Celiac.com 02/20/2021 - Does that question seem like a totally absurd notion? Is it possible that the manufacturers of pet foods are so out of touch with animals' nutritional requirements that their formulary blunders are accidental? After studying the effects of gluten, dairy, soy, and corn on human and pet health for the past seven years and reading what researchers have known for years, I have come to the conclusion that there is something seriously wrong in Mudville.
 
After the incredible pet food recall story of the past year, any pet owner with a functional brain has to be questioning why we feed dogs and cats the way we do.  Notice that I did not include veterinarians in that last sentence.  I am afraid that we have been too thoroughly programmed to look at this situation with innocent eyes.  Once again, I cannot throw stones here but simply wish to make a point.  When asked what to feed, I used to parrot what we have all been led to believe: "Just stick with a good, name brand of pet food and stay away from the generic brands, especially those that spell it ‘Dog Fude'.  Haha.  And, do not add table food to your pet's commercial diets because that will simply unbalance the formula that the pet food manufacturers have worked so hard to get right over their years and years of research and manufacturing." 

Oh, how I hang my head in shame now that I know differently.  
 
I have had this discussion with countless clients over the past 28 years of practice.  It has only been in the last seven years that I have been awake to the reality of just how unscientifically these foods are formulated and produced.  All one has to do is look at the ingredient list and compare it to what we know these pets would consume in the wild.  It also helps to know the history of what man has done to the grains and other ingredients that make them even more unnatural and harmful.  
 
All of the grains are human-made, human-raised crops that we have cultivated for human consumption starting very early in our agricultural history.  People love to point out that man ate wheat and drank milk in Biblical times so these things must be good and healthy.  Even well-intentioned, Scripture-oriented books make this claim.  But they leave out two key points: The wheat we consume now is no longer "God's wheat" and the milk we drink is no longer "God's milk".  The original wheat was "pure in its generations" (no hybrids) and contained 1-2% gluten.  This was changed forever by our Northern Germanic ancestors in the mid 400's A.D.  when they blended two other plants to "God's wheat", creating a hybrid and one that contained much more gluten...so much more that they were stricken with "coeliac disease" (gluten intolerance).  It is this new hybrid wheat, which we term ‘common wheat,' that became the ancestor of today's wheat, which now contains as much as 55% gluten, a far cry from the 1-2% found in original wheat.  Our wheat is no longer pure in its generations, as it has become a mutant blend of multiple plants that man has continued to manipulate, especially in the recent past.
 
The parallel to the wheat story is "the tale of two milks".  The milk they drank in Biblical days was goat's milk.  Remember, they were tending their flocks by night, not their herds.  Cattle (oxen) were used for doing work and providing meat.  It was not until the middle of the second millennium that man went into the dairy industry utilizing cow's milk.  Goat milk...the universal foster milk...has 0-2% casein, gluten's evil twin and a troublesome glycoprotein that has also been tied to numerous immune-mediated disorders.  Cow milk contains a whopping 80-86% casein, the protein that Borden uses to make Elmer's glue.  Lactose is not the culprit in milk.  It is the various proteins in cow milk- including alpha s-1 casein, alpha lactalbumin and beta lactalbumin- that do the harm to cells and stimulate the (appropriate) immune responses.  I will leave it to the reader to decide who may have started the lactose myth.  Understand that goat milk has plenty of lactose and all mammals can be successfully raised on goat milk provided they have not already developed a serious intolerance to the myriad of proteins in cow's milk.
 
Corn has a very interesting story too.  Did you know that corn is the only grain that is not self-propagating? Wheat, for example, produces seeds that will fall and produce more wheat.  Corn must be planted by man in order to grow.  If left alone, it would cease to exist.  It was cultivated in Mesoamerica in the millennia B.C.  and went through many changes during its domestication.  In other words, man had his hands in the making of corn right from the start.  The interesting thing is that wherever this new grain was introduced, pellagra (niacin deficiency) broke out.  Many texts will say that it is because the niacin was "locked" inside the corn making this essential vitamin unavailable for absorption, which appears to be true.  But, the common characteristic of the "big 4"...gluten (wheat, barley, rye), casein, soy and corn...is their ability to damage the villi of the intestine (duodenum) where many essential nutrients including niacin are absorbed.  So, was the pellagra due to the unavailable niacin in the corn or due to the fact that the corn blocked the absorption of niacin from the remainder of their diet? Just how much of this new corn were they eating? Was there no other source of dietary niacin? The fact is that corn proteins can block the absorption of calcium, iron, iodine, B complex (including niacin), C, and numerous trace minerals (e.g.  zinc, boron, magnesium, manganese) in the same fashion that gluten, casein, and soy can block absorption in susceptible individuals.
 
Soy was Asia's mistake.  After examining the serious ill effects of soy on human health, I can say that with all confidence.  Wheat was the Northern Germanic's blunder, cow milk consumption was the Anglo-Saxon's error, corn was the Mesoamerican's faulty creation, and soy was the Asian's serious mistake.  They should never have removed soy from the ground, where it was used in crop rotation as a way to fix nitrogen in the soil.  I suspect that one fine day, someone asked why this crop could not be eaten.  They quickly learned that it had to be processed to be consumed safely, including soaking and fermentation, the latter being the key.  If one were to read the rigorous process that soy must undergo to render it safe for human consumption, I dare say that the majority would ask "What is the point?" Even after that complex process is completed, the finished product contains more potentially harmful proteins and estrogens than all others.  It is fully capable of inducing villous atrophy of the duodenum and is known to be a powerful factor in the development of thyroid disease and estrogen-related disorders.  Soy milk has 16-22, 000 times more phytoestrogens than mothers' milk.  The effect on the developing child is both potentially devastating and well-documented.  All of the "big 4" are used to make industrial adhesives, but soy is used to make super glue.  Yes, they put your car together with soy-based super glues.
 
Now, I must ask the reader- Is a little ol' veterinarian from Alabama really the only one who understands all of this stuff or do the research and development departments of the pet and human food giants know most of what I just wrote? Are the people responsible for making decisions concerning your pet's nutrition blissfully ignorant about how unnatural these man-made, man-raised crops are for your dog and cat or are they making bad decisions in the face of what they know to be true and good? To be honest, I sometimes wrestle with which is actually worse...ignorance or greed.  I suspect that greed is worse because, after all, it is the "root of all evil".  But the ignorance in the face of available knowledge is really frightening.  It implies that all of the other undesirable human traits are in play- laziness, apathy, deception, self-centeredness, etc.  At least the greedy are motivated.  If they could be motivated for good, we would really have something.  So, we can easily see that it is the combination of these two...ignorance and greed...that reduce the world to something very short of ideal.
 
After all is said and done, we are left with questions like "Why do we feed carnivores all of these grains?"; "Why are cats fed dry foods when they are so unlike what they would eat in nature?"; and "Why are the average ages of dogs only 12 years and cats only 13 years in the USA when they have been known to live 30 and 40 years respectively?"  "Don't the pet food makers know better than to make these diets with such harmful ingredients?"  "Are they ignorant or greedy...or something else?" I've even been asked by thinking clients "Could these food companies be in cahoots with veterinarians so that the pets stay sick and the vets who are pushing these foods make more money?"  Or: "Are the pet food makers and the pharmaceutical companies working hand-in-hand to keep each other in business?" Others, including veterinarians, realize that the pet food companies (and pharmaceutical companies) are often responsible for the continuing education of vets and ask how that figures into the grand scheme of things.  These are ALL great questions.
 
