We Still Have A Lot of Work to Do!

With The Gluten Effect’s publishing finally on the horizon, we’ve been contacting various groups who support those patients with celiac disease. It is my hope to educate those groups on the difference between celiac disease and gluten sensitivity such that we can help their family and friends who, while perhaps not celiac, may very well be suffering from the many problems gluten sensitivity creates.

While we have received many positive responses I chose to share the one “negative” response I received as an example of the pervasive attitude in the medical community which we have to overcome to help the millions of people suffering with gluten sensitivity.

Here’s the letter: (I have left out the person’s name and the specific group in order to respect confidentiality.)
Dear HealthNOW staff,

Thank you for your email. While I appreciate the importance Dr. Petersen places on the diagnosis of gluten intolerance, and her commitment to her patients, I must decline the request to add your links to our web site at this time.

We are affiliated with the Celiac Disease Foundation, and generally advise physicians and patients to follow the guidelines for celiac diagnosis and treatment recommended by university celiac disease centers, including those at U.C. San Diego, Columbia University, University of Maryland and University of Chicago. This approach appears to differ in significant ways from the one described on your web sites. For example, the use of Enterolab stool testing, and the dismissal of the intestinal biopsy as a misguided approach advocated by "several" clinicians, is inconsistent with our philosophy (8/26/08 entry in her blog).

While alternative approaches to diagnosis may prove fruitful in the future, we feel we will have the greatest impact in our local medical community at this time by using the resources of universities and peer-reviewed medical journals that mainstream physicians trust. We do, however, strongly support the use of integrative medicine in the treatment of celiac disease and gluten sensitivity.

There is a great deal yet to be discovered about celiac disease and gluten sensitivity, and I wish your colleagues well in the path they have chosen.


And here's my response:

Dear ________ (name left out to protect identity),

Thank you for your response. I would like to thank you for all the
good work you're doing in the field of celiac disease. Hopefully you will grant
me a few minutes of your time so that I can "state my case" for the work I'm doing with gluten sensitivity.

My upcoming book is heavily referenced and peer review literature is
among those over 400 references. Once such reference is from The
New England Journal of Medicine, October 2007 article by Peter Green,
MD.

Below are some quotes from the article and some comments from me.
"The diagnostic criteria developed by the European Society for
Pediatric Gastroenterology and Nutrition require only clinical
improvement with the diet, although histologic improvement on a
gluten-free diet is frequently sought and is recommended in adults
because villous atrophy may persist despite a clinical response to the
diet."

[In my experience of over 20 years I frequently see dramatic changes
in patient's health from a gluten-free diet despite a negative
intestinal biopsy. I believe the opinion of the above European
Society whereby clinical improvement on a gluten-free is sufficient,
is a trend that will soon be more prevalent here in the US.]
Serologic [Blood] Testing

"Typical indications for serologic testing include unexplained
bloating or abdominal distress; chronic diarrhea, with or without
malabsorption or the irritable bowel syndrome; abnormalities on
laboratory tests that might be caused by malabsorption (e.g., folate
deficiency and iron-deficiency anemia); first-degree relatives with
celiac disease; and autoimmune diseases and other conditions known to
be associated with celiac disease."

"The most sensitive antibody tests for the diagnosis of celiac
disease are of the IgA class. The available tests include those for
antigliadin antibodies, connective-tissue antibodies (antireticulin
and antiendomysial antibodies), and antibodies directed against tissue
transglutaminase,"

[Serologic testing of an IgA and IgG nature is what I utilize in my
practice and recommend for patients. Enterolab is mentioned for those
patients not local to our area who have doctors whom refuse to order
the serologic testing. While the limitations of the stool testing of
Enterolab are mentioned in our upcoming book, if it's the only
possible choice available, it may well provide the data a patient needs to make the important change to a gluten-free diet. And if that dietary change results in health improvement, it’s certainly worthwhile.]
"Although no studies have examined the number of biopsies required
for diagnosis, we believe that at least four to six endoscopic-biopsy
specimens should be obtained from the duodenum [small intestine], given the patchy
nature of the disease and the difficulty of orienting the small pieces
of tissue taken during biopsy for assessment of villous morphology."

