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avoid gluten (wheat, rye, barley) to cure Celiac Disease and related autoimmune diseases, Alessio Fasano, U Maryland SOM, Scientific American

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  • Rich Murray
    avoid gluten (wheat, rye, barley) to cure Celiac Disease and related autoimmune diseases, Alessio Fasano, U Maryland SOM, Scientific American 2009.07.27 with
    Message 1 of 1 , Aug 3, 2009
      avoid gluten (wheat, rye, barley) to cure Celiac Disease and related
      autoimmune diseases, Alessio Fasano, U Maryland SOM, Scientific American
      2009.07.27 with 68 comments in plain text: Rich Murray 2009.08.03
      Monday, August 3, 2009



      Alessio Fasano is professor of pediatrics, medicine and physiology and
      director of the Mucosal Biology Research Center and the Center for Celiac
      Research at the University of Maryland School of Medicine. Much of his basic
      and clinical research focuses on the role of intestinal permeability in the
      development of celiac disease and other autoimmune disorders.

      Scientific American Magazine - July 27, 2009

      Celiac Disease Insights: Clues to Solving Autoimmunity
      Study of a potentially fatal food-triggered disease has uncovered a process
      that may contribute to many autoimmune disorders
      By Alessio Fasano

      My vote for the most important scientific revolution of all time would trace
      back 10,000 years ago to the Middle East, when people first noticed that new
      plants arise from seeds falling to the ground from other plants -- a
      realization that led to the birth of agriculture. Before that observation,
      the human race had based its diet on fruits, nuts, tubers and occasional
      meats. People had to move to where their food happened to be, putting them
      at the mercy of events and making long-term settlements impossible.

      Once humans uncovered the secret of seeds, they quickly learned to
      domesticate crops, ultimately crossbreeding different grass plants to create
      such staple grains as wheat, rye and barley, which were nutritious,
      versatile, storable, and valuable for trade. For the first time, people were
      able to abandon the nomadic life and build cities. It is no coincidence that
      the first agricultural areas also became "cradles of civilization."

      This advancement, however, came at a dear price: the emergence of an illness
      now known as celiac disease (CD), which is triggered by ingesting a protein
      in wheat called gluten or eating similar proteins in rye and barley. Gluten
      and its relatives had previously been absent from the human diet. But once
      grains began fueling the growth of stable communities, the proteins
      undoubtedly began killing people (often children) whose bodies reacted
      abnormally to them. Eating such proteins repeatedly would have eventually
      rendered sensitive individuals unable to properly absorb nutrients from
      food. Victims would also have come to suffer from recurrent abdominal pain
      and diarrhea and to display the emaciated bodies and swollen bellies of
      starving people. Impaired nutrition and a spectrum of other complications
      would have made their lives relatively short and miserable.

      If these deaths were noticed at the time, the cause would have been a
      mystery. Over the past 20 years, however, scientists have pieced together a
      detailed understanding of CD. They now know that it is an autoimmune
      disorder, in which the immune system attacks the body's own tissues. And
      they know that the disease arises not only from exposure to gluten and its
      ilk but from a combination of factors, including predisposing genes and
      abnormalities in the structure of the small intestine.

      What is more, CD provides an illuminating example of the way such a triad --
      an environmental trigger, susceptibility genes and a gut abnormality -- may
      play a role in many autoimmune disorders. Research into CD has thus
      suggested new types of treatment not only for the disease itself but also
      for various other autoimmune conditions, such as type 1 diabetes, multiple
      sclerosis and rheumatoid arthritis.

      Early Insights
      After the advent of agriculture, thousands of years passed before instances
      of seemingly well-fed but undernourished children were documented. CD
      acquired a name in the first century A.D., when Aretaeus of Cappadocia, a
      Greek physician, reported the first scientific description, calling it
      koiliakos, after the Greek word for "abdomen," koelia. British physician
      Samuel Gee is credited as the modern father of CD. In a 1887 lecture he
      described it as "a kind of chronic indigestion which is met with in persons
      of all ages, yet is especially apt to affect children between one and five
      years old." He even correctly surmised that "errors in diet may perhaps be a
      cause." As clever as Gee obviously was, the true nature of the disease
      escaped even him, as was clear from his dietary prescription: he suggested
      feeding these children thinly sliced bread, toasted on both sides.

      Identification of gluten as the trigger occurred after World War II, when
      Dutch pediatrician Willem-Karel Dicke noticed that a war-related shortage of
      bread in the Netherlands led to a significant drop in the death rate among
      children affected by CD -- from greater than 35 percent to essentially zero.
      He also reported that once wheat was again available after the conflict, the
      mortality rate soared to previous levels. Following up on Dicke's
      observation, other scientists looked at the different components of wheat,
      discovering that the major protein in that grain, gluten, was the culprit.

      Turning to the biological effects of gluten, investigators learned that
      repeated exposure in CD patients causes the villi, fingerlike structures in
      the small intestine, to become chronically inflamed and damaged, so that
      they are unable to carry out their normal function of breaking food down and
      shunting nutrients across the intestinal wall to the bloodstream (for
      delivery throughout the body). Fortunately, if the disease is diagnosed
      early enough and patients stay on a gluten-free diet, the architecture of
      the small intestine almost always returns to normal, or close to it, and
      gastrointestinal symp­toms disappear.

      In a susceptible person, gluten causes this inflammation and intestinal
      damage by eliciting activity by various cells of the immune system. These
      cells in turn harm healthy tissue in an attempt to destroy what they
      perceive to be an infectious agent.