Some related questions I often hear are: "Why don't more people know what you just told me?" and "Why doesn't my doctor talk to me this way?" Of course, I can write for hours offering answers to these and many other questions, but I would like to leave them with you to think about for a while.  
 
How will the public find the answers to these questions and our initial query found in the title of this piece? Quite simply, they will find them on the Internet and by talking with others.  Thank God (literally) for the Internet.  Sure, the World Wide Web is a mixed blessing.  It is a home for the spider and trap for the unsuspecting victim.  But the vast majority of what I have written on my ever-expanding Website can be confirmed by doing creative Internet searches.  I am constantly amazed at what can be quickly found using a simple search.  All we need is an idea and it can be turned into an afternoon, a week, or a lifelong quest.  My mission has been to discover truth and make it available to those who need it.  I certainly believe that I have had divine guidance in much of my journey, something else that is available to anyone who desires It.  But the first step is to wake up and see the startling fact that there is something seriously wrong in Mudville.  
 
This awakening can be quite unsettling but well worth the process.  We must put our minds in gear and apply our common sense.  When we do this, the first thing that happens is the flooding of our thoughts with questions.  (That is a good thing.) Then the answers follow.  They are out there, but the deeper we go down the rabbit hole the harder the questions become...  and frequently, the more disturbing the answers.  It can be a painful process.  A solid spiritual base is an invaluable asset because the ultimate answer to why things have gone so wrong lies in what is in the hearts of men.
 
Where are the hearts of those who produce the foods that we and our pets consume?

Reference:
1. Cellier C, Green P.  Review Article: Medical Progress—Celiac Disease.  N Engl J Med 2007;357:1731-43.

Celiac.com 02/13/2021 - I was interviewed for a national diabetes magazine the other day.  They wanted to know how a diet such as the Specific Carbohydrate Diet would be for diabetes sufferers, especially since, in Australia, 10% of diabetics are also diagnosed with celiac disease.  For diabetics the all important question is how carbohydrates affect their blood sugar level, and that the recommended foods have a low Glycemic Index.  The Glycemic Index (GI) is a measurement of the type of carbohydrates in a particular food, and how fast 50 grams of this carbohydrate raises blood glucose levels (and consequent insulin secretion and effects produced by the pancreas) as it is digested.  It is also important to consider the Glycemic Load of foods.  For those of you who aren't familiar with it, the Glycemic Load was devised to make the Glycemic Index useful in the real world.  

The problem with the Glycemic Index is that the tests use 50 grams of carbohydrate from the food being tested.  On a practical level, that means they test a plateful of spaghetti, but a truckload of cucumbers! It doesn't take into account how food is eaten in the real world, making benign foods seem damaging.  

The Glycemic Index is the measurement of how rapidly a given carbohydrate food is absorbed, and therefore how fast it spikes blood sugar.  In general, a rapid rise in blood sugar triggers a large insulin release.  The Glycemic Load is the Glycemic Index multiplied by the actual number of grams of carbohydrate eaten.  Ten or less is a low Glycemic Load—11 to 20 is a medium load, and anything over 20 is high.  

Take carrots.  Carrots have a high Glycemic Index for a vegetable—around 50.  But do you know how many carrots you'd have to eat to get fifty grams of carbohydrate? More than fifty! The carbohydrate content of eating two whole carrots with a meal is too small to cause a significant rise in blood sugar levels.  Oatmeal, on the other hand, has about the same GI as carrots, but a one cup serving of cooked oatmeal has 25 grams of carbohydrate, for a Glycemic Load of 12.5 in contrast to say 5 baby carrots which has 4 grams of carbohydrate and a Glycemic Load of 2—very low.  

So how do the foods allowed on the Specific Carbohydrate Diet rate, in regard to the GI and GL? Is this a good thing for diabetics and everyone else wanting to be healthier? 

The Specific Carbohydrate Diet is based on ‘Simple Carbohydrate Foods' or rather monosaccharides which are the single molecule carbohydrates which need no enzyme to be digested.  Carbohydrate foods naturally divide themselves into two groups: 1.  starches and refined sugars, and 2.  everything else.  It's the concentration of carbohydrates in the starches and refined sugars that makes them a problem to those with bowel disease and/or diabetes.  The specific carbohydrates allowed on the diet and used in the Healing Foods cookbook are the ones that are in most low GI foods.  These foods are simple fresh foods, such as fresh fruits and vegetables, some low starch pulses, nuts, meats, cheeses and yogurt.  Even the baked goods which are sweetened with honey are acceptable as the almond meal used instead of the wheat flour contain monounsaturated fats which slows the absorption rate of glucose from the honey into the bloodstream.  

Considering all these factors, diabetics, digestive disease sufferers, and generally everyone who wants to live a more energetic and healthy life should be able to benefit from the recipes in Healing Foods: Cooking for Celiacs, Colitis, Crohn's and IBS.  

Celiac.com 02/05/2021 - Recently, a team of doctors in the Czech Republic conducted a study of the inflammatory action of wheat gluten, and its relation to chronic diseases.  

Even with all of the research that has been conducted, many of the causes and mechanisms behind inflammatory and autoimmune diseases remain shrouded in mystery.  Doctors just don't know what causes most autoimmune diseases or how they actually work.  It is assumed that some sort of a breakdown occurs in the innate and adaptive immune system that regulates the body's mucous.

On one level this makes a great deal of sense.  Epithelial cells make up our skin and the linings of our respiratory, digestive and uro-genital tracts.  From the moment we're born, our epithelial cells are coming into contact with the substances from the outside world.  Our skin is regularly bombarded by germs, bacteria, and other foreign substances.  Just the simple act of breathing brings dirt, germs, bacteria and other foreign substances into contact with the epithelial cells that line our lungs.  Eating and drinking brings dirt, germs and bacteria into contact with the epithelial cells that line the digestive and uro-genital tracts.  

It is the job of our mucous layers, and the mucous they generate, to protect our epithelial cells that line our respiratory, digestive and uro-genital tracts.  When the mucous layer fails, the immune system can be stressed.  When the immune system breaks down or over-reacts, autoimmune ailments can result.  Unlike the multiple layers of epithelial cells that form the protective layers of our skin, just a single layer of epithelial cells protects our uro-genital, respiratory and digestive tracts.

Many people are surprised to learn that the surface area of human skin averages just two square meters in size, while of the lining of the respiratory, digestive and uro-genital tracts average about 300 square meters.  Again, these surfaces are mostly covered with just a single layer of epithelial cells, yet to fend off the millions of micro-organisms that regularly bombard them they must be able to tell the bad from the good microorganisms and to keep the bad ones from crossing the epithelial barrier.

Unlike other food proteins, the group of proteins in wheat, known as gliadin, has the ability to cause immune cells to produce cytokines.  Cytokines are proteins and peptides that function as signaling compounds.  Simply put, they tell other cells what to do.  

Inflammatory Activity of Gluten in Chronic Disease

In the case of celiac disease, the presence of wheat protein activates immune cells to produce cytokines that tell the cells lining the intestine to become inflamed as a means of protecting the body against what it sees as a foreign invader.

