Celiac.com 11/26/2021 - Celiac disease has a prevalence of 1/100.  Between 90-99% of celiacs are HLA DQ2 and/or DQ8 positive.  Every individual has two DQ serotypes.  Because the molecular HLA nomenclature can be confusing DQ serotyping is a method for simplifying the results.  There are four major types and 5 subtypes: HLA DQ1, DQ2, DQ3 and DQ4; DQ1 has two subtypes; DQ5 and DQ6 whereas DQ3 has three subtypes; DQ7, DQ8 and DQ9.  Each individual has two copies of HLA DQ.  One DQ type is inherited from each parent.

Though 35-45% of individuals of Northern European ancestry are DQ2 and/or DQ8 positive only 1% has classic celiac disease as defined by abnormal blood tests and small intestinal biopsies.  Several autoimmune conditions also occur more frequently in DQ2 and DQ8 positive individuals.

There is accumulating scientific evidence that many individuals are gluten sensitive and respond to a gluten free diet though they have normal blood tests and/or normal intestinal biopsies (fail to meet strict criteria for celiac disease).  This is commonly being referred to as non-Celiac gluten sensitivity (NCGS).  Many individuals who have NCGS are relatives of confirmed celiacs and were previously referred to as latent celiacs.  Electron microscopy and immunohistochemistry studies of individuals with normal biopsies but suspected of or at risk (1st degree relatives of celiacs) have revealed ultrastructural abnormalities of the intestine and those who chose a gluten free diet usually responded and many who did not ultimately developed abnormal biopsies on long term follow-up.  Seronegative celiac has also been recognized.  That is, blood tests are negative, but the biopsy reveals classic abnormalities of celiac and the individual responds to a gluten free diet.

Fecal antibody testing for gliadin (AG) and tissue transglutaminase (tTG) by Enterolab in Dallas has revealed elevations in 100% of celiacs tested and up to 60% of symptomatic individuals without Celiac disease (NCGS) even if not DQ2 or DQ8 positive.  (Fine, K unpublished data).  The only DQ pattern he found not associated with gluten sensitivity is DQ4/DQ4, a pattern typically found in non-Caucasians who are known to have a low prevalence of Celiac disease.

Testing for DQ2/DQ8 has been suggested as a way to exclude celiac disease.  That is, if you are negative for DQ2 and DQ8, then you are very unlikely to have celiac disease.  However, well documented cases of celiac disease and Dermatitis Herpetiformis (DH) have been confirmed in DQ2 and DQ8 negative individuals.  Moreover, we now have the clinical experience that other DQ patterns predispose to gluten sensitivity because these individuals frequently have elevated fecal antibodies to AG or tTG and respond to a gluten free diet.

Why some people develop celiac disease or become sensitive to gluten is not well understood.  Risk factors include onset of puberty, pregnancy, stress, trauma or injury, surgery, viral or bacterial infections including those of the gut, medication-induced gut injury or toxicity (e.g.  NSAIDs), immune suppression or autoimmune diseases, and antibiotic use resulting in altered gut flora (dysbiosis).  The severity of the sensitivity is related to the DQ type, pre-existing intestinal injury, degree of exposure to gluten (how frequent and large a gluten load an individual is exposed to), and immune status.  Once initiated, gluten sensitivity tends to be life-long.  True celiac disease requires life-long, complete gluten avoidance to prevent serious complications, cancers, and early death.

Serotypes can be determined from blood or buccal mucosal cells obtained by oral swab from several commercial labs including Prometheus, Labcorp, Quest, The Laboratories at Bonfils, and Enterolabs.  Fecal IgA anti-gliadin and IgA tissue transglutaminase antibody testing is only available commercially in the U.S. through Enterolabs.  The fecal AG and tTG testing may be helpful to those with normal blood tests for celiac and/or a normal small bowel biopsy but suspected of being gluten sensitive.  Though the fecal antibody results are not widely accepted by many “celiac experts” numerous testimonials of individuals testing positive only on fecal tests who have responded to a gluten free diet can be found in support groups, web postings, personal communication from Dr. Fine, and this physician’s clinical experience.

References:

1. Abrams et.al.  Seronegative celiac disease:increased prevalence with lesser degrees of villous atrophy.  Dig Dis Sci 2004;49:546-550.
2. Alaedini A.  and Green P.H.R.  Narrative Review: Celiac Disease: Understanding a Complex Autoimmune Disorder.  Ann Intern Med.  2005;142:289-298.
3. Arranz et.  al.  Jejunal fluid antibodies and mucosal gamma/delta IEL in latent and potential coeliac disease.  Adv Exp Med Biol.  1995; 371B:1345-1348.
4. Dewar D.  and Ciclitira P.  Clinical Features and Diagnosis of Celiac Disease.  Gastroenterology 2005;128:S19.
5. Kappler et.al.  Detection of secretory IgA antibodies against gliadin and human tissue transglutaminase in stool to screen for coeliac disease in children:validation study.  BMJ 2006; 332:213-214.
6. Kaukinen et.al.  HLA-DQ Typing in the Diagnosis of Celiac Disease.  Am J Gastroenterol.  2002;97(3):695-699.
7. Fine KD and Rostami K.  Don’t throw the baby out with the bath water.  BMJ February 13, 2006 rapid response editorial.
8. Fine K.  Early diagnosis of gluten sensitivity before the villi are gone.  Transcript of presentation to Greater Louisville Celiac Support Group, June 2003.
9. Picarelli et.al.  Antiendomysial antibody detection in fecal supernatants: in vivo proof that small bowel mucosa is the site of antiendomysial antibody production.  Am J Gastroenterol.  2002 Jan;97(1):95-98.
10. Sbartati A.  et.al.  Gluten sensitivity and “normal” histology: is the intestinal mucosa really normal? Dig Liver Dis 2003;35:768-773.
11. Sollid L.  and Lie B.  Celiac Disease Genetics:Current Concepts and Practical Applications.  Clinical Gastroenterology and Hepatology 2005;3:843-851.
12. WGO-OMGE Practice Guideline Celiac Disease.  World Gastroenterology News.  2005;10(2):supplement 1-8.

Celiac.com 11/19/2021 - The association between celiac disease and a range of respiratory diseases has long been recognized(1).  An exploration of the literature on this point brought me several new insights.  For instance, I learned that gluten sensitivity is also an important risk factor for certain lung disorders.  Although celiac disease was only slightly more frequent (one of 29 subjects had celiac disease) a whopping 40% (12 of 29) of patients with sarcoidosis showed gluten sensitivity(2).  I also learned that some researchers are even pointing to celiac disease as an underlying cause of some cases of lymphocytic bronchoalveolitis(3) which is an inflammation that narrows the airways in the lungs.  Perhaps the most startling new insight I gained was that despite compliance with a gluten-free diet, patients with celiac disease continue to show signs of a mucosal defect in the lungs(4).  

From a personal standpoint, although I experienced asthma and many breathing problems as a child, I have blamed my 25 years of smoking cigarettes for the bulk of my lung problems.  While I remain confident that this is a large factor in the lung disease I have today, I am also realizing that my celiac disease is a contributing factor.  I have made some important strides in improving my lung function as a result of my studies, and it is these that I would like to share with you here.  

Although my memory is vague on this point, I’m sure I experienced improvement from the celiac diagnosis and subsequent gluten-free diet.  I’m also sure that food allergy testing, and subsequent avoidance of problem foods, helped stabilize my breathing to the point where I have rarely experienced breathing crises in the last six years.  Nonetheless, I have been limited by a very small capacity for exercise and the predictable losses in conditioning.  In the process of researching ketogenic and low carb dieting for a video I am working on, I chanced upon a reference(5) to a study of healthy women that claimed a 5% increase in peak flow and a 10% improvement in pulmonary function after one week on a low carbohydrate diet(6).  