      A Diagnostic Discovery
      Fuller details of the many mechanisms through which gluten affects immune
      activity are still being studied, but one insight in particular has already
      proved useful in the clinic: a hallmark of the aberrant immune response to
      gluten is production of antibody molecules targeted to an enzyme called
      tissue transglutaminase. This enzyme leaks out of damaged cells in inflamed
      areas of the small intestine and attempts to help heal the surrounding

      Discovery that these antibodies are so common in CD added a new tool for
      diagnosing the disorder and also allowed my team and other researchers to
      assess the incidence of the disease in a new way -- by screening people for
      the presence of this antibody in their blood. Before then, doctors had only
      nonspecific tests, and thus the most reliable way to diagnose the disease
      was to review the patient's symptoms, confirm the intestinal inflammation by
      taking a biopsy of the gut, and assess whether a gluten-free diet relieved
      symptoms. (Screening for antibodies against gluten is not decisive, because
      they can also occur in people who do not have CD.)

      For years CD was considered a rare disease outside of Europe. In North
      America, for example, classic symptoms were recognized in fewer than one in
      10,000 people. In 2003 we published the results of our study -- the largest
      hunt for people with CD ever conducted in North America, involving more than
      13,000 people. Astoundingly, we found that one in 133 apparently healthy
      subjects was affected, meaning the disease was nearly 100 times more common
      than had been thought. Work by other researchers has confirmed similar
      levels in many countries, with no continent spared.

      How did 99 percent of cases escape detection for so long? The classical
      outward signs -- persistent indigestion and chronic diarrhea -- appear only
      when large and crucial sections of the intestine are damaged. If a small
      segment of the intestine is dysfunctional or if inflammation is fairly mild,
      symptoms may be less dramatic or atypical.

      It is also now clear that CD often manifests in a previously unappreciated
      spectrum of symptoms driven by local disruptions of nutrient absorption from
      the intestine. Disruption of iron absorption, for example, can cause anemia,
      and poor folate uptake can lead to a variety of neurological problems. By
      robbing the body of particular nutrients, CD can thus produce such symptoms
      as osteoporosis, joint pain, chronic fatigue, short stature, skin lesions,
      epilepsy, dementia, schizophrenia and seizure.

      Because CD often presents in an atypical fashion, many cases still go
      undiagnosed. This new ability to recognize the disease in all its forms at
      an early stage allows gluten to be removed from the diet before more serious
      complications develop.

      From Gluten to Immune Dysfunction
      Celiac disease provides an enormously valuable model for understanding
      autoimmune disorders because it is the only example where the addition or
      removal of a simple environmental component, gluten, can turn the disease
      process on and off. (Although environmental factors are suspected of playing
      a role in other autoimmune diseases, none has been positively identified.)

      To see how gluten can have a devastating effect in some people, consider how
      the body responds to it in most of the population. In those without CD, the
      body does not react. The normal immune system jumps into action only when it
      detects significant amounts of foreign proteins in the body, reacting
      aggressively because the foreigners may signal the arrival of
      disease-causing microorganisms, such as bacteria or viruses.

      A major way we encounter foreign proteins and other substances is through
      eating, and immune soldiers sit under the epithelial cells that line the
      intestine (enterocytes), ready to pounce and call in reinforcements. One
      reason our immune system typically is not incited by this thrice-daily
      protein invasion is that before our defenses encounter anything that might
      trouble them, our gastrointestinal system usually breaks down most ingested
      proteins into standard amino acids-the building blocks from which all
      proteins are constructed.

      Gluten, however, has a peculiar structure: it is unusually rich in the amino
      acids glutamine and proline. This property renders part of the molecule
      impervious to our protein-chopping machinery, leaving small protein
      fragments, or peptides, intact. Even so, in healthy people, most of these
      peptides are kept within the gastrointestinal tract and are simply excreted
      before the immune system even notices them. And any gluten that sneaks
      across the gastrointestinal lining is usually too minimal to excite a
      significant response from a normally functioning immune system.

      CD patients, on the other hand, have inherited a mix of genes that
      contribute to a heightened immune sensitivity to gluten. For example,
      certain gene variants encoding proteins known as histocompatibility
      leukocyte antigens (HLAs) play a role. Ninety-five percent of people with CD
      possess the gene either for HLA-DQ2 or for HLA-DQ8, whereas just 30 to 40
      percent of the general population have one of those versions. This finding
      and others suggest that the HLA-DQ2 and HLA-DQ8 genes are not the sole cause
      of immune hyperactivity but that the disease, nonetheless, is nearly
      impossible to establish without one of them. The reason these genes are key
      becomes obvious from studies of the function of the proteins they specify.

      The HLA-DQ2 and HLA-DQ8 proteins are made by antigen-presenting cells. These
      immune sentinels gobble up foreign organisms and proteins, chop them, fit
      selected protein fragments into grooves on HLA molecules, and display the
      resulting complexes on the cell surface for perusal by immune system cells
      called helper T lymphocytes. T cells that can recognize and bind to the
      displayed complexes then call in reinforcements.

      In patients with CD, tissue transglutaminase released by intestinal
      epithelial cells attaches to undigested gluten and modifies the peptides in
      a way that enables them to bind extremely strongly to DQ2 and DQ8 proteins.
      In consequence, when antigen-presenting cells under intestinal epithelial
      cells take up the complexes of tissue transglutaminase and gluten, the cells
      join the gluten to the HLAs and dispatch them to the cell surface, where
      they activate T cells, inducing the T cells to release cytokines and
      chemokines (chemicals that stimulate further immune activity). These
      chemicals and enhancement of immune defenses would be valuable in the face
      of a microbial attack, but in this instance they do no good and harm the
      intestinal cells responsible for absorbing nutrients.