In the skin, mucosa, and lymphoid tissues there is a highly specialized kind of white blood cell called a dendritic cell.  The role of dendritic cells is to initiate a primary immune response by activating lymphocytes and secreting cytokines.

Research has shown that when these dendritic cells are exposed to wheat gliadin, they cause the body to increase the production of cytokines, which in turn triggers inflammation of the mucosal layer.  This pattern of activity seems to play an important part in celiac disease.

As stated earlier, this thin epithelial layer is all that protects the body from invasion by harmful intruders.  It is also a place where nutrient exchange occurs.  In the respiratory tract, oxygen is exchanged.  In the digestive tract, nutrients are absorbed.  In fact, for nutrients to be absorbed, it is necessary for there to be a degree of permeability in these cell linings.

If they kept everything out, we'd die of malnutrition, or maybe thirst.  If they let everything in, we'd likely die of one disease or another.  So, the body keeps up a delicate balancing act here.  In fact, the body has developed a highly sophisticated system of mechanical and chemical mechanisms whose job it is to protect this single layer of epithelial cells by identifying, degrading and removing intruders, while identifying and permitting beneficial items like nutrients to pass freely into the body for processing.

In healthy folks, this process works very smoothly.  The bad stuff is broken down and cleaned out, while the good stuff is permitted to cross the barrier and to carry the proper nutrients to our bodies.

Once we leave the sterile environment of the womb, billions of different bacteria begin to colonize most of our mucosal and skin surfaces.  Whether a person is healthy or not, the number of foreign bacterial cells living on and in our bodies far outnumber the cells we have when we are born.  

Most of these bacteria are beneficial, with the most beneficial bacteria residing in the gut.  In fact, there are so many different kinds, with such high levels of specificity, that scientists haven't yet been able to cultivate all of them.  These beneficial bacteria in the gut play an important role in immunity, metabolism, and other activities.

Gluten's Connection to Various Chronic Diseases

A wide range of inflammatory and autoimmune diseases are associated with celiac disease and untreated celiac patients, including a higher risk of complications from anemia, infertility, osteoporosis, and gastrointestinal cancer.  Many other disorders are associated with celiac disease, including endocrine diseases like type 1 diabetes, thyroiditis, connective tissue diseases, liver diseases, and Down syndrome, along with nervous system disorders like epilepsy, ataxia, and peripheral neuropathy.  One of the strongest associations with celiac disease is autoimmune diabetes.  We now know that 5-10% of diabetic patients have celiac disease, a rate more than 5 to 10 times that of the general population.  Almost all of these patients improve on a gluten-free diet.

It's unclear why a gluten-free diet might produce improvement in some of these people with these conditions, but one prominent hypothesis is that a percentage of folks with those conditions have compromised gut barriers that somehow permit undigested gluten that provokes an immune response.

An interesting side-note here is that mainstream researchers have recently begun to admit that diabetes, which was previously thought to be "exclusively" endocrine in nature, and heart disease, which was thought to be "purely" circulatory in nature, are both characterized by an inflammation component.  In other words, inflammation of tissue, and therefore, of cells, plays an important part in both diseases.  Similarly, celiac disease, which was thought to be largely gastrointestinal in nature, is increasingly showing connections to a wide range of disorders that affect nearly every major organ in the body.

Strangely, or perhaps not so strangely in light of this recent evidence, a gluten-free diet seems to have a beneficial effect on a number of chronic diseases in people who are entirely free of celiac disease.

Some patients with psoriasis and urticaria, for example, have shown improvement with a gluten-free diet, as have some patients with cryptogenic ataxia and peripheral neuropathy.

A number of schizophrenics have shown a reduction of symptoms on a gluten-free diet.

Also, a number of people with rheumatoid arthritis who observe a vegan, gluten-free diet have reported improvement in their condition.

Animal models have proven to be helpful in better understanding many different diseases and to help create new and more effective treatments.

There's a whole specialized area of biology called "Gnotobiology." These people specialize in working in germ-free conditions.  Gnotobiologists have developed strains of animals that are reared in germ-free environments.  

Imagine if you had never been exposed to any of the harmful or beneficial bacteria that colonize the human body once it leaves the sterile environment of the womb.  You would make a great guinea pig for better understanding how disease might work.

Like people, once rats are born, they undergo a profound change.  Intestinal microflora have a major effect on their mucosal immune system.  One of the benefits of using gnotobiotic animal models is that researchers can separate the effects of microflora and dietary antigens.

Since scientists know that applying wheat-gliadin to the gastro-intestinal tracts of conventionally raised rats of the AVN strain beginning shortly after birth results in pronounced jejunal changes, that is, celiac-associated lesions, it's beneficial if they can have a "clean" group of rats to test and compare against the conventionally raised rat group to see if there's some kinds of microflora that might provide some protection against celiac disease.

One of the things that the research team discovered is that breastfeeding seemed to be profoundly protective against the adverse effects of wheat gluten.

The research team actually looked at rat pups in which they had induced enteropathy to compare those given breast milk to those handfed on formula.  Among other things, they found that rats that were suckled never showed flat mucosa so characteristic of celiac damage when exposed to wheat-gliadin.  

Its unclear exactly why this is, though breast milk has so many beneficial elements to it, that it's hard to imagine it not being responsible for a great deal of immune-related development in general.  Rat breast milk in particular imparts epidermal growth factor (EGF), which seems to play an important part in of the rat's jejunal cells.

The research team also studied the effects of gliadin in a model system.  In fact, the team was able to take a close look at the effects of gluten on cells within the stomach cavities of mice.

In one test, a group of rats received epidermal growth factor via breast milk, while another group received straight formula with no EGF.  Both were treated with wheat-gliadin.  Rats without EGF showed villous atrophy, while those receiving breast milk, and thus, EGF, were protected against pathological mucosal changes and also against celiac-associated damage.

Basically, it all boils down to several things:
First, it looks very much like the way is paved for the development of celiac disease by the innate immune system when the presence of gliadin promotes functional and phenotypic maturing in dendritic white blood cells, which then leads to the gliadin peptides being presented to certain T lymphocytes, which then trigger the associated inflammation and resulting damage.

The research team concluded that it does, indeed, seem to be the unique structure of gluten and its fragments that provokes the response from the mechanisms of innate immunity.  In predisposed individuals, gluten seems to more readily activate an immune response than other proteins like soy protein and egg protein.  

Breastfeeding seems to offer some protection against gluten intolerance and associated damage.

In many cases, a gluten-free diet brings about improvement in chronic inflammatory and autoimmune diseases.

Celiac disease is just one of many inflammatory and autoimmune diseases to be associated with the intestinal damage arising from chronic exposure to gluten in gluten-intolerant individuals.  Also, many inflammatory and autoimmune diseases show improvement once gluten is excluded from the diet.

Reference:

1. Published In "Inflammation and Infection.  The Golden Triangle: Food—Microflora—Host Defense".  P.J.  Heidt, Z.  Midtvedt., V.  Rusch, D.  van der Waaij (Eds.) Old Herborn University Seminar Monography, 2007

Celiac.com 01/29/2021 - The U.S. has taken the lead of the industrialized world when it comes to weight-gain, especially obesity, and many other industrialized nations are in close pursuit.  Since Ancel Keys' flawed assertion linking dietary cholesterol with heart disease in 1951, the industrialized world has sought to reduce its consumption of fats—especially saturated fats(1).  Consequently, the last fifty years has seen a steady shift away from dietary fats.  Our carbohydrate consumption, particularly in the form of grains and sugars, increased at the same time—and the obesity epidemic was begun.   

