What's Your Celiac and Gluten IQ?

Are You a Well Educated Celiac?

The hazards to health created by celiac disease and gluten sensitivity are well understood. From nutritional deficiencies to osteoporosis, from depression to autoimmune disease, and from psoriasis to thyroid disease, there are few areas of the human body that gluten doesn’t impact in a negative way. 

There is so much emphasis on our inadequate abilities to diagnose celiac disease and gluten sensitivity, that when we do finally make the diagnosis I believe we are guilty of another problem – Lack of adequate education to those affected patients.

Removing Gluten Is NOT Enough to Heal the Gut

A research study released by the American Journal of Gastroenterology, (2010) . The article was entitled “Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet”. The research team hailed from the Division of Gastroenterology and Hepatology at Mayo Clinic College of Medicine.

They stated that while most adults with celiac disease feel better after treatment with a gluten-free diet, the rate of small intestine recovery is less certain. Their aims were to estimate the rate of intestinal recovery after a gluten free diet in a cohort [a group of people with statistical similarities] of adults with celiac disease, and to assess the implications upon health of persistent intestinal damage after a gluten-free diet.

There was a pool of 381 adults with biopsy-proven celiac disease, 241 had both a diagnostic and follow-up biopsy. Among these 241, the confirmed mucosal recovery at 2 years following diagnosis was 34% and at 5 years was 66%. Most patients (82%) had some positive clinical response (they felt better) to the gluten-free diet, but it did not prove a reliable marker of intestinal recovery. 

Poor compliance to the gluten-free diet, severe celiac disease as defined by diarrhea and weight loss, and total villous atrophy at diagnosis were strongly associated with persistent intestinal damage. 

More Healing = Less Future Risk of Disease

There was a trend toward an association between mucosal recovery and a reduced rate of all-causes of death, adjusted for gender and age. 

The conclusions were that intestinal recovery was absent in a substantial portion of adults with celiac disease despite treatment with a gluten-free diet, and that there was an association between confirmed intestinal recovery (vs. persistent damage) and reduced mortality independent of age and gender. 

So what can we learn from this?

1.      Eating gluten-free when you are sensitive will cause you to feel better.

2.      Going on a gluten-free diet is not enough to ensure that your intestines will heal.

3.      Failing to heal your intestines puts you at increased risk for disease and death.

4.      Successfully healing your intestines reduces your incidence of death from disease.

While you likely knew the first point, 2 through 4 are perhaps less well known. 

Where I see that we are failing the gluten intolerant population is in the narrow focus of  eliminating gluten as the only needed treatment.  What the above research proves is that, unfortunately, for over 30% of those diagnosed, simply eliminating gluten is insufficient to ensure intestinal healing and thereby prevention of future disease states.

If patients were educated that healing their intestine would make the difference between contracting serious disease or not, and extending their life expectancy or not, I think they’d be more interested in ensuring that it occurs.

I am not a researcher but my clinic sees hundreds of patients who conform with the results of this study completely.  Patients come to see us who have been told that they shouldn’t consume gluten and for the most part they follow that recommendation.  They know that they feel better when they are gluten-free so that is an impetus to not cheat.  When they do cheat they know that they’ll “pay” for it but they still do so with some regularity.

Cheaters Beware!

Why do they cheat?  Because they believe that the diarrhea, headache, bloating, etc is temporary and that when it goes away they are “fine” again.  Their thought process is not unreasonable, it’s just wrong!

If each patient was educated that cheating created intestinal destruction that in turn put them on a fast track towards disease and early death, I believe that cheating would take on a whole new perspective.

Patients need this education and they need it often. Our book “The Gluten Effect” was written with this intention – our patients actually requested it.   They asked for a written reminder of why they should maintain their gluten-free lifestyle. Later I began taping Youtube videos because other patients preferred a reminder in a video form.

I personally am attempting to educate in a few different because it is terribly upsetting to meet individuals, as I so often do, who have been diagnosed celiac or gluten sensitive and do not follow their diet solely due to ignorance.

After almost 25 years of clinical experience I also know that some people “hear what they want to hear” and doctors with the best of intentions cannot get through to everyone.  But I strongly believe that we could be doing a much better job of education and enlightenment.

