatitis herpetiformis – classical non-GI manifestation of Celiac
Diarrhea, chronic
Diverticulitis
Duodenal ulcers
Ears – fluid - resulting in dizziness, balance issues (vertigo), itching ears
Eczema
Edema
EEG abnormalities – may persist for 1 year on gluten-free diet
Emotional behavioral disorders… irritability, petulance, impulsivity, depression, anxiety, aggressiveness, autism, ADHD, Schizophrenia, Asperger’s
Epilepsy – associated with cerebral calcification, migraines, hyperactivity, myoclonic ataxia.
Esophageal symptoms (dysphagia, dysmotility, reflux esophagitis, heartburn, non-cardiac chest pain)
Fibromyalgia
Flatulence, bloating, severe abdominal cramps, diarrhea
Folic acid deficiency
Food sensitivities to soy, milk, MSG, dairy
Gallbladder dysfunction
Gastric ulcers
GERD, heartburn
Glucose handling issues ***
GI bleeding, occult (X-ray negative)
GI disorders- IBS, Crohn’s. ulcerative colitis, chronic diarrhea, steatorrhea, constipation
Recurrent aphthous ulcers, nausea & vomiting, macroglossia, leaky gut, Pancreatic insufficiency, dyspepsia, esophageal reflux
Gastroparesis
Glomerulonephritis, IgA mediated
Graves disease
Gynecological disorders
Hashimoto’s autoimmune thyroiditis
Hair abnormality, baldness, premature gray
Headaches - migraines
Heart - Ischemic heart disease, cardiomyopathy – idiopathic dilated, chest pain, non-cardiac; pericarditis (recurrent)
Hematuria – blood in urine- micro and macroscopic
Hemorrhoids
Hepatitis, chronic, active
Hives (urticaria)
Homocysteine – elevated due to lack of absorption/methylation nutrients
Hormonal/endocrine abnormalities. Elevated plasma testosterone, reduced plasma dihydrotesterone, elevated lutenizing hormone, hyperprolactinemia, hyper or hypo-parathyroidism associated with bone disease, hypo or hyper- thyroidism, growth hormone deficiency,
IBS – irritable bowel syndrome
Insomnia
Iron deficiency
Inflammation (elevated CRP measurement)
Lactose intolerance – found in 50% celiacs
Leaky gut syndrome/abnormal intestinal permeability
Liver disease – other causes besides auto-immune
Magnesium deficiency
Malabsorption issues – low hemoglobin, reduced mean corpuscular volume, low B12, low folic acids, chronic diarrhea, flatulence, weight loss with wasting, chronic fatigue
Mineral deficiencies - Malnutrition – deficiencies in iron, zinc, calcium, magnesium, potassium, selenium, vitamins B6, B12, folic acid, A, D, E, and/or K –
Memory; forgetfulness
Microscopic colitis
Miscarriages
Neuropathy/Ataxia
Neurological conditions – chronic and of unknown cause including brain atrophy, optic nerve neuropathy, paresthesia, peripheral neuropathy, polyneuropathy.
Neurological – brain plaques; wheat brain;
Neurological symptoms of dysregulation autonomic dysfunction including
cerebella ataxia, hypotonia, developmental delay, learning disorders, depression, migraine, and headache.
Neural tube defects, mothers of children born with
Osteopenia/osteoporosis
Obesity – inability to lose weight
Otitis media
Pancreatitis
Pericarditis
Polymyositis
Prostatitis, chronic
Psoriasis
Schizophrenia
Seizure disorder – Idiopathic
Sjogrens’ syndrome
Short stature in children
Thyroid – autoimmune in up to 13% of Celiacs-- can be reversed in some cases within a year on gluten free diet but the tendency remains.
Thyroid disease – hypo/hyper.
Weight loss/failure to gain weight; also weight gain

*** Inflammatory mediators block insulin receptors – likely cause of insulin resistance and precursor to Diabetes Type 2 and very often, obesity.

Notes of interest:
Comment from another source:
In patients with Hashimoto’s and breast cancer, check genetic test for gluten intolerance because it is associated with Hashimotos’s and high risk of breast cancer recurrence if gluten continues to be consumed.

Insomnia as a result of gut inflammation.
About 80% of the neurotransmitter, serotonin, is produced in the gut. Serotonin is needed for the production of melatonin. Sleep and bone- health issues, result from the blocking of serotonin production when there is intestinal inflammation.

III. THE IDENTIFICATION PROBLEM
There is no shortage of confusion or misinformation on how gluten-sensitive individuals are identified. New, highly-definitive and accurate lab testing procedures are now available that eliminate false positives and negatives. Tragically, medicine has been in the dark for a very long time and many people have suffered and died because of the confusion.(Braly)

Historical accounts show “celiac affection” was identified in 100 A.D. and the term means ‘abdominal disease.’ Celiac disease is most commonly associated with gluten sensitivity but it is really much more and it is not limited to a disease of the intestine. There is gluten-sensitive Celiac disease and non-celiac disease. Two separate issues.(Braly)

As far back as 1950, this disorder was found to cause severe malabsorption of all nutrients – many associated with autoimmune diseases and certain forms of epithelial cancers and lymphoma… all related to the body’s reaction to the protein molecule in wheat, barley, (oats), rye, spelt, kamut and triticale. This is an immune attack stimulated by the most-consumed food substance in the Western world, particularly in the United States where wheat has become so highly processed and hybridized.(Braly)

The identification problem has always been that doctors relied on the only diagnostic test available, the intestinal biopsy, which only presents after severe damage is done in the intestine; but meanwhile, other manifestations were ignored. (Braly)

Dr. Braly says: “Applying assumptions and generalizations about one form of gluten sensitivity to all gluten-related conditions is potentially dangerous.” Dr. Braly and others have clearly shown many types of human tissue are damaged by gluten contact. He says, “If we are mounting an immune response to gluten, it is reasonable to conclude that we are leaking some of these proteins or derivative peptides into our blood. If they are in the blood, then a wide range of tissue damage is predictable.”

