Celiac.com 09/21/2019 (Originally published 04/05/2010) - I am a veterinarian who is doing research on the origins of disease.  This came about after my miraculous recovery from multiple ailments following my diagnosis of food intolerance, particularly celiac disease.  I have chronicled my recovery and findings on my website, www.dogtorj.com.

I’ve come to the conclusion that most of what we call “diseases” are long-term symptoms arising from the “civil war” taking place in our bodies, between its residents—our cells and those entities designed to help and protect those residents (e.g. viruses and bacteria) and the constant barrage of immune challenges that we throw at them (e.g. food lectins, carcinogens, chemicals/preservatives, trans fats, fluoride (an “antibiotic” and carcinogen) air pollution, etc., etc.  These, coupled with our horrific fast-food diets, inadequate sleep/exercise/sunlight, and self-induced misery through alcohol/drug abuse and our penchant for sugar have brought all of the plagues of Pandora’s Box on humankind.

Yet we keep pointing the finger at microorganisms like viruses and bacteria, including L-forms and mollicutes, as the enemy.  Granted, most don’t know or fully understand the true nature of viruses and bacteria - that they are crucial for our survival, being important instruments in our adaptation to this ever-changing environment in which we live.  But shouldn’t intelligent people be asking why these guys are so ubiquitous yet a relative few people are suffering from the “diseases” caused by these “culprits?

The fact is that viruses and L forms do what they do because they need to survive because they are crucial to our survival.  Would you disagree that if we could snap our fingers and make all viruses and bacteria disappear from the planet that the entire ecosystem would collapse? Certainly, we know that the vast majority of these bacteria are not pathogenic? What really distinguishes a pathogen from a saprophyte—or a helper?

When huge numbers of the population are infected with various “pathogenic” bacteria and yet remain asymptomatic, shouldn’t it give us pause? Why do they become such culprits of disease in the “unfortunate” few? Are they just unfortunate or have they done something—or lived somewhere, in the case of pollution—that has brought this plague on themselves?  We know that the number one risk of developing legionnaire’s disease was/is cigarette smoking.  Now there’s a surprise.

I believe down to my core that viruses and bacteria work in concert to help us all, especially when it comes to adaptation and survival.  Bacteria form L-forms and viruses mutate because they need to survive - they are critical to our survival and only become pathogens when we have forced them into doing so with the laundry list of abuses given above.  Cancer is little more than a virus (and/or an intracellular bacteria) forcing that cell to duplicate out of control in a desperate attempt to protect itself, and the cell it was designed to protect, as well as escaping those noxious elements (we call them “carcinogens”) that have forced them into this final phase of adaptation.  

Our immune systems tried valiantly to deal with this during the preceding “autoimmune” phase, a term I no longer use because the thought of our immune system attacking itself for no reason is preposterous, especially in light of research on L-forms.  And, we can’t say we weren’t warned by the broad array of symptoms we were given: the heartburn; IBS; allergies; hives; cough; migraines; seizures; fatigue/depression; etc.; etc.  

Certainly, there are those who have become so afflicted and immune challenged that they need some pharmaceutical aid to deal with these helper-turned-“culprit” bacteria but to become dependent upon antibiotics for any significant length of time is both potentially dangerous and unnecessary.  If we stop the assault we are visiting on these misunderstood and reactionary residents, we can come off the drugs (like I did) and re-establish the status quo, and long before the two or three year mark in most cases, I believe.

People simply need to know that we are the culprit, not these microorganisms at which we keep pointing our scientific fingers.  Why? Because these organisms—the viruses, bacteria, L-forms and mollicutes—are here to stay! It is we who are the transient visitors.  And if we want to enjoy our stay, we’re going to have to learn how to treat ourselves, and those who reside within us, a whole lot better.

Celiac.com 09/14/2019 (Originally published 04/05/2010) - Spring is finally here.  It’s time to think of warmer weather, green buds on trees, green blades of grass poking through the straw-like landscape… think green.  Think green about your food, too.  

Researchers claim that green vegetables promote good colon health and are good for the heart.  They provide folic acid to pregnant women to help prevent birth defects.  And greens in the kale family contain as much calcium as milk.  They help balance all the sodium in our diets by providing healthy potassium.  Age-related macular degeneration is a leading cause of blindness among individuals over the age of 50.  A research study in Massachusetts found that people who ate spinach, collards, and other dark green, leafy vegetables five or six times a week had 43% lower risk of the disease than those who ate it less than once a month.  And finally, green foods are loaded with antioxidants, minerals, and flavonoids.  

So how do you go about presenting green foods in enough different ways and with enough appeal to satisfy your family’s taste buds?  First, learn how to cook each vegetable for peak presentation and nutrition.  Then, concentrate on fun ways to incorporate “green” into your meal planning.  The typical refrigerated shelf life for most leaf vegetables is ten to twelve days.

When cooking broccoli, steam it to keep the green color and to retain all the nutrients.  If you don’t have a steamer, put the broccoli in a colander and suspend it over a pot of boiling water for a few minutes.