      CD patients also tend to have other genetic predispositions, such as a
      propensity for overproducing the immune stimulant IL-15 and for harboring
      hyperactive immune cells that prime the immune system to attack the gut in
      response to gluten.

      Guilt by Association
      What role might antibodies to tissue transglutaminase play in this
      pathological response to gluten? The answer is still incomplete, but
      scientists have some idea of what could happen. When intestinal epithelial
      cells release tissue transglutaminase, B cells of the immune system ingest
      it -- alone or complexed to gluten. They then release antibodies targeted to
      the enzyme. If the antibodies home in on tissue transglutaminase sitting on
      or near intestinal epithelial cells, the antibodies might damage the cells
      directly or elicit other destructive processes. But no one yet knows whether
      they, in fact, cause such harm.

      In the past nine years my colleagues and I have learned that unusual
      intestinal permeability also appears to participate in CD and other
      autoimmune diseases. Indeed, a growing body of evidence suggests that
      virtually the same trio of factors underpins most, and perhaps all,
      auto­immune diseases: an environmental substance that is presented to the
      body, a genetically based tendency of the immune system to overreact to the
      substance, and an unusually permeable gut.

      Finding the Leak
      It is fair to say that the theory that a leaky gut contributes to CD and
      autoimmunity in general was initially greeted with great skepticism, partly
      because of the way scientists thought of the intestines. When I was a
      medical student in the 1970s, the small intestine was described as a pipe
      composed of a single layer of cells connected like tiles with an impermeable
      "grout," known as tight junctions, between them. The tight junctions were
      thought to keep all but the smallest molecules away from the immune system
      components in the tissue underlying the tubes. This simple model of the
      tight junctions as inert, impermeable filler did not inspire legions of
      researchers to study their structure, and I was among the unenthused.

      It was only an unexpected twist of fate, and one of the most disappointing
      moments of my career, that drew me to study tight junctions. In the late
      1980s I was working on a vaccine for cholera. At that time, the cholera
      toxin was believed to be the sole cause of the devastating diarrhea
      characteristic of that infection. To test this hypothesis, my team deleted
      the gene encoding the cholera toxin from the bacterium Vibrio cholerae.
      Conventional wisdom suggested that bacteria disarmed in this way would make
      an ideal vaccine, because the remaining proteins on a living bacterial cell
      would elicit a strong immune response that would protect against diarrhea.

      But when we administered our attenuated bacteria to volunteers, the vaccine
      provoked enough diarrhea to bar its use. I felt completely disheartened.
      Years of hard work were literally down the toilet, and we were faced with
      two unattractive options: giving up and moving on to another research
      project or persevering and trying to understand what went wrong. Some
      in­tuition that there was more to this story prompted us to choose the
      latter path, and this decision led us to discover a new toxin that caused
      diarrhea by a previously undescribed mechanism. It changed the permeability
      of the small intestine by disassembling those supposedly inert tight
      junctions, an effect that allowed fluid to seep from tissues into the gut.
      This "grout" was interesting after all.

      Indeed, at nearly the same time, a series of seminal discoveries clarified
      that a sophisticated meshwork of proteins forms the tight junctions;
      however, little information was available on how these structures were
      controlled. Therefore, the discovery of our toxin, which we called the
      "zonula occludens toxin," or Zot (zonula occludens is Latin for "tight
      junction"), provided a valuable tool for clarifying the control process. It
      revealed that a single molecule, Zot, could loosen the complex structure of
      the tight junctions. We also realized that the control system that made this
      loosening possible was too complicated to have evolved simply to cause
      biological harm to the host. V. cholerae must cause diarreha by exploiting a
      preexisting host pathway that regulates intestinal permeability.

      Five years after the formulation of this hypothesis, we discovered zonulin,
      the protein that in humans and other higher animals increases intestinal
      permeability by the same mechanism as the bacterial Zot. How the body uses
      zonulin to its advantage remains to be established. Most likely, though,
      this molecule, which is secreted by intestinal epithelial tissue as well as
      by cells in other organs (tight junctions have important roles in tissues
      throughout the body), performs several jobs -- including regulating the
      movement of fluid, large molecules and immune cells between body

      Discovery of zonulin prompted us to search the medical literature for human
      disorders characterized by increased intestinal permeability. It was then
      that we first learned, much to my surprise, that many autoimmune diseases --
      among them, CD, type 1 diabetes, multiple sclerosis, rheumatoid arthritis
      and inflammatory bowel diseases -- all have as a common denominator aberrant
      intestinal permeability. In many of these diseases, the increased
      permeability is caused by abnormally high levels of zonulin. And in CD, it
      is now clear that gluten itself prompts exaggerated zonulin secretion
      (perhaps because of the patient's genetic makeup).

      This discovery led us to propose that it is the enhanced intestinal
      permeability in CD patients that allows gluten, the environmental factor, to
      seep out of the gut and to interact freely with genetically sensitized
      elements of the immune system. That understanding, in turn, suggests that
      removing any one factor of the autoimmunity-causing trinity -- the
      environmental trigger, the heightened immune reactivity or the intestinal
      per­meability -- should be enough to stop the disease process.