I have now been following a low carbohydrate diet for more than a month.  My average peak flow has increased by about 15%.  Far more importantly, my tolerance for exercise has increased quite dramatically.  Although I still become breathless after vigorous exercise, I can engage in mild to moderate exercise for considerable periods without any breathing difficulty.  This constitutes a considerable improvement in my breathing and provides an important increase in the quality of my life.  

I realize that smoking is a foolish habit to start.  Despite many warnings I continued this habit for many years, until six months prior to my celiac diagnosis.  I know I am fortunate in not having contracted any of the deadly diseases caused by smoking.  Thus, I take solace in the research that shows that tobacco smoking is a way of self-treating the symptoms of celiac disease(7,8,9,10).  These publications have helped me deal with the self-recrimination that accompanies the knowledge that I created my own breathing problems.  It has also led me to a deeper understanding of the powerful addiction I experienced, the illness I felt after I did finally quit, and the recognition that celiac disease has shaped a great deal of my life.

References:

1. Stevens FM, Connolly CE, Murray JP, McCarthy CF.  Lung cavities in patients with coeliac disease.  Digestion.  1990;46(2):72-80.
2. Papadopoulos KI, Sjoberg K, Lindgren S, Hallengren B.  Evidence of gastrointestinal immune reactivity in patients with sarcoidosis.  J Intern Med.  1999 May;245(5):525-31.
3. Brightling CE, Symon FA, Birring SS, Wardlaw AJ, Robinson R, Pavord ID.   A case of cough, lymphocytic bronchoalveolitis and coeliac disease with improvement following a gluten free diet.  Thorax.  2002 Jan;57(1):91-2. 
4. Robertson DA, Taylor N, Sidhu H, Britten A, Smith CL, Holdstock G.  Pulmonary permeability in coeliac disease and inflammatory bowel disease.  Digestion.  1989;42(2):98-103.  
5. The Ketogenic Diet: A Complete Guide for the Dieter and Practitioner by Lyle McDonald. 1998.
6. Kwan RM, Thomas S, Mir MA.  Effects of a low carbohydrate isoenergetic diet on sleep behavior and pulmonary functions in healthy female adult humans.  J Nutr.  1986 Dec;116(12):2393-402.  
7. Suman S, Williams EJ, Thomas PW, Surgenor SL, Snook JA.  Is the risk of adult coeliac disease causally related to cigarette exposure? Eur J Gastroenterol Hepatol.  2003 Sep;15(9):995-1000. 
8. Austin AS, Logan RF, Thomason K, Holmes GK.  Cigarette smoking and adult coeliac disease.  Scand J Gastroenterol.  2002 Aug;37(8):978-82.  
9. Vazquez H, Smecuol E, Flores D, Mazure R, Pedreira S, Niveloni S, Maurino E, Bai JC.  Relation between cigarette smoking and celiac disease: evidence from a case-control study.  Am J Gastroenterol.  2001 Mar;96(3):798-802.  
10. Snook JA, Dwyer L, Lee-Elliott C, Khan S, Wheeler DW, Nicholas DS.  Adult coeliac disease and cigarette smoking.  Gut.  1996 Jul;39(1):60-2.

Celiac.com 11/12/2021 - Is it possible for a large, multi-billion dollar, multi-national corporation like McDonald’s to make an honest mistake—even if that mistake benefits them directly by increasing their sales and bottom line?  For many people the answer is no—never—there must be some conspiracy or greedy modus operandi at work which better explains the situation.  If you are a die-hard conspiracy theorist there may be little in this article that will change your position with regard to McDonald’s and their recent “gluten problem.”  My hope, however, is that people on both sides of this issue will gain some knowledge here—especially with respect to how difficult it really is for all food companies to determine and guarantee the gluten-free status of their foods.  Additionally, I believe that we can all learn something from McDonald’s mistake (or uncovered secret plot!), and how they have dealt with it.

For many years McDonald’s has told its customers via their Web site and customer service telephone line that their French fries and hash browns were gluten-free.  Due to their wide availability and low price these menu items have become a staple for many people on a gluten-free diet.  The drama surrounding these foods began on February 13, 2006, when the Houston Chronicle broke this story: “McDonald’s: Fries Have Potential Allergens.”  This article revealed that the natural flavoring used in those menu items actually contains wheat as an ingredient.  According to a March 8th email from Catherine E. Adams Ph.D, R.D., McDonald’s Corporate Vice President Worldwide Quality Systems and Nutrition, McDonald’s first noticed this potential problem when one of their ingredient suppliers had to comply with the new Food Allergen Labeling and Consumer Protection Act, which required that supplier to list, if present, any of the eight major allergens (or their derivatives) on the packaged food’s product label. The supplier complied and informed McDonald’s of their “use of wheat as an ingredient in the natural flavoring.”  

A Case for Innocence

There are several reasons why I believe that this whole incident was a large, avoidable, mistake on the part of McDonald’s (rather than a secret plot): 

1. The timing of the event: This story broke one month after the new labeling laws took effect.  McDonald’s likely had no idea that wheat was in the natural flavoring until it was revealed to them by their supplier (of course they should have done due diligence and known this back when they created their gluten-free product listing.); 
2. Something that was contained in Ms. Adams’ March 8th email response: “While the new law applies to packaged food products—not the restaurant industry—in our ongoing efforts to communicate to our customers we thought it was important to share this information.”  She is legally correct here—the new law does not require McDonald’s to reveal the fact that there is a wheat-derivative in their natural flavoring—the law does not apply to the restaurant industry and only applies to the packaged food consumer market (certainly this is a loophole that needs to be changed in the future).  If McDonald’s wanted to keep this a secret from the public they could easily have done so because there is no legal requirement for them to disclose any allergens in their foods. They have done this on a strictly voluntarily basis for many years now;
3. Public image: McDonald’s has gone to a great deal of effort over the years to voluntarily disclose their list of “safe” foods for people with various allergies—mainly because it is good for their public image—and to a certain extent the allergy market has been a source of revenue and has likely increased their sales.  Misleading people with regard to the allergens in their foods, whether it is done on purpose or by mistake, would surely lead to major lawsuits that would likely negate any financial gain achieved from this relatively small market—and would create a public relations nightmare.  To a company like McDonald’s public image is everything. It seems doubtful that they would intentionally take such a great risk to gain a share in such a small market.

Let the Lawsuits Begin

Very soon after the newspaper story broke the French fries and hash browns were taken off of McDonald’s gluten-free list on their Web site.  On February 19,, 2006, the Wall Street Journal ran the article: “McDonald’s Faces Three Lawsuits,” and thus began the “lawsuit bandwagon” that continues to the present. It has the potential to ultimately cost them tens if not hundreds of millions of dollars through a class action suit.  At about this same time I actually had to ban a major Colorado law firm from the Gluten-Free Forum (www.glutenfreeforum.com) because they were trying to use the site to solicit forum users to join a class action suit that they planned to bring against McDonald’s. This violated the site’s rules against advertising.

McDonald’s Response

On February 20,, 2006, only one day after the Wall Street Journal article appeared, Jack Daly, Senior Vice President of McDonald’s Corporation, issued a media statement on their Web site titled: “McDonald’s Fries are ‘Gluten and Allergen Free,’ According to Expert.”  It stated that: 

“Scientific evaluation by one of the world’s leading experts on gluten sensitivity and allergenicity, Dr. Steven Taylor of the Food Allergy Research and Resource Program of the University of Nebraska, has confirmed again that our fries are gluten free and allergen free.  Based on this analysis, we believe the lawsuits filed are without legal merit.”  