Steaming leafy greens (spinach, kale, Swiss chard) destroys the chlorophyll and will leave you with a messy gray wad.  Precook leafy greens by boiling in water for 3 to 10 minutes then drain and season.  Or sautéed in a little oil with some red pepper seeds and garlic.

Cabbage can be added to soups, casseroles, stews, stir-fries.  It can be rolled and stuffed, shredded for coleslaw, or eaten steamed with steamed potatoes.  

Leave the skin on zucchini for added fiber.  Shred the zucchini into meatloaf, scrambled eggs, and muffins.  This is a great vegetable to grill, or brush it with oil, sprinkle with seasoned breadcrumbs, then bake or broil.  

When selecting asparagus, thin spears are more tender than the thicker ones.  Steam them lightly so they’re still tender-crisp, or brush lightly with oil and grill or broil.  Sprinkling cooked asparagus with a little Parmesan cheese will enhance their flavor even more.

Peas don’t need much boiling time, nor do green beans.  When using frozen peas in a salad, you can just rinse them off under warm running water and not even bother pre-cooking them.

Swiss chard and beet greens are delicious boiled, drained, then tossed with a little olive oil and vinegar.

There are so many novel and delicious ways to incorporate more greens into your diet…

Restaurants are now offering “lettuce wraps”.  You’re served a dish of large lettuce leaves along with bowls of fillings and you create your own lettuce wrap.  You can do the same thing at home using romaine lettuce leaves.  Bread isn’t a necessary ingredient to make a fun and luscious sandwich.  Fillings can vary from fajita (julienned veggies often with sautéed strips of beef or chicken) or a salad filling (egg, tuna, chicken, salmon, or ham salad) to a Mediterranean veggie filling of sautéed zucchini, mushrooms, onions, green pepper, kalamata olives, feta cheese, all sprinkled with Italian seasoning.

Create your own pizza by doubling the amount of green pepper.  Or leave off the pasta sauce and brush your pizza crust with olive oil, sprinkle with Italian seasoning, then top with chopped spinach or sautéed zucchini slices, roasted red peppers, and crumbled feta cheese.

Vegetable soup can be a virtual pot of greenery!  Stir in chopped spinach and mustard greens, peas, cut green beans, shredded cabbage, chopped kale and argula, shredded zucchini, and chopped parsley.

Are you making gluten-free macaroni and cheese?  Stir in peas and/or green beans.  Pasta?  Stir shredded zucchini into the marinara sauce or skip the sauce and just toss the pasta with sautéed chopped spinach and a little minced garlic.  .  

Sometimes you just have to munch on something.  Have a container of hummus or ranch dressing close by to dip broccoli florets, celery and cucumber sticks, and strips of green pepper.

Quiche is a great for hiding greens.  You can fold in chopped broccoli, spinach, artichokes, and/or asparagus tips.

Stir-fry broccoli florets, snap peas, bok choy, celery, fresh baby spinach, and parsley; add a little gluten-free soy sauce and serve over rice.

Put fresh parsley in everything.  It adds color, flavor, and nutrition.  It also helps keep your breath fresh.

Another “green” you may not think of is green olives.  Their oil doesn’t clog arteries and green olives can be added to salads, antipastos, salsa, Bruschetta, sliced on top of pizza, or simply marinated and enjoyed alone.

Don’t overlook green herbs.  Fresh mint is a glorious addition to salads, pesto, meatballs, peas, and iced tea.  

The darker the green, the healthier it is for you.  So mesclun greens (often called spring mix), and baby spinach have more nutrition than iceberg lettuce.  Dark green vegetables are high in fat-soluble vitamins A, K, D, and E.  These vitamins require a little bit of dietary fat in order for the body to absorb them, so add a little olive oil when preparing the greens to make sure your body absorbs all of the vitamins you are eating.

Spinach Mandarin Salad (Gluten-Free)

This recipe is from the book “Gluten-Free Cooking for Dummies”

Ingredients:

• ¼ cup pine nuts
• 2 tablespoons orange juice
• 1 ½ tablespoons balsamic vinegar
• 2 tablespoons olive oil
• 1/8 teaspoon salt
• 1/8 teaspoon pepper
• 2 teaspoons honey
• ½ teaspoon brown mustard
• 4 cups fresh baby spinach leaves
• ¼ red onion, sliced thin
• 1 can (15 ounces) mandarin oranges, drained

Directions:

Place the pine nuts in a small skillet that has been sprayed with nonstick spray. On medium-high heat, toast the nuts, stirring frequently, until they are lightly browned. Remove pan from heat and cool. In a large bowl, whisk together the orange juice, vinegar, oil, salt, pepper, honey, and mustard. Add the spinach and toss until evenly coated. Add the onion, oranges, and pine nuts then toss to distribute evenly. Serves 4.

Celiac.com 09/12/2019 (Originally published 04/05/2010) - All of us with celiac disease or gluten sensitivity share something in common: we started eating gluten free to improve and protect our health.  But many of us focus on gluten free and few or no other aspects of good nutrition and end up making mistakes with our diet that lead to unhealthy weight gain or other new health problems.  