      Therapies to Topple the Trinity
      As I mentioned before, and as this theory would predict, removing gluten
      from the diet ends up healing the intestinal damage. Regrettably, a lifelong
      adherence to a strict gluten-free diet is not easy. Gluten is a common and,
      in many countries, unlabeled ingredient in the human diet. Further
      complicating adherence, gluten-free products are not widely available and
      are more expensive than their gluten-containing counterparts. In addition,
      sticking perfectly over years to any diet for medical purposes is
      notoriously challenging. For such reasons, diet therapy is an incomplete

      Consequently, several alternative therapeutic strategies have been
      considered that disrupt at least one element of the three-step process.
      Alvine Pharmaceuticals in San Carlos, Calif., has developed oral
      protein-enzyme therapies that completely break down gluten peptides normally
      resistant to digestion and has an agent in clinical trials. Other
      investigators are considering ways to inhibit tissue transglutaminase so
      that it does not chemically modify undigested gluten fragments into the form
      where they bind so effectively to HLA-DQ2 and HLA-DQ8 proteins.

      No one has yet come up with safe and ethical ways to manipulate the genes
      that make people susceptible to disease. But researchers are busy developing
      therapies that might dampen some of the genetically controlled factors that
      contribute to the immune system's oversensitivity. For example, the
      Australian company Nexpep is working on a vaccine that would expose the
      immune system to small amounts of strongly immunogenic forms of gluten, on
      the theory that repeated small exposures would ultimately induce the immune
      system to tolerate gluten.

      With an eye toward blocking the intestinal barrier defect, I co-founded Alba
      Therapeutics to explore the value of a zonulin inhibitor named Larazotide.
      (I am now a scientific adviser for Alba and hold stock options, but I no
      longer participate in making decisions for the company.) Larazotide has now
      been tested in two human trials examining safety, tolerability and signs of
      efficacy in celiac patients who ate gluten. These were gold-standard
      trials -- randomized, placebo-controlled tests in which neither the drug
      deliverers nor the patients know who receives treatment and who receives a
      sham, until the trial is over.

      Together the tests showed no excess of side effects in patients given
      Larazotide rather than the placebo. More important, the first, smaller study
      demonstrated that the agent reduced gluten-induced intestinal barrier
      dysfunction, production of inflammatory molecules and gastrointestinal
      symptoms in celiac patients. And the second, large study, reported at a
      conference in April, showed that CD patients who received a placebo produced
      antibodies against tissue transglutaminase but that the treated group did
      not. As far as I know, this result marks the first time a drug has halted an
      autoimmune process, interfering specifically with an immune response against
      a particular molecule made by the body. Other drugs that suppress immune
      activity act less specifically. Recently Alba received approval from the
      U.S. Food and Drug Administration to expand studies of Larazotide to other
      autoimmune disorders, including type 1 diabetes and Crohn's disease.

      These new prospects for therapy do not mean that CD patients can abandon
      dietary restrictions anytime soon. Diet could also be used in a new way.
      Under the leadership of Carlo Catassi, my team at the University of Maryland
      has begun a long-term clinical study to test whether having infants at high
      risk eat nothing containing gluten until after their first year can delay
      the onset of CD or, better yet, prevent it entirely. "High risk," in this
      case, means infants possess susceptibility genes and their immediate family
      has a history of the disorder.

      We suspect the approach could work because the immune system matures
      dramatically in the first 12 months of life and because research on
      susceptible infants has implied that avoiding gluten during the first year
      of life might essentially train that developing immune system to tolerate
      gluten thereafter, as healthy people do, rather than being overstimulated by
      it. So far we have enrolled more than 700 potentially genetically
      susceptible infants in this study, and preliminary findings suggest that
      delaying gluten exposure reduces by fourfold the likelihood that CD will
      develop. It will be decades, however, until we know for certain whether this
      strategy can stop the disease from ever occurring.

      Given the apparently shared underpinning of autoimmune disorders in general,
      researchers who investigate those conditions are eager to learn whether some
      therapeutic strategies for CD might also ease other autoimmune conditions
      that currently lack good treatments. And with several different approaches
      in the pipeline to treat CD, we can begin to hope that this disease, which
      has followed humanity from the dawn of civilization, is facing its last
      century on earth.

      A Clue to Delayed Onset
      People with celiac disease are born with a genetic susceptibility to it. So
      why do some individuals show no evidence of the disorder until late in life?
      In the past, I would have said that the disease process was probably
      occurring in early life, just too mildly to cause symptoms. But now it seems
      that a different answer, having to do with the bacteria that live in the
      digestive tract, may be more apt.

      These microbes, collectively known as the microbiome, may differ from person
      to person and from one population to another, even varying in the same
      individual as life progresses. Apparently they can also influence which
      genes in their hosts are active at any given time. Hence, a person whose
      immune system has managed to tolerate gluten for many years might suddenly
      lose tolerance if the microbiome changes in a way that causes formerly quiet
      susceptibility genes to become active. If this idea is correct, celiac
      disease might one day be prevented or treated by ingestion of selected
      helpful microbes, or "probiotics."

      Note: This article was originally printed with the title, "Surprises from
      Celiac Disease."

      Further Reading
      Updates: Whatever Happened to Virus-Built Batteries?
      What is histoplasmosis?
      Autism and Antibodies
      Infected with Insanity: Could Microbes Cause Mental Illness?

      T Cell Turnoff
      Fact or Fiction?: Stress Causes Gray Hair
      A New "Designer" Treatment for Multiple Sclerosis
      Can the Ravages of Dementia in HIV/AIDS Be Arrested?