Support Groups to the Rescue

Shortly after the release of Jack Daly’s media statement the Gluten Intolerance Group (GIG) issued a press release titled “McDonald’s: A Safe Place for Celiacs to Eat According to the Gluten Intolerance Group”, which backs up McDonald’s claim that their fries and hash browns are gluten-free.  The Celiac Sprue Association (CSA) also released a statement on their Web site that supported McDonald’s, and in much more detail than the GIG’s, including the following statement:

“The CSA has examined the commercial manufacturing process of the natural flavoring with wheat as a starting ingredient which is used in connection with the McDonald’s Corporation French fries and hash browns. CSA provides the following statement after knowledgeable, careful evaluation and review of the process and pertinent test results. French fries and hash browns prepared in oils with this flavoring might be considered, commercially, to ‘contain no gluten.’”

What Does “Gluten-Free” Mean Anyway?

Reliable sources have since revealed that the wheat used in McDonald’s natural flavoring is processed in such a way that nearly all proteins are removed, much like the distillation process removes gluten from wheat, and that the actual gluten content in the French fries and hash browns—according to RidaScreen Gliadin Elisa testing—is less than 3 parts per million (PPM).  It is still possible for partially broken down wheat proteins to be present, so a Rast test was also done and no wheat-allergic residue was detected.  Together these results are convincing and indicate that McDonald’s French fries and hash browns are indeed gluten-free by any current standards that are in use anywhere.  But “less than 3 PPM” is not zero gluten—right?  Keep in mind that it is currently impossible for anyone to say that any food or product is 100% gluten-free—there is no analytical technique that can say that there is zero gluten in a sample, and the best detection limits I have seen report low ranges from 2 to 20 PPM—not zero.  The Codex Alimentarius, which covers the U.S.A., and Canadian standards for gluten-free is 20 PPM for naturally gluten-free foods, and there is currently no gluten-free standard for the U.S.A.

Do the Lawsuits have Merit?

Based on the aforementioned test results it is highly doubtful that McDonald’s has hurt anyone with these products—which is what must be shown in such cases—the claimants must demonstrate actual damages, loss or injuries related to the defendant’s actions (or inactions), and if they cannot do this their suits will be without merit and will be thrown out (which is what I believe will happen here).  Even if the testing had found higher levels of gluten in the products the claimants would still be facing an uphill battle.  This is because they would still have to demonstrate that a specific injury was caused to them by McDonald’s, and that their injury didn’t occur by another means.  In other words they would have to show that there were no other sources of gluten contamination in their diets, which is something that is difficult if not impossible to do in a legal context.  On top of these problems the claimants must overcome the fact that in the U.S.A. there are no current legal regulations regarding the use of the term “gluten-free” on packaged or restaurant foods.  The only thing that comes close is the Codex Alimentarius, which are voluntary industry guidelines and not legal regulations. 

The Damage Done

Whether or not McDonald’s wins or loses these lawsuits may, however, be irrelevant. To a certain extent the damage has already been done—and it does not stop simply with the damage that was done to their public image and reputation. The fact that many people with allergies and intolerances will never again trust McDonald’s (or companies like them) is just the most obvious fallout from this whole mess.  There is a much larger picture taking shape that began with McDonald’s no longer listing the gluten-free product information for many of the items that they used to list. Their French fries, hash browns, shakes, dressings, etc., and other companies have also discontinued their “gluten-free” product listings.  Some companies have even stopped using the term “gluten-free” on their labels, even though their products remain gluten-free.  One company even contacted me and wanted to be removed from the offerings at The Gluten-Free Mall due to liability concerns that began when they heard about the McDonald’s fiasco.  

For companies like McDonald’s the potential benefits of providing such voluntary information  must outweighs the risks.  The extensive publicity surrounding these events has made it clear that the risk of being wrong when making the claim that a product is free from an allergen, even if the mistake is an honest one that began with perfectly good intentions, is very great. So why risk making such claims at all? (This will be the question asked by the companies’ lawyers anyway.)  The fallout from this may not end for some time. Certainly anyone making, selling or claiming that their products are gluten-free (or free from some other allergen) must be concerned about the possibility of litigation.  In the end it will likely be easier for many companies not to bother with the allergen market at all, especially once real gluten-free regulations are created here in the U.S.A., which will happen in the next couple of years. 

Hindsight

How could McDonald’s have avoided all these problems in the first place?  The most obvious answer is that they could have avoided making any claims about the allergens in their products. That would have left those of us who have food challenges in the dark.  Does that sound like McDonald’s to you?  I hope such a negative scenario doesn’t become the norm for such companies.  Perhaps the best solution would have been for them to consult with some of the many celiac disease/gluten-free experts, for example the Gluten Intolerance Group’s new Food Certification Program, or with Donald D. Kasarda, Former Research Chemist for the United States Department of Agriculture, and made 100% sure that their lists were accurate (in this case it appears that their lists were accurate, but disclosing ALL of the actual ingredients in their products would have avoided much of this controversy).  

I think that all food companies can learn a valuable lesson from these events: it is better to test your products before you have any issues, and to continue to test them periodically. It is better to conduct ingredient research up front and consult with experts before publishing any gluten-free product listings—this is an ongoing process and must be done regularly because ingredient suppliers may change.  Once the information is compiled and determined to be accurate it is better to disclose ALL ingredients used in every product.  Web sites are a great place for such information.  Even if you operate a restaurant and are not legally required to do so, public disclosure is best when it comes to things that your customers put in their mouths—and your customers have a right to know exactly what they are eating.  Fast food companies should print ALL ingredients on the packaging no matter how scary they sound.  Individuals who are concerned about such matters will, or should, be familiar with what is and is not safe for them. 

Celiac.com 11/05/2021 - This is going to be a bit different from most of your medical lectures, I think.  I hope you are up for “different”.  If nothing else, the hard copy in your conference notes will give you something to read on the plane home.

“Hmmm—which metaphor do I use to best illustrate the fate of conventional medicine as we now know it?  Which one will give the clearest vision of the dramatic paradigm shift that is now taking place, one that will change the way we practice the art of healing for the rest of man’s days?  Which will they grasp, take to heart, and run with to share with their clients, patients, and loved ones, to give them the good news—the fabulous news—this ‘gospel’ of medicine: That we are in sooooooo much more control of our health destinies than we have ever believed, certainly more than we have ever been told?  This is awesome news.  But how do I take them from the deception that we are “genetically-flawed organisms at the mercy of man’s mechanical and pharmaceutical creations” to the truth that we reap what we sow?  Yes, even in medicine, that timeless principle applies.  But once again, this is GOOD news.”

Melodrama???  Is this opening statement simply a gimmick to get the attention of the audience?  I personally don’t think so—but I hope it worked.  It is the truth.  

We are all witnessing, at this very moment, the most important shift in medicine of all time as far as I can see.  We should be extremely excited to be alive to observe this phenomenal event firsthand, especially those who have been waiting for years to see this transition occur as many of you have.  Certainly, there have been many who have known the folly of long-term symptomatic medication: taking aspirin for fevers caused by viruses, stopping intestinal symptoms at all costs, and “relieving” the airway obstructions of nasal congestion and bronchoconstriction that were designed to limit the offending agents that caused the symptoms in the first place.  “Oh, now you’re sounding like one of those holistic nuts!”  Yup.  And their wisdom has been suppressed long enough.  The approach that the body never makes mistakes and that all symptoms serve a purpose has been buried long enough—too long—and it is time for it to be resurrected.  

So, on to our first metaphor.  Man, I love Tolkien.  What a phenomenally wise guy, his epic tales overflowing with truth and wisdom about man’s struggle with himself and the forces-at-be.  And the conflict for the possession of Middle Earth serves as a fantastic parallel to the one that we face everyday, with every bite and every breath—and every pill—in the battle for our health.  There are many foes and there are huge towers that loom over the battlefield, housing those that create the enemy and direct them into our fields.  One of these towers was constructed by men and the forces that drive them in what will be seen as a vain attempt to control man’s medical plight through the use of “magic”, potions as they were once called, to reverse symptoms that came upon the unfortunate victims of illness.  “Do you have fever?  Not any more.  We have a pill for that.  Do you have heartburn?  Not anymore.  We have a bunch of pills for that.  Do you have fibromyalgia?  Well, we have lots of pills for that one.  And, they work ‘OK’, but you will still suffer a bit—as your bank account dwindles.  Do you have cancer?  Well, we have soooo much that we can do, but it is a bit of a crap-shoot.  You may survive your particular form of this disease with therapy or you may die actually sooner if we treat you.  On the other hand, you may conquer this one but die of a different cancer.  We won’t really know ‘til we try.” 