"The spectrum of pathologic changes in celiac disease ranges from
near-normal villous architecture with a prominent intraepithelial
lymphocytosis to total villous atrophy. Pitfalls in the pathological
diagnosis include overinterpretation of villous atrophy in poorly
oriented biopsy specimens and inadequate biopsy sampling in patients
with patchy villous atrophy."

"Celiac disease occurs in nearly 1% of the population in many
countries. The diagnosis, which is straightforward in most cases, is
usually established on the basis of serologic [blood] testing, duodenal [small intestine] biopsy, and observation of the response to a gluten-free
diet. A poor response to the diet is common."

[This is the area where I know our opinions diverge but please hear me
out for a moment. There are 23 feet of small intestine and a biopsy
is attempting to identify small patches of villous atrophy. I have
many, many patients who are extremely gluten sensitive whom have been
told that they are absolutely fine to eat gluten. Why are they told
such a thing? Because their biopsy was negative. Are we really
helping our patients condemning them to lifelong suffering based on a
test of such a gross nature? I don't believe so. Much of the poor
response to diagnosis may very well occur because so much damage has
been done when a diagnosis is finally confirmed. By the time the villi
are flattened, often irrevocable damage has occurred to the digestive tract or some other organ system. Once autoimmune disease occurs, complete remediation is often not possible. Below Dr Green mentions the importance of early diagnosis. I don't believe that for the majority of people suffering from gluten sensitivity that early diagnosis is going to occur based on the use of intestinal biopsy alone. It’s too gross of a test for many patients and too insensitive at time to detect subtle changes of the villi. This is the very reason I utilize the testing I do, including the response of from the patient upon elimination of gluten from their diet. Early diagnosis is exciting because a patient discovers that they are gluten sensitive while they still have good functioning of their small intestine. A true early diagnosis should occur long before intestinal villi have been severely damaged. And that in sum is what I believe will be looked back on as our current greatest mistake - waiting for villous atrophy on biopsy before diagnosis is akin to waiting to diagnose risk for cardiovascular disease until the patient has suffered their first heart attack. As doctors we promise to do no harm. I believe we must seriously rethink and readjust our diagnostic criteria for diagnosing celiac disease and gluten sensitivity.]
"Increasing awareness of the epidemiology and diverse manifestations
of the disease, as well as the availability of sensitive and specific
serologic [blood] tests, especially among primary care physicians, will lead
to more widespread screening and diagnosis, which in turn will lead to
greater availability of gluten-free foods and efforts to develop drug
therapies that relieve patients of the burden of a gluten-free diet.
In addition, earlier diagnosis may lead to a reduction in the
complications of the disease."

Thank you for your time. I'd be happy to send you a copy of
our upcoming book, The Gluten Effect. And I'd would love to hear your
feedback.

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!”

Where did my flat tummy go?

Below is a case study from our upcoming book, The Gluten Effect. J.W. had some very common complaints, but the "common treatment" she was receiving was having no effect. I think she speaks for many.

No, I’m Not Pregnant!

J. W. is a classic example of weight complaints typical of adrenal exhaustion. She had developed a big belly that she could not get rid of. She felt bloated all the time, and no matter how often she exercised or how closely she watched her caloric intake, her weight remained the same. She felt constantly four months pregnant.

We diagnosed her with gluten sensitivity, and after being off gluten for several months, she went from a size fourteen to a size six, with a thirty-pound weight loss. She not only lost the weight, but it came off her “problem areas” first—her stomach and her face. She now had a flat belly, which she had never enjoyed before. J.W. also noted that her bloating was gone, and that she felt “clean” inside.

We diagnosed several infections, which were treated successfully as well, which also removed other chronic stressors from her system. In J.W.’s case, the distribution of weight around the mid-region of the body was typical of excessive cortisol production with adrenal exhaustion. Once gluten was removed, the stress on her body subsided, and a normal weight distribution returned.

Does this sound like you? Have you developed a “spare tire” (or, I’m told the more politically correct description is “muffin top”)?

What we’ve discovered after working with patients for over 20 years is that much of that “tire” can be due to swelling of the small intestine and the resulting adrenal fatigue from malabsorption of nutrients. You have about 23 feet of small intestine. Look down - that’s a lot of track to be laid down in a relatively small space.