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      Lisa Kuntz at 09:34 AM on 07/21/09
      I am excited that such a readable & thorough article has appeared in the
      Scientific American. CD in my family was diagnosed with the assistance of
      an Integrated Health Practitioner, not via a traditional medical practice.
      I hope the article will raise the awareness of the both the medical
      profession & general public. For my daughters & myself, having an accurate
      diagnosis of the cause of nebulous symptoms has altered our lives.

      elizllo@... at 09:38 AM on 07/21/09
      The illustrations in this article delivered to my mailbox today, allow the
      complexities of the science of gluten intolerance to be easily understood by
      For those of us with Irish, Scandinavian, or American Indian genetic
      background, as well as others of us, gluten intolerance may very well be the
      open door for many of the diseases of inflammation and aging.
      Since eliminating the wheat family two years ago, my thyroid has calmed
      down, my osteopenia hip pain has ended, my digestion is uneventful and
      healthy, and my extra weight has become past history.
      As I re-engineered my recipes for comfort foods like mac and cheese, pizza,
      lasagna, chocolate chip cookies, brownies, and others, I decided to share my
      work, in my book entitled, Gluten Freedom EveryWay Comfort Foods Cookbook.
      I give presentations sharing my story and helping people understand that
      illness and aging don't have to go together.
      Could the secret to reducing health care costs, as well as balancing the
      national debt, be hiding in eliminating the most common food in the American
      diet from the plates of those affected? It's a simple question and one I ask
      myself every day.

      Elizabeth Lowe
      Newport News. Virginia

      Ellen in Maryland at 04:56 PM on 07/21/09
      Thank you for publishing such a well-written and engaging article. I have
      celiac disease and am extremely grateful for the author's important work on
      this topic!

      Karen2 at 04:59 PM on 07/21/09
      If undiagnosed celiacs might cost $25,000 per consumer (~$75 billion) and
      even much more money (possibly $ 50 billion) for medical treatment of
      chronic conditions and types of health crisis caused by missed diagnosis of
      celiac (such as colon cancer), and throw in another say, $50 billion for
      odds and ends to deal with other types of effects - like self-medicating
      (substance abuse), poor general functioning and productivity (driving and
      other accidents) and restructuring of educational and social programs
      (learning disability, behavioral disorders) - - -

      Why is the medical professional community not mandating the re-education of
      medical practitioners and the testing of patients to find those who might
      have been overlooked? Do we need to spend another 6 years studying the
      financial benefits of diagnosis ?

      Why is it not a Standard to test patients who have symptoms of atypical
      nature? When do these symptoms become "legitimate" celiac identifiers?

      Why is there a home test for celiac in Canada and many other countries,
      while the FDA has not approved it for sale to us?

      kclancy at 05:01 PM on 07/21/09
      This is far and away the best article I have read on gluten intolerance,
      inflammation and disease. Kudos to Fasano for such an accessible article. I
      am both gluten intolerant and a researcher in food intolerances, and am glad
      to have something to give to my family to educate them.

      JeanneTX at 06:32 PM on 07/21/09
      I am one of the many people who used the testing provided by Dr. Fasano's
      EnteroLab in Texas. Though I do not have a DQ2 or DQ8 gene, I have two DQ3
      genes, which manifest in a strong gluten intolerance, along with a strong
      intolerance for dairy, soy, and more. Without those tests, I would have
      been a different person, trying to live with issues as far ranging as
      inability to focus my eyes to extreme joint and ligament pain to my tailbone
      moving out of place, and much more. I am extremely thankful for his
      Jeanne in Texas

      pgs at 10:25 PM on 07/21/09
      The following is a direct response to this comment.
      Dr. Kenneth Fine is the director of Entero Lab. I, too, utilized his

      pgs at 10:26 PM on 07/21/09
      Entero Lab is run by Dr. Kenneth Fine.

      carlson1143 at 01:03 AM on 07/22/09
      Dr Fine is a recovered Gluten Intolerant. I come from a huge family with
      gluten intolerant problems. He by far is the most respectable expert for our
      situation. I listen to him out of respect for his insight and wit. He humbly
      figured it out for himself and now for me and dozens of my family. God Bless
      Dt Fine.

      nogluten4me at 09:00 AM on 07/22/09
      The following is a direct response to this comment.
      In response to Karen2's question as to why the medical community is not
      mandating the re-education of MD's . I feel the answer was in the figures in
      your post. There is no doubt that "billions" are spent each year treating
      the symptoms of undiagnosed CD. For this reason there is too much money at
      stake for the labs, drug companies and repeated visits to the doctor if
      suddenly a trial gluten-free diet becomes the "first step" toward finding
      out if the person is gluten intolerant. If you recall in the article the
      part about the connection between grain shortages during WWII and the
      decline of CD symptoms you can understand that it was not an expensive test
      that produced this conclusion but simply the "process of elimination". The
      same thing would occur if one were to do an elimination diet on their own.
      Most of us however would not think to do this without the blessing of our
      primary care MD. If the doctors were unwilling or unable to suggest this on
      their own for whatever reason (money or lack of knowledge) I am afraid we
      cannot expect much to change in the near future. This is a perfect example
      of why healthcare is so expensive.

