Gluten sensitivity and Celiac Disease: new understanding and testing options
Celiac disease is an autoimmune condition that causes certain characteristic changes in the lining of the small intestine. The trigger for Celiac Disease is a severe reaction to gluten, a protein found in wheat and some other grains. Although there is a blood test for Celiac Disease, it is not always reliable and the standard for diagnosis is an intestinal biopsy to identify the changes that are typical of this illness.
Although Celiac Disease used to be considered rare, there is evidence that the incidence of this serious and sometimes life-threatening illness has been growing. A recent study that compared military records from 50 years ago to current ones concluded that over this time period the incidence of Celiac disease rose from one case in 700 people to one in just one hundred (Gastroenterology
, 2009 July; 137(1): 88-93). The reasons for this explosion are not entirely clear but there is a probable link to changes in the composition and processing of food, as well as new environmental challenges to the immune system.
Aside from Celiac Disease, people can suffer from different types of sensitivity to gluten that are not associated with the same characteristic intestinal changes. Mainstream medicine does not recognize these other forms of sensitivity to gluten, but many doctors and nutritionists, myself included, strongly believe they exist and are common.
We believe this because of the many improvements we see in our patients after they eliminate gluten from their diets. These improvements are wide-ranging: some people recover from depression – including severe depression – with elimination of just this one protein. Gluten also has strong associations with hyperactivity, lack of focus, and autism, and all these conditions can improve. In other cases it helps digestive disorders. It can also help patients with fatigue or fibromyalgia, and sometimes even autoimmune diseases like Rheumatoid Arthritis show positive responses.
Other times nothing improves and we are left wondering if gluten sensitivity is not a factor, or if these patients are also sensitive to something else and we missed it.
Over the years I tried many tests for gluten sensitivity but none were reliable, so I reached the conclusion that the only valid approach was trial elimination. This may have changed since I recently found a laboratory called Cyrex Lab that has developed innovative and potentially very helpful tests. You can find the lab and read about their tests here: www.cyrexlabs.com.
This lab may have the only truly reliable blood test for both gluten sensitivity and Celiac Disease. The reason is that they are able to screen for reactions to 24 components or forms of gluten. As a result this is the only test that is comprehensive enough to capture the vast majority of people who react to gluten.
Another test this lab developed measures the presence and severity of leaky gut, a condition almost always associated with gluten sensitivity. With it, the intestinal lining becomes hyper-permeable and allows food particles that are not completely digested to be absorbed. This leads to immune reactions that eventually weaken the immune system and may trigger autoimmune diseases. Leaky gut can also disrupt brain activity as the food particles that are absorbed act as false neurotransmitters.
As for gluten sensitivity, I had never found a reliable test for leaky gut, but Cyrex appears to have developed one. It measures immune reactions to proteins that can only come in contact with the immune system when there is leaky gut. Not only is this test reliable, it can also quantify the severity of this condition.
Sometimes even when all indicators suggest that gluten avoidance should help, it doesn’t. Other times it helps for a while and then no longer does. I long suspected that in these cases the body is reacting to other foods aside from gluten. As it turns out, there are approximately 25 foods that are cross-reactive with gluten. This means that if the body is reacting to gluten it can easily also react to one or more of these.
Many people who are familiar with the gluten-free diet know that a protein in milk called casein is highly cross-reactive with gluten, so much so that we usually recommend also avoiding dairy when first starting a gluten-free diet. Other foods that are cross-reactive with gluten include rice, oats, or quinoa, but also – odd as it may seem – sesame seeds and coffee.
Cyrex also offers a test to identify reactions to all of these cross-reactive foods. I think this test is essential if results of gluten avoidance are disappointing, or the benefits seem to have been lost. If you have questions about these tests or would like to know more about prices do not hesitate to call my office.