Folks, we are in the year 2005 as I write this piece.  We have now placed man-made landers on the moon, Mars, and Titan—one of the moons of Saturn, on the other side of the asteroid belt and Jupiter (Wow!)—but we still don’t know that it is total folly to artificially kill a fever that our body produces solely to control the virus that caused it.  Yes, we are still in the Dark Ages of medicine, so the Lord of the Rings analogy is very appropriate.  We might as well be wearing animal skins to work instead of lab coats.  If we don’t know that it is totally insane to stop a vital fever then we certainly can’t see that acid blockers unleash Helicobacter pylori, (who has been cultured from atherosclerotic plaques of coronary and carotid arteries) or that some of the immunosuppressive elements of cancer “therapy” are counterproductive when it comes to fighting all of the viruses that caused the cancer to begin with.  (Just thought I’d quickly throw in a little actual medicine at this point.) 

But—BUT—here’s the cool thing.  We have just been through the battle at Helm’s Deep.  For you Tolkien fans, you know that this was a huge turning point in J.  R.  R.  Tolkien’s portrayal of the battle for Middle Earth.  The forces that were bent on the destruction of mankind were coming against the remnants of man, who were hold-up in a fortress built into a mountain.  It was a seemingly solid foundation from which to defend against the oncoming hordes, but the numbers and armaments of the enemy were potentially devastating.  As the evil forces approached and the battle ensued, it appeared hopeless for man, battling side by side with elves (angels) and dwarfs.  The leaders of those in the fortress decided to ride out to meet the enemy, a valiant move but one that seemed certain to seal their doom.  But then, over the hill—in a flash of light—came Gandalf and a tremendous army on horseback, who divided the enemy, slaying many and sending the remainder running back to their towers to recover and regroup.  Victory was man’s, for the moment.  We dodged a bullet as they say today.  But shortly, the real battle was to begin—the final battle for Middle Earth and the ultimate survival of mankind.

Oh, how myth puts things in perspective, eh?  As a wise author named John Eldridge just wrote in his book Waking the Dead, myths are not simply fictional stories made up to entertain us.  They are poignant tales that illustrate timeless truths.  They paint mental pictures of these truths that we can draw upon to visualize things that we know to be true in our hearts.  They give us faith, hope, and strength to go against what often seem like insurmountable odds to accomplish vitally important tasks and reach our goals.  In those myths, we win Helm’s Deep against all odds; Cinderella rises from the ashes to marry the Prince; the Lion King grows up, remembers who he is, and takes his rightful place in the Kingdom; Fiona finds out that she would rather be an ogre and live happily ever after with Shrek than take her “rightful” place in her previous world.  They all illustrate how man’s undying spirit can help conquer those circumstances that would hold him back.  

In my mind, nothing illustrates our struggle to learn the truth about medicine (and other life lessons) better than Tolkien’s trilogy.  All of the elements are there, including things “seen” and “unseen”.  It is the classic struggle involving good and “evil”, with man and his knowledge, beliefs, and shortcomings all working together and in opposition to produce the battle of—and for—our lifetime.  All of the players are there: the wise masters; those that were seduced by “the dark side”; elements of greed, ignorance, and lust for power; and the undercurrent in which man searching desperately for truth, wisdom, and justice and the reason that all of this is taking place.

“So, enough of the stage-setting.” you might be saying.  “How in the world did you get Helm’s Deep out of the current medical situation in which we find ourselves and why all of the ‘prophetic’ references?” Well then, let’s get to it.  We’ll start with a news flash.  A relatively small band of men have finally understood the vital importance of—this is so cool—FOOD in our health.  Wow! What year is it again?  How long have we been saying, “You are what you eat?” But, how many have understood this and grasped the full meaning of that statement and what has unfortunately become a worn out cliché’?  

Many think in limited terms, I’m afraid, supposing that this expression means things like “eat your broccoli” or “don’t eat too much saturated fat”.  Little do they know that the actual staples of their diet are harming them with every bite and setting the stage for most of the plagues that will befall them.  When we add in the man-made chemicals, preservatives, colorings, and flavor enhancers, the self-induced nature of our suffering should become readily apparent.  

A whopping 75% of the calories in the Standard American Diet (appropriately abbreviated the S.A.D.) come from the number one and number two human, dog, and cat food allergens: cow’s milk and wheat.  Why they are the top allergens and why soy and corn join them to round out the top four will be the main topics of this discussion.  But as if this is not bad enough, 90% of prepared human foods have hydrogenated oils in them and 60% have MSG (monosodium glutamate), which we will be talking about very shortly.  Throw in things like aspartame (a known neurotoxin and MSG’s evil twin), tons of sugar and salt, preservatives, chemicals, estrogens, pesticide residues, and more and you have a pretty good start on how we arrived at Helm’s Deep.  When we see that the vast majority of pet foods are made with their main allergens, then we can understand why these little angels (elves) and dwarves are fighting right along side of us.  Oh, and we can’t forget the horses.  They are vitally involved in this battle.

But, the real question (and this is huge) is “Why are cow milk and wheat the number one and two human, dog, and cat food allergens?” The answer is so simple that it is literally stupefying.  There are substances in these “foods” and the other primary food allergens (soy and corn) that do physical harm to the intestinal tract, thereby eliciting an immune response.  Part of this response is intended to go off to distant locations (skin, ears, lungs, brain, etc) to warn us that the damage is taking place.  Yes, the enemy is sneaky and their initial attack on the headquarters of our camp is cloaked in secrecy.  But, those with their eyes open should see the smoke rising from that assault.

In cow’s milk the culprit is casein, a very powerful glycoprotein, from which they make waterproof industrial adhesives.  “What?” Yes, they make GLUE from casein.  Who’s picture is on the bottle of a very popular brand of household glue, one that the kids could eat in elementary school if they had a craving for it (which we will also cover)?  Yep, a well-known dairy company makes that glue and the cow is on the label.  It is made from casein.  And, it DOES stick to your (and your pet’s) gut, primarily that first stretch of the intestinal tract known as the duodenum, keeping this vital section of bowel from functioning optimally.  Its adhesive properties are advertised in the form of a moustache in the ever-popular “Got glue?” ads.  Stick out your tongue after drinking milk.  Yuck! Is it really a stretch to think that it sticks to our intestinal tracts?  The thinking person is saying, “But the stomach breaks it down, doesn’t it?” The bad news is that, even with the tons of acid it produces—and the heartburn and chronic gastritis that follows—the glue still survives to reach the duodenum.  (Only the fermentation process that takes place in the fore stomachs of the ruminant destroys this glue.)

Who knows this and how do we know?  Most doctors both know and don’t understand this.  (“Huh?”) It’s a conundrum to me, too.  How can they know to tell you not to take certain medications with milk because it will block the absorption of that drug and not know that milk physically blocks other things at the same time?  How can some pediatricians tell new moms not to give cow milk products until the baby is on an iron-rich diet and not see that this same milk blocks iron absorption in adults, contributing to the fact that iron-deficiency anemia is the number one nutritional deficiency in the world, including in these United States—the red-meat-consumption capital of the world.  How can that be?  Simply stated, we are not absorbing what we consume.  And now we know EXACTLY why, don’t we?  But, cow’s milk and casein are only the beginning.  (Note: Why do I keep specifying cow’s milk?  Here is the neat thing: goat milk is nearly devoid of casein, which is real reason why goat milk is considered the “universal foster milk”—and why the Greeks elevated the goat into the heavens—for the milk it gave.  All mammals could be successfully raised on goat milk.  BUT, feed those same infant mammals cow‘s milk and watch how many come apart at the seams.  The casein is the culprit, NOT the lactose.  Goat‘s milk has plenty of lactose.  So much for that deception.) 