Some people can adopt the type of gluten-free diet that is commonly eaten and feel well.  But for most people the gluten-free diet is a great starting point but not an end-all.  It’s an eating plan that we can gradually adapt in individual ways to form the best diet for each of us.  If you want to eat gluten free for what it was meant for – promoting long-term good health – give your diet an upgrade by following these dietary guidelines from my new book Gluten Free Throughout the Year:

Go gluten free naturally.  It’s tempting to buy a lot of food products that are labeled gluten free, but the main foods that you should purchase are those that are naturally gluten free, such as vegetables, fruits, poultry, fish, and meat.  Stocking up on whole foods and creating meals with them is the best way to avoid even trace amounts of gluten and to eat a diet rich in nutrients that support health.  

Be choosy about the food products you buy.  When selecting foods, look for those that are labeled gluten free and that don’t contain hidden sources of gluten.  But also look for those that aren’t made with refined white rice flour (often labeled as rice flour as opposed to brown rice flour) and starches, such as potato starch or tapioca starch.  Regular eating of nutrient-poor refined ingredients sets us up for nutrient deficiencies, unhealthy weight gain, and chronic diseases such as heart disease and type 2 diabetes.

Become more unrefined.  Don’t just avoid refined flour.  Do your best to steer clear of foods with other refined ingredients known to promote degenerative disease – namely, refined sugars and refined fats.  Refined sugars include sugar (typically listed as “evaporated cane juice” on food labels), high-fructose corn syrup, and fructose.  Refined fats include vegetable oils, such as corn oil, soybean oil, cottonseed oil, safflower oil, sunflower oil, and partially hydrogenated oil.

Personalize the diet for you.  It’s common for gluten-sensitive people to be allergic or sensitive to other foods, such as cow’s milk, soy, eggs, or yeast, and to develop uncomfortable symptoms, including gastrointestinal distress, nasal or sinus congestion, joint aches, or other ailments, from eating them.  The only way to clear up the health problem is to avoid the offending food.  Customize the diet for your best health by identifying and avoiding the particular foods that are problematic for you.

Eat more against the grain than you’re used to.  The Western diet we have grown up on and are accustomed to is high in high-carbohydrate, wheat-based grains, which sets us up for weight gain and insulin-related health conditions such as type 2 diabetes.  When we go gluten free, we tend to think we just have to switch the wheat-based bread, pasta, baked goods, and snack foods we were eating with gluten-free versions of those foods.  Gluten-free grains are free of gluten but they are still high in carbohydrates and relatively low in nutrients compared to the carbohydrates and calories they provide.  Most vegetables, on the other hand, have considerably fewer carbohydrates and are much higher in vitamins and minerals.  It goes against the type of diet most of us are used to, but for many nutritional reasons, it’s important to fight the tendency to trade a standard high-grain diet for a gluten-free, high-grain diet.  Instead, eat more vegetables.  That is the overlooked secret to long-term weight control and optimal health that many people, including most who go gluten-free, miss.  

* This article was excerpted and adapted from Gluten Free Throughout the Year: A Two-Year Month-to-Month Guide for Healthy Eating (Against the Grain Nutrition, 2010) by Melissa Diane Smith.

Celiac.com 09/06/2019 (Originally published 04/05/2010) - I have a mental calendar that outlines some of the major contributors to the celiac community.  It is a limited one, as I can not list all of the many thousands of contributors to our community.  But I think I am aware of some of the most prominent of these, beginning with the discovery of the efficacy of the gluten free diet.  

In the 1930s, the most significant insight into celiac disease came from Dr. Willem Karel Dicke, a towering giant in the field of celiac research.  His contribution of the gluten-free diet is the single most powerful contribution to the celiac community that has ever been made.  Although others expressed insight into this condition, Dr. Dicke serves, in my mind, as the starting point for a modern understanding of celiac disease and gluten sensitivity.  We cannot guess just how long it might have taken before some other pediatrician or gastroenterologist listened to the insightful comments of a concerned mother who had noticed that her child’s skin rash (possibly dermatitis herpetiformis) resolved when wheat was removed from the child’s diet.  Please pause for a moment to think about this.  Even seventy five years after Dr. Dicke’s discovery, would your physician, or your child’s pediatrician, investigate a nutritional theory you offered him or her? I think very highly of her, but I’m not sure that my physician would do so.  The fact that Dr. Dicke listened that carefully to this concerned mother is the springboard that vaulted him to what I believe is the single greatest achievement in the history of celiac disease.  

By the 1950s, after Dr. Dicke’s thesis was published, the Crosby capsule was developed by Dr. William H. Crosby and was a major step forward for taking endoscopic biopsies from the small intestine.  It may have been a mixed blessing though.  While it identified some patients with severe, widespread villous atrophy, it likely missed most cases of celiac disease.  During those early years, a gluten free diet was considered an extreme dietary measure and was usually not recommended unless celiac disease could be confirmed.  Many physicians continue to see the diet in that light.  Fortunately, that paradigm is changing, both through the improved quality and distribution of gluten free foods along with the trend of more and more health care professionals coming to realize some of the many benefits and the reduced burden of following a gluten free diet.  