A recent issue of People magazine reported on a 17 year old young woman who struggled extensively with obesity and could not halt a steady and dangerous trend of weight gain(2). The only answer she and her parents could find was to have an adjustable band surgically placed around her stomach.  This band makes it painful to eat more than very small portions.  The band was loosened somewhat as she approached her target weight, but it still severely limits the quantity of food she can eat.  Although she is much happier and healthier at her current size, I could not help but wonder if the surgery was a mistake.  No mention was made of ruling out celiac disease.  It is doubtful that celiac disease was even considered.  Yet Dickey and Kearney reported on an examination of data gathered on 371 newly diagnosed celiac patients.  These two researchers found that 39% of these patients were overweight, one third of whom were obese, while only 5% of these celiac patients were underweight at diagnosis(3).  Further, Dr. Joseph Murray has repeatedly discussed two case histories of morbidly obese patients with occult celiac disease(4).  Tragically, the diagnosis came too late for one of these patients.  She died before the gluten-free diet could reverse her obesity and the health hazards that go with it.  

The information, that gluten can and does cause obesity and that a gluten-free diet can reverse it, does not seem to have reached physicians involved in general practice or those working in the field of obesity.  The young woman featured in the People article might have been spared considerable pain and expense had she first been investigated for celiac disease and gluten sensitivity.  This article also mentioned that the number of children between ages 10 and 19 who are undergoing the same gastric surgery tripled between 2000 and 2003 yet it is doubtful that celiac disease was ever considered among these children.  How many of these children could be spared the pain and risks associated with gastric weight-loss surgery? Such experimentation with their nutrition is also suspect because their bodies are still developing and such artificial alterations may be depriving these children of important nutrients.  (I have previously speculated that celiac associated obesity results from food cravings driven by specific nutrient deficiencies.) 

Given the recent discovery that celiac disease afflicts more than 1% of the U.S.  Population(5) and gluten sensitivity has been found in 11% of those tested at a Texas shopping mall(6) and given the rates of overweight and obese individuals found among newly diagnosed celiac patients, it seems likely that much of the weight-gain epidemic that is sweeping the industrialized world is being fueled by undiagnosed gluten sensitivity and celiac disease (gluten syndrome).  I suspect that if our civilization is ever to escape this adipose prison, we must return to getting more of our calories from fats, and fewer from grains and sugars.  

References: 

1. Taubes G, Good Calories.  Bad Calories.  Alfred A.  Knopf.  New York, 2007.  16-17
2. Williams A, One Teen's Gastric Surgery.  People.  Dec.  17, 2007.  107-110
3. Dickey W, Kearney N.Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet.  Am J Gastroenterol.  2006 Oct;101(10):2356-9.  
4. Murray, J.  American Celiac Society conference, Mt.  Sinai Hospital, NYC, 1997 and Canadian Celiac Association National Conference, Calgary, 1999.
5. Celiac Disease Foundation 2001
6. Fine K, personal communication.  

Celiac.com 01/16/2021 - Oh dear! This week I met three parents in my clinic who are quite annoyed.  Perhaps infuriated is more accurate.  All three families have a child who has been unwell for years.  All three children had blood tests done over the last two years by another pediatrician—these tests showed high levels of gluten antibodies (a high IgG-gliadin level) which was ignored.

Anna is nine years old.  She is now gluten-free and is better: she sleeps all night, has no tummy pains, has more energy and she is enjoying life again.  She is strictly gluten-free.  Even small amounts of gluten upset her tummy.  She says "I feel good!"

Previously, she had tummy pains since two years of age.  However, over the last few months everything got worse with very bad tummy pains and more diarrhea.  Two years ago she had a blood test which showed high gluten antibodies—IgG gliadin 72 (usually less than 20 units).  But this result was ignored by her pediatrician.

When I saw Anna I repeated her blood tests: she had persistently high gluten antibodies (IgG gliadin 60) but no evidence of celiac disease (a normal tTG).  

Her parents, with a sense of irritation said: "Obviously, her diagnosis under the nose of our previous doctor, so why did he miss it?  Why didn't he suggest going on a gluten-free diet at that stage?  It would have stopped Anna having another two years of suffering!  How frustrating!  Why don't more doctors know about this diagnosis?"

Emma 
I unscrambled Emma's illness recently.  She is eight years old.  Emma's mum sent me this thank you card:

"Dear Dr Ford, We just want to say a BIG THANK YOU for all you have done for us!  Emma has been pain free from her gluten free diet!  All of us are now gluten-free and we feel more energized and happier in our tummies!  Your information has also helped some of my friends!  Keep going and informing people about this important information.  Thank you so, so much.  

PS: Hopefully we won't have to see you again!"

Emma had been seen by another pediatrician two years ago who did blood tests showing very high IgG-gliadin antibodies at 91 units (should be less than 20) a normal tTG, and the genes associated with celiac disease (DQ2/DQ8) were not detected.

My repeat tests showed that her gluten antibodies were still very high (IgG-gliadin  86).  She showed a dramatic response to the gluten-free diet.   Her tummy pains and lethargy melted away.  She is now a happy, vibrant eight-year-old, and with grateful parents.

Dan
Perhaps Dan's story is the saddest.  He is now 12 years old.  He has had constipation and leaky poos for more than five years.  He smells.  He is embarrassed that he has accidents in his pants.  School is difficult.  His parents are exasperated that Dan seems to have no control of his bowels.  Dan is depressed and anxious about his terrible situation.

Yet again he was assessed by another pediatrician a few years ago.  His gluten antibodies were sky high (IgG-gliadin of 94) but ignored because he had no evidence of celiac disease.  Dan had to go through a lot of "behavior modification" therapy, but with no benefit—it only made him more anxious and withdrawn.

Yes, you guessed it.  His repeat blood tests confirmed a gluten problem.  And yes, within a few weeks of going gluten-free he is now in control of his bowels—at long last.  He can now give me a smile.  He has the gluten syndrome and has suffered years of unnecessary pain and embarrassment.  His parents had labeled him as lazy, naughty and manipulative.  He was being lined up for some more psychotherapy.  Oh Dear!

Please help these children!
I often feel moments of sadness and frustration in my clinic.  I hear similar stories every day.  I see parents crying with relief that the answer has, at last, been found.  I also see families who are angry.  A gluten-free remedy is so simple and benign, yet it has not been suggested despite elevated IgG gliadin antibodies.  

This complacently and blindness causes unnecessary suffering.  Many of my medical colleagues continue to ignore gluten sensitivity.  They are in denial.  They attribute the response to a gluten-free diet to a placebo effect.  They undermine their patients through telling them to go back to eating gluten because they do not have celiac disease.

The way forward is for the gluten-free community to keep spreading the word: that gluten can cause a great deal of harm to many people and it needs to be considered as a front line diagnosis.  The good news is that this year some researchers in the big Celiac Foundations and Celiac Research Institutes in the USA are starting to research gluten-sensitivity.  At last Gluten Syndrome is being taken seriously.  We need to help all of the Annas, Emmas and Dans of this world.