Further, we need to educate patients of the secondary effects associated with gluten. When the immune system of the intestine is suppressed, as is the case of a gluten intolerant patient, inhospitable and pathogenic organisms can gain entry into the intestine and remain there.  These organisms may be in the form of bacteria, parasites, amoebas or worms, and if they are not identified and eradicated, complete healing of the intestines is all but impossible. 

The good bacteria that are housed in the gut, known as the microbiome or probiotics, make-up  much of the intestinal immune system. In gluten intolerant patients this important population of organisms is often insufficient due to the onslaught from gluten and pathogenic organisms that have weakened it.  If the population of these probiotics is not restored to a healthy, robust balance, any attempt to achieve a healthy intestine will too be unsuccessful.

Diagnosing any cross-reactive foods, other food sensitivities or allergies, any other sources of toxins, and hormonal imbalance should also be on the checklist to rule out.

Lastly, it is an interesting catch-22 that in order to digest our food we need enzymes and enzymes are made from the nutrients we digest.  This circular pattern is dramatically interrupted in the gluten intolerant patient.  Celiacs in particular suffer from very poor absorption.  It shouldn’t then come as a surprise that augmenting with proper enzymes may be critical for “priming the pump” until proper digestion of nutrients is restored.

Unfortunately I find that few, if any, of these points are made clear to patients who are gluten intolerant.  Most feel that they are doing all that they need to simply by maintaining a mostly gluten-free diet.  Nothing could be further from the truth.

Find a Clinician Who Treats the Secondary Effects of Gluten

To review we need to do the following, something we call the Secondary Effects of Gluten:

-          Maintain a “perfect” avoidance of gluten

-          Test for the presence of pathogenic organisms

-          Test for any imbalance of the probiotic organisms

-          Evaluate the need for enzymes

-          Evaluate for the presence of any other food sensitivities or allergies, e.g. dairy

-     Evaluate for any toxins or hormonal imblance

-          Educate the patient until they have a full understanding of the above

-          Test to ensure that the intestine is healed

Need Help? We're Here for You! 

If you felt as if I was describing you above, you are not alone. As I mentioned earlier, adrenal fatigue/exhaustion is almost epidemic. If you would like assistance and don’t have a clinician whom you feel can assist you, consider contacting us for a FREE Health Analysis. We are a Destination Clinic and treat patients from across the country and internationally. We would be delighted to help you as we have been doing so for over two decades.

Visit us at www.RootCauseMedicalClinic.com. If you have questions or need any help, I’m here for you! Call 408-733-0400.

I look forward to hearing from you.

To your good health,

Dr Vikki Petersen, DC, CCN, CFMP


IFM Certified Practitioner

Founder of Root Cause Medical Clinic
Co-author of “The Gluten Effect”

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

Can Your Skin Have Celiac Disease?

I Don't Like the Way We Treat Skin Conditions in this Country

One of my pet peeves is the way skin conditions are treated in this country. I cannot state what happens elsewhere, although I fear it’s similar, but here in the US dermatologists (skin doctors) tend to treat skin the way one would a stain on one’s shirt. In other words they direct all their attention to trying to make disappear, the rash, the dryness, the burning, etc. topically.

Why is that an error? The skin is an organ. In fact it’s our largest organ. It's also important to know that the skin is most closely related to the digestive tract, another very large and very important organ.

You Can Have 'Leaky Skin' in Addition to a 'Leaky Gut'

When we discuss celiac disease and gluten sensitivity, we often mention a leaky gut, a condition whereby the integrity and health of the small intestine is compromised. Interestingly, the skin can also be ‘leaky’ or too permeable. This problem actually explains why some people react to applying gluten topically while others do not – it depends on whether or not they have leaky skin.

There is a classic skin condition associated with gluten called dermatitis herpetiformis or DH. It is often knows as the celiac disease of the skin.

What is Dermatitis Herpetiformis (DH)?

DH appears as blisters in symmetrical areas of the body, including elbows, knees, buttocks, lower back and back of the head.  The blisters are usually inflamed and red with severe burning and itching.  The burning and itching can be present before a rash ever appears. I had one patient describe it as ‘lit kerosene beneath his skin’.

An immune substance called IgA, that is produced in the lining of the gut, is found as deposits in the skin of a DH patient. It is believed that gluten in the diet combines with IgA and together they enter the blood stream where they clog up small blood vessels in the skin. This manifestation creates an additional immune response by white blood cells and the result is the rash of DH. 