In the 1960s, Dr. Curtis Dohan was the first to test the hypothesis that gluten might be a factor in schizophrenia – perhaps appreciating that LSD, taken by many Psychology and Psychiatry students at that time to mimic the experience of the schizophrenic, is refined from the mold that grows on gluten grains.  He pointed to similarities between the indoles found in the urine of schizophrenics and those found in gluten grains.  He went on to conduct research and publish his findings along these lines for more than two decades.  His publications would prove prophetic even among those who had previously disparaged his work, as we now know that many schizophrenics mount immune responses to gluten that are usually quite dissimilar to those found in most celiac patients.  Nonetheless, the evidence of gluten as a factor in schizophrenia has now been established by several different approaches conducted by several different groups.   

As Dr. Dohan was conducting his first research in this area, one of the most enduring and important figures in Twentieth Century celiac research entered the arena.  Dr. Michael N.  Marsh began his illustrious career in medicine with his graduation from the University of Leeds, School of Medicine in 1960.  After a brief foray into obstetrics, he specialized in gastroenterology and dedicated most of the next 40 years to sub-specialty research on celiac disease.  His work unveiled many facets of the immunological reactions to gluten inherent in celiac disease which provided a foundation for many subsequent advances in celiac research that followed.  He developed the rectal challenge protocol which, although it continues to be experimental, is probably the best single test for identifying celiac disease and only celiac disease.  As if that were not enough, he also developed the Marsh system to aid pathologists in categorizing the various forms of altered villous morphology that are consistent with celiac disease.  Dr. Marsh’s retirement in 2000 was a loss to every celiac patient on the planet.  Although he went on to publish another book about celiac disease and write and publish several more papers before he shifted to the pursuit of yet another doctoral degree (his fourth by North American standards).  

In 1984, Doctors Cooke and Holmes, contemporaries of Marsh, compiled a compelling medical textbook.  Coeliac Disease may have been the first medical textbook devoted exclusively to celiac disease.  It owns a special place in my heart because it is so well written that I found the information quite accessible even when I first began to explore the literature on celiac disease.  These venerable gastroenterologists continued to conduct original research and thoughtful commentary both in the literature and at conferences.  

In the same decade, Dr. Martin Kagnoff was, I believe, the first to suggest that exposure to viral agents (specifically adenovirus 12) in addition to the predisposing HLA genetic markers, might be the key difference between those with the genetic predisposition who did and did not develop celiac disease.  Several investigations have since explored exposure to other viral agents, with varying degrees of success.

Also in the 1980s, both doctors Paul and Kozlowska each published separate accounts, in German and Polish respectively, of celiac children.  About 70% of these youngsters showed signs and symptoms that are diagnostic for attention deficit disorders (ADD) but these criteria went away after six months to a year of strict compliance with a gluten-free diet.

Again, in the 1980s, Dr. Vijay Kumar was an early pioneer in the development of antibody testing for celiac disease.  

Early in the 1990s, Dr. Carlo Catassi pioneered the use of endomysium antibody tests to conduct large screening studies for celiac disease among children throughout entire school districts in Italy.  He first revealed high rates of celiac disease in Italy, of 1:250 (a startling number at that time) then in Sub-Saharan Africa where 5.6% of Saharawi children were shown to have celiac disease.  These findings served as a template for similar work conducted in the USA.  It was spearheaded by a group of researchers including Dr. Alessio Fasano, Dr. Peter Green, and several others at medical centers across the US.  These same individuals have done wonders for celiac awareness in North America.  

Also in the 1990s, Dr. Kenneth Fine raised an early and strong voice in recognition of non-celiac gluten sensitivities.  His voice continues to echo through the celiac and gluten sensitive community, as his laboratory continues to test for fecal antibodies against gluten.  

By the mid 1990s, Dr. Marios Hadjivassiliou had pioneered many facets of gluten-induced neurological disease, raising the alarm that more than half of neurological disease of unknown origin is associated with gluten sensitivity.  

And in 1997, Dr. A. De Santis and associates showed smoking-gun evidence on SPECT scans, that removal of gluten from the diet of at least one schizophrenic returned the patient to normal blood distribution in the brain, and normal behaviour.  

From  the 1980s and continuing into today, Dr. Rodney Ford, a long time advocate of the gluten free diet for many associated conditions,  first conceptualized the notion that celiac disease may begin as a neurological condition and only a subset of those whose nerves are injured by gluten will go on to develop villous atrophy.  Further to the work of Hadjivassilou, Fine, Paul, Kozlowska, and Dohan, he has gone on to work on teasing out information from his patients and their records to show the gluten free diet can provide substantial academic and social benefits to these children.  

In the 1990s Dr. Joseph Murray added some startling examples to the long list of anecdotal reports of anomalous, overweight celiac patients.  Near the end of that decade Dr. William Dickey investigated this issue and found that while 22% of one group of celiac patients were underweight, 34% were overweight, and the remainder fell somewhere in the normal range.  Thus, only a minority of Dr. Dickey’s patients fit the malnourished and wasting stereotype often associated with celiac disease.  His data demonstrate that the possibility of celiac disease should not be dismissed on the basis of body mass index when working with normal, overweight, and obese patients.   

