Friday, August 24, 2012

You Don’t Need an Intestinal Biopsy to Diagnose Celiac Disease

Intestinal biopsies have long stood at the front of the line as the ‘gold standard’ for celiac disease diagnosis. If little pieces removed from the small intestine failed to reveal major tissue destruction, a patient was told that they were free of the disease, despite what other factors came into play.

I have been frustrated by this approach for years because I have too often seen the devastating effects created by telling someone who was gluten intolerant that they were ‘okay’ to eat gluten simply because their biopsy was negative.

An intestinal biopsy does not tend to show positive during the early stages of celiac disease. Quite the contrary, the disease must be quite advanced before this insensitive, invasive and expensive test is positive. That is my greatest complaint. Celiac disease is devastating to many systems of the body, chief amongst them the digestive tract and the nervous system. The more advanced the damage the more difficult it is to regain one’s health.

Not only are we barely diagnosing 5% of those who suffer, but we typically only do so after the patient has spent a decade seeing numerous doctors. We then hold out an insensitive test as the standard that must be met to receive a diagnosis. Ridiculous!

If it was you or a loved one, wouldn’t you want to receive a diagnosis as soon as possible, before long term damage occurred to your body?  Of course you would.

Two new research studies were just released in the Journal of Pediatric Gastroenterology and Nutrition both of which fly in the face of conventional thought regarding intestinal biopsies. Published in May and June this year, these studies both came to similar conclusions although they took different routes. They concluded that in the patients they studied a biopsy was unnecessary for the diagnosis of celiac disease.

The study in May, entitled “A Biopsy Is Not Always Necessary to Diagnose Celiac Disease”, examined 283 pediatric patients suspected of having celiac disease. The results of a blood test, tTG, and their response to a gluten free diet was also investigated.

The conclusion of the research was that pediatric patients whose tTG lab test is equal to or above 100 U/mL (units per milliliter) and for whom symptoms improved upon instituting a gluten free diet, may not need a small intestinal biopsy to confirm their celiac disease.

This is a tremendous step forward in the diagnosis of celiac disease. I personally let out a “hurrah” at the point regarding the importance of seeing improvement with a gluten free diet. This is a contention that I’ve held for a long time but we are only just beginning to see it given validity in research.  Feeling better on a gluten free diet is a valid diagnostic tool and should not be ignored.

The second study published in June, also in the Journal for Pediatric Gastroenterology and Nutrition was entitled, “HLA-DQ genotyping combined with serological markers for the diagnosis of celiac disease; Is intestinal biopsy still mandatory?” I know that title is a mouthful but basically they were looking at combining genetic testing with blood testing and asking if that was sufficient to diagnose celiac disease, without a biopsy.
They found the association of genetic and blood testing to have a very high predictive value for celiac disease. In fact the numbers approached 99%!

The researchers’ final recommendations were to omit the biopsy and utilize blood and gene testing instead.
If this area is new to you, then you’ll just have to trust me when I tell you that these results are a bit earth shattering in this field. In fact, many would argue with you that such research even existed, so entrenched are they in an outdated model. But the results are out, two in the past two months, with more to come I’m sure.
It’s time to confront the facts that we, as a country, are poor at diagnosing celiac disease and our ‘gold standard’ test has fallen down way too many times to ever regain the ‘gold’ crown. Doctors in this field shouldn't feel badly about learning more and changing their opinion as new information comes available. Doctors are supposed to do what they do for the greatest good of their patients, period.

Please share this information with friends, family and your doctor. We have a long way to go before we can pat ourselves on the back for our high diagnostic rate of celiac disease and gluten sensitivity. But we can make strides by leaving older, less accurate diagnostic modalities behind us while embracing newer more effective testing.

Contact me with any questions you may have. I am here to help and task myself with staying on the cutting edge of this field. Our destination clinic treats patients from across the country as well as internationally. We would be delighted to assist you.

To your good health,
Dr Vikki Petersen, DC, CCN
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect”

Wednesday, August 22, 2012

Is there a Lab Test for Gluten Sensitivity?

When we published our book “The Gluten Effect” three years ago, we coined the word ‘gluten sensitivity’ to mean an intolerance to gluten that didn’t fall within the confines of a wheat allergy or celiac disease. We were convinced this condition existed, despite very little to no agreement by the scientific community at the time, based on the results and improved health of our patients.

Today there is officially no doubt that gluten sensitivity exists and affects a great number of people – likely 10+ times those affected by celiac disease.

Where the conundrum lies now is that there is still considered to be no ‘official’ lab test to diagnose gluten sensitivity. Instead, based on a recent report published in BioMed Central, it is more of a process of elimination whereby a wheat allergy and celiac disease are ruled out, but the individual clearly feels better on a gluten-free diet and worse when they consume gluten.

However in the article mentioned above, there was mention of a blood test called an AGA or anti-gliadin antibody test. This is a test that measures the immune system’s reaction to ingested gluten. The paper stated that there was a possibility that the AGA test could be used as a marker for diagnosing gluten sensitivity.
To corroborate that, I came across another study from the University of Bologna in Italy whereby individuals with celiac disease where compared to those with gluten sensitivity and it was found that while those with gluten sensitivity tested negative for all celiac blood tests, over half of them tested positive for AGA.
These researchers stated that AGA could be valuable for those suspected of having gluten sensitivity when celiac disease had been ruled out.