      Ann D at 11:21 AM on 07/22/09
      I am blown away at the potential medical revolution from addressing gluten.
      As a 55-year old female chemist who first began a gluten, casein, and soy
      free diet 8 months ago (first diagnosed 6 months ago), I know what "could
      have been" if this had been diagnosed as a child with symptoms that would be
      obvious today. I grew up having so many expensive tests and tx for symptoms
      that included GI, infertility, spontaneous abortion (we are childless),
      fibrocystic breasts, eczema, chronic bladder/vaginal infections, diarrhea,
      migraines, sinusitus--surgeries & more CTs & MRIs than I can count.
      No physician ever suggested gluten as a cause; even today many have never
      heard about it. At age 30 I stopped eating most wheat after noticing that
      this helped stop diarrhea and a sunburned-looking facial reddness right
      after eating wheat, or upon exercising (family called it bread red.) In
      2005 a GI doctor, upon hearing this, did the intestinal biopsy, but told me
      it was negative so I was not celiac and could still have gluten. I had been
      eating a little wheat and hidden gluten until Dec. 2009 when I read more
      research suggesting links to diabetes, cancer, dementia, etc. I began a
      strict gluten free diet then and immediately began to feel better. Now 8
      months later I feel better than I ever have in life, even as a youth. I
      observed that avoiding dairy and soy helped much, too. Not having
      digestive symptoms was a thrill; I now feel so alert, happy, energetic.
      More surprisingly, an assortment of other pesky problems that I have lived
      with much of my life went away; as a scientist this leaves me flabbergasted.
      I list these here as evidence to maybe add puzzle pieces for researchers,
      physicians, and those with shared symptoms: Since going gluten/casein/soy
      free, no more: brain fog (feeling drugged), acne rosacea, itchy oozy
      eczema, arthritis, hypertension, chronic tendinitis in elbows, tinnitus,
      bladder incontinence (when sneezing, coughing, laughing, sometimes urgency),
      toenail fungus (go figure!), chronic vaginal yeast/B. vaginitis infections,
      sinusitis (can now wake up breathing through my nose), fatigue, and even
      having 1 or 2 swollen taste buds every time I ate tangy fruits (tomatoes,
      citrus, melons--now this doesnt happen). Whether these symptoms went due
      to improved nutrient absorption or from toxin removal, I dont know. I just
      know that researchers in this area are onto something very, very big. The
      implications to healthy living, healthcare costs, and government and private
      insurance are mind-boggling!

      Jennifer in Novato at 03:27 PM on 07/22/09
      I'm particularly interested in the late onset of celiac disease, which
      happened to me. What caused the bacteria in my intestines to change? I'm
      hopeful they can retrain my gut to accept gluten again some day.

      GFMSMom at 08:42 PM on 07/22/09
      I am the perfect example of linking intestinal permeability and Celiac
      disease with other autoimmune diseases. I have Multiple Sclerosis, and
      after much research and with the help of excellent alterntive practitioners,
      I was tested for celiac disease. After testing positive for CD and
      allergies to other food proteins (casein and egg), changing my diet
      accordingly, and healing my digestive tract, I have eliminated all my
      symptoms of course of CD, but also Multiple Sclerosis. It has been 3 years,
      and the change in my health has been profound. So many people are skeptical
      of using diet to treat MS, but for me it has been a miracle. I wish that
      others seeking conventional treatment for MS, and other autoimmune diseases
      would also get tested for CD. I will also add, that I was considered a
      non-symptomatic celiac, for I had no digestive distress that others see as
      the hallmark symptom. I was only diagnosed after I sought alternative
      treatment for my newly diagnosed Multiple Sclerosis.
      I will save this article for the naysayers.....

      wordsworth at 09:20 PM on 07/22/09
      I don't buy "nogluten4me's" conspiracy theory that says some remarkable
      collusion (as if such a thing were possible) between doctors, labs and drug
      companies is somehow keeping physicians from being educated about CD. The
      reality is that many CD symptoms are common to many diseases and disorders.
      It's not that most doctors don't know about CD - it's that it might not be
      their "top of mind" thought when they see certain things. My wife was
      diagnosed with CD not because of any intestinal symptoms, but because she
      broke her foot twice for little obvious reason. The doctor sent her to a
      metabolic specialist, who suspected and eventually confirmed CD.

      Greater awareness would be great, but the lack of it is not the result of
      some massive conspiracy or because drug companies (which get nothing from
      CD), labs (which get very little) or physicians are milking it to make
      another buck.

      nogluten4me at 06:32 AM on 07/23/09
      The following is a direct response to this comment.
      After reading the post by wordsworth I must admit how silly my comments were
      regarding a conspiracy. I agree that greater awareness is the key. Thanks
      for the reply.

      John from Concord at 11:21 AM on 07/23/09
      I was treated for chronic depression, ADD, something not unlike chronic
      fatigue syndrome that was attributed to the Addison's Disease I developed at
      age 20, and chronic sinusitis for many years. All of those things (not the
      Addison's itself, but that damned fatigue and "brain fog") went away within
      days when I cut gluten out of my diet after receiving a Celiac diagnosis
      three months ago, at age 42. Within days! My mother, a nurse, now believes
      that I developed it at age 3. It is a profound and odd thing to be an adult,
      in one's 40s, married, with a career one likes, and to find that one's
      physical, mental, and emotional capabilities are -- suddenly -- much greater
      than one had believed, with nothing more than a dietary modification to