No discussion of heroes of the celiac community would be complete without further mention of Dr. Alessio Fasano and his work.  As previously mentioned, he has contributed enormously to celiac awareness.  However he and his lab associates also discovered and characterized zonulin, a major mediating factor of intestinal permeability.  He is also involved in the subsequent development of Larazotide, a drug that permits celiac patients to consume gluten with little or no adverse effects.  

Celiac awareness is growing rapidly in the US and Canada.  Celiac and gluten sensitive patients have great cause for optimism as these many paths of research continue to open up.  However, much of that work is not yet complete.  Two people I know well have recently been diagnosed with pernicious anemia, yet neither of the attending physicians has even suggested testing for celiac disease.  However, the future is full of promise for our children and their children.  Enormous strides are being made in building awareness (celiac disease is commonly in the media now) and more and more physicians and patients are increasingly aware of celiac disease and it is being diagnosed much more frequently with every passing year.  

That’s where we’ve been.  But where are we going? Has awareness built to critical mass where it will be self sustaining? It is hard to say.  But so many of those diagnosed with celiac disease believe, as I do, that we should have been diagnosed much earlier, if only the doctors had listened to what we were telling them.  We are understandably anxious to see this trend of overlooking celiac disease come to an end.  Each of us, in our own way, continues to push celiac awareness and as long as this is happening, I think we can assume that the trend toward increasing celiac awareness will be self sustaining, at least in the short term.  

It may also be fair to suggest that through increasing celiac awareness and the resulting reduction in delays to diagnosis, there will be fewer celiac-related cancers and autoimmune diseases arising out of untreated celiac disease.  Increased awareness is also making more gluten-free foods more widely available.  And economies of scale should eventually bring down the price of these food items.  In all, earlier diagnosis should lead to increased life expectancies and improved quality of life for younger generations of celiac patients.   

But those gains are only the tip of the iceberg.  Increased rates of diagnosis should lead to fewer children struggling in school, greater general nutritional awareness.  Larazotide or its derivatives will keep us safe when dining in risky places.  More than half of neurological diseases of unknown origin may become preventable and more treatable.  Some mental illnesses may prove to be more treatable on a gluten free diet.  

The current status of celiac awareness and available therapies gives good cause for optimism.  The future is looking better too.  2009 saw a multi-author publication identifying non-celiac immune reactions in schizophrenic patients.  Two years earlier, we saw a report by Anderson et al. that indicated higher rates of cancer and death among those with non-celiac gluten sensitivity than among those with celiac disease.  The tide is turning.  Non-celiac gluten sensitivity is clearly beginning to get some attention as a serious condition in its own right.  This augurs well for increasing awareness of gluten sensitivity.  Since this group forms 10 to 12 percent of the general population, and if studies of this sort continue to be conducted, we may soon see exponential gains in gluten free options.  Perhaps a cultural shift away from gluten grains is a possibility.  Both groups that conducted these investigations may someday be recognized as heroes for their willingness to investigate these questions.  

We may soon see a day when gluten free wheat is used to make bread that is safe to eat for all of us.  That research has been under way in Germany for quite some time.  Similar efforts are under way in the US.  The future may also see the development of digestive enzymes that, when taken with gluten, will break the bonds that bind the harmful peptides in gluten.   

All of the above are very worthy goals.  But there is a vastly greater benefit that is currently growing in our midst.  There is a sense of connection and belonging that each of us feels when we encounter another person who also avoids gluten to improve or preserve their health.  We are forging an international fellowship that knows no racial, economic, or social barrier.  Our common bond is our shared journey through a gluten-infested labyrinth that shapes our food supply.  And we feel a sense of affinity which may be one of Humanity’s most important needs.  This sense of kinship arises in the context of support groups, listservs, commercial enterprises that serve our needs and day-to-day encounters in our communities.  We are a growing fellowship of gluten avoiders.  

This article originally appeared in the Spring 2010 edition of Celiac.com's Journal of Gluten-Sensitivity.

Celiac.com 10/22/2010 - More and more we’re hearing from frustrated patients who, despite being vigilant about their gluten-free diet, continue to suffer health problems.

I have been involved in the field of celiac and gluten sensitivity for over 15 years and am delighted by much of the recent increased awareness and attention given to the area.  But I’m also concerned about the lack of assistance given to many patients who have been definitively diagnosed with either celiac disease or gluten sensitivity.  While being correctly given the advice to not eat gluten, they are not provided with a follow-up program to address and treat the secondary effects of gluten sensitivity.  This oversight condemns many to ongoing ill health.

The focus of this article is on the types of conditions we see clinically with our patients, some of the recent research that corroborates our findings, and steps you can take to address the underlying root cause of these problems.

Leaky Gut

Also known as increased intestinal permeability, a leaky gut refers to a loss of integrity of the lining of the small intestine.  Recall that the small intestine is approximately 23 feet in length and has the surface area of a tennis court.

