Personally I hate doom and gloom titles to blogs. I think it’s overdone and truly I like to take the high road if I can. But this one, we’ve just got to look at. Ok? Here we go:
New research from Dr Fasano and a team of others was recently published in BMC Gastroenterology. The title of the article is “Trace gluten contamination may play a role in mucosal and clinical recovery in a subgroup of diet-adherent non-responsive celiac disease patients”. The title is a mouthful, but basically the researchers were curious about a subgroup of celiac that fall into the category of non-responsive celiacs. These patients continue to have symptoms despite a strict gluten-free diet and some continue to show villous atrophy as well.
As a side note, I’d like to say that I’m grateful to these researchers for the work they've done. I've long thought that both non-responsive and refractory celiac disease were likely quite treatable, without the use of dangerous medications. Here at HealthNOW we have found that to be true. We have rarely had a patient whose ‘seemingly’ refractory or non-responsive celiac disease was not improved with our program. So while we've had suspicions, there was no research to had to support what we have seen clinically – until now that is!
But, back to the research… This group took 17 patients with diagnosed non-responsive celiac disease, 6 of whom had the dangerous refractory type. All patients met with a dietitian who confirmed that they were strictly avoiding gluten in their diet.
The hypothesis was that gluten contamination was potentially to blame for their continued symptoms and, for some, lack of healing of their small intestine. The researchers created a gluten contamination elimination diet. (See table below for the specifics.)
The diet, that excludes all grains other than rice, came about in part from a startling discovery that 32% of all single ingredient gluten-free grains, flours and seeds were contaminated with gluten! Not good. It is thought that the contamination likely occurred during the course of milling, processing and/or transport. The exact ‘how’ remains unknown, but the facts are that it did occur, and that’s a problem.
Is it a problem for everyone? Hard to know. The researchers claim that most celiacs can safely tolerate about 10 mg of gluten cross-contamination daily. This is about 500 grams of food containing 20 ppm of gluten, the legal limit whereby a food can be labeled gluten-free. While the immune system’s of some patients can sustain that amount of gluten, others clearly cannot. And certainly there are many patients who are unable to tolerate even low gluten exposure without negative ramifications.
The gluten contamination elimination diet, removed grains understandable, but it also removed processed food. The thought is that the more highly processed a food, the more likely contamination occurs. Their hypothesis must have been correct, because here are the results:
Of the 17 total patients evaluated, 14 ‘responded’ to the diet, which was an 82% success rate. The definition of ‘responded’ was a strict one – it meant that the patient had no further symptoms and was no longer suffering from villous atrophy (if the test was performed). Excellent result!
But even more impressive was this fact. At the beginning of the study, 6 patients were diagnosed and met the criteria for refractory celiac disease. After following the diet, 5 of these 6 patients were completely symptom-free and no longer met the criteria for that serious condition. Therefore, out of 6 dangerously ill patients, only 1 did not respond. That means that a mere 17% of the initial 100% diagnosed with the disease actually had it after following the diet. It also means that 83% of those patients were needlessly being given immunosuppressive drugs.
What was also exciting was the finding that 79% of the entire group evaluated was, after a 3 to 6 month period following the diet, were able to return to their ‘regular’, non-restricted gluten-free diet and maintain their lack of symptoms. The researchers felt that the 3 to 6 month period was enough time to ‘heal’ the immune system such that its ability to tolerate some cross-contamination improved.
I would like to add that evaluating these patients for the secondary effects of gluten, including infections, probiotic insufficiency, cross-reactive foods, toxins, nutritional deficiencies and hormonal imbalance, would also be a good idea. I’m curious how many of these patients may have regressed again after a passage of several months back on their processed food diet. This is a time frame we find that our patients, who have done well gluten-free, but who have not been evaluated for the secondary effects, tend to again become symptomatic.
Do you know anyone who seems ‘ultra’ sensitive to gluten contamination? Do you know anyone who seems to react to foods that are ‘gluten-free’? Perhaps you know someone who has been diagnosed with non-responsive celiac or refractory celiac disease. If so, please do pass this information along to them. You could truly make an impact on their health.
If your health, or that of a friend or loved one, is not at the level you desire, consider contacting us for a free health analysis. Just give us a call at 408-733-0400. Our destination clinic treats patients from across the country and internationally, so you don’t need to live locally to receive assistance. We are here to help!