“So, rather than ignoring chronically ill, non-celiac gluten-sensitive individuals who show no tissue damage on biopsy, we suspect that any and all identifiable immune responses to gluten should be recognized as dangerous. The evidence strongly suggests everyone mounting such an immune response should be encouraged to strictly exclude all gluten from his/her diet.”

“It is important to remember that the term ‘celiac disease’ is meant to encompass all forms of gluten sensitivity. Until the identification term is officially changed, don’t be mislead to think you are not affected by a gluten sensitivity by excluding the name ‘celiac’… Consider any of the symptoms or reactions a red flag/warning you should have checked out.”

Sobering statistics… Thirty-nine out of forty celiacs in the United States and Canada go undiagnosed and continue to struggle with chronic ill health. (Braly)

TYPES OF CELIAC DISEASE AND NON-CELIAC GLUTEN SENSITIVITY (Braly)
Classic Celiac Disease
Before now, it has taken around 10 years in the US and Canada before an accurate diagnosis was pronounced because the signs of classical celiac are the exception not the rule in Celiacs.
(Pale, lethargic, diarrhea, excessive gas, abdominal pain, malnutrition signs, low-grade fever, bloated stomach and floating stools.)

Atypical Celiac Disease
Often unlikely to be consider a likely connection to Celiac…live-threatening cavities in the lung wall, severe rheumatoid arthritis, persistent headaches… doctors rarely connect to Celiac.

Silent or Asymptomatic Celiac Disease
Nearly half of symptoms are silent. Half of all biopsy-proven celiacs have no abdominal symptoms even though damage has been occurring for years. If left untreated, cancer is frequently the consequence. This risk can be reversible if a GF diet begins early enough.

Latent Celiac Disease
Celiac is suspected but no intestinal damage can be found; yet months or years later, frank celiac disease is found. Often seen in first degree family members of celiacs and in recently-diagnosed insulin-dependent diabetics. The initial biopsy is negative… but tends to turn positive in six months to three years later. These are the people who get in trouble because of the previously inadequate testing... they had negative testing and were told it’s okay to consume gluten. If a blood test is positive but biopsy negative, they should be treated as celiacs. Current thinking says not to wait for a positive biopsy but take immediate steps to be gluten free.

Non-Celiac Gluten Sensitivity
Those people who have a nonspecific injury to the intestinal mucosa that leaks food proteins and toxins into the blood but do not have the damaged villi and/or increased intestinal immune cells found in untreated CD can be said to have non-celiac gluten sensitivity. Identification is as simple as getting the blood tests for specific antibodies. Non-celiac gluten sensitivity affects about 20% of the American and Canadian population and along with the telling elevated antibodies against gluten, can be found in most of the same ailments that are overrepresented among untreated celiacs.

Dermatitis Herpetiformis –
An example of both celiac and non-celiac gluten sensitivity
Sub-group of celiac disease. Lifelong gluten-sensitive skin disease.
Presents in rash-like lesions, primarily in common locations – back of knees, buttocks, elbows and face. About 75% show intestinal damage on biopsy and have increased cancer risks about the same as those in untreated CD. Few dermatologists recognize the disease and often those who do recommend drugs over dietary interventions and the fact that the cancer risk is preventable with a gluten-free diet.

Dr. O’Bryan explains the identification problem and why it’s so important to be current with testing. [The following are quotes from his teleconference directed to an audience of healthcare professionals. I’m quoting verbatim for this introductory section because of the importance of understanding the seriousness of gluten sensitivity. J. ] All Dr. O’Bryan’s statements are supported by scientific references, [he provided a list of 134 slides on the studies] unless he qualifies with the statement… “in my opinion, or in my clinical experience.”
Key abbreviations:
CD celiac disease
VA villous atrophy
AB antibodies
IEL’s Intra-Epithelial Lymphocytes.
TTA tissue transglutaminase

NEJM says: “Celiac is most common life-long disorder in Europe and US.” …
If it is the most common the country, how common is it in your practice?
It is there and not being identified?
Ratio is bad. Gut symptoms ratio is 8:1. For every 1 with gut symptoms there are 8 that don’t have these symptoms.

One of the problems is to pin down the definition of “celiac.” In the past, CD means total villous atrophy (VA) If no VA, you don’t qualify by many, many different criteria to be labeled as Celiac Disease.

There may be partial VA. You may just have the inflammation called increased IEL’s (Intra-Epithelial Lymphocytes) which occurs before the tissue atrophies (wears down). He likens the micro-villi in the intestine to “shag” carpeting. Your intestine is a tube lined with shag carpeting. Celiac disease is when your shags wear down and you have “Berber” carpeting instead of shag. So if you don’t have Berber, you don’t qualify for a diagnosis of CD. You can have partial Berber but it doesn’t qualify for the diagnosis. That’s why there is such a disconnect among most of the gastroenterologists who are the likely ones to identify this via histology because they have been trained; ie, if you don’t have the total VA, you don’t have CD.

JAMA/ Sept 09 – Small-intestinal Histopathology and Mortality Risk in Celiac Disease
With few exceptions, research has shown increased risk of death in CD – between 35 and 72%

Study did 351,403 biopsies –
Found 29,148 celiacs -(29,000 had increased antibody (A levels but had not yet worn down their shags.)
13,446 were found to just have inflammation…meaning an increase in the IEL count.
3719 had latest celiac disease

So, no increased blood values; did not have shags worn down – just increased IEL’s which is the first and most sensitive marker of the mechanism (important to emphasize “mechanism”) that causes the shags to wear down… it is the mechanism of the inflammation – increased IEL’s – so they found 13K with increased IEL’s…which are produced inside the microvilli and they produce the cytokines…they activate the inflammatory cytokines that cause the tissue damage.

13,000 with inflammation
3,700 increased blood values w/no VA
29,000 had outright celiac disease.