Here is the important thing.  The other “foods’ that coat (and subsequently damage) the intestinal villi—and the ONLY ones that do this along with casein—are gluten, soy, and corn.  These are the big four or the “four horsemen of the apocalypse” as I now like to call them.  And it is man and animals against casein, gluten, soy, and corn as the title implies.  The strongest evidence of their potential harm is found in the fact that all of these food elements are used to make adhesives—powerful adhesives.  Casein, gluten and soy are the strongest, stickiest, and most powerfully antigenic glycoproteins while corn is a slightly less powerful but nonetheless very significant player (especially the corn that we have recently created).  They put cars together with the super-glues manufactured from soy protein.  They make waterproof industrial adhesives from casein and gluten that are used for numerous purposes ranging from the glue on stamps and envelopes to putting metal together.  But, the “best” they can do with corn glues is to put cardboard boxes together.  So, we see why the FDA and veterinary lists of food allergens are what they are: in order, the (primary) food allergens are cow’s milk, wheat, soy, and corn.  (We will discuss “secondary” allergens in a moment.) Soy could become number one—if that were possible.  Fortunately, there are too many soy opponents who will keep this from happening.

Now, here is what should really grab attention of veterinarians and (hopefully) not let go.  Talk about hindsight being 20:20.  When I graduated from vet school 26 years ago, dog foods were corn-based.  (Keep in mind that corn has been modified to “death” over the past 25 years.  Ever hear the term “hybrid corn”?  Do you remember the Starlink /CRY9C corn scare a while back and how Taco Bell took the fall for that one?  You only heard the beginning of that story.) The bottom line is that corn was bad enough and was, in retrospect, causing so many of the problems that we saw back then, especially in the “trouble breeds”: the German shepherd, Poodle, Cocker, Shar Pei, some giant breeds, and the Irish setter.  (Remember when there were Irish setters around?  We’ll be getting to that soon.)

But—BUT—when we started adding wheat to the diet of pets about ten years later, we effectively landed the single-most devastating blow to veterinary health that we had struck since adding a milk coating to the puppy and kitten chows.  Don’t let that last part slip past you, either.  The cow’s milk coating we had on the growth formulas was a HUGE problem that we are just now seeing the vital importance of.  In a recent medical study, researchers in human medicine found that our children that ingested cow’s milk in the first five days of life had a staggering 40-50 times higher rate of asthma, type-1 diabetes, and juvenile-onset rheumatoid arthritis when compared to the general population.  Oh, no! How could that be?  You need to remember what is going on in the gut and immune system of the newborn during the first five days of life as well as understand the concept of “lectins”—antibody-sized glycoproteins derived from the big four—to really grasp the importance of this cataclysmic mistake.  Much of this particular issue is outside of the time restraints of this presentation but I think you will find that this “fun fact” fits right into the grand scheme of things.  We will discuss lectins a bit later, however.

So, we added wheat to the pet foods about 16 years ago.  Why?  Did we not know better?  Yes, we did.  Veterinary texts in print at that time boldly listed cow milk and wheat as the leading food allergens.  So, why did we do it?  (Hmmm—Remember those powers and principalities I alluded to in the opening comments.  Their two most formidable manifestations are greed and ignorance.) Actually, there was a geopolitical phenomenon that occurred at that time.  We had a “wheat glut” develop in this country as a result of numerous factors, including the fact that China became the number one grower of wheat in the world and thereby stopped importing it from us (an amazing transition in their diet which has its own prophetic implications).  We had more wheat in this country than we knew what to do with (and we are repeating history with SOY right now.  There is no new thing under the sun.  Ecclesiastes 1:9).  Therefore, wheat became cheaper than corn and the pet food companies started making kibble from wheat instead of corn.  So easy to see—in retrospect.

The fact is that I remember that time now like it was yesterday.  I was practicing in California and suddenly my colleagues and I were talking about how sick dogs and cats were rather than our golf games when we went to lunch.  It is now a well-defined moment of time in my memory that still shocks me when I think about it.  Man, talk again about 20:20 hindsight.  Suddenly, every dog had allergies, immune-mediated diseases, and cancer, not just the usual suspects.  When I went to school the subject of allergies (atopy) was just another lecture, not the lecture.  In an instant, the mutts from the pound were just as riddled with allergies as the pure-breeds.  The old adage of “Heinz 57” dogs being healthier than pure breeds was becoming less and less true.  Breeds like the Golden retriever were turning into money pits and their owners were saying things like “I love this breed but I can’t afford to have another one.” You as veterinarians remember this all happening, don’t you?  If not, you may be too young or just need your memory jogged—or your glasses adjusted—as did some of my educators.

I was at an orthopedic seminar recently put on by the guys who taught me at Auburn University.  They were concentrating on the topic of juvenile bone diseases and the same breeds kept popping up on the slides: the Rottweiler, the Lab, the German shepherd, the Rottie again, another Lab, another Lab, and yet another Lab.  You get the picture.  They also mentioned how they had learned through experience that the puppy chows were harming these dogs more than the adult foods.  They weren’t sure exactly why that was so but they no longer recommended the “high-powered” puppy foods for rapidly growing breeds that were prone to these conditions.  I was squirming in my chair like a four year old that needed to go to the restroom.

After the lecture, I approached one of the instructors (one of my favorites of all time—still is) and asked him a question.  “Where are all of the Irish setters these days?  I noticed that you don’t have them up there in your slides anymore,” and I smiled a really big, leading smile.  He said, “I don’t know.  Now that you mention it, we don’t see that breed much anymore, do we?  Why do you ask?  Do you know why we don’t see them?” (Chuckle, chuckle.)  I said “As a matter of fact, I do know why they’re not around much anymore.  That’s what happens when you feed a celiac lots and lots of wheat.” (Blank stare).  I asked, “Do you remember what celiac disease is?” He thought for a pretty long moment and said that he didn’t.  It sounded familiar but he couldn’t recall.  I reminded him that celiac disease was gluten intolerance, an immune-mediated reaction to gluten in wheat, and that the Irish setter was the only breed KNOWN to be afflicted with this condition in the veterinary literature.  I went on to explain how we transitioned from corn to wheat after I graduated and that once we did, the Irish setter became nearly “extinct”—end of story.  He was truly amazed at my insight.  As people were starting to crowd around him, I told him that this was just the tip of the tip of the tip of the iceberg and that I would talk to him more about it later.  I went on to compose a five-page letter on my laptop that day and give it to all of the lecturers at the end of the session, explaining how this had become my “mission” (and that this was going to be the contribution that the Upjohn representative was “expecting” when he handed me the Upjohn Award for outstanding senior student in small animal medicine—twenty-some-odd years late).  I never heard from any of those instructors again, despite follow-up Emails.

Why didn’t they see the vital importance of what I was trying to share with them?  Why didn’t they see the link between celiac disease, the demise of certain breeds, and the fact that puppy chows were worsening juvenile bone diseases?  It was right in front of their faces.  Are we all that blind?  Have we all had the brains washed right out of us in medical schools?  Do we really think we know everything when, in fact, we understand very little and are confounded by the knowledge that we do have?

Here is the key!!! As lecturers (and preachers) are fond of saying, “If you get one thing from what I say today then please get this.” The duodenum is “Pandora’s Box”.  There.  Got it?  You can go home now.  LOL.  What?  You don’t understand?  I’ll say it more slowly.  “The duodenum—is—Pandora’s—Box.” Of course you don’t understand—yet! But you will and this little gimmick will help to keep it in your frontal lobe, I hope.  Why do I call the duodenum “Pandora’s Box”?  Because, once you “open” it (damage it), you unleash the plagues—and potentially all of the plagues—that can befall man and animals.  “Now wait a minute”, you might say.  “I have been following this up to now but you are waaaay over the top now.” Hold on.  This is going to be good—really good.