Now imagine that 23 feet is swollen due to irritation created by a diet that doesn’t suit your body, or an infection. When it swells it has to go somewhere – welcome spare tire!

So the solution is to discover the underlying cause of the swelling. Now I’m not against exercise, quite the contrary. But I can promise you that all the crunches in the world will not flatten a tummy that’s swollen from a food intolerance or irritation from an untreated parasite or bacteria.

What do you need to do?

1. Discover if you’re gluten intolerant for starters. There are tests available for this and remember we’re talking about finding out if you're sensitive to gluten, not just if you have celiac disease.
Enterolab has a test you can order yourself (http://www.enterolab.com/ ) or you can work with your doctor providing they understand the difference between gluten sensitivity and celiac disease.
2. If you already know that you’re sensitive to gluten then realize that you must be perfect about removing it from your diet. Being good “most of the time” is just not enough.
3. If you have not had a comprehensive stool analysis to check for the presence of infectious organisms this really is something you should look into. As was mentioned in an earlier post, it is rare that a gluten sensitive individual DOESN’T have some type of infection due to years and years of assault on the immune system from eating gluten.
4. Get an idea of how your adrenal glands are functioning. We're not talking about adrenal gland disease which is very serious, but rather adrenal fatigue or exhaustion which is quite common. There will be an upcoming post specifically on the adrenal glands soon but suffice to say adrenal fatigue is very associated with malabsorption of nutrients which as you know is definitely an effect of being gluten sensitive. The good news is that with some natural nutrition and lifestyle management, adrenal function is not difficult to restore.
5. Lastly if you’ve already done all of the above and still don’t have the flat tummy you desire, you most likely are suffering from a “leaky gut” which needs some extra support to get completely healed. This support could come in the form of strong probiotics, the amino acid glutamine (not to be taken until you’re assured of not having an infection, however) or a medication called ketotifen which has a local effect to reduce irritation in the gut. This last medication would only be used for a short period of time.

I hope this is helpful.

Happy 2009! Our book “The Gluten Effect” will be out next month and it is one of our new year’s resolutions to have gluten sensitivity "come out of the closet” this year and be recognized for how common and hazardous it is to millions of people's health.

To your good health,

Dr Vikki Petersen

My Daughter Began My Gluten Journey

Today is my daughter’s 16th birthday. You may wonder the appropriateness of bringing that up on a gluten blog but it actually is completely germane. You see it is because of her that gluten sensitivity got on my radar in the first place. I had two children prior to my daughter and they were both quite healthy. I breastfed all three children so it was with some concern that I viewed my third child’s weight and overall health. She was “skinny” as compared to my previous “chubby” babies, tended towards rashes and liked to projectile vomit. Yes it was definitely that last trait which got my attention. It’s one thing reading about projectile vomiting and quite another thing witnessing it!

So like any good mother and doctor, I tried to discover what was bothering my daughter. Simultaneously I was trying to help my mother who had never enjoyed good health and was almost 70 when my daughter was born. Coincidentally I discovered they were both sensitive to gluten about the same time. And, much to my own dismay, I realized I was the sole genetic link between them!

And while my response of - “Why Me?” - was very similar to many who are diagnosed with gluten sensitivity, it soon became a blessing as all three of us started to exhibit excellent health.

My mother is now 85 and says that she’s enjoyed the past 15 years much more than the first 70 due to her improved health and vitality. She is spry, healthy and takes no medications (exclusive of bio-identical hormones).

My daughter fortunately never knew the poor health that both my mother and I suffered from and I am very happy about that.

Earlier today I had a conversation with a patient whom I haven’t seen in many years. She suffered from many digestive problems when she originally came to see us and we diagnosed her with gluten sensitivity. She definitely noticed an improvement being off gluten but never really stuck with it. She would “limit” consumption but that was as good as it got. She called to tell me that she was recently diagnosed with an autoimmune disease. It was so frustrating to realize that the odds of that autoimmune disease being prevented by a strict adherence to a gluten-free diet all those years ago were great. We discussed, once again, the importance of being completely gluten-free but unfortunately I don’t think she is yet ready to hear it.

It is so wonderful to have the opportunity to help patients each day at the clinic. But I want to do so much more. I want all the millions of people who are being affected by gluten to know it before they suffer any longer.