Despite DH’s relationship to celiac disease, only 20% of patients suffering from it have any digestive symptoms. However, villous atrophy, the hallmark destruction of the small intestine consistent with celiac disease, is present 80% of the time. This ‘silent’ destruction likely contributes to the very few who are correctly diagnosed with DH. Instead they are given creams, lotions and steroids, all focusing on the rash itself instead of addressing the root cause of the condition – in this case dietary gluten consumption.

We know that DH exists and we know that it is the skin’s expression of the disease celiac. One would think that having that knowledge would be enough to appreciate that gluten can causes manifestations in areas beyond the digestive tract. But unfortunately we continue to hear of case after case whereby the patient had to diagnose themselves with celiac disease or gluten sensitivity when their doctor refused to test them because they had no or minimal digestive complaints.

The incidence of DH is thought to be 10 in 100,000 typically beginning in the 2^nd to 4^th decade of life. It is two times more common in men and more so in Caucasians of northern European descent. DH affects about 15%-25% of patients with celiac disease.

Skin Conditions Reflect Gut Health

 In our practice we like to say that the skin is a reflection of gut health. Whether the condition is acne, eczema, dry skin, psoriasis or DH, when a skin condition is present we look to the gut. Researchers of DH agree with us. In fact they suggest that the tTG enzyme that is classically measured in the blood for celiac disease has a ‘skin derived’ version that indicates the presence of DH. They feel the underlying mechanism has to do with molecular mimicry between the gut’s tTG and the skin’s. By the way, Cyrex Labs is soon to release this particular skin-related tTG as a blood test for DH.

Treatment for DH is twofold:

1. Dapsone – a drug given for symptomatic relief that has a dangerous side effect of creating hemolytic anemia

2. Gluten-free diet

Why Are We Unsuccessful in Treating DH?

 What’s the success rate? Full remission is only seen in 10-20% of patients. Not very good, I think you’ll agree.

Why does this occur? The patient and their doctor tend to focus solely on the appearance of the skin, rather than the state of health of the small intestine and body as a whole. When the skin “looks” better, patients cheat on their diet. It sounds ill advised and it is, especially considering that DH increases one’s risk of developing other autoimmune disease (thyroid, diabetes, etc) as well as small intestinal cancer.

But is it the patient’s fault? No, in my opinion it’s their doctor’s. Although with much good information available to pretty much everyone on the internet, I guess we can hold patients somewhat accountable. In the main, I think the brunt of the responsibility lies with the doctors who do not themselves know enough about DH and misdiagnose it as another condition or correctly diagnose it but then put no emphasis on healing the body as a whole.

Find the 'REAL' Root Cause of Your Skin Condition

 If you or someone you know has a skin condition, regardless of whether it turns out to be DH, know this: The skin reflects the health of the digestive tract and with poor digestive health present, optimal health will be absent. Find a clinician who has the correct viewpoint of the body and who understands that skin conditions need to be treated by embracing the whole body , not topically.

Need Help? We're Here for You! 

If you felt as if I was describing you above, you are not alone. As I mentioned earlier, adrenal fatigue/exhaustion is almost epidemic. If you would like assistance and don’t have a clinician whom you feel can assist you, consider contacting us for a FREE Health Analysis. We are a Destination Clinic and treat patients from across the country and internationally. We would be delighted to help you as we have been doing so for over two decades.

Visit us at www.RootCauseMedicalClinic.com. If you have questions or need any help, I’m here for you! Call 408-733-0400.

I look forward to hearing from you.

To your good health,

Dr Vikki Petersen, DC, CCN, CFMP


IFM Certified Practitioner

Founder of Root Cause Medical Clinic
Co-author of “The Gluten Effect”

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

References:

Journal of European Academy of Dermatology and Venereology. 2009 Jun;23(6):633-8. Epub 2009 Mar 10.

“Guidelines for the diagnosis and treatment of dermatitis herpetiformis.”

World Journal of Gastroenterology  2007 April 14;13(14): 2138-2139

“Celiac disease and skin: Psoriasis association”

Journal of the American Academy of Dermatology. 2009 Jul;61(1):39-43.

“Autoantibodies against epidermal transglutaminase are sensitive dx marker in pts w/ DH on a normal or g-free diet.”

Clinical Gastroenterology and Hepatology. 2005 Apr;3(4):335-41.

“Permeability, zonulin production & enteropathy in DH.”