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The Continuum Concept

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I ran across an article by Mark Hyman, M.D. practicing physician a pioneer in functional medicine, which was about another autoimmune disorder, diabetes. Since there is some correlation between celiac disease and Diabetes,as both are autoimmune disorders, I thought what he had to say gave some insight to what we are expierencing with celiac disease. At least, it gave me a different perspective on what we are all experiencing.

The Continuum Concept

Most medicine is based on clear-cut, on-or-off, yes-or-no diagnoses. Most conventional doctors are taught that you have a disease or you don't, you have diabetes or you don't. There are no gray areas. This approach is not only misguided, it is dangerous, because it misses the underlying causes and more subtle manifestations of illness. Practicing medicine this way completely ignores one of the most fundamental laws of physiology, biology, and disease: The continuum concept. There is a continuum from optimal health to hidden imbalance to serious dysfunction to disease. Anywhere along that continuum, we can intervene and reverse the process. The sooner we address it, the better.

Are not the manifestations and differences in degrees of symptoms of Gluten Intolerance part of the continuum of celiac disease? In fact, it seems so obvious that it is so, and yet many doctors miss this concept altogether. For example, many doctors dismiss you as NOT having celiac disease if there is no villinus atrophy, not even suggesting a trail run of a gluten free diet.

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This is an excellent point and very important for people to understand. It is a systemic problem that goes well beyond just doctors.

Fee-for-service insurance systems do not handle gray areas very well. They work best when every ailment/problem is yes/no, on/off, clear-cut. That way, a doctor can assign a particular diagnosis code and get reimbursed. Since this is how doctors make their living (and pay their staffs), they are incentivised to see things as black-and-white.

Society (at least in the U.S.) complicates this by its predilection to "game the system". If insurance companies opened up reimbursement for "continuum" care, they would go bankrupt. Without discrete anchors for diagnosis and treatment, insurance companies would have to pay for an ever-widening spectrum of treatments. Consider someone with a poor diet. They will suffer varied ailments down-the-road. Their "continuum care" treatment would involve eating better in order to head off more serious and more expensive problems. Should their insurance subsidize their grocery bill? And, if it did, does anyone doubt that there would be those who would try to have their insurance pay for filet for dinner along with a triple-chocolate desserts?

My feeling is that we as a society do this to ourself. We are best characterized as pigs at a trough with each one so afraid of losing its position at the trough. As a result, we cling so tightly to the status quo that needed change is essentially impossible.

Anyone who steps back can see that this also goes well beyond health care. It touches every aspect of our lives. Consider the economic crisis. It wasn't caused just by Wall Street and CEO's with multimillion dollar bonuses. It was caused by everyone who "pigged out" on easy credit and/or who gamed the financial system. For example, last year I visited an office and talked to an acquaintance who told me he was losing his house. His bank was foreclosing and his wife and daughter were leaving him. I felt really bad for him and listened to his problems. While he talked, one of his coworkers told him UPS had just delivered some boxes for him. I assumed it was a business shipment but when he opened the boxes, they contained hunting gear. Not only that, but there was two of everything. Somehow sensing my confusion, he explained. In order to declare bankruptcy, he had to stop using his credit cards for three months. As a result, he wanted to buy stuff now so he could be ready for hunting season. Since he would be without credit during hunting season, he would not be able to replace anything that broke so he bought replacements now.

We need things like continuum care. However, to get it, we will as a society need to step back from the trough and somehow effect a "societal enlightenment".

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I found what you wrote to be very interesting as I had not thought about the continuum concept in those terms. But, the article seemed to be more about the diagnostic decisions made about what is wrong with a patient. Doctors do seem to see things in black and white when it comes to diagnosis. When in fact, there are degrees of illness which doctors do not always acknowledge. Also, labs like to draw lines in the sand, saying that the patient has a certain disease if numbers go over the line, but don't if numbers fall below it. I think celiac disease is like this. It presents as more of a continuum of signs, symptoms and degrees of illness. We aren't all totally similar in our reaction to gluten, yet we all have a disease state where the consumption of gluten causes illness. Anyway, it's just another perspective from which to try and understand the differences that we see where gluten intolerance is concerned. I hadn't thought about it all in these terms before and found this article enlightening, so thought I'd share.

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I ran across an article by Mark Hyman, M.D. practicing physician a pioneer in functional medicine, which was about another autoimmune disorder, diabetes. Since there is some correlation between celiac disease and Diabetes,as both are autoimmune disorders, I thought what he had to say gave some insight to what we are expierencing with celiac disease. At least, it gave me a different perspective on what we are all experiencing.

The Continuum Concept

Most medicine is based on clear-cut, on-or-off, yes-or-no diagnoses. Most conventional doctors are taught that you have a disease or you don't, you have diabetes or you don't. There are no gray areas. This approach is not only misguided, it is dangerous, because it misses the underlying causes and more subtle manifestations of illness. Practicing medicine this way completely ignores one of the most fundamental laws of physiology, biology, and disease: The continuum concept. There is a continuum from optimal health to hidden imbalance to serious dysfunction to disease. Anywhere along that continuum, we can intervene and reverse the process. The sooner we address it, the better.

Are not the manifestations and differences in degrees of symptoms of Gluten Intolerance part of the continuum of celiac disease? In fact, it seems so obvious that it is so, and yet many doctors miss this concept altogether. For example, many doctors dismiss you as NOT having celiac disease if there is no villinus atrophy, not even suggesting a trail run of a gluten free diet.

Thank you for posting this! I was so lost until finding this board and this post helps me out even more...

I have mostly neuro symptoms (brain fog, depression, anxiety, etc) with less GI symptoms. My ttg-iga tested positive, but my endo came back negative.

All the doctor said was my results were "normal" with NO EXPLANATION of what my symptoms could be coming from. In fact, I didn't even speak to the doctor about my results, I only spoke with his Physician's Assistant over the phone. I'm sick and tired of our healthcare system just dismissing people if there is no clear-cut explanation for anything.

So, I decided to take things into my own hands and go gluten-free last week. I honestly have had SO much more energy and less anxiety and depression. The only slip-up I've had so far was at my work holiday party that I planned, and WOW did I pay for it later that day and the following day. I can't believe what a big difference I have noticed already though.

As far as I can tell, I would be non-celiac gluten sensitive if my body continues to respond well to the diet. No thanks to my GI doctor!

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A lot of us in the mental health field subscribe to the continuum theory - and whenever I'm training people on diagnosing depression, anxiety, ADHD, OCD, etc I draw a continuum and say that the only diagnosis I know of that is black and white is pregnancy - nearly everything else falls somewhere on a continuum.

Granted, there may be a line that gets crossed somewhere along the way on that continuum for an official diagnosis - such as villous atrophy or more than two weeks of depressive symptoms - but it's not an 'us' vs. 'them' - it's differing shades of grey.

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