They said it was the largest, most well-represented study of mortality in CD and the number of deaths (over 3000) exceeds that of all earlier studies together.

They found if you had total VA, (shags completely worn down) your risk of dying early in life was 39% increased mortality than the general population.

If you just had latent celiac disease, increased AB but shags still look okay…your increased mortality was 35%.

So the obvious question is, “should we be waiting for the villi to wear down before we act on this?” Absolutely not!!! This just slams that argument right out of the ball park. If you have antibody levels, you need to address it.

But –here’s the kicker – if you just had inflammation, just had increased IELs, your blood values were not elevated and shags not worn down, it was a 72% increase in mortality – double!!! Think about it – double the risk of mortality…if you have gluten sensitivity. Why?

No one looks for the inflammation in the gut. No one treats the sore gut that doesn’t have any obvious pathology that’s identifiable. The result is if you just have this inflammation, you have double the risk of mortality.

They said excess mortality was observed independent of histopathology. (whether shags worn down or not).
JAMA Sept 2009, Small Intestinal Histopathology and Mortality Risk in Celiac Disease

The Study Summary Statement:
“We examined mortality in two entities not previously studied – inflammation w/o VA and latent CD (meaning increased blood values). The mortality was highest in inflammation… it was double.”

So start with that : One of the most common and lifelong disorders in the country… Attention, ‘docs’ … IN THE COUNTRY!!!…. has double the mortality if you have no markers that you can identify with it. None of the standard markers-- don’t have increased antibodies. And no villous atrophy on an endoscopy with histology.

Double the mortality for one of the most common, life-long disorders in the country!!!.

This is not something you’ll see on “occasion”… or that comes in once in a while…this is in your practice everyday or every other day and as you learn how to identify this correctly and treat it comprehensively, whatever your technique is – acupuncture, chiropractic, internist – whatever your protocols, the results will be enhanced dramatically.

People often ask, who should I be considering for this?
The response is: EVERYONE!

The concept is – you must understand that mortality is doubled when you just have inflammation in the gut.

[Pause for this to sink in. Does Dr. O’Bryan’s introduction get your attention?...Jackie]

Often people are tested and found to be negative for tissue transglutaminase (TTA) and the doctor says it’s safe to eat wheat or gluten-containing products because the blood work was negative. It’s found that people who go on GF diet feel better but no one wants to do that – understandable as it is a dietary mainstay- it’s the most common food we eat – what’s more common in the diet than wheat? Breakfast, lunch and dinner most every day, most every meal… it is an extremely frustrating condition to have. But the science tells us:

In Aliment & Pharmacology 2007(6) published paper “Immunoglobin A autoantibodies against transglutaminase 2 in the small intestinal mucosa predict forthcoming coeliac disease and identifies the mechanism of why we feel better off gluten.

Again, transglutaminase in small intestinal mucosa predicts forthcoming celiac – serum IgA endomycelial and transglutaminase antibodies are powerful tools in disclosing celiac disease without overt VA. The key word is “overt” which means total VA. The blood tests are right on the money if you’ve got total VA.

However, seronegative celiac disease occurs – antibody positivity correlates with more severe VA and not the mode of presentation. “Blood tests in clinical practice lack the sensitivity reported in the literature”.
Digestive Disease and Science 2004

Digestive and liver diseases in 2007- showed serology seems to be ineffective in detecting most of the patients affected by subclinical or silent disease – (meaning they don’t have total VA).

In NEJM they tell us in 2003 – Endomycelial AB showed that sensitivity to this marker was 100% in patients with total VA but the value fell to 31% in patients with CD who had partial VA .so if the shags aren’t totally worn down, the endomycelial AB sensitivity drops to being accurate 3 out of 10 times…and it’s wrong 7 out of 10 times… so people on their way to becoming Berber are missed by blood tests.…

If you don’t have total villous atrophy, the blood tests until now, miss it. If you have total VA, the blood tests are right on the money. Patients with partial villous atrophy are not included in the studies. The mistake has been we thought it meant all celiac patients at every stage of development. Up to now the blood tests are not accurate.

AmJ Gastroentroology published paper…looked at 1571 – healthy people screening for celiac (picked out of the blue) and found 59 were celiacs but only 20% showed positive on endomysial AB and 60% showed positive on transglutaminase AB. And 70% showed on Elisa endomysial AB. The point is --the antibodies are not accurate unless there is total VA. This paper says, you can’t do just one marker – need to look at more than one to make sure you get it.

Important: The reason there has been this conundrum – He calls it the conundrum of gluten sensitivity” because all of the papers talk about celiac disease until quite recently have always used the definition of CD to determine who they included in their cohort so if you don’t have total VA – just partial VA – or if just inflammation which now you know according to JAMA is the most dangerous with double mortality risk – if you just had inflammation. You aren’t in the studies so there has never been a study that looked at how accurate the test are for those. There are many, many papers saying the test is accurate with total VA.

The conundrum occurs because patients go to the GI or internist, get a blood test or endoscopy comes back negative – blood values are positive yet the endoscopy is negative and then the Gastroenterologist says OK to eat wheat even if had elevated AB. So a lot of people are never tested again and think they are okay for a lifetime and they are not.

Less than half of patients with celiac disease on a gluten-free diet have complete normalization of intestinal biopsies, intestinal permeability defects, and antibody levels (after a mean of 9.7 years on a GFD)..
19% of patients (after a mean of 9.7 years on a GFD) had no detectable gluten in their diets but 75% of them had abnormal permeability
Dig Dis Sci (2010) 55:1026–1031

There is gluten in rice, corn and in most every grain but it is a different family of gluten than those in wheat, rye, and barley etc. This is a particular family of glutens that are toxic because the digestive system can’t break them down. It’s a sensitivity to a certain peptide in the gluten contained in wheat. There are over 60 peptides in gluten. We check for the 33 dimer (called 33 mer) peptide of the gluten protein in wheat, known as alpha gliaden, and every blood test that is out there looks for alpha gliaden.

