Tuesday, June 24, 2014

Celiac Disease vs. Gluten Sensitivity—Are They Different?

70-80% of Medical Research is Funded by Pharmaceutical Companies

We live in a society where medical treatment efficacy is gauged by two major standards:

1) Make a diagnosis, then

2) Find the drug best suited to treat the symptoms associated with that diagnosis

Fully 70-80% of all medical research is funded by pharmaceutical companies. Where does celiac disease fit into this paradigm? Celiac disease is considered to be a rare disorder and there is no drug to treat it. You can imagine where that puts it on the hierarchy of most medical practitioners.

In addition, the “face” of celiac that most doctors are taught, is a patient presented with chronic diarrhea and severe weight loss. Is it any wonder that little emphasis is put on its diagnosis? Once the patient with severe weight loss has been ruled out for cancer and other serious diseases, then their doctor might consider celiac disease.

What’s the Difference Between Celiac Disease and Gluten Sensitivity?

In my opinion, very little. The problem we have encountered is that celiac disease is the only manifestation of gluten sensitivity that medicine has been able to diagnose. And not very well at that—considering it takes the average celiac patient as long as 10 years before they're even given the proper diagnosis.

So what is the problem?

Is it that something considered rare is not often looked for?  Partially.

Is it because there's no drug to treat it, so there's no “easy fix”?  Partially.

Is it the fact that the only treatment for it is a dietary change—and no one really wants to “condemn” a patient to never eating wheat, rye or barley again?  Definitely!

Is Celiac Disease Just a Subset of Gluten Sensitivity?

Celiac disease is just the tip of the iceberg of the greater issue called “gluten sensitivity”. 

In this case, the tip is 1/40 of the whole iceberg—because research has been telling us that while celiac disease affects 1% of the population, gluten sensitivity’s incidence is anywhere from 7% to up to 40%

Estimates vary widely. But even conservative estimates take it right our of the “rare” category with higher estimates putting it squarely in the category of obesity which is considered to be an epidemic!

The Problem with “Diagnosis”

The “gold standard” for diagnosing celiac disease has been a positive intestinal biopsy that reveals severe degradation of the surface of the small intestine. But damage has to occur for many years before such a test is positive, not to mention all the secondary problems that have likely arisen during that time. Yet we wait and wait for that positive test during which time it's considered “perfectly good medicine” to tell a patient to continue eating gluten if their test is negative!

Is It Malpractice?

I have been saying that, within the decade, the current protocols being used to diagnose and treat celiac disease will be looked upon as malpractice. Is that too strong a statement? I don't think so. 

Do we wait for a patient to have a heart attack before we assess risk factors for cardiovascular disease? Of course not!

So why is it acceptable to allow a patient to get to the point of severe atrophy of their intestine with concomitant malabsorption, inflammation, and risk of autoimmune disease before we make a diagnosis? It isn't!

Gluten Intolerance Puts You at Risk for Many Severe Diseases

I've been working with gluten sensitive patients for around 20 years and even co-authored a book on the subject, "The Gluten Effect". What I have come to find out through research and clinical experience has taught me that we have an obligation to our society to change our procedures and strategies.

We are creating many ill patients by missing the diagnosis of gluten sensitivity.

Such things as: obesity, depression, anxiety, fatigue, migraines, IBS, and autoimmune disease (such as arthritis, lupus, diabetes, thyroid disease, and osteoporosis) are all implicated with gluten sensitivity. The list is long and growing as we learn more.

Everyone Should Be Screened

I believe everyone should be screened for gluten intolerance, which includes both celiac disease and gluten sensitivity. It involves a simple lab test which should be evaluated by an experienced clinician. The reasoning behind this is that interpretation of these tests requires some experience and it's often not a simple “yes” or “no” proposition.

Most researchers and clinicians prefer also using a blood test, although the efficacy of saliva testing has been validated. Personally, I use blood and saliva testing both for my patients, with a stool test recommended for those living too far away to come into the office.

What if the test is equivocal? What if it’s in the gray “suspicious but not confirmed” area? The TRUE gold standard test is evaluating a dietary change—it's called elimination and provocation. Eliminate gluten completely from your diet for a minimum of 30 days and see how you feel. If you notice a change, that is considered a positive test.

We are committed to spreading the word about gluten and are here to help you, your family and friends. Patients come to see us from around the country and internationally.  

Our clinic is in Sunnyvale, California. Please let us know if you want to visit. Or call to schedule a FREE CONSULTATION: (408) 733-0400.
I look forward to hearing from you.

To your good health,
Dr. Vikki Petersen, DC, CCN
IFM Certified Practitioner

Founder of HealthNOW Medical Center

Co-author of “The Gluten Effect”

Author of the eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”


dhead said...

This is a very informative post and I am glad I read it during this particular time.

My wife is a GI nurse and recommended I try eliminating gluten from my diet to see if all of my so called "gluten intolerance symptoms" would go away. Well what do you know? They are all gone. You can check out more about my story at glutenfreethin.com

Right now I am at a cross roads. Since starting a gluten free blog I have considered myself as someone who has a gluten allergy but not Celiac Disease. As I read more and more stories about Celiac and the diagnosis, it dawned on me that I may actually have Celiac disease. However, it is my understanding that because I am currently not eating gluten, it would be next to impossible to get an accurate reading on a test. I hear a lot about a genetic test. What are your thoughts on that?

I will be using various pieces of info from your article in my next blog post. Well done.

Seamus Lowe said...

I've been trying to figure this out for a while. I have a friend who has Celiac disease and I have other friends who are gluten intolerant and both of them have a lot of problems with it. I never really understood what the difference was until now, so I'm grateful for this article. I'll have to talk to my friends about it again so I can know more.
-Seamus | http://www.acr-research.com/study-137-Celiac-Disease-(SLC)

The HealthNOW Doctors said...

@dhead - sorry about the delay in getting back with you. Somehow your comment slipped through... I think a genetic test would be a smart idea. If you don't have the genes for celiac you can't possible have it, so that would be a great first step.

Let me know if that helps and if you have any other questions.