Gluten, in the sensitive individual, is a known cause of leaky gut, but in a perfect world the elimination of gluten would allow healing to occur resulting in an intact, healthy intestinal lining.

Alas, we do not live in a perfect world and other factors contribute to the health of the gut.  Infections in the form of parasites, amoebas, bacteria, and the like, can certainly contribute to continued increased permeability.  Likewise, other food reactions, chief among them dairy, can cause persistent irritation and thereby prevent healing.  Imbalance of the beneficial bacteria or microbes that comprise the microbiota of the intestine, as well as nutritional and pancreatic enzyme deficiencies, are also suspected to limit healing.

Let’s take a look at each of these individually:

Infections

Whether one has celiac disease or is gluten sensitive, one thing is for sure, one’s immune system has been overtaxed due to the presence of gluten in the diet.  Depending on the age at diagnosis, it is often several decades of stress that the immune system has undergone.

Such an overburdened immune system is unable to be as vigilant as a healthy one and as a result it allows such organisms as parasites, amoebas or bacteria to infiltrate the body.  Some estimates suggest that the digestive tract is normally exposed to a pathogenic organism every 10 minutes.  A healthy intestinal immune system is able to identify and eradicate those organisms as part of its normal activities.  An unhealthy immune system often “misses” such organisms and they happily take up residence in the small intestine.

Interestingly, some of these organisms create crypt hyperplasia and villous atrophy that appears the same as that caused by gluten.  Imagine the frustration of a patient who is being told by their doctor that they are not following their diet when indeed they are.  What’s being missed?  The presence of an infectious agent.

In the 2003 American Journal of Gastroenterology, researchers reported a large percentage of small intestinal bowel overgrowth (SIBO) in celiac patients with persistent GI symptoms despite adherence to a gluten-free diet.  These patients were off gluten, as instructed, but were still having diarrhea due inhospitable organisms in their intestines.

This segues nicely into the next area I want to discuss – dysbiosis or imbalance of the friendly bacteria in the small intestine.

Dysbiosis

The population of organisms found in the intestines of celiac patients (treated with a gluten-free diet or not) is different from that found in healthy control groups.  The ratio of good bacteria to bad was found to be reduced in celiac patietnts regardless of whether their celiac disease was active or inactive.  Because the “bad” bacteria are pro-inflammatory in nature, they can be responsible for creating some of the initial problems with celiac disease, as well as helping to perpetuate them despite following a gluten-free diet.

In the August 2009 Scientific American, Dr Fasano made a very interesting statement regarding these microbes or probiotics as relates to the age of initiation of celiac disease.  He stated: “Apparently they [probiotics] can also influence which genes in their hosts are active at any given time.  Hence, a person whose immune system has managed to tolerate gluten for many years might suddenly lose tolerance if the microbiome changes in a way that causes formerly quiet susceptibility genes to become active.  If this idea is correct, celiac disease might one day be prevented or treated by ingestion of selected helpful microbes.”

Isn’t this fascinating?  If you haven’t read the complete article I encourage you to do so, but it is sufficient to say there is scientific discussion that entertains the notion that a healthy microbiome or probiotic population is not only anti-inflammatory (a good thing to help prevent many diseases) but may actually act as a “switch” that turns on and off the expression of certain genes.

Therefore, part of our program is to examine the population of the microbiome through laboratory testing, and supplement as needed, to support a healthy anti-inflammatory population.  In the past we typically prescribed probiotics only for a few short months following the eradication of a pathogenic organism.  But in the last several years it has become clear that our patients’ clinical profile is much more stable with continued probiotic supplementation.

Dairy Sensitivity

It can be difficult to confront major changes in one’s diet.  Removing gluten is definitely a big challenge and sometimes my patients look at me forlornly when I simultaneously recommend the elimination of dairy products.  I try to encourage them by promising that organic butter is allowed and by quickly recommending my favorite coconut ice cream, as well as cheese and milk substitutes.

Contrary to the passing thought that I wish to be cruel, there is excellent documentation to back up what we’ve seen clinically for years - gluten and dairy are truly not our friends.

The majority of the world’s people are lactose intolerant.  Populations such as Asians, African Blacks, those of Jewish descent, Mediterraneans, Mexicans and North American Blacks all exceed 70% intolerance to lactose. 

Note that many drugs and supplements may contain lactose as well, so be vigilant.

Estimates suggest that we retain the enzyme to digest our human mother’s milk for 2 to 5 years and after that milk from any mammal is likely toxic because it’s too high in protein and phosphorus, making proper digestion impossible.  Human milk is very low in protein but rich in essential fatty acids.

Casein, a protein from milk, is strongly associated with allergic reactions.  Therefore putting lactose and casein together presents double jeopardy to the body.  In this country, milk contains more toxins per gram than any other food, so you can see that there’s great cause for concern.

Earlier we spoke of leaky gut.  Dairy stops the formation of glucosamine in the intestine making it one of the primary causes of leaky gut.

I could expand on this further but perhaps we’ll save that for a future article.