Some of the laboratories are going to using deamidated gliaden which is still a 33 mer peptide but a deamidated version of it and it’s more sensitive for correlating with VA so deamidated gliaden is a more sensitive marker if you’re looking for indicators of inflammation in the gut that likely contribute to VA. It is not as accurate for gluten sensitivity in general, but for the gut --that is for gluten enteropathy-- deamidated gliaden testing is a good one.

IV. THE INFLAMMATION FACTOR (O’Bryan)
“ Let’s talk about this inflammation issue
The inflammation involved is connected with the immune systems’ reaction to inflammation so we need to address how to manage this.
It’s not like just shot-gunning in an anti–inflammatory…to see if we can put the fire out.. The bottom line is you have to stop throwing gasoline on the fire….that’s the first thing. Find out the sensitivities, gluten, etc but you need to know about the gut bacteria because the immune system is there to protect us…the Armed Forces of the body..

So if there is a threat…the immune system is activated and when activated through the selective kinase response modulators where you initiate particular genes – messenger rNA and either activate an inflammatory response or activate an anti-inflammatory response. So when we’ve got this environment – when this intestinal milieu is so toxic to us your immune system is in a constant state of stimulating the inflammatory genes…. And we (erroneously) think taking anti-inflammatories is the answer. There is nothing wrong with your immune system, it’s not an immune system gone haywire. You’ve got to stop throwing gasoline on the fire and the immune system will calm down.
Sometimes it’s stuck in an “open” position and you have to close the valve, but the vast majority of the time what most have been doing is we have been trying to put the fire out which is a great thing to do and critically important but we need to stop activating the genes that are triggering the inflammatory cascade. You can’t just throw in anti-inflammatories and let them eat Twinkies.”

V. HIDDEN, UNSUSPECTED, ELUSIVE SOURCES OF GLUTEN
Complicating the avoidance issue is the fact that wheat is not just limited to the obvious grain products. Wheat flour is used as a filler in cold cuts, deli meats and sausages. It’s used to dust frozen vegetables and as a thickener for soy sauce. It’s a common additive in soup and other packaged products. Many pharmaceutical medications use gluten as a filler or binding agent and in various hair products such as thickening conditioners, wheat protein is indicated on the label. Inhaling the gluten molecule is a common and unsuspected exposure…as when blow-drying hair treated with a gluten-containing product.

Check medications for gluten, check vitamins and supplements for gluten and soy – check the shampoos, and toothpaste and body lotion. These often contain gluten and soy. Some practitioners say there is no way gluten in shampoo can permeate the scalp which may be correct, but there are a lot of studies indicating that inhaling gluten initiates the immune response…so shampooing would do it, or smelling products with gluten, you can initiate the immune response. (O’Bryan)

The gluten-containing grains to avoid include: wheat, rye, barley, spelt, triticale and kamut. While oats do not naturally grow containing the gluten protein, because contamination occurs from using shared equipment for harvesting, trucking, milling, processing and packaging, the experts dealing with gluten sensitivities require their patients also avoid oats. Even products grown organically and processed in “gluten-free” facilities and labeled as such were randomly tested over a span of several years and were found to be highly contaminated with gluten.

Other surprise sources of gluten…(not limited to just this list)
Beer
Binders
Bouillon cubes
Bran
Brown rice syrup
Couscous
Dextrin
Extenders
Ice cream
Imitation seafood, bacon
Malt, Malt Vinegar
Modified Starches, food starches
Pudding
Seitan
Soy Sauce, Teriyaki sauce (unless wheat-free)
Sprouted grains
Tabouleh
Udon
Some herbal tea and flavored coffee

The Paleo-style diet eliminates the use of all grains. However, some people seem unable to give up grains totally so brown rice, millet, quinoa, and buckwheat hopefully offer gluten-free options. Flours of rice, sorghum and garbanzo provide a flour-subsitute for baking. Purists say that if there is shared processing equipment…most products will have some degree of contamination, so be aware. It’s important to understand how small an amount of gluten causes reactivity.

There is also the concern for the crossreactive foods to consider so if by going gluten free, the person still experiences symptoms, they should be tested for the 24 known crossreactive foods as well. Many people say…”Oh, I went gluten free and I had no changes…”… either they were not strictly gluten free, may have not carefully read labels, or have the cross-reactivity. Most people are affected to some degree by gluten sensitivity.

Often processed food contains hidden gluten. Acronyms for hidden gluten
Fu – dried wheat gluten
HPP – hydrolyzed plant protein
HVP – hydrolyzed vegetable protein
MSG – monosodium glutamate
TPP – textured plant protein
TVP – textured vegetable protein

CROSS REACTIVE FOODS IDENTIFIED BY SPECIFIC TESTING. (Cyrex Labs)
•Cow's Milk
•Alpha-Casein & Beta-Casein
•Casomorphin
•Milk Butyrophilin
•American Cheese
•Chocolate
•Sesame
•Hemp
•Rye
•Barley
•Polished Wheat
•Buckwheat
•Sorghum
•Millet
•Spelt
•Amaranth
•Quinoa
•Yeast
•Tapioca
•Oats
•Coffee
•Corn
•Rice
•Potato

VI. EXPOSURE TO THE GLUTEN MOLECULE (O’Bryan)
Rotation diet – does it work for gluten?
“Whoever came up with the rotation diet? Have we forgotten about Memory B cells? If you develop antibodies to foods, you develop Memory B cells. They don’t go away… Oh but if we only do it every 4 days or every 7 days, I don’t get sick…Well, that’s great, but now you’ll have a way of measuring antibody loads accurately. So you go on a GF diet for six months and re- test and the AB load is gone and maybe your thyroid AB or lupus a/b that weren’t high enough yet to be a disease -
There is a whole world to know about predictive antibodies - So you go out and eat gluten and rotate it once a week and then just wait a month and do the test again. You’ll find your immune system is reacting again.