If you have any comments or questions I would love to hear from you through our

Celiac.com 01/09/2021 - Ever stand on a school playground when a very loud siren would go off and feel like it was rattling your brain because it was so loud? If not from the local school ground, perhaps that siren was at the fire station, or other public building in your neighborhood? For the last 40 to 50 years, many of us remember hearing an ‘air raid siren' go off.  In our area, it was on the first Tuesday of the month at 1:00PM.  Air raid drills were a ‘warning system' to let us know that we had to take cover.  From the days of the attack on Pearl Harbor through the dawning of the Nuclear Age, the air raid siren was designed to give us all a chance to ‘take cover' to get ourselves and our families to safety.  Well as it turns out, our bodies have a similar early warning system.

The National Institutes of Health tells us that Auto-Immune Diseases (the immune system attacking our own body tissue) collectively affect more than 24 million people per year in the U.S.(1)  To put this in perspective, Cancer affects nearly 9 million people per year and Cardiovascular Disease affects close to 22 million people.  And we know that only about 1/3rd of the people with an Auto-immune Disease are diagnosed.(2)  That means about 72 million people are suffering with a self-destruction process (the immune system attacking its own body tissue).  That puts Auto-Immune Diseases at the top of the list of the most common diseases in America today.  But it's not screened for.  To most of us, autoimmune diseases are unknown.  Our medical system waits until the signs and symptoms are severe enough with organ failure and irreversible damage before we identify it.  It's not screened for, it's looked at as a ‘last-resort' type of diagnosis.

In general, autoimmune disorders can be classified as either organ specific or non-organ specific.  In organ-specific autoimmune diseases, antibodies are specifically directed against targets localized in a particular organ and are often detected in the blood.  Examples of organ-specific autoimmunity include Hashimoto's Thyroiditis (thyroid tissue), Type I Diabetes (pancreas tissue), Multiple Sclerosis (brain and nerve tissue), and Myasthenia Gravis (muscle tissue).  

In contrast, the non-organ-specific autoimmune disorders are characterized by the presence of antibodies directed against multiple targets (not specific to a particular organ).  This results in the involvement of several organs or endocrine glands and is often characterized by the presence of specific circulating antibodies.  Non-organ-specific autoimmunity includes diseases such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), and Scleroderma.(9)

A growing number of studies have identified that the body makes these antibodies directed against itself—otherwise known as auto-antibodies—years, and sometimes for a decade before a diagnosis is made.  The antibodies damage tissue slowly and steadily until finally people begin showing symptoms, and eventually receive a diagnosis.  

In Systemic Lupus, for  example, research shows that the progression of auto-antibodies for Systemic Lupus Erythematosous (S.L.E.) begin to present five years before a diagnosis is typically made. The immune system began an ‘early-warning system' (by producing auto-antibodies), and was starting to say "there's a problem here".  At this initial point, the patients did not have symptoms severe enough that warranted seeing their doctor.

Unfortunately, in the vast majority of cases, no one is monitoring this early warning system.  And so the body has to speak a little louder (more and different antibodies begin being produced)—no one is listening.  And then a little louder—no one is listening.  This continues for years until the body has to begin screaming.  And how does the body scream? Pain.  Have you ever stood under the telephone pole on the school playground when that Tuesday 1:00 PM siren went off? It rattles your brain.  That's what is happening in the body when there eventually is enough damage that a diagnosis of an autoimmune disease becomes obvious-it can't be ignored.  Researchers are telling us that autoimmunity appears to be a warning system that has gone beyond ‘early warning' to ‘take cover'.

It takes years from the first identification of antibody presence to the point of ‘clinical onset'—when the symptoms are obvious that something is wrong, and a diagnosis is made.  The levels of up to seven different antibodies may continue to rise for five years or more before the diagnosis.

If patients were armed with such information, they could start fighting the ailment years before the threshold of damage has been passed and a diagnosis is evident, thereby preventing or delaying symptoms.  One just has to look for the evidence.

Arguably, the most common auto-immune disease is also the only one where the ‘cure' is known and uncontested.  For some, gluten causes an ‘alarm reaction' in the immune system with a ‘call out the troops' type of attack response.  (upregulating macrophage pro-inflammatory gene expression and cytokine production).(5,6)

When this allergy to gluten (found in wheat, rye, barley and spelt) stimulates the production of auto-antibodies to the intestinal tissue (anti-transglutaminase or anti-endomysium antibodies), Celiac Disease is the diagnosis.  And this auto-immune disease is readily put into remission and disappears with a life-long avoidance of gluten in any form.(4) 

Are there early warning signs of Celiac Disease? Yes, there are.  We know that Celiac Disease-associated antibodies can be identified up to 5.2 years before a diagnosis of Celiac Disease can be made. (17)

Numerous pain syndromes and auto-immune diseases have been associated with an ‘alarm response' to gluten.  From peripheral neuropathies (numbness and tingling in the arms and legs) to crippling migraines and ataxia, from acute myocarditis (inflamed heart) to chronic pancreatitis, from vitiligo (loss of pigment-white spots-in the skin) to Primary Biliary Cirrhosis (Gall Bladder problems), from Multiple Sclerosis to Rheumatoid Arthritis, from Attention Deficit Hyperactivity Disorder (ADHD) to Epilepsy, in sensitive individuals, gluten may initiate this auto-immune response.(5,14)

So which organ is vulnerable to this auto-immune attack, this calling out of the troops? The target tissue seems to be determined by one's genetics (the blueprint you were born with) and all of the mitigating factors (accumulated exposures we've had in our lives such as toxic chemical accumulation, repeated use of antibiotics or other drugs contributing to intestinal permeability, heavy metal toxicity, excess stress hormone production, poor food choices…).(7)

This response may affect tissue throughout the body and has been identified with brain and peripheral tissue(8), liver epithelial cells, pancreatic beta-cells(8), thyroid tissue (9), bone cells(10), skin tissue(11), skeletal muscle(12), myocardium(13), and the brain and nervous system.  And it does not require the production of auto-antibodies to the intestines-that is, gluten intolerance can occur and be associated with other autoimmune diseases without the diagnosis of Celiac Disease (14).  

As an example, 57% of patients with neurological dysfunction of unknown cause have elevated antibodies to gliadin (a protein in wheat).  Only 35% of this group also have evidence of intestinal damage (Celiac Disease).  The remaining 65% have gluten sensitivity and elevated antibodies to the brain (cerebellum) or the nerves in the arms and legs, a situation analogous to that of the skin in Dermatitis Herpetiformis.(14) It appears that wheat can directly stimulate an auto-immune attack on the brain and nervous system in sensitive individuals without the diagnosis of Celiac Disease.

Elevated antibodies to gliadin and gluten (the protein in wheat) are the immune systems way of saying "this food is not good for me".  Many researchers take the position that if there are elevated antibodies to wheat, but there is no evidence of Celiac Disease, there is no evidence of value to avoiding wheat.  This position is historic and is in the process of changing.  The idea that until the sirens are screaming, it's ok to eat wheat, even if the immune system is saying "this is not good for me", is a position that more and more doctors are realizing is causing unnecessary suffering.