      Craig_S at 11:44 AM on 07/23/09
      I hope this helps your study, my child who is now 6.5 years old has been
      gluten free for 4.5 years. He was diagnosed 6 months after he stopped breast
      feeding. He rapidly lost weight could not walk, climb, and at the end could
      not hold up his head. He was emaciated, had a distended stomach. Once he
      went gluten free after doctors suggested MD, brain cancer, cystic fibrosis
      (during the six months of testing) he made a miraculous recovery in 2-4
      weeks of diet change. The rest of the family was tested for CD and found
      that my 8 yo son was also CD. I tested negative, however I had a bout with
      lyme, and babesios, then traveled to India for work. I became very sick in
      India and started going downhill after returning to the US. I underwent
      massive amounts of antibiotics, both oral and IV. I displayed classic CD
      and classic lyme, joints, skin lesions, and neuroborreliosis including
      aphasia. When all else failed over an 18 month period of antibiotics, I
      finally went gluten free. After 4 months of GF I feel great and all my
      symptoms are gone, being horribly sick for nearly two years is no picnic,
      particularly when it affected my thought process and ability to speak. I am
      46 years old so you have some idea of how late in life dramatic symptoms can
      appear. My children are thriving, thanks to GF and so am I. My sister was
      diagnosed at 40, years after the family accused her of being bulimic all her
      life due to her inability to gain weight and constant sickly appearance,
      were we ever wrong.

      LindainCA at 05:16 PM on 07/23/09
      Thank you , SA for the wonderful article! As someone with Celiac's Disease
      (my daughter and partner have it as well), I'm thankful that the disease and
      its health repercussions are becoming more mainstream. In my teens, I was
      misdiagnosed for about 7 years (which is common, from anectdoctal evidence
      of others). I cannot say strongly enough; for those with Celiac's, avoiding
      gluten is not a lifestyle choice, it is a necessity.

      Re: Karen2's questions about testing...Kimball Genetics in the States has a
      very convinient cheeek swab DNA kit available which confirms whether one is
      positive for the DQ2 and DQ8 genes; their test also includes the alleles for
      each gene. Some health insurance pays for it, others do not. In our case,
      insurance did not pay, but we felt the cost was well worth it in order to
      confirm our daughter's status before she entered school where we are not
      able to control and monitor her food intake as closely.

      Cheers, and thanks again, SA for a wonderful, well written, thorough and
      enlightening article!!

      Linda, CA

      katyak at 09:07 AM on 07/24/09
      As a medical student and gluten free diet adherent, I was fascinated by the
      discovery of a possible drug to inhibit leaky gut. I'm also on the midst of
      studying V. cholera and its toxins and I will never forget its action. Thank
      you to the scientists who continue to study this disease. I hope to join
      your ranks one day (in the near future!).

      sunstruck1 at 01:35 PM on 07/24/09
      The following is a direct response to this comment.
      I did precisely that - an elimination diet on my own. My 3.5 year old son,
      who couldn't hold food down and had "failure to thrive", on our second full
      celiac-free day, asked for breakfast 3 times! He began recovery in 24 hours,
      and I am (at 47) still recovering. Of course, I know now we may never be
      properly diagnosed because we are eating right and no longer causing the
      damage to our villi crucial for diagnosis (at this time, anyway). But we
      feel better, and nothing can make me go back to gluten. I still have muscle
      and joint pains, but I have no migraines, and the cramping I thought was
      from fibroids is gone. There are other issues to be examined (I have thyroid
      problem of low T3 that my primary care physician is treating and not
      ignoring - the way the specialist she sent me to did!) but perhaps I'm on my
      way to learning what autoimmune problems may be causing me to "prematurely
      age" - or at least, that's what it felt like! I too appreciate this

      larkalt at 05:45 PM on 07/24/09
      I probably have celiac disease, but I've kept on developing new food
      intolerances even with a gluten-free diet. So I probably have a leaky gut
      for some reason.
      I sure hope that if Alba starts selling a drug to stop leaky gut, it won't
      have allergens in the fillers!!! But it's my dismal expectation that it

      Stacie at 06:02 PM on 07/24/09
      I was diagnosed with Celiac Desease when I was 2 years old - that was 43
      years ago. Most of my life no one knew what was going on, not even doctors.
      My parents suffered watching me go through the torture of CD. They still
      tear up today when reflecting on this time. It is only in the last 10 years
      or so have I felt "normal" in the sense that others could finally understand
      what I was living, that I was not crazy and they need not give up on
      treatment for other physical problems I have since encountered.
      My CD was so misunderstood that I was separated while in kindergarten from
      the other students at snack time - because they were eating graham crackers
      and I could not.
      My elder sister has since been diagnosed (when she was 28 years old) as well
      as my mother - who thought all along she had it but had not been diagnosed.

      AngelaE. at 04:45 AM on 07/25/09
      My six year old son who was born weighing almost 9 pounds, developed failure
      to thrive and dropped to the bottom 1 percentile of weight by 17 months of
      age. He had a speech delay, behavioral problems, and sensory issues. His
      doctor kept ignoring our concerns about his lack of weight gain and told us
      to be happy he wasn't overweight. He was diagnosed with autism at age 4 1/2.
      Fortunately, we took him to an autism specialist who told us to put him on a
      gluten free and casein free (GFCF) diet. Within days his symptoms of autism
      began to disappear. He does not have a formal diagnosis of CD, because his
      blood tests came back negative after being GF for 4 months. He is doing very
      well today and most people would never guess was diagnosed with autism.
      I am 45 y/o and was diagnosed with celiac disease by intestinal biopsy one
      month ago after several months of severe indigestion. After going on a
      strict GF diet my digestive symptoms disappeared completely. I have a
      history of anemia, unexplained miscarriages, and yeast infections.
      Aside from preventing untold suffering, I am certain that routine screening
      for CD would save our economy billions of dollars in unecessary tests and
      medical procedures.

      robert schmidt at 09:54 AM on 07/25/09
      An excellent article; well written, easily understood, with solid science
      backing up the conclusions as well as clearly defined "next steps". Articles
      like this are why I read scientific american. Please, keep up the good work.

      larkalt at 10:04 AM on 07/25/09
      The following is a direct response to this comment.
      I relate to what you said a lot. I'm also an analytical person, and I was
      just so shocked to find the orthodox medical system, which we are taught to
      trust, was so horribly wrong.