Nutritional Deficiencies

When we eat, the ultimate goal is that the food will be broken down into components that can be assimilated into the bloodstream and delivered as fuel to all our trillions of cells.  Discovering that one is sensitive to gluten and eliminating it goes a long way toward achieving this goal.  However, some vitamins and minerals should be tested to ensure that their levels are normalizing on a gluten-free diet.  Otherwise good health may be a fleeting target.

Folic acid, vitamin B12, Iron and Vitamin D levels are all very important to measure.  Supplementation is often needed to optimize the levels of these substances.  Follow-up testing ensures that this objective has been achieved or maintained and should be part of a comprehensive program.

Discovering that you’re gluten sensitive and following the diet should be rewarded with dramatically improved health.  If that is not the result, other problematic factors need to be isolated and treated.  Such a program is not difficult and is well worth the effort.

Please let me know if I can answer any further questions.

To your good health!

This article originally appeared in the Spring 2010 edition of Celiac.com's Journal of Gluten-Sensitivity.

Celiac.com 07/19/2010 - Thinking about sending your youth to a gluten-free camp, but not sure if the benefits outweigh the cost? A new study was conducted to determine the quality of life among young celiac campers and it is indicating that camp may not only be fun for younger celiacs, but also improve their general well-being, self-perception and emotional outlook.

The Department of Pediatrics, University of California San Francisco, recently published the results of a study they administered which indicates strong evidence that gluten-free camp is important to the physical and emotional well-being of young celiac patients. The study surveyed 104 celiac youth, 7-17 years old who attended a gluten-free camp. Before, and after attending the camp, each camper was given a 14-question survey, using a Likert scale, to evaluate their emotional outlook, overall well-being and self-perception.

Of the 77 campers that completed the survey before and after attending the camp, all of them showed marked improvement in all three categories and were found to greatly benefit from attending a gluten-free camp. The reasons for the health benefits can be attributed to providing strictly gluten-free food for the campers, so no food was off limits to them. Also cited for the improvement of the campers was that all campers shared similar food sensitivities and they therefore felt safe and included among the other campers, decreasing the social anxiety that many celiacs feel when dining with non-celiacs.

Interestingly, campers who had been on a gluten-free diet for less than four years were more positively impacted by the gluten-free camps than were the campers who had been on a gluten-free diet for more than four years. The difference in results between the newer gluten-free campers and the more experienced gluten-free campers suggests that, over time, adaption to celiac disease can decrease the social anxieties that are often associated with the disease. To accurately test the endurance of these findings, once a young celiac has returned to normal daily activities, more tests will be needed. For now, it is safe to assume that not only is camp a great break for you and your kids, it is also important for their overall health and general well-being.

Source:

• http://pediatrics.aappublications.org/cgi/content/abstract/125/3/e525

Celiac.com 05/15/2010 - Willem-Karel Dicke was born in 1905, in Dordrecht, Holland, and died Utrecht in 1962.  Dicke was a Dutch pediatrician, the first clinician to develop the gluten-free diet, and to prove that certain types of flour cause relapses in celiac disease patients.

From 1922 until 1929, Dicke studied medicine in Leiden.  He then specialized in pediatrics in Juliana Children’s Hospital in The Hague from 1929 until 1933.  In 1936, at just 31 years of age, he was named medical director of the hospital. 

In the 1940s and 1950s he went on to formally establish the gluten-free diet, forever changing treatment methods and clinical outcomes of children suffering from celiac disease.  By 1952, Dicke recognized that the disease is caused by the ingestion of wheat proteins, not carbohydrates. 

From the late 1880s into the 1920s and 30s, doctors like R. A. Gibbons, Sidney Haas and others pioneered the use of specialty diets to treat celiac disease.  Diets such as the banana diet, the fruit diet, the carbohydrate diet (fruit, puree of potatoes or tomatoes), the beefsteak diet, the milk diet had all been tried, with some success.

In his now seminal 1950 thesis on celiac disease and wheat-free diet, Dicke lays out the results of the detailed dietary study he conducted over several years at the Juliana Children’s Hospital on a patient with celiac disease.

The study likely had its earliest beginnings at the advent of Dicke’s promotion to medical director, if not slightly before.  From the testimony of Dicke’s wife in 1991, we know that Dicke was convinced of the beneficial effect of wheat free diet even before 1940.  She confirmed that between 1934 and 1936, Dicke began to conduct experiments with wheat free diets confirming Christopher Booth’s comments in The Lancet, Feb 25, 1989:

“It was a young mother’s statement of her celiac child’s rash improving rapidly if she removed bread from the diet that alerted his interest,” when Dicke was a pediatrician in The Hague in 1936.

Dicke published his first report on a wheat-free diet in Het Nederlands Tijdschrift voor Geneeskunde in 1941.  (W. K. Dicke: A simple diet for Gee-Herter’s Syndrome).  At the time, celiac was still called Gee-Herter’s syndrome.  It reads, in part:

“In recent literature it is stated that the diet of Haas (Banana-diet) and Fanconi (fruit and vegetables) gives the best results in the treatment of patients suffering from coeliac disease.  At present (World War II) these items are not available.  Therefore, I give a simple diet, which is helping these children at this time of rationing.  The diet should not contain any bread or rusks.  A hot meal twice a day is also well tolerated.  The third meal can be sweet or sour porridge (without any wheat flour).”