The sad and startling fact is that I have yet to meet a health professional (MD, DVM, or nurse) that has been able to tell me what the duodenum ABSORBS.  In fact, I have had numerous casual conversations with members of all of these professions during which they looked me in the eye and boldly stated that the duodenum absorbs “nothing”.  Then, once I remove the dagger from my heart (not throwing stones, of course, because before five years ago, I didn’t know either), I go on to explain that the duodenum does nothing less than absorb the vast majority of our calcium, iron, iodine, B complex, vitamin C, zinc, boron, lithium, chromium, magnesium, manganese, blah, blah, and blah.  In fact, it absorbs just about everything but our calories, proteins, fats, and fat-soluble vitamins (which is a lot of course).  The amazing fact is that 95% of our vitamin D activity takes place in the proximal one-third of our duodenum, where the initial and majority of damage caused by the “big four” glue-foods take place.  

Yes, the “glue foods” (as I like to refer to them) leave the stomach—glug, glug, glug—and coat the villi of the duodenum (and jejunum), especially the first one-third of the duodenum.  Then, those glycoproteins from the gluten grains (wheat, barley, and rye), casein, soy, and corn induce an immune response in susceptible individuals.  Certainly, not all people or pets have an immune response to these glues, but according to recent studies, the incidence is so much higher than once thought that anyone who understands this should have the same medical “revelation” that I have had—that we have found the “mother lode”.  

When I was diagnosed as a celiac 5 years ago, it was considered a “rare disorder occurring in less than 1:5,000 people”.  No wonder doctors (and veterinarians) had forgotten about it.  But, in the first week of study about my new-found condition—the one that explained everything that was currently plaguing me and all that had been wrong with me since I could remember—I found that they were diagnosing people on the other side of the Atlantic at the rate of over 1:100.  “Say what???  How could it be rare over here, when most of us came from those people—Anglo-Saxons, Italians, Scandinavians, French and Germans?” Yes, there was something amiss.  So, I jumped into the study of celiac disease with both feet, discovering that casein, soy, and corn all did the same thing as gluten.  I also found out the truth about hydrogenated oils, MSG, aspartame, sugar, the lactose myth, air pollution, and much, much more.  (It was so profound that I started a parallel study in religion and prophecy.  But that’s a whole ‘nother sermon.  Smile.)

I began writing to one of my best friends from high school, an internist at one of our biggest local hospitals.  He casually stated that he was glad to see that I was feeling well but that celiac disease was “rare” and that I was simply doing what many do that finally get properly diagnosed with a chronic condition—projecting my illness upon others.  At the time, that upset me and I started writing to him like an angry prophet, advising him that if he wanted to get way ahead of the pack, he would start learning all that he could about celiac disease.  I even asked him if he believed in God, “because this revelation was Biblical in proportion”.  That settled it—I was “nuts”.

But, he was the one who sent me the New England Journal of Medicine article about eight months later that boldly labeled celiac disease as the most under-diagnosed (and misdiagnosed) condition in the country and stated that it was occurring in at least 1:250 Americans without their knowledge.  “Na, na, na, na, na,!” (LOL).  Actually, I did not call him and rub it in.  By then, I had experienced a few of what I call “Jonah experiences”, learning that you catch more flies with honey.  Plus, I had received a pretty good glimpse of how and why something this important could be so unknown and misunderstood—and why things were sooooo upside down.  The fact is that the Mayo Clinic and Johns Hopkins University published their incidence studies last year and found celiac disease to afflict 1:122 Americans.  Yes, that is the new “official” number.  However, the unofficial number published by celiac authorities is 1:33.  Whoa!

But here’s the “bad news”.  (Actually, you will come to see that this, again, is good news.) We are only talking about celiac disease here.  And wheat is the number two food allergen.  What is number one again?  Cow’s milk (with casein).  I wonder what the true incidence of casein-intolerance is?  Is it more frequent than gluten intolerance?  I would have to believe so.  While wheat-containing foods (the targets of Dr.  Atkins’ partial truth) make up nearly 25% of the calories of the S.A.D., cow milk products make up a whopping 40% of our overall caloric intake.  Errrh!!! What about soy—the “third plague” as I like to call it..  Errrh, again!!! How about corn, the fourth horseman?  Here’s a scary thought: What about a mix and match of the four—some or all of the “big four”?  Think that happens?  Of course it does.  These guys can ride separately or they can form a gang.  We all know a gang is harder to control, don’t we?

Now for the pathophysiology that you have been waiting for.  The food allergies are just the indicators.  During the time that the body is reacting to the “glue” from these foods, the IgE antibody—the allergy antibody—is formed to go out and warn us of the damage that is taking place in the duodenum.  Otherwise, this is a stealth condition in most cases, with only one-fourth of celiacs and related food intolerants having gastrointestinal symptoms.  Get that?  That is very important.  In fact, this is CRITICAL for all to understand, as it explains much and opens a door through which all truth-seekers must pass.  (“There he goes, getting all melodramatic again.”) 

Individuals—whether they are humans, dogs, cats, or horses—can go years and years before the bottom drops out of this condition.  And it takes the bottom dropping out for most of us to wake up to what’s going on, doesn’t it?  We are the masters of denial as well as the patsies of deception.  “I’ll do it ‘til I have problems.  Then, I‘ll quit.” (e.g.  cigarette smoking, drugs, alcohol, or over-eating).  The bad news is that by the time you have obvious problems with your lungs, liver, kidneys, heart, brain, immune system or duodenum, then you are waaaay down the wrong road.  It is a consistent pattern that we can live on about 25% of our organ function—one half of one kidney, a fourth of our liver, multiple coronary arteries occluded, numerous neurons destroyed, etc.  before (BEFORE) we even start having symptoms.  That’s a good news/bad news thing isn’t it?  As vets, we know that most of our conditions in the pet are “acute-on-chronic”—acute manifestations of chronic problems.  I used to think that this was due to unobservant owners or the laid-back lifestyle of the pet.  But when I started seeing friends and loved ones dropping dead of heart attacks and strokes without warning and I found out that atherosclerosis starts as early as 5 years old, I knew that we were missing something.  Yep, we are made to take a licking and keep on ticking as the old Timex ads used to say.  The bad news is that we are beating our poor bodies (and those of our pets) to death and don’t know it or, at least we don’t fully understand the magnitude of what we are doing with every bite—and breath.  

Imagine now that over 1:30 humans have celiac disease or are afflicted with the other related food intolerances (casein, soy, and/or corn)—food induced villous atrophy of the duodenum.  It can affect the jejunum as well.  We know that this also occurs in the dog, with our old “extinct” friend the Irish setter being the glaring example.  (I was absolutely ecstatic to hear that there was a pathologist in a major university in the northeast who has reopened the book on celiac disease.) Now, combine that fact with the consequences of the chronic malabsorption of calcium, iron, iodine, B complex, C, and numerous trace minerals, all of which are vital in the development and normal functioning of our bodies and immune systems.  Do you have it in your mind yet?  Let it sink in for a second.  (Pause)

Which symptoms or clinical signs are likely to show up first?  If you said gastrointestinal signs, you would be wrong (unfortunately).  If you said signs associated with chronic calcium malabsorption or allergies you would be right.  In some it is the former while in others the latter.  The “worst of the worst”—those that have the earliest immune reaction to the glue foods—will have the IgE and IgG related symptoms first.  These are your infants, human or pets, with congestion, itching, rashes, irritability, chronically sore throats, and ear problems.  Some of them do have colic and diarrhea but these should not be required signs to make one suspicious of food problems.  The “best of the worst” (and I rarely use the term the “best of the best” anymore) have the signs of calcium malabsorption first if they have any signs at all.  Remember: the proximal one-third of the duodenum is greatly responsible for calcium metabolism and absorption.  In the best-case scenario, these glue foods form a coating on these villi and keep them from performing optimally.  (Here you go.  Think of a beautiful coral reef with gorgeous sea anemones and multi-colored sponges.  Got it?  The “villi” of the anemones are swaying back and forth in the crystal clear water, absorbing small particles of food floating in the water.  So serene, so perfect.  NOW, imagine that same reef after the oil spill from the Exxon Valdez.  Got that?  How well do those anemones do when they are coated with oil?  Some will survive but many, many will die.  I think you have the picture.)