I agree. I find the AGA test to be helpful when testing for gluten sensitivity. However, the AGA test is looking at a small portion of the gluten protein (a very large structure) and there are considered to be hundreds of portions responsible for creating an intolerance to gluten in a patient. Therefore, by looking at only one section, it only makes sense that we would miss diagnosing many people. And sure enough that is the case. Not only do we only diagnose 3-5% of the US population who suffer from celiac disease, when it comes to gluten sensitivity it is likely far worse than that.

For that reason, I use a more comprehensive lab test that looks at a wide variety of potentially problematic proteins and enzymes – 12 in total.

It is quite possible, and I am speculating, that the 50% of patients who didn’t test positive for AGA in the above study, would have tested positive for one of the 11 other components in the above mentioned test. Hopefully future studies will look at this.

More research needs to occur in this area, no argument. But while that is occurring, I don’t want anyone to continue suffering or allow their health to worsen because no one will definitely give them a diagnosis. Too often, patients who test negative for celiac disease are told that they are fine to consume gluten when nothing could be farther from the truth!

If you suspect gluten sensitivity might be causing you to have digestive, emotional, neurological, hormonal or weight issues, please contact me. I am here to help and would be delighted to assist you. Gluten intolerance is a known cause of over 300 diseases and conditions, so it may very well be the culprit affecting your health.
By the way, the lab test mentioned above is called an ‘Array 3’ and it is performed by Cyrex Labs. I have no personal connection to the lab and am simply one of their customers.

I hope you found this information helpful and if you’d like a free health analysis, please call 408-733-0400.

To your good health,
Dr Vikki Petersen, DC, CCN                                                                                                                        
Co-author of “The Gluten Effect”
Author of the eBook: “Gluten Intolerance – What you don’t know may be killing you!”

Wednesday, August 01, 2012

When is it Safe to Introduce Gluten to an Infant

It has always bothered me that research concerning introducing gluten to infants cited 4 months as a time to begin. It never rang true for me that it would be a good idea to introduce a potentially toxic substance to such a young body when the immune system isn’t at full strength and the liver doesn’t have its full detoxification abilities engaged.

Fortunately I found some new research to support my ‘gut’ reaction on this topic. Just a few months ago, March 2012, several researchers from the United States and Italy published a study titled “Proof of concept of microbiome-metabolome analysis and delayed gluten exposure on celiac disease autoimmunity in genetically at-risk infants”. While the title is a mouthful, the results are easy to understand. This study can be found in PLoS One, an open access peer-reviewed scientific journal published by the Public Library of Science (PLoS).

Thirty infants were part of this study and each had the genetic markers that showed susceptibility to celiac disease. All infants were breastfed for the first 6 months of life and then they were put into two separate groups. The first group was exposed to gluten beginning at 6 months while the second group received no gluten until 12 months of age.

The researchers analyzed the types of bacteria that made up the microbiome or population of good bacteria contained in the gut. The techniques they used were very sophisticated in that they revealed the DNA make-up of the various species present.

All the children were tracked until they were two years of age.
There was a profound difference in the population of bacteria found in the two groups of infants. It was so much better and healthier in the group that did not receive early exposure to gluten that the researchers concluded that a benefit could be derived from delaying gluten exposure until at least 12 months of age. Perhaps another study will be done to see if waiting until 18 months or even 24 months would provide greater benefit.

The reason for the difference in bacterial health is not known at this time, although it could have something to do with the maturity of the digestive tract as time passes.

We know that abundant and strong good bacteria actually have the ability to keep ‘bad’ genes, such as those that cause celiac disease, turned off. If early exposure to gluten so weakens the good bacteria present that they cannot prevent bad gene expression, this study could be a landmark that will forever change the way our infant population is fed.

More research will tell, but in the meantime I will hold to my recommendation of waiting minimally a year, if not two, before introducing gluten to an at-risk infant. Also appreciate that this was a celiac-prone population. We have yet to get information on how this might relate to that greater population suffering from gluten sensitivity.

Have you had any experience with at-risk babies and introducing gluten? I’d love to hear from you.
If you have questions or would like a free health analysis, please give me a call – 408-733-0400. Awareness of gluten intolerance needs to be raised dramatically and I am committed to do so.

To your good health,
Dr Vikki Petersen, DC, CCN
Author of “The Gluten Effect”
Co-author of the e-Book: “Gluten Intolerance – What you don’t know may be killing you!”
“Proof of concept of microbiome-metabolome analysis and delayed gluten exposure on celiac disease autoimmunity in genetically at-risk infants”. M. Sellitto, G. Bai, G. Serena, W.F. Frickle, C. Sturgeon, P. Gajer, J.R. White, S.S. Koenig, J. Sakamoto, D. Boothe, R. Gicquelais, D. Kryszak, E. Puppa, C. Catassi, J. Ravel, A. Fasano, PLoS One. 2012/7(3):e33387.