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!”