This is what the glycoproteins from gluten, casein, soy, and corn do.  They coat the villi—at best—and “kill” the villi at worst, with the first and most severe damage taking place in the proximal third of the duodenum.  No wonder I had flat feet, short legs, rib abnormalities and painful joint laxity—and bad teeth—as a child and later developed rotator cuff problems, bilateral inguinal hernias, and premature disc ruptures of my neck and back.  I’m a classic celiac.

But now YOU know why the most food allergic dogs have the worst orthopedic problems.  How cool is that???  Think about them: the Labs, Rottweilers, German shepherds, the Labs, the Rotties, the Labs, the Labs.  Hmmm—I’ve heard that before.  (smile).  Why is it that they can’t nail down the genetics of hip dysplasia?  Hmmm—again.  AND, now you know why two of the most food allergic small breeds—the Cocker and Shi Tzu—hold the age record for when they start blowing intervertebral discs.  Yep, they do it as early as ONE YEAR OF AGE, don’t they?  Why again?  They have been malabsorbing the building blocks of their skeletal system (calcium and vitamin C) since they were first put on the grain-infested puppy chows.  What makes up collagen, again?  So, you also know why the Cavalier King Charles Spaniel (and I have yet to see one that wasn’t severely food allergic) dies of acute mitral valve prolapse at 5 years of age.  What is that valve made of again?  How did we create the chondrodysplastic breeds like the food allergy afflicted, Demodex-encrusted, cherry-eyed, respiratory challenged, squatty body English bulldog, anyway?  Shall I continue?  I could give countless examples that would keep us into the wee hours of the morning.  I think you are seeing the pattern here, right?  The allergies are there to warn us that the damage is taking place in the gut.  Again, the allergies are things “seen” to help us understand the things “unseen”.  Watch for this pattern.  It will come up again and again.

This is only the beginning, unfortunately and fortunately.  (Please keep in the very front of your mind that the malabsorption syndrome leads to chronic deficiencies in so many vital nutrients.  This is paramount in importance.  Keep chanting, “Pandora’s Box, Pandora’s Box.”) We are still on the tip of the tip of the iceberg.  And perhaps this is a good time to throw in the other analogy with which I was considering opening this dissertation.  Try this one on for size:

Conventional medicine is steaming headlong into an enormous obstacle that is titanic in importance and yet has only a small piece of its mass protruding from the surface right now.  The medical establishment (including both human and veterinary) has built a mighty vessel that many would deem unsinkable.  “We have made such great gains in extending life” comes the announcement from the captain.  “And one day, we will find the cures for cancer and the diseases that plague us all.” And the passengers all say “Hooray!!! It will be clear sailing from there!” The applause dies down and the captain exclaims, “And we are working on better ways to make these necessary drugs more available, more well-known by the public, and more affordable to you.  Very soon, many of these drugs will be available over-the-counter and you will no longer need to even consult with your physician about them.  Simply choose what is right for you by watching your television and then going to your local drugstore, supermarket, or gas station food mart to pick them up.  You will be wise enough to choose for yourself.” Again, the crowd roars with approval.

But, there is something looming in the waters, just off the port bow.  Some call it an iceberg.  Others call it a “rock”.  I call it the Truth.  This treatise so far has mapped out the tip of the tip of this iceberg.  With the binoculars you now have, you can see it.  Do you see it???  If your eyes are good enough, you can see much of what is below the surface, too.  The water is a lot clearer out in the ocean than you may think.  And this “unsinkable” vessel that man has created is heading straight for it.  Why?  They are not looking for it.  Many are happy, quite content with the cruise they are on.  Others don’t really know any other way to behave on a cruise like this.  Others are desperately trying to keep those who would worry about icebergs distracted so that they don’t spoil the cruise for the others.  Ignorance and greed are at the controls—our two biggest nemeses—with contentment being a first mate.

Suddenly—WHAM—the mighty craft  hits “the rock”.  It starts to take on water.  People are dying from drugs they have taken for years: HRT, NSAIDS, nasal decongestants, and what will be the next group- the cholesterol statin drugs.  The epilepsy drugs don’t work anymore and the pets on board are being put to sleep for “non-responsive epilepsy”.  The vaccines that were meant to protect us “turn on us”, making us question their role in everything from producing the full clinical disease to hard-to-detect/prove sub-total entities of that disease, such as epilepsy, chronic liver disease, immune glomerulonephritis, cardiomyopathy, or worse.  The captain is shouting, “Don’t panic.  We will figure out what to do.  Calmly man the lifeboats.” But some do panic as they had so much faith in this indestructible piece of man’s technology, the same technology that put landers on the moon, Mars, and Titan.  

But, it is this same technology that does not seem to understand that taking an NSAID for a fever caused by a viral infection is not a wise thing to do.  It is the same captain’s mates that don’t see that Helicobacter pylori—the opportunistic bacteria that causes deep stomach ulcers—hates an acid stomach and that heartburn is designed partly to control his growth.  If they don’t know that, then they certainly can’t see how this beast that they have been feeding with antacids and problem foods leaves the stomach when the individual’s immune system takes a nose dive (after a lifetime of malabsorbing nutrients vital to its health) and takes up residence in a cholesterol plaque (that is safe-guarding a weakened artery) and causes it to break off, inducing a stroke or a myocardial infarction.  How can they see that?  They have their eyes on the moon and the stars.  (And yet, a study done by a group of cardiologists found that a shocking 85% of atherosclerotic plaques that were cultured for H.  pylori were positive for this critter.  Think about that for a second.  Sinking in?). 

Go to Part 2: Food Intolerance—Man and Animals versus Gluten, Casein, Soy, and Corn or How We Won the Battle of "Helm's Deep" (Part 2 of 2)

Celiac.com 08/31/2006 - All of us have patterns of proteins on the surface of our white blood cells. These proteins are known as human leukocyte antigens (HLA), one of which is DQ. Celiac disease and non-celiac gluten sensitivity (NCGS), and several autoimmune conditions occur more frequently with certain HLA DQ types. DQ gene testing is performed by analyzing cells from a blood sample or from a Q-tip swab of the mouth. HLA types have a naming system that can be confusing even to scientists and physicians but here is my explanation of the testing, the results, and what they may mean to you and your family.

Each of us has two copies of HLA DQ. Because there are 9 serotypes of DQ we are all DQx/DQx where x is a number between 1 & 9. For example, I am DQ2/DQ7. I received the DQ2 from one of my parents and the DQ7 from the other. Because we get one DQ type from each of our parents and give one to each of our children it is easy to to see how the DQ genes pass through a family. This is important because two DQ types, DQ2 and DQ8, are estimated to be present in over 98% of all people who have celiac disease, the most severe form of gluten sensitivity.

Rarely, true celiac disease or dermatitis herpetiformis, the skin disease equivalent of celiac, have been reported to occur in people who do not have DQ2 and/or DQ8. However, according to unpublished data from Dr. Ken Fine of Enterolab, the other six types, except DQ4, are associated with risk for elevated stool antibodies to gliadin, the toxic fraction of gluten, and/or tissue transglutaminase (tTG) an enzyme. Both of these antibodies are usually elevated in the blood of individuals with celiac disease though they may be normal in the blood of individuals who are gluten sensitive and have a normal small intestine biopsy but respond favorably to a gluten-free diet.