Many doctors and health care practitioners believe that even in the absence of indicators of outright Celiac Disease-that is with normal transglutaminase or endomysial antibodies, or a normal biopsy, we are best served by heeding the message our body is giving us, and avoiding these foods.  The concern is that if we ignore the actions of our immune system (elevated antibodies to wheat), the auto-immune process of the body (attacking its own tissue), may years down the road leave us standing under that telephone pole with the siren going off rattling our brains, or thyroid, or pancreas, or heart…

Dr. Thomas O'Bryan is a graduate of the University of Michigan and the National College of Chiropractic.  He is a Diplomate of the National Board of Chiropractic Examiners, a Diplomate of the Clinical Nutrition Board of the American Chiropractic Association, and a Certified Clinical Nutritionist with the International and American Association of Clinical Nutritionists.  He is a Certified Applied Kinesiologist.  He is a Certified Practitioner in Functional Biomechanics from the Motion Palpation Institute.  He is a member of the Institute of Functional Medicine, the International and American Association of Clinical Nutritionists, the American Chiropractic Association, the International Academy of Preventive Medicine and numerous other professional organizations.  

References:

• 1.    National Institutes of Health.  Autoimmune Diseases Coordinating Committee.  Autoimmune Diseases Research Plan. Accessed 1/18/07.
• 2.     Bland, J, Understanding The Origins and Applying Advanced Nutritional Strategies For Autoimmune Diseases.  March 2006.
• 3.    Notkins, A, Predictors of Disease, Scientific American, March 2007, 72-78.
• 4.    Murray, J, The Widening Spectrum of Celiac Disease.  Am J Clin Nutr 1999;69:354–65.
• 5.    Betterle C., Update on autoimmune polyendocrine syndromes (APS), ACTA BIOMEDICA 2003; 74;9-33.
• 6.    Zanoni,G, In Celiac Disease, a Subset of Antibodies against Transglutaminase Binds Toll-Like Receptor 4 and induces Activation of Monocytes, PLoS Med. 2006 Sep;3(9):e358.
• 7.    Kumar,V,Celiac Disease-Associated Autoimmune Endocrinopathies, Clinical and Diagnostic Labortory Immunology,July 2001, p.  678–685.
• 8.    Alaedini,A, Immune Cross-Reactivity in Celiac Disease: Anti-Gliadin Antibodies bind to Neuronal Synapsin 1,J Immunology,2007,178:6590-6595.
• 9.    Freeman HJ.  Hepatobiliary and pancreatic disorders in celiac disease.  World J Gastroenterol 2006; 12(10): 1503-1508.
• 10.    Moreno, M,The IL-1 gene family and bone involvement in celiac disease, Immunogenetics (2005) 57: 618–620 .
• 11.    Abenavoli L, Cutaneous manifestations in celiac disease.  World J Gastroenterol  2006;12(6): 843-852.
• 12.    Kozanoglu, E, Proximal myopathy as an unusual presenting feature of celiac disease, Clin Rheumatol (2005) 24: 76–78.
• 13.    Frustaci,A, Celiac Disease Associated with Autoimmune myocarditis, Circulation, 2002;105:2611-2618.
• 14.    Hadjivassiliou, M, Gluten Sensitivity as a Neurological Illness.  J Neurol Neurosurg Psychiatry, 2002;72:560-563.
• 15.    Sategna-Guidetti C., Prevalence of Thyroid Disorders in Untreated Adult Celiac Disease Patients and  Effect of Gluten Withdrawal: An Italian Multicenter Study, AJG—Vol.  96, No.  3, 2001.
• 16.    Oderta G., Thyroid Autoimmunity in Childhood Coeliac Disease, .  J Paediatr Gastroenterol Nutr, 2002 Nov;35(5):704-5.
• 17.    Salmi,T., Immunoglobulin A autoantibodies against transglutaminase 2 in the small intestinal mucosa predict forthcoming coeliac disease Aliment Pharmacol Ther 24, 541–552

Celiac.com 01/02/2021 - You are what you eat—right?

Although it sounds simple enough, on closer examination, it's a whole lot more complicated than it appears. Now throw in some gluten, a couple of celiac encoded alleles, some villous atrophy, and suddenly it becomes a little murky. You're not only what you eat—but also what you're able to digest, absorb, assimilate, and eliminate. If you have celiac disease, this whole process becomes compromised, ending with an inability to efficiently use the nutrients consumed—even if your diet is good.

Celiac disease is a genetically predisposed autoimmune condition in which gliadin, the toxic fraction of gluten, stimulates an inflammatory response in the gastrointestinal tract. The primary site of injury is the small intestine, which is also where most digestion, absorption, and assimilation of nutrients occur. Digestion is the mechanical and chemical breakdown of food into simple molecules that can be absorbed and used by the body. Assimilation is the process in which that fuel enters the cells and tissues and provides us with vitamins, minerals, and caloric energy.

What natural approaches can we utilize to help heal the gastrointestinal tract, address nutritional needs, boost immunity, and increase overall wellbeing? We'll get to that in a minute, but first it's important to take a closer look at what's going on when that bagel and cream cheese we ate for breakfast starts wreaking havoc once it's swallowed. We know that celiac disease is characterized by damage to the lining of the small intestine (villous atrophy), which can lead to malabsorption of nutrients and secondary autoimmune conditions and food intolerances. That's not good. But, on the upside, we also know what the precipitating environmental factor is that leads to celiac disease and its unpleasant side effects. It's food (the gluten in the bagel) which, in the grand scheme of things, is a pretty good deal as far as autoimmune diseases go. By removing gluten from the diet and making positive lifestyle changes, significant improvement often occurs fairly quickly.

As Hippocrates so aptly put it more than two thousand years ago, "Let thy food be thy medicine and thy medicine be thy food." That sounds pretty good to me. I can't complain when part of my prescription for healing is a nice meal of grilled salmon, brown rice with shiitake mushrooms, roasted beets, and a spinach salad. Add a small chunk of organic dark chocolate with raspberries and a cup of herbal tea and how can I possibly complain? That's my kind of medicine. *See nutrition therapy notes at the end of this article.

Nutrition therapy, appropriate supplementation, yoga, and enhanced mind-body awareness provide the holistic components needed to assist the healing process and restore vitality, resilience, and optimal health. The idea is to make appropriate lifestyle changes to facilitate healing and bring wholeness and balance to the body. The following list contains a few highlights from my own wellness odyssey. See if some variation of these approaches might work for you as well.

Maintain an Open Mind

Health care isn't simply about diagnosing a disease and prescribing medication. It's about treating the whole person—body, mind, and spirit. It's about enhanced self-care, knowledge, awareness, and preventive therapy. Holistic approaches tailor treatments to meet the unique needs, both biochemical and social, of the individual. These aren't quick fixes; they are subtle and powerful transformations that can cause a chain reaction of positive outcomes. Celiac disease presents a complex challenge, but it can also be the incentive needed to effectively change your mind, your body, your health, and your life—in a positive new direction. Explore the ancient wisdom of Ayurveda; take a natural cooking class; discover the benefits of whole, organic foods; try yoga, meditation, or tai chi. Our bodies are not made up of unrelated systems, so it is important, especially with multi-symptom autoimmune conditions like celiac disease, to focus on a multitude of lifestyle changes to achieve optimal health.

Eat a Variety of Simple Foods

That literally means simple foods—whole, fresh and preferably organic. If there is a long list of ingredients on the label, if you can't pronounce the words, or if you don't recognize them as real food, avoid it. Whole foods are gluten-free by default. You don't need to read the label on an apple. It's much harder to decipher what's in a baked apple treat from a fast food chain, especially when there are 40 different ingredients listed, many of which are unrecognizable. Go to the source—choose the apple. Eliminate or minimize processed foods.