Memory B cells – it’s like a vaccination for measles. You need a certain bolus of measles to stimulate the immune system to produce antibodies to measles. Once you’ve produced that assembly line that builds a/b to measles, it’s with you the rest of your life. You shouldn’t have a/b right now to measles unless you’ve been exposed….none should be detectable in your blood stream, but the Memory B cell for measles is vigilant for the rest of your life. If exposed, the switch is flipped to produce measles AB again.

When you go to Africa you need vaccination months ahead of the trip but if you go back to visit 5 years later, you only need a booster shot 2 weeks before you go because the system is already there.

The immunologists have shown us is with the initial bolus and Memory B cells, future insult – how much does it take to reactive the original AB again? It’s 1/1,000th the initial bolus to reactivate the original antibodies. You don’t feel it when you start producing lupus antibodies because you have a gluten sensitivity and your genetic weakness has put you vulnerable to lupus; you don’t feel it when you develop TPA antibodies – you feel it at the endstage when the TPA antibodies have destroyed so much tissue – so now you’ve got symptoms.

My personal opinion – I don’t believe in rotation diets if you have antibodies to the food….because now we know that those antibodies to food are one of the environmental catalysts that contribute to the development of the Number 3 cause of mortality in this country…auto-immune diseases.

Now with this lab, there is a way of testing all this so you won’t be just a good idea based on symptomatology. You clear patients of their antibodies, then if they really want to go back on gluten again or whatever the food is – fine.. let them do it and then after a length of time, recheck for the antibodies.. If still negative, then what can you say?…but all the science says it’s not going to be okay.

In about 2 years, Cyrex Labs will have run thousands of tests with rechecks so we’ll be able to publish on this.

Environmental doctors who do desensitizations to food allergies… when it comes to gluten, I would be cautious. Ask: do you have experience? (with results). Some practitioners are doing various techniques and then telling their patients it’s okay to eat wheat again. I have kindly asked these people who seem to have a lot of followers, if they would finance a study – do the antibody tests and show that your technique reduces or eliminates the antibodies…Then it would be safe to tell people to go back on the food.”

Dr. O’Bryan’s personal belief is that when these techniques reduce or eliminate the symptoms of a particular immune response – without measuring that response – means you just cut the wire that goes to the hot line on the dashboard and the body will find another way of manifesting—‘this is a problem’… that’s his belief; he has no science behind it but says: “So now we have the technology, whatever the technique – then test it and prove it by showing there are no antibodies being produced if they go back on the food.”
Important…He says - there is a great danger there because people will cheat and activate the immune system for another 90 – 120 days…with one exposure where the antibody is occurring.. It is really dangerous to offer them those products as options.

In recurrent antiphospholipid syndrome – people lose babies.

Single exposure – published paper 3,300 and some first degree relatives of 1500 celiac patients - followed for 20 years. About 5000 people…We know the standard mortality for celiac is 2:1 – in general – that means- if I have celiac and I’m 58 – my brother is 57 and he doesn’t have celiac, I’m twice as likely to die at any age compared to him. 2:1 … but those that followed the GF diet for 20 years…meticulously followed the diet…their SMR was 0.5 to 1. Dying half as often instead of twice as often. They worked hard, in control of what they are eating and taking care of themselves. Those that averaged gluten once a month, their SMR was 6:1 – 500% more likely to die early in life by having gluten once a month. When you read these studies – the impact really hits you. and you must look your patient in the eye and say you can’t have a piece of Cathy’s birthday cake…because you are taking some enzymes to help out. Once a month is all it takes to initiate the inflammatory cascade.

VII. INTESTINAL PERMEABILITY
Intestinal permeability caused by the inflammatory response to gluten and then a “little cheating” by eating gluten revs up the whole cascade all over again. “minor” exposures have “major” consequences.

The size of the macromolecules that come through the intestine is critical to whether the immune system responds or not. According to immunologists, the immune system doesn’t respond to anything smaller than 5,000 daltons.

Lactulose-manitol used for testing intestinal permeability…
Lactulose is 500 daltons
Mannitol is 250 so they are inert molecules that pass through the gut wall but the immune system doesn’t pay any attention to them.

But… gluten is 80,000 daltons
Gluten peptides – around 40 – 50,000 depending on the peptide – huge.

They are not supposed to get through the gut wall but they do and then the immune system responds.

Lipopolysacchardies are 150-300,000 daltons so if you get antibodies to lipopolysaccharides, you’ve got a huge permeability issue going on…so this is a blood test that looks at both the structure, autoimmunity – looking at antibodies attacking and destroying the body’s own tissue… occludin, zonulin and actomycin and then a mechanism. These are gigantic molecules getting through into the blood stream. (O’Bryan)

[The unified atomic mass unit (symbol: u) or dalton (symbol: Da) is a unit that is used for indicating mass on an atomic or molecular scale. It is defined as one twelfth of the rest mass of an unbound atom of carbon-12 in its nuclear and electronic ground state,[1] and has a value of 1.660538921(73)×10−27 kg.[2] One dalton is approximately equal to the mass of one proton or one neutron. Wikipedia]

VIII. TREATMENT (O’Bryan)
Steps to heal the gut permeability.

1.Stop throwing gas on the fire…figure out what the gasoline is.. this is a great example of Functional Medicine at work…Institute for Functional Medicine…we train physicians on how to get the 30 thousand foot view….whatever they are doing.. how do you get the big picture? I teach for the IFM…I teach about the gut so how appropriate that I’m passionate about this one.

2. Look for the bacteria that’s in the gut that shouldn’t be there and get rid of it.

3. Create the intestinal milieu to be strong and healthy – 77% of our immune system is in the gut so we need to create a much stronger gut system that can deal with oral tolerance and determine friend from foe much better.

4. Do nutrients to begin the regeneration and the healing. You’ve got to do that because permeability is still there – years… after going on a GF diet.