Fine has publicly reported that elevated stool antibodies to gliadin and/or tTG have been detected in all of the untreated celiacs tested in his lab and 60% of non-celiacs who have symptoms consistent with gluten sensitivity but in none of the controls tested including cow manure. Follow up surveys of those individuals with elevated stool antibodies who initiated a gluten-free diet compared with those with elevated antibodies who did not reportedly showed significantly improved quality of life and improved symptoms in the gluten-free group.

He also reported DQ2 and DQ8 positive individuals have had, as a rule, the highest elevations of stool gliadin antibody followed by those who are DQ7 positive. Only those who are doubly positive for DQ4 have not been found to have significantly elevated antibodies to indicated gluten sensitivity. This is consistent with the differences in prevalence rates of celiac disease seen in various parts of the world since DQ4 is not generally found in Caucasians of Northern European ancestry where celiac incidence is highest but in those from Asia or Southern Africa where there is a very low incidence of celiac disease and gluten intolerance.

DQ2 & DQ8, the two major types present in 90-99% of people who have celiac disease, are present in approximately 35-45% of people in the U.S., especially those of Caucasian race of Northern European ancestry, with highest risk of celiac disease but the prevalence in U.S. of celiac disease is 1%. Though a prevalence of 1 in 100 is very common and much higher than had been believed for years, only a fraction of the genetically at risk are confirmed to have celiac disease by abnormal blood tests and small intestine biopsies. However, the number of people who report a positive response to gluten-free diet is much higher.

The stool antibody tests results would support this and the concept of a spectrum of gluten sensitivity that is much broader and in need of better diagnostic definitions. I am an example of someone who is DQ2/DQ7 who has normal blood tests for celiac disease but abnormal stool antibody tests and symptoms that responded to gluten-free diet. The strict criteria for diagnosing celiac disease, which is abnormal blood tests and a characteristic small intestine biopsy showing classic damage from gluten, is much narrower than what is being seen clinically.

It is becoming obvious to many of us who have personal and professional medical experience with gluten intolerance and celiac disease that the problem of gluten sensitivity is much greater and extends beyond the high risk celiac genes DQ2 and DQ8. Traditionally it is reported and believed by many that if you are DQ2 and DQ8 negative you are unlikely to have celiac disease or ever develop it, though this cannot be said with 100% certainty especially since there are documented cases of celiac disease and the skin equivalent of celiac disease, known as dermatitis herpetiformis (DH) in individuals who are DQ2 and DQ8 negative.

Therefore, knowing your DQ specific serotype pattern may be helpful for several reasons. For example, if you have more than one copy of DQ2 or DQ8, you carry two of the major genes. For example, if you are DQ2/DQ2, DQ2/DQ8, or DQ8/DQ8, a term Scott Adams of www.celiac.com has dubbed a "super celiac" you may be at much higher risk for celiac disease and have more severe gluten sensitivity. Certainly if you are DQ2 and/or DQ8 positive you are at increased risk for celiac disease. After a single copy of DQ2 or DQ8, it appears that DQ7/DQ7 might be next highest risk. Dr. Fine has also noted some other associations of the DQ patterns with microscopic or collagenous colitis, neurologic manifestations of gluten sensitivity and dermatitis herpetiformis, which has been one of the gluten sensitive conditions noted to be, at times, occurring in DQ2, DQ8 negative individuals.

Why some people get celiac Disease or become gluten sensitive is not well understood but certain factors are believed to include onset of puberty, pregnancy, stress, trauma or injury, surgery, viral or bacterial infections including those of the gut, medication induced gut injury or toxicity e.g. non-steroidal anti-inflammatory medications such as aspirin, ibuprofen, etc., immune suppression or autoimmune diseases especially since several of those factors are associated with onset or unmasking of gluten sensitivity in someone who is at risk or not manifesting any recognizable symptoms. There is also well known group of individuals who are termed "latent" celiacs. They are at high risk because they have close relatives who have celiac disease with whom they share one or more of the celiac genes DQ2 and/or DQ8 though they usually have few or no symptoms but sometimes have abnormal blood tests and/or biopsies indicating possible or definite celiac disease. Others have negative blood tests and normal biopsies but symptoms that respond to a gluten-free diet.

The severity of the sensitivity to gluten appears to be related to the DQ type, family history (highest risk is in the non affected identical twin of a celiac), pre-existing intestinal injury, degree of exposure to gluten (how frequent and large a gluten load an individual is exposed to), and immune status. Once initiated, gluten sensitivity tends to be life long. True celiac disease requires life-long complete gluten avoidance to reduce the increased risk of serious complications of undiagnosed and untreated celiac such as severe malabsorption, cancers, especially of the GI tract and lymphoma, other autoimmune diseases and premature death due to these complications.

Again, DQ testing can be done with cells from blood or by a swab of the inside of the mouth but not all labs test for or report the full DQ typing but only the presence or absence of DQ2 and DQ8. The lab that performs DQ testing is usually determined by an individual insurance company on the basis of contracts with specific commercial labs. However, if your insurance contracts with Quest Labs or the Laboratory at Bonfils (Denver, CO) full DQ can be done if ordered and authorized by the insurance company.

For those willing to pay out of pocket, Bonfils performs full DQ testing for Enterolab (www.enterolab.com) on a sample obtained by a Q tip swab of the mouth. Since it is painless and non-invasive it is well tolerated especially by young children. Also because the testing can be ordered without a physician and the sample obtained in their home using a kit obtained from Enterolab it is convenient. The kit is returned by overnight delivery by to Enterolab who forwards the test onto Bonfils. The cost is $149 for the genetic testing alone and has to be paid for in advance by credit card or money order and is generally not reimbursed by insurance.

Enterolab also provides the stool testing for gliadin and tissue transglutaminase antibodies to determine if gluten sensitivity is evident. The gliadin antibody alone is $99 or the full panel includes genetic typing, stool testing for gluten and cows milk protein antibodies, and a test for evidence of malabsorption is $349.

Again, the advantages of full DQ testing is determining if someone has more than one copy of DQ2 or DQ8 or carry both and therefore have a higher risk for celiac disease or more severe gluten intolerance. If you are DQ2 or DQ8 negative then your risk of celiac disease is low, though not non-existent. If you are not DQ4/DQ4 then you do have risk for gluten sensitivity. If you determine all DQ types within enough family members you can piece together a very accurate history of the origin of celiac and gluten sensitivity within a family and make some very accurate predictions of risk to other family members.

Though the lay public and many clinicians are finding the genetic tests helpful, many, including most physicians, do not understand the genetics of gluten sensitivity. We are awaiting Dr. Fines published data on the significance of stool antibody tests and their association to the other DQ types as his lab is the only lab offering the stool antibody tests in the U.S. Other celiac researchers in U.S. have failed to reproduce his assay but scattered reports in the literature are appearing including a recent article in the British Medical Journal indicating stool antibody testing is feasible, non-invasive, and using their protocol, highly specific but not sensitive for celiac disease in children. (Editors note: When present, these antibodies indicate celiac disease. However, they are not present in many cases of celiac disease.)

In the meantime, many patients are faced with the uncertainty and added cost of full DQ testing and stool testing due to the failure of traditional blood tests, small bowel biopsies, and the presence or absence of DQ2 and DQ8 to diagnose or exclude gluten sensitivity. Physicians unfamiliar with this testing are increasingly presented with the results and confused or skeptical pending published reports. The medical community continues to lack a consensus regarding the definitions of non-celiac gluten sensitivity and what tests justify recommendations for gluten-free diet. It is clear that gluten sensitivity, by any criteria, is much more common than ever thought and a hidden epidemic exists.

Dr. Scot Lewey is a physician who is specialty trained and board certified in the field of gastroenterology (diseases of the digestive system) who practices his specialty in Colorado. He is the physician advisor to the local celiac Sprue support group and is a published author and researcher who is developing a web based educational program for people suffering from food intolerances,Open Original Shared Link

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