You also might want to reconsider if your food is being delivered through a window while you're in your car—even if the meal is gluten-free. Celiac disease is characterized by compromised digestion; don't add to it by eating fast food in the fast lane. Sit down, relax, chew your food well, and consciously eat and enjoy your meal. How you eat is almost as important and nourishing as what you eat.

Experiment with Different Grains

Exchanging wheat for white rice flour and tapioca starch is okay in small doses, but there are so many more nutritious choices available. Teff is much higher in calcium, magnesium, and iron. The whole grain makes a great breakfast porridge and the flour adds richness and flavor to baked goods. Amaranth, unlike wheat, contains all the essential amino acids and is considered a high-quality protein. The same goes for quinoa, which is incredibly versatile.

Choose Supplements Wisely

One of the most widely used forms of alternative therapy today is the use of herbal and dietary supplements. Many of these are helpful, some are ineffective, and others may be harmful. Educate yourself before taking supplements that make extraordinary health claims. If it sounds too good to be true, it probably is. Supplements can be expensive, often contain hidden gluten, and may interact with medications, so it's important to do your homework before you buy them.

Having said that, there are some important supplements to consider including in your wellness regimen. While a good, high-quality multivitamin and mineral supplement is no substitute for a variety of whole fruits and vegetables, it might be helpful to ensure you're getting the micronutrients you need, especially considering the nutrient deficiencies that are often secondary to celiac disease. Choose a high-quality multi and make sure it's gluten-free and can be easily digested. Many tablets are so tightly pressed and packed with binders that they are nearly impossible to digest. Hard tablets can be crushed and added to applesauce or other soft foods to disguise the taste. That works in the same way that chewing your food thoroughly before swallowing does—both increase the efficient breakdown and use of nutrients, whether in food or a multivitamin. I have a small mortar and pestle that I use to crush tablets for easier absorption. You can also find multivitamins in soft-gel capsules, which dissolve easier when mixed with digestive juices.

Probiotics can help restore balance to the digestive tract, especially if you've taken antibiotics. These beneficial "friendly" bacteria occur naturally in cultured milk products, but also come in liquid or capsule form. An imbalance of intestinal bacteria can increase symptoms associated with celiac disease.

Digestive enzymes are protein molecules that accelerate biochemical reactions. They break down our food so we can absorb it more efficiently. Supplementing with digestive enzymes may be helpful for people with chronic GI problems. There are many different varieties of digestive enzymes; some are from plant sources, some are animal-based, some contain gluten. Consult with your health care professional for help in determining which ones are right for you. And always check to make sure they are gluten-free.

Yoga

I saved this for last because of the importance it plays in overall health and wellbeing. It is estimated that 16 million or more Americans practice yoga on a regular basis and many are convinced (and I'm one of them) that it is the key to enhanced physical and emotional health. Western scientists are just beginning to study and appreciate the wide range of benefits yoga offers people with chronic conditions. Research shows that a committed yoga practice not only strengthens and tones the body, but also quiets the mind and reduces stress, lowers blood pressure, relieves asthma symptoms, balances hormones, strengthens the cardiovascular system, eases digestive problems, helps alleviate inflammation, and on and on. There's a reason it's been around for thousands of years.

Exploring holistic and alternative approaches to health and healing might be the perfect "medicine" for reversing the problems associated with celiac disease. And before you know it, you won't define yourself as having a disease, you'll define yourself as having renewed inspiration and vitality.

*Nutrition therapy notes
(This is the short version; I'm only listing the highlights. These foods were chosen to boost immune function and reduce symptoms associated with celiac disease.)

• Salmon—Rich in omega-3 fatty acids, which help reduce inflammation and are thought to be protective against many types of cancers. Salmon is also rich in selenium, tryptophan and vitamin D.
• Brown rice—Excellent source of manganese, selenium, magnesium and fiber.
• Shiitake mushrooms—A symbol of longevity in Asian culture, these mushrooms are rich in a compound called lentinan, which boosts immune function. They are also high in antioxidants and iron.
• Beets—Good source of antioxidants; rich in folate, manganese, and potassium.
• Spinach—Calorie for calorie, spinach is a powerhouse. It's packed with vitamins K, A, and C, manganese, folate and iron.
• Dark Chocolate (gluten-free)—I'm sure you've heard the news; dark chocolate is very high in protective antioxidants. It is also rich in magnesium, iron, and vitamin D. Aren't we lucky!

Reference:
1. Cellier C, Green P. Review Article: Medical Progress—Celiac Disease. N Engl J Med 2007;357:1731-43.

Celiac.com 07/19/2008 - When I was 6 years old, I lived in Dallas, Texas, and I had a best friend named Judy. It was at her house that I first ate a bagel. I fell in love with its chewy, crusty texture. I didn’t know much at that age, but I knew that I loved eating those bagels – I couldn’t get enough.

I also knew, from a very young age, that something was wrong with me. Something that they would one day discover and name after me. I had stomachaches all the time. I can’t remember a time when my stomach didn’t hurt at least a little bit.

“You were so healthy when you were young,” my mother is fond of saying. Painfully shy and uncomplaining–yes. Healthy, no. We were just blissfully unaware of what lay in wait for future doctors to discover.

In high school, I was anemic, and experienced several bouts of tachycardia that were written off to anxiety. And then after I was married, I twice struggled with infertility. Later, the “stomachaches” returned and worsened and doctors removed my gallbladder thinking that stones were to blame and then my uterus thinking it might be hormones causing my symptoms.

Along the way, in trying to diagnose me, doctors discovered insulin-dependent diabetes, low thyroid and high cholesterol. I also have bipolar disorder. I take a combination of 13 medications a day for my health maintenance, and I’ve been to the hospital at least 18 times in the past year. But still, I felt that they hadn’t hit upon that one thing that was really wrong, that was causing my stomach to hurt so badly.

Then, two years ago, I had added “severe bone pain” to my ever-growing list of symptoms and went to see a rheumatologist. He refused to believe it was a simple case of arthritis and tested me for malnutrition. I had no Vitamin D in my blood – a tell tale sign that something was wrong with my gut. Next came the antibody test and then a biopsy that proved that the tiny villi that lined my intestines were indeed “flattened.” We had a diagnosis after only 10 years of actively seeking one. I had celiac disease, an auto-immune disease where you can’t digest wheat or gluten, the wheat protein.

 “What? I can’t eat bread? I can’t have bagels?”

I was sure I would starve to death when I heard that this removal of all glutens from the diet was the only treatment for the disease whereby the lining of a person’s intestines is badly damaged. If left untreated, it can lead to things like malnutrition, brain ataxia, osteopenia, and eventually a cancer called lymphoma.

More specifically, what was happening was the lining of my intestines was shriveling, shrinking in reaction to the gluten in the bread or other products made with wheat. The damaged intestines repair themselves with the removal of gluten from the diet, but it must be strictly adhered to for life. Even the smallest taste of wheat or gluten would immediately return my villi that line the intestines to a flattened mass. 

At first I was afraid to eat anything. All day long, gluten loomed at me from dark corners. At night I dreamt of bagels and pizza.