It’s a very aggressive nutritional protocol and it’s not a two-minute thing.
His website has lots of info. There is no simple, quick answer, but there is a multi-step process that has to be done.

Critters are a key component in healing the gut. You’ve got to address the gut and there are bacteria in the guts of children with Celiac disease that have never been identified in humans before!

So think about lipopolysaccharides and how our immune systems have developed to protect us from an environment that we are accustomed to but now we have these kids with bacteria that have never been identified in humans before. 37% of the kids with Celiac disease and 19% of them still had it even after a year on a gluten-free diet. These bacteria are producing lipopolysaccharides, going through the membrane, getting into the blood stream, going to the brain, going to the joints, going to the kidneys, going to the lungs, the liver, …who knows what symptoms they show up with down the road – who knows? It just depends on their genetic vulnerability and how strong their immune system is.

So you need to learn which probiotics are antibacterial and which probiotics help to stimulate your own intestinal production of bacteriocins because these people are loaded with bacteria that are just slowly killing them – causing permeability, opening up the tight junctions and the immune complexes and antibodies are formed to the bacteria. Why do you think some of the GI stool tests say, “taxonomy unavailable for identification?” Because it’s not in the data banks. Unknown! These children are loaded with this bacteria never seen in humans before…We have to begin treating the gut like the primary entry for all disease. This sounds so fanatical.. but the old time healers always said …”death begins in the colon” We are up against this now. We have the science to show us and we look at these things and say …”what”??? (O’Bryan)

For diets – we always recommend GF, dairy free, soy free, sugar free and caffeine-free except for green tea. Called Modified Mediterranean Diet.

The Science behind it: Lactase, which digests lactose, is produced in the single cell epithelial lining of the microvilli. When there is inflammation in the microvilli – which is the trigger for the development of intestinal permeability either from bacteria or viruses, or gluten – when you have inflammation, you don’t produce adequate amounts of lactase - and you don’t break down lactose and so you have lactose intolerance.

The casein antibodies is more of a genetic thing – although he hasn’t seen any papers on it yet. Casein is more like gluten in terms of being a genetic vulnerability. But in terms of dairy in general, there is great science behind eliminating dairy for a year – 6 months isn’t long enough

With Celiacs, you have to wait a year before the microvilli produce adequate amounts of lactase. That single-cell epithelial lining is also where you produce cholecystekinin which sends the message to the gall bladder about fat intake and the need for bile production – which is why when you have celiac disease, you have increased gall bladder volume and reduced gall bladder emptying. So the messenger (cholecystekinin) isn’t secreted because of the inflammation in this single cell lining of the epithelium. When you have increased GB volume and reduced emptying, you get GB stones from the bile just sitting there. Stones are more common in celiacs. (O’Bryan)

Gluten-free products are abundant. Be very cautious about using these various breads and baked goods unless you are very certain of the purity and assay of the raw materials used and the strict adherence to using certified gluten-free raw materials and equipment. Read labels carefully
Bob’s Red Mill Gluten Free caries a statement that they dedicate a specific production room to GF products. They test batches before and after packaging and quality control meets Codex Alimentarius GF standards.

Since wheat and barley are used in beer making, beer lovers can try one of the GF beers…Bard’s Tale Dragon Gold from Buffalo.
Anheuser-Busch – Redbridge – made from sorghum
Green’s beers – England; New France Beers – Canada. Ramapo Valley Brewery in New York – Honey Passover Beer withKosher yeast.

For the most part, Paleo eating is just safer and easier. It’s a mindset and, once you get over that, “poor me-deprivation syndrome, you’re on the path to a healthier body.

VIV. GENETIC SUSCEPTIBILITY
To develop Celiac disease, you need a genetic susceptibility.
And you need an environmental exposure and intestinal permeability. Just because you have the gene, doesn’t mean you get it; just that you are genetically sensitive. The environmental exposure can range from Bisphenol A to mercury to food allergens as an environmental trigger.

Case study…person developed CD after she had Lyme disease and was treated with 28 days of intense antibiotic therapy…so undoubtedly had dysbiosis and then developed the intestinal permeability. An additional complication – had an amalgam filling removed without the protective biologic dentistry procedures so the mercury that entered the system depleted the zinc to the point where her sense of taste was nil. Subsequently, she tested for the HLA DQ 2 and 8 markers…the two most known genetic sensitivity markers which indicated she was positive on both markers. So her genetic sensitivity was there all along; all she needed was the exposure and permeability.

Seventy three percent of celiac patients (who have total VA) have a lack of blood flow to their brain… called hypoperfusion – which produces brain fog. They think more clearly on a GF diet. This would apply to those with migraines as well. (O’Bryan).

X. GENETIC TESTING
Testing for genetic markers to determine inherited propensity to develop gluten sensitivity and/or Celiac is important. The markers, HLA-DQ2 and/or HLA-DQ8 are present in about 43% of the normal American population. (Fine, Braly, O’Bryan)… See Cyrex Labs website on testing for the genetic markers. If detected, then it’s obviously smart to avoid the disease-causing food.

This is especially important for younger people where specific food avoidance can prevent damage and surgical interventions to save intestinal tissue. One case of a young girl whose parents were told she was gluten sensitive, chose not to follow the warning because it was ‘too limiting’…She developed Crohn’s disease and at age 14 and after a bowel resection, she returned to the doctor who initially warned her. Testing found her to be positive as was her mother. She was told that she was facing a colostomy if she persisted in eating the wrong foods. Her family finally became serious and went gluten free.

Gluten sensitivity in Celiac’s causes injury to the bowel wall but does not penetrate the layers of the of the bowel wall as in Crohn’s. Crohn’s patients still have to strictly avoid the gluten/gliaden protein since typically they have very high antibodies. Many Crohn’s patients are unaware of the total gluten abstinence issue.

XI. TESTING
Avoiding gluten may not be adequate. This is where testing becomes critical. If you are one of the individuals who is also affected by cross-reactive molecules in other foods, the problem can continue…either with or without symptoms and the damage continues. Remember symptom free doesn’t mean “home free… no risk.”

