Friday, October 01, 2010

Are You a Celiac Waiting to Happen?

Over the years patients have told me stories of “developing” a gluten intolerance later in life.  They stated that they tolerated gluten “just fine” until… X happened.  The life-changing moment included such things as a major stress, an infection or an illness of some sort. But what these patients all had in common was that they were adamant about one thing:  before X happened they were fine and after X happened they could no longer tolerate gluten.

The stories were interesting of course but as a clinician my major goal and focus was to restore their health.  Whether they were subtly intolerant to gluten before the life-changing event or they were completely normal, as they insisted, was impossible to prove, but it did cause me to wonder which was the case.

That was until yesterday!  A fabulous research article emerged (or I should say it WILL emerge as it won’t be published in the journal until December 2010) from the Annals of Medicine entitled “Natural history of celiac disease autoimmunity in a USA cohort followed since 1974”.  It could be more aptly named: “Celiac Disease Found to Develop Later in Life”.

In the study over 3,500 subjects were followed who had given blood samples in 1974, 1989 and again every two to three years up to 2007. During that 33 year span of time their blood was tested for celiac disease. Astoundingly the incidence of the disease rose from one in 501 subjects in 1974, to one in 219 in 1989 – it literally doubled over the course of 15 years.

While seven of the participants were found to have celiac based on their 1974 blood samples, none of them were ever diagnosed. By 1989, the number of cases rose to 16, though only one had been officially diagnosed. (That’s a pitiful 6% diagnosis rate.) At least two people developed celiac after they turned 50.

While we know that individuals must have a genetic predisposition to develop celiac, scientists aren't sure why gluten intolerance would develop after so many seemingly gluten-tolerant years.

Dr. Fasano, one of the researchers, commented that environmental factors may trigger changes in the immune system that could activate anti-gluten genes. Specifically he stated that the significant changes in our environment include such things as more antibiotics, more vaccinations, bioengineered foods, chemicals we haven't been [previously] exposed to, and pollutants at record high concentrations.
I couldn’t agree more.  This study supports what we see in our clinic on a daily basis, we just never had the research before to support the clinical findings.  Science used to think that our genes were hard-wired and there was nothing we could do to influence them. Research now shows us that genes are more plastic or flexible and influencing their “on” and “off” switches is something we have control over.
It’s exciting to think that we can selectively turn off a gene predisposing us to a disease, isn’t it?  I’ve always explained to my patients that genes dictate a tendency or a “leaning towards” a certain health disposition.  But that tendency is not engraved in concrete and if you want to counteract that tendency, in most cases you can.
This study shows us that despite having a genetic predisposition, many of the individuals followed over 33 years took half a lifetime to develop celiac disease. The gene was there but it wasn’t turned “on” in childhood as we always assumed it was in celiacs. It took decades for the anti-gluten gene (as Dr Fasano termed it) to turn on.  But the 64 million dollar question is WHY did it get turned on at all and WHAT could have been done to prevent it?
I know the researchers claimed that a definitive reason was unknown butI would like to make some suggestions based on clinical experience.
I believe that a healthy, optimally functioning body would be less likely to turn on negative genes. Yes, I know that achieving optimal functioning is easier said than done, but one will never accomplish true health if one doesn’t believe that it is attainable first. 
If we were to go down a checklist of items that need to be done it would look something like this: 
1.       Discover and eliminate from the diet any food sensitivities.  This would include gluten and dairy as the most common but soy, corn and eggs (to name a few) are also found. If you follow this blog at all you’ll know the importance behind isolating foods that your body reacts negatively to.  But suffice to say that consuming a food that puts stress on the GI tract is not at all compatible with good health.
2.       Discover and eradicate any infectious organisms.  Such things as bacteria, parasites, amoebas, yeast and worms can all be found in the intestine much to the detriment of not only the individual’s immune system but they also cause intestinal inflammation and a leaky gut. Such inflammation and increased permeability is a known underlying cause of poor health and autoimmune disease.
3.       Normalize the health and strength of the body’s immune system.  It is estimated that about 80% of the body’s immune system resides in the gut. Chronic inflammation from gluten, other foods, toxins and/or pathogens all results in a weakening of the trillions of immune promoting organisms known as probiotics or the microbiome of the gut. Laboratory tests can help to estimate how robust or weakened these species are.
4.       Improving the body’s health should facilitate the removal of most if not all medications from the individual’s life.  So many drugs have the side effect of increasing intestinal permeability and weakening the immune system that their removal is vital to restoring health.
5.       Detoxification of the body and the patient’s lifestyle is also critical when you desire to turn good genes “on” and bad genes “off”. Diet cannot be overestimated in its importance.  Seven to nine servings of organic fruits and vegetables, beans, legumes and purified water all have detoxification attributes.
6.       Regular exercise of the aerobic, stretching and strengthening variety should be done minimally 4 to 6 times per week  for at least 45 minutes.
7.       Laboratory tests to assess the liver’s ability to successfully detoxify as well as evaluating the presence of any heavy metal toxicity is also necessary to reduce any undue stress.
8.       Utilizing more natural cleaning products, soaps and other hygiene products will also reduce the toxic load on the body.
This research study shows us that celiac disease is not a disease of childhood and the fact that it “seems” to be more prevalent is not because it has become a fad to eat gluten-free but because there is an increased incidence of gluten intolerance in our population as it gets older.  Everyone, regardless of their age, should be screened for celiac disease and gluten sensitivity.  We can truly save lives if we institute broader screening. And, perhaps if we strive to institute the 8 steps mentioned above we could in fact turn “off” some of the celiac and other autoimmune genes. Now wouldn’t THAT be a happy day!
I hope you find this information helpful.  Please let me know if I can be of any assistance to you or your family.
To your good health,

Dr Vikki Petersen


3 comments:

Hans Keer said...

It's not only celiac that lies in wait. A lot of other diseases are caused by gluten too. I blogged about it yesterday. You can read the post, which is called "Your daily bread, pasta and pizza are killing you" here http://bit.ly/cyKHre. VBR Hans

Pig in the Kitchen said...

A really interesting, thought-provoking article, thank-you.
Pig x

Anonymous said...

So, did you violate the embargo, or... How else would you know this won't be published until 12/10? I sure hope you didn't violate the press embargo because that makes it very difficult on REAL journalists.