The problem is that gluten is hidden in many foods. Obviously it is in bread, bagels, pizza, pasta, most fried foods (all wheat flour-based products) but it also is in many processed foods like canned soups and salad dressings, ice creams, foods made with caramel color, malt, barley, rye, HVP, spelt, and the list goes on. It also means that I must use separate utensils to butter my gluten-free bread, separate pots and pans to cook my food and separate colanders to drain my corn or rice-based pastas. Even certain toothpastes and lipsticks are suspect.

To have celiac disease means that you no longer can rely on that convenience factor of ordering take-out or eating fast-food. It means that you have to be prepared each and every time you eat, bringing with you sauces and dressings, buns and breads.

You learn, too, that part of the reason bread is bread is because of the gluten. It is what holds it together and gives it its chewy texture. Breads made from rice and corn and the like are mealy and fall apart. They must be kept frozen and then toasted, and even then are just not the same.

Eating out is risky. You must carefully research a restaurant before you go, finding out if they offer any gluten-free foods and usually speaking to the manager and the chef. I usually go to one of two restaurants that I know to have gluten-free menus. Even then you risk cross-contamination or accidents. The other day, I found a crouton in the bottom of my salad bowl. This can be disastrous to a person with celiac disease.

It signaled all things dark and dastardly, and sure enough, later that night, it started: a gnawing, a clawing from the inside out. Something akin to severe hunger but more raw than that. Then it settled in the pit of my stomach and churned into a piece of broken glass. A reaction to gluten can feel as though every time you move you’re stabbed by a shard of glass until you’re bleeding from the inside out. This can result in severe projectile vomiting and other gastrointestinal symptoms that are mostly unmentionable.

The Other Celiacs
There are those people who have celiac who are really upbeat about it all – perky even. There are also celiac patients who have mild or no symptoms of the disease. I’m not one of them. They will tell you that we are among the lucky ones, the ones who know they have the illness, the ones who have been diagnosed and now have all this healthy good-for-you food at our disposal. They laud the nature of the illness whereby the only treatment is dietary and does not require surgery or other invasive means. But if you ask me, I would much rather have one surgical procedure that would “cure” me and be able to digest wheat the rest of my life than to have to make such a lifestyle overhaul. To have celiac is to be socially awkward at best and to be in constant pain at worst. It is not something one wishes to have.

The worst part is no one (other than another celiac sufferer) understands, from the family member who wants you to try “just one bite” of her homemade streusel to the restaurateur who mistakes white flour for a non-gluten product because it has been “bleached” to the medical professional who thinks it’s a simple allergy rather than an auto-immune disease. The lack of awareness of celiac is astounding given that nearly two million Americans are said to suffer from it.   The problem is it is widely under-diagnosed. One in 133 Americans are said to have celiac disease but only one in 2000 knows they have it.

Lack of Awareness
When we are little kids, we are taught that doctors are there to help us. I have very few doctors who actually help me. I had one doctor -- an endocrinologist – say that they would figure it all out at the autopsy. To have a chronic illness is to realize that there is no cure. You will not be cured. You will learn to live with some amount of pain and illness.

This lack of awareness of the disease and its effects even among medical professionals is unnerving. I’ve shown up at hospitals vomiting blood, writhing in pain with blood pressure so low I should be crawling yet I’ve been told nothing was wrong with me, that all of my blood work was “perfectly normal” and therefore I should just go home and rest.

Of course if they had checked my gluten antibodies, they would have found that they were twice as high as was normal, pointing to an accidental ingestion of gluten, which sent my body into a tailspin of auto-immune hell. Yet there is no “auto-immunologist” to which I can turn for help.

What’s even more frustrating is that celiac disease is not a rare illness – it is estimated that it could even affect three million Americans!

Lessons Learned
I dream of bagels that I can digest that taste good. I dream of hospitals where treatment comes without scrutiny and care comes with respect.

 And I dream of a place I can go and be welcomed where “everybody knows the name” of celiac sprue. A place where people understand that it is not a simple thing to just“eliminate gluten” from one’s diet as gluten – the wheat protein – isin many, many foods, some obvious, yes, but many hidden, too.

In the meantime, I’m learning to eat to live and not the other way around. And I’m enjoying the simple things in life – the friends who will drive far enough to find a gluten-free restaurant; the same friends who won’t devour the bread basket in front of you!

Celiac.com 12/20/2007 - Celiac disease is under-diagnosed because many celiac disease patients do not show classic gastrointestinal symptoms. Highly sensitive and specific serological tests have led to the diagnosis of celiac disease in patients for whom short stature may be the only obvious symptom. Researchers from Brazil and Italy have previously reported that celiac disease accounts for 1-5% of short stature in children.

Prevalence of celiac disease varies widely according to geographic location. Although epidemiological studies are lacking in India, celiac disease reporting has increased exponentially due to targeted screening and better serological tests. To better understand the relationship between short stature and celiac disease, researchers from the Endocrine Clinic of the Postgraduate Institute of Medical Education and Research in Chandigarh studied children referred for a work-up of short stature from January 2005 to December 2006.

Researchers enrolled 176 patients, half male and half female, who fit the criteria for short stature: height ≥ 2.5 standard deviations below the mean for chronological age, growth rate below the fifth percentile for chronological age, and height ≥ 2 standard deviations below mean for chronological age when corrected for mid-parental height. Most patients were 10-15 years old (mean age of 14.5).

Researchers took detailed histories and carried out clinical evaluations and screening tests. If they could find no endocrine cause for short stature or if diarrhea had been present for more than 3 months, researchers estimated IgA anti-tissue transglutaminase antibodies (anti-tTG) and performed an endoscopic biopsy.

Celiac disease was found in 27 (15.3%) of the patients, making it the single most common cause of short stature. 25 children had pituitary disorder (14%), 24 had hypothyroidism (14%), and constitutional delay of growth and puberty or  familial short stature accounted for 18 (11%). Other less common causes of short stature were metabolic bone disease, Turner syndrome, adrenal disorders, diabetes mellitus, and nutritional deficiency. All celiac disease patients were positive for tTG antibodies and had a duodenal biopsy suggestive of celiac disease. All celiac disease patients were symptomatic; the most common symptoms after growth retardation were anemia (88%), weight loss (80%), diarrhea (69%), and delayed puberty (54%).

The average time to diagnosis for these patients was 5.5 years (95% cI: = 2.5 to 8.5 years). The celiac disease patients were treated with a gluten-free diet, calcium (500 mg/day), vitamin D (300,000 U cholecalciferol once every 3 months), and iron and multivitamin supplementation including folic acid and vitamin B12. During the 6-9 month follow-up period, growth rate velocity increased significantly from  2.9 cm/year (95%  cI = 2.41 to 3.39 cm/year) to 8.9 cm/year (95% cI = 6.7 to 11.1 cm/year).

Celiac disease can lead to short stature by causing autoimmune hypothydroidism, resistance to growth hormones, and malabsorption of protein, calcium and vitamin D. Additionally, celiac disease can lead to hypogonadism which inhibits the pubertal growth spurt. Researchers recommend that all short children be screened for celiac disease.

Resources
Bhadada, S. Bhansali, A., Kochhar, R., Shankar, A., Menon, A., Sinha, S., Dutta, PP., and Nain, C. Does every short stature child need screening for celiac disease? Gastroenterology [OnlineEarly Articles]. doi:10.1111/j.1440-1746.2007.05261.x