Complete information on the new, cutting edge accurate testing is now available at Cyrex Labs. Go there and read the specifics. (see references)

XII. MICROSCOPIC COLITIS…
There is a condition of the colon that deserves mention and thanks to Dr. Fine who did his residency with Dr. John Fortran, well known gastroenterologic researcher who discovered and named the condition called ‘microscopic colitis’-- a disorder with chronic diarrhea, the mucosal appearance of the colon by colonoscope is all but normal but that on a biopsy what is noted is infiltration of the lamina propria and to some extent the epithelium with lymphocytes and plasma cells much in the way that the small intestine is affected in celiac disease.

This was first published in 1979 and Dr. Fine began working with Dr. Fortran in 1986 and by 1989 he was assigned a project to understand why sometimes patients with microscopic colitis got a disease in their small intestine that looked like celiac disease but didn’t always respond to a gluten free diet….and the extension of that being that many people with celiac disease are later diagnosed with microscopic colitis. So in the 90’s Dr. Fine began epidemiologic and histopathologic research to understand the differentiation of the lesion of microscopic colitis and the lesion of celiac in the intestine as well as the epidemiologic overlap which turns out to be like many chronic inflammatory disorders in true celiac – about 5%... so about 5% of celiacs have diabetes, colitis, arthritis or lupus or whatever and the reverse as well so if you took a cohort of microscopic colitis patients, you could find 3-5% had markers in their serum –at the type it was endomysial antibody which was the tell-tale marker of celiac and with a biopsy of the small intestine and you’d find that lesion.

They found in their research of small biopsies of patients with microscopic colitis that 70% actually had some type of mild inflammation, sometimes minimal villous abnormalities- often times though, not atrophy so not celiac disease, and that the HLA genetics of microscopic colitis turned out to overlap with celiac disease about two-thirds of the way, so about 2/3 of colitis patients had the markers of celiac disease… that would be the HLA DQ2…which is the most prominent gene related to celiac disease (present in about 90% of celiac patients in America). The remainder of celiacs will have the HLA DQ8…. They have one of the two.

He found a group of patients that overlap with one another – more women have these diseases then men – they have the same HLA genetics. They had a lesion that looks very similar under the microscope but with serologic testing of patients with microscopic colitis only revealed true celiac disease (ie, a known anti-gliaden reaction in about 3 – 5%) and maybe there was another 6% that had anti-gliaden antibodies without the celiac markers – but that was no more than the normal population. The general population – 10-12% - every study in America shows that non-celiac patients have anti-gliaden antibodies in their blood.

Symptoms include chronic diarrhea, and myalgias and will have antibodies for gliaden inside the intestine but not in serum and they do not have villous atrophy initially, but are found to eventually develop celiac disease without interventional measures. These patients get well on a gluten-free diet – sometimes a dairy free diet as well..

XIII. BIO - REFERENCES
Dr. Braly's most recent book...
Authors: James Braly, M.D. & Ron Hoggan, M.A.
Dangerous Grains: Why Gluten Cereal Grains May Be Hazardous to Your Health turns the U.S. Food Guide Pyramid upside down by exposing the myriad health risks posed by gluten grains, such as wheat, rye, barley, oat, spelt, kamut, and triticale. The authors, leading experts in the field of food allergies, and celiac disease, present compelling evidence that our grain-centered diet is to blame for a host of chronic illnesses. Largely misunderstood and frequently misdiagnosed, these disorders can be prevented and reversed by the useful program outlined in this important new book

James Braly, MD is an expert in food allergies and gluten sensitivity. During hi 20 years of clinical and research experience, he has helped develop, implement and popularize food allergy testing and celiac disease screening among physicians throughout the United States. Dr. Braly is himself, gluten sensitive.

Ron Hoggan, MA, was diagnosed with celiac disease in 1994. His subsequent research on the disease and the gluten grains that provoke ti has been published in numerous newsletters and journals and on many websites. Hoggan is a widely respected lecturer and writer within the gluten-sensitive and medical communities

Kenneth Fine, M.D. is board certified in internal medicine and gastroenterology. He has been professionally involved in patient care, medical research, teaching, directing clinical laboratories, and public health for over 20 years. He is a medical doctor, scientist, gastroenterologist, nutritional expert and internet medicine pioneer, educating audiences for decades with inspiring health and scientific information.

As the founder and current director of the non-profit Intestinal Health Institute in Dallas, Texas (www.intestinalhealth.org), and EnteroLab Clinical Reference Laboratory (www.enterolab.com), Dr. Fine has been able to further his ground-breaking research of intestinal disorders and diagnosis of food sensitivity as well as the discovery of dietary effects for relief of chronic inflammatory and autoimmune diseases. As an academic physician, he has been on the teaching staff of hospitals and medical universities, and has published over 40 scientific articles and medical text book chapters. For complete CV, visit [www.intestinalhealth.org].

Dr. Thomas O’Bryan is a leading researcher, writer and internationally recognized speaker and work shop leader specializing in Gluten Sensitivity & Celiac Disease. He is a Sherlock Holmes for chronic disease and metabolic disorders..

Dr. O'Bryan is a practicing graduate of the Institute for Functional Medicine's hallmark program Applying Functional Medicine in Clinical Practice. Using the tools of Applied Kinesiology, Laboratory and Functional Medicine, Dr. O'Bryan assists patients in reclaiming their health with an emphasis on diet and nutrition. This provides a motivating and successful game plan for patients who previously suffered from debilitating symptoms, high risk for disease and frustrating medical problems. His passion is in teaching the many manifestations of Gluten Sensitivity and Celiac Disease as they occur inside and outside of the intestines.