In the Netherlands, the last winter of World War II, the winter of 1944/45 became known as the ‘Winter of Hunger.’ 

Delivery of regular food staples, such as bread, was largely disrupted, especially in the western part of the country.  This meant that people had to turn to uncommon foods, such as tulip bulbs, for sustenance.  It was during this time that Dicke became even more convinced that eating less grain, along with unusual foods, such as tulip bulbs, improved the clinical condition of his patients. 

Dicke’s next major confirmation came when Allied planes started dropping bread in the Netherlands, and these same children began to deteriorate rapidly. 

After World War II, Dicke conducted a series of experiments with standardized diets were performed on four children in the Wilhelmina Children’s Hospital in Utrecht and in one child in the Juliana Children’s Hospital in The Hague.  These experiments involved excluding or adding wheat or rye flour over long periods in the diets of these children with coeliac disease. 

In Dicke’s post-war experiments, children were challenged with different cereals under a strict dietary protocol with measurement of total fecal output, fecal fat content, and the fat absorption coefficient was calculated.

Dicke worked closely with biochemist J. H. van de Kamer of the Netherlands Central Institute for Nutritional Research TNO in Utrecht, who developed the first accurate and easily available method for measure fecal fat content in wet feces.  Dicke also worked closely with H. A. Weyers, a pediatrician from the Wilhelmina Children’s Hospital in Utrecht, who developed a method that used the coefficient of fat absorption to analyze fecal fat excretion in children with celiac disease.

Based on these findings Dicke concluded in his 1950 thesis that wheat flour, but not well-purified wheat starch (amylum), and also rye flour, triggered the anorexia, the increased fecal output, and the streatorrhea common in celiac patients.  Dicke presented his doctoral thesis on the subject at the University of Utrecht in 1950.

Dicke’s 1950 thesis refers to a celiac disease patient he treated in 1936.  The patient’s symptoms disappeared and he returned to normal weight and growth patterns after following a strict wheat free diet in the hospital.  However, each time the boy went home and was unable to maintain a wheat free diet, he suffered a decline in his growth curve. 

Dicke charted these advances and reversals over four long-term admissions.  Each time the trend towards normal growth was restored.  In his thesis, Dicke presents several growth curves of children treated with a wheat free diet.  In long term studies over several years he shows that, with a wheat free diet, these children gain weight, reaching normal growth patterns when compared with age matched controls.  At the end of chapter 3 of his thesis he concludes that:

“- if certain types of meal, such as wheat and rye are replaced in the daily diet, the patient improves;
- acute attacks of diarrhea, do not occur, provided these types of meal are not given;
- after a latent period which can vary in length, deterioration and acute attacks of diarrhea re-occur, if the objectionable types of meal are added to the diet too soon....”

In 1953, together with van de Kamer and Weyers, he subsequently published Coeliac disease IV “An investigation into the injurious constituents of wheat in connection with their action on patients with coeliac disease.”

They wrote that the alcohol soluble or the gliadin component of the water insoluble protein of wheat was responsible for the fat malabsorption in patients with celiac disease. 

Although these findings were quickly confirmed by researchers in Britain, Scandinavia, and Germany, some researchers, especially in America, questioned the wisdom of a gluten free diet.

After the establishment of the intestinal biopsy technique for the diagnosis of celiac disease, it became apparent that a wheat free diet should be maintained for long periods before an adequate response occurred, as Dicke had predicted. 

In 1954, Dr. Dicke, Charlotte Anderson, and a number of their colleagues, confirmed these findings, and described the damage to the lining of the small intestine as being directly related to celiac disease.

In 1957 he was appointed a professor of Utrecht University and became a medical director of Wilhelmina Children’s Hospital.

To honor Willem Karel Dicke, Netherland’s Society of Gastroenterology established a gold medal in his name, to be presented to pioneering researchers in the field.  Willem Dicke himself was named as the recipient of the first gold Dicke Medal.

Dr. Dicke died in 1962 of cerebrovascular disease.  He was just 57 years old.

Sources:

• Willem Dicke.  Brilliant Clinical Observer and Translational Investigator.  Discoverer of the Toxic Cause of Celiac Disease, by David Yan and Peter R.  Holt , M.D. DOI: 10.1111/j.1752-8062.2009.00167.x
• GUT 1993; 34:1473-1475
• Mulder, C.  “Pioneer in Glutenfree diet: Willem Karel Dicke 1905-1962 Over 50 Years of Gluten Free Diet.”  appended to: English translation by C.  Mulder June 1, 1993 of  Dicke, W.K.  “Coeliac Disease  Investigation of Harmful Effects of Certain Types of Cereal on Patients Suffering from Coeliac Disease.” Ph.  D.  Thesis, State University of Utrecht, 1950