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  • Dr. Rodney Ford M.D.
    Dr. Rodney Ford M.D.

    The 'Masking' of Celiac: Do Not Ignore the Smoking Gun

    Reviewed and edited by a celiac disease expert.

      Journal of Gluten Sensitivity Autumn 2014 Issue


    Caption: Photo: CC--Dennis Jarvis

    Celiac.com 01/02/2015 - What an odd thing to say: “Do not mask the appearance of celiac disease.” Inferring that you keep on eating gluten, despite early signs of celiac disease, until you get enough damage to your intestines that it can be seen under a microscope. I totally disagree with this concept—but this is still a common belief of medical practitioners.

    For instance a dietitian said this recently: “Gluten-free diet as an experiment to see if you (or your children) feel better, can be beneficial, but this approach can mask underlying celiac disease.”

    Have you ever heard of a doctor “masking” the diagnosis of heart disease by failing to treat high blood pressure or high cholesterol until the patient has a heart attack? Ridiculous! Have you ever heard of a doctor “masking” the diagnosis of depression so that the person is suicidal before given help? Ridiculous!

    A colleagues writes: “As far as ‘masking’ celiac disease, that would be like saying that a person who is pre-diabetic should continue to eat lots of sugar and carbs so they can destroy enough beta cells to develop full blown diabetes. That eating low carb might mask diabetes. Meanwhile the pre-diabetic blood sugars can continue to damage the body in many insidious ways. Maybe these dietary changes should be looked at as preventive measures that are good.”

    So why is the “masking” concept reserved for celiac disease? I regard a slightly raised tTG result as a ‘smoking gun’ (this also goes for EMA and DGP). Yes, the concept of “do not go gluten-free so that you do not mask celiac disease diagnosis” is contentious.

    There are many threads to this problem:

    1. Celiac disease is a progressive condition—it slowly gets worse the longer you eat gluten;
    2. In the early stages of celiac disease, it cannot be diagnosed by endoscopy biopsy;
    3. The biopsy test is inaccurate and relies on experts to recognize early disease;
    4. Most people who get gluten-illness do not have celiac disease;
    5. Gluten-related-disorders-without-gut-damage are indistinguishable from early-celiac-without-gut-damaage-yet;
    6. Carrying the HLA DQ2/DQ8 gene cannot be used to make a diagnosis, but if you do not carry the gene, it will be very unlikely that you have celiac disease;
    7. The “masking” concept originated a few decades ago when biopsy was the only way to diagnose celiac disease;
    8. Now, the blood tests for celiac disease (EMA, tTG, DGP) are more accurate than the biopsy, and can turn positive BEFORE there is any histologic evidence of gut damage;
    9. Once celiac disease has become established, you cannot guarantee complete remission;
    10. Gluten challenge is detrimental to your health;
    11. A gluten challenge (to create serious bowel damage) can take years, during which time ongoing body damage (brain, skin and bowel) is ongoing;
    12. Celiac disease and gluten-senitivity often co-exist.

    This concept is addressed in my new book “Gluten-related disorder: sick? tired? grumpy?” Available as an ebook at http://www.GlutenRelatedDisorder.com.


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    Fourteen year old daughter had many symptoms but negative to blood tests and no family history. Went on gluten challenge and was diagnosed on follow up endoscopy. Yes, I guess we can say that the challenge "caused" damage, however had we not done that, she may still be eating gluten to this day (she would not have gone gluten-free without proof). There are many celiacs who test negative to the blood tests, and even to the endoscopy. Not an easy disease to diagnose. That goes without saying.

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    Ankylosing Spondylitis is another disease of immunity where doctors(not all) want to see "damage" to the joints(sacroiliac) before they will diagnose it. Fortunately they seem to be moving away from this. I agree that diagnosing through inducing damage is primitive.

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    I always want to ask people who say don't stop eating gluten until tested, WHY? Would you tell a smoker to keep smoking until they get lung cancer? If a person feels better and healthier on a gluten free diet that they have chosen to eat, then more power to them. Getting diagnosed gets you nothing extra. No one gives you free pills or money or anything for getting diagnosed.

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    Guest Ramesh Shah, Ph.D.

    Posted

    celiac disease/Gluten sensitivity represents in the simplest form antigen-antibody or allergic reactions. The receptors on endothelium and T-cells in an activated state react with the antigen (gluten) and cause the damage to the intestinal lining. When you take gluten away (from the diet) by consuming gluten free diet or even by taking the enzyme (AN-PEP) with the low gluten or "so called" gluten-free diet, you have removed the cause of the disease, pure and simple.

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    Please send more info on gluten intolerance and anxiety and depression.

    Sue, you can easily do your own research ..... just "ask" Google the following ... "are gluten intolerance and anxiety related to celiac disease" ? You will get many responses to your question. Read many of the numerous responses to get a well-rounded bit of information.

     

    BTW -- People tend to use words that "say" one thing but mean another such as using the word allergy. A wheat allergy is a separate thing and not the same as celiac disease. When you have celiac disease that does not mean you are "allergic" to gluten. The same applies when you've been diagnosed with non-celiac gluten sensitivity. For those of us with a gluten (actually gliaden) intolerance -- the proper terms are those used above. I hope this is helpful to you.

    Keep reading and researching .....

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    Is it possible that the processed food industry has an interest in putting down the idea of going gluten free? After all, there are not many processed foods that celiacs would feel safe in consuming. I go down the frozen food cases and toss back one package after another because there is wheat listed in the ingredients. It is nice to be able to pop some enchiladas in the microwave for a quick dinner, but most contain wheat, even though the tortillas are made from corn. I think that wheat is a cheap filler/thickener to use in food, so it appears in most everything. And wheat is ubiquitous in the snack food aisles. Just think of the drop in snack food consumption if a large percentage of the population went gluten free. It would be interesting to know if the food industry sponsors physician conferences in which there is discussion of going gluten free.

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  • About Me

    Dr. Rodney Ford is a Pediatric Gastroenterologist. He was Professor of Pediatrics at the Christchurch School of Medicine. He runs the Children's Gastroenterology and Allergy Clinic in New Zealand. He has written a series of 7 books on gluten (www.DrRodneyFord.com). His main theory is that symptoms from gluten reactions arise from brain and nerve damage. His latest book is "The Gluten Syndrome" which encapsulates current ideas and concepts of gluten and the harm that it does.

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