Dr. O’Bryan holds many professional appointments including Adjunct Faculty, Institute for Functional Medicine, Adjunct Faculty, Institute for Integrative Medicine, Adjunct Faculty National University of Health Sciences, Scientific Advisory Council, International and American Association of Clinical Nutritionists, Certification Advisory Committee, Institute for Functional Medicine.
[www.thedr.com]

You can view the Dr. O’Bryan’s slide presentation at this website.
It is wort

Another terrific informative and helpful piece of work, Jackie. Your efforts are much appreciated and thought-provoking.

Is it your impression that main-stream Gastro-Enterologists are aware of this content? I ask this because many of your sources seem to be pretty mainstream journals. Up til now, at least, all my Docs seem either unaware of, or dismissive of, the concept of gluten sensivity, and treat all gut issues with a colonoscopy recommendation. Once that is attended to, so far they haven't had much to offer.

Louise

Brilliant work, Jackie. Gluten sensitivity was clearly at the root of my afib. Have been gluten-free a few years now.

Trent

Thanks Louise... no… that’s not my impression at all. Most GI docs, Internists and the like still don’t have a clue.

Yes, the studies are all mostly new and cutting edge. This is why the book is important; the seminars and teachings by Drs Fine, Hyman, O’Bryan and Braly are so critical in helping people find the root-cause of their chronic diseases…. Many of the serum tests have not been reliable… until now… the Cyrex Labs and EnteroLabs are using the latest methods so accuracy is there. Colonoscopies don’t catch it… although a Dx as a result of the scoping might give a clue… diverticulitis, hemorrhoids, IBS, etc.. would point toward further testing to confirm gluten sensitivity …or just doing the strict avoidance diet and observing changes.

Jackie

Hi Trent - thanks. I was thinking about your success when I was compiling this. I went gluten free several years ago after much resistance on my part. IAs I read down the list of associated symptoms/conditions, I'm sure that sensitivity was the culprit for me... and for AF as well.

Good to hear from you,
Jackie

Thanks Jackie, great posting. Gluten was also central to my afib episodes. I did not absorb magnesium very well. Now that I am off all grains, my cells are magnesium conductors. What a change! I invested in a Vitamix and drink green drinks all day. It beats bread.

Steve

Hi Jackie,

Kudos on another fabulous and thorough research report on such an important topic!

Ironically, I got my Enterolabs test back 6 weeks ago and Alas, I had positive Antigliadin IgA antibodies, plus positive on the other markers including malabsorption of fats ... so no wonder the low IC Mag inspite of large oral Glycinate doses and requiring now daily IM Mag-sulfate injections to get right .. plus my having to take 13,000IU plus of Vitamin D3 to keep my levels in the 75ng/ml range ( Vit D being fat soluable as well) . Also, any other oral supplements or hormones like thyroid and hydrocortisone for cortisol replacement also need larger doses than otherwise would be the case without an active gluten sensitivity and bloating that was my main symptom that led to the test.

The bloating happened a bit over a year ago after 4 years in Holland with their fabulous breads and the like!

Also, I was positive for both of the main Gluten/ Gliadin genes making me doubly more prone to full blown Celiac Disease if I continued with any gluten which I have now cut out of the diet.

Received the literature as well on the Cyrex labs test last month and am going to do that one as well to rule in or out any other related proteins that might be having glute-like reactions as well to kill all the birds with one stone if possible. Many thanks for the great detailed summary!

Aloha nui, Shannon

Shannon - thanks for posting your experiences and the confirmation of your test results. The implications are far more common than most realize and certainly the nutrient absorption complication you point out is a key factor especially for afibbers but for many, many other ailments. You should continue to make consistent progress with the strictly gluten-free diet as well as eliminting the cross-reactivity potentials as well. Avoiding the progression to CD is certainly critical.
Best to you, Jackie

Jackie,

Thank you very much for this well-researched and most interesting report. I noted the frequent references to inflammation. Are hs-CRP or other inflammation markers elevated in gluten sensitivity and celiac disease?

Hans

Hans – In the lecture segments I’ve heard, Dr. O’Bryan does not specifically associate the marker for cardiovascular risk (a rise in CRP) as a result of gluten sensitivity but many articles on gluten sensitivity do address the potential. Dr. O’Bryan notes that: “It is not known whether C-reactive protein is a marker of atherosclerotic burden or whether it reflects a process (e.g. inflammatory fibrous cap degradation) leading to acute coronary events.”

As you can see from the list of tests included in the array panels at Cyrex, CRP is not included.
[www.cyrexlabs.com]

As I recall, Dr. Fine of EnteroLab did not emphasize evaluation of CRP either.

Jackie

Jackie,

As far as I know CRP is a marker of systemic inflammation, not just a marker for cardiovascular disease. Patients with or at risk for diabetes, hypertension, stroke and colon cancer also tend to have higher CRP values. In any case, there are several other biomarkers for inflammation like IL-6 and IL-8. I am surprised that none have been linked to gluten sensitivity.

Hans

It's probably that they have determined the CRP test is not definitive enough for conclusive screening for gluten sensitivity whereas those targeted by EnteroLab and Cyrex are the ones proven to be the most accurate markers.... at least that's my observation because all these experts really are deep into this and have been for many, many years.

Jackie

I just had a Food Sensitivity Test done by Alcat in Florida and have been identified as having a severe reaction to Gluten/Gliadin and intolerances to many other foods. I have had afib for 4 years and really only got serious about it within the past 6 months or so. What a winding path I had to go down to get to this diagnosis. In fact my wife insisted that I take this test, not my doctor. By using a hormone test the doctor previously identifed that my Cortisol levels are way down as well, indicating Adrenal fatigue. She had also done a Nutreval test and told me at the time that my GI was very compromised and I was not absorbing minerals. Her nutritionist suggested a Gluten free diet, but without emphasis, and I partially ignored it. When I got these results I just felt the energy drain out of me. I have been pulling byself up by the bootstraps for so long.

The Alcat test missed things like Hemp, Chia (Salba) Aloe etc. Would the Cyrex labs test me more conclusive in this area?

Thanks again Jackie for the great report.
Ron