I am convinced that what we know to be true about gluten and its ability to ruin people’s health will be common knowledge within the decade. But in the meantime we can only continue to communicate about it – a message I hope that our book does well. Speaking of which, The Gluten Effect is finally about to go to print. Getting this book completed has felt like a fourth child - very exciting and a lot of work! January is the expected release and I’ll fill you all in on the specifics as they’re available to me.

So the takeaway from this message is this: Don’t rule gluten out as a causative factor in your health problems or those of the ones you love. Take a lab test but better yet change your diet. Go gluten-free for several weeks and see how you feel. If you have questions write me; I truly want to help!

To you good health!

Dr Vikki Petersen
drvikki@healthnowmedical.com

It’s Frustrating!

It can be very frustrating knowing what we know and not being able to get that information to everyone who needs it. I keep reminding myself that our book, The Gluten Effect – How “Innocent” Wheat is Ruining Your Health, is being publishing in January 2009. Only 2 months away but sometimes it seems like an eternity. It took us 5 years to write. Okay, we seriously started last January 2008 but I personally made some feeble attempts over the previous 4 years.

Back to my frustration – a patient came in 9 months ago very overweight and walking with the help of a cane. She hadn’t been suffering silently. She was a bright, proactive woman who was diligently searching for an answer to her problems. She received diagnoses and drugs but no particular improvement of her condition.

We see many patients and while we delight in every success story, sometimes we don’t remember how bad a patient’s symptoms were when they first arrived. When this patient came in last week she had to remind us of her cane. It had disappeared several months ago so it had become a bit “out of sight, out of mind” for us. But for her it was a miracle. She has lost 40 lb and at last week’s visit was proud to announce that she had just completed a half-marathon walk. Yes folks, that’s 13 miles of walking and not a cane in sight!

What changed? She found out that she was sensitive to gluten. Utilizing the HealthNOW Method we restored strength to her immune system and her adrenal glands as well, but the biggest missing ingredient was a life-long gluten sensitivity which had remained undiagnosed.

Do you see what’s so frustrating? I want to shout it from the rooftops. I want to enter every gastroenterologist’s office on the planet and do a lecture about gluten sensitivity to all the patients and staff.

Another patient, one who knows she is gluten sensitive came into the office the other day to receive some chiropractic care along with physical therapy. She told me that she recently went to her general practitioner for her annual physical and informed him that she was avoiding gluten and how much her health had improved as a result. (She had been on the verge of a heart attack about 2 years prior.) Despite relating her tremendous health improvements to her M.D, he insisted that if she didn’t have unrelenting diarrhea it was ridiculous for her to avoid gluten.

Do you see why I’m frustrated?

The number of M.D.s in this country who equate gluten sensitivity with celiac disease is phenomenal. Waiting for a positive celiac diagnosis is akin to waiting for a heart attack to occur before you tell a patient they have high cholesterol. It’s barbaric. And mark my words, within the decade gluten sensitivity WILL be known, understood and the idea of waiting for a positive intestinal biopsy before diagnosing it will be considered malpractice.

To Your Good Health,

Dr Vikki Petersen

Foods Posing the Biggest Hidden Dangers to the Gluten Sensitive

Now that you know you’re sensitive to gluten you’re very carefully avoiding all the wheat bread, bagels, cookies and cakes. You’ve stopped eating oatmeal for breakfast (you know about the contamination of oats) and you watch those protein bars for all signs of glutinous grains. You’re aware that fried chicken and breaded anything is also a problem and you’ve realized the hidden danger of sauces and things like meat loaf.

So where might you get tripped up? The biggest problem we run into with patients is with certain ethnic foods that cook with soy sauce. It’s just not “obvious” that soy sauce has wheat in it. When you cook at home you can definitely enjoy cooking with wheat-free soy sauce (usually known as Tamari) but Chinese and Japanese food very often contains soy sauce and if the sauce is brown you probably just got a nice hit from gluten.

The cautionary tale here is keep learning about food and how it’s prepared. As someone who enjoys cooking I know how many things are prepared so I rarely get fooled.

It you’re sensitive to gluten ANY is too much – way too much!

I hope this helps!

To your good health,

Dr Vikki Petersen