      You may find after a year or so that it's not limited to gluten, dairy and
      soy. Food sensitivities often surface in stages. That happened to me.
      And now, the only foods I can eat that I ate regularly while eating gluten
      are lettuce, radishes and vanilla beans.

      The new diet reduced my anxiety, depression and anger a LOT. Also I stopped
      being "hypoglycemic" - getting jittery after eating sweets. And much less
      joint pain, "brain fog (feeling drugged)", and less sinus inflammation.

      "I am blown away at the potential medical revolution from addressing
      gluten. As a 55-year old female chemist who first began a gluten, casein,
      and soy free diet 8 months ago (first diagnosed 6 months ago), I know what
      "could have been" if this had been diagnosed as a child with symptoms that
      would be obvious today. I grew up having so many expensive tests and tx for
      symptoms that included GI, infertility, spontaneous abortion (we are
      childless), fibrocystic breasts, eczema, chronic bladder/vaginal infections,
      diarrhea, migraines, sinusitus--surgeries & more CTs & MRIs than I can
      count. "

      Jeff C. at 11:23 PM on 07/25/09
      Fascinating article. The comments regarding the difficulties of lifetime
      adherence to the gluten-free diet struck home with me. My sister, years
      after a positive diagnosis, lapsed back into her old eating habits and ended
      up in the ER malnourished, emaciated, and with severe neurological problems.
      She is fine now, but denial almost killer her.

      I am very surprised how a six page article discussing gluten intolerance,
      dietary peptides and leaky gut could completely omit a single reference to
      autism. So many autistic children have made remarkable recoveries with
      gluten-free and/or casein-free diets specifically due to the elimination of
      peptides in the bloodstream (from leaky gut). Wouldn't the treatment
      advances described have huge implications in treating the rapidly expanding
      ranks of autistic kids? Or does saying that risk the wrath of the American
      Academy of Pediatricians?

      royozanne at 06:04 PM on 07/26/09
      This article shows that the medical establishment is slowly coming along,
      however, still suggesting solutions based upon pharmaceutical intervention
      rather than to correct mistakes in living.

      The alternative medical community has long recognized this triad of
      autoimmune disease stimulating factors and has been busy addressing it in
      effective, wholistic approaches for many years.

      The single most important step is to "break the vicious cycle by teaching
      parents to become healthy before they conceive children, take the necessary
      steps to give birth to healthy babies and continue to raise them in a
      healthy manor until adulthood.

      These children have intact, healthy intestinal tracts. They have no CD or
      any other autoimmune diseases and they accomplish this without taking any
      pharmaceutical drugs.

      There are 3 main steps to raising children in this way, which should be
      followed by every family.

      Step 1: Eat nutrient rich foods following the principals of proper
      nutrition used by healthy people the world over for thousands of years.
      These principles have been largely discarded in the last 200 years in favor
      of an industrialized food system.

      These principles were carefully delineated by Dr Weston A Price in the
      1930's and are taught today through the Weston A Price Foundation.

      Step 2. Avoid toxins that are unnecessary and degrade your health as well
      as contribute to a leaky gut and an overactive immune system. Examples are;
      heavy metals like mercury (in amalgam dental restorations), petrochemicals
      like the industrial PCB's, pesticides, fertilizers, most pharmaceutical
      drugs and plastics, radioactivity and electromagnetic pollution coming from
      improper wiring and filtering of our electrical equipment, cell phones,
      microwave ovens and towers.

      Step 3. Find a Healing Art that you can depend upon to build your health
      over time. Well done healing arts build your bodies health, strengthening
      immunity and resilience in many ways. This greatly aids in preventing any
      type of chronic disease from gaining a foothold. Examples are Ayurveda,
      Traditional Chinese and Homeopathic Medicine.

      Parents that follow these 3 steps are rewarded with vibrant, robust, good
      natured , healthy, children that grow into well balanced, healthy,
      productive adults without chronic diseases or the need of expensive medical

      People following these guidelines, and there are thousands that do, have
      health care costs that are often less than $500/year for entire families.

      Roy Ozanne, MD, HMD

      Dr. Karen J. Krahl, D.C. at 06:51 PM on 07/26/09
      I have probably been gluten intolerant my whole life and have had
      malabsorption syndrome since I was a child, resulting in pica, and iron
      deficiency anemia among other things. It wasn't until I started studying
      with the Institute for Functional Medicine, and did the "physician health
      thyself" thing, that I started connecting the many dots, that lead to
      discovering my own undiagnosed problems. Laboratory testing and elimination
      diets later, I realized I had the genetic propensity, a positive malfeasance
      A test..which not all gluten intolerants will show positive for, + Anti-TPO
      antibodies test, showing my immune system was attacking my thyroid, and
      later the beginning of Hashimoto's Hypothryoiditis. Asthma, eczema and
      number of other problems are also connected. Though I'm a practicing
      chiropractor and have studied nutrition for years, even practiced
      macrobiotics many years ago, it took me awhile to connect the multiple
      effects that were being caused by gluten. Also more is being written about
      this and studied as the years go by, and our science is getting more
      refined. As to the above comment about MD's; in my experience doctors are
      very slow to change their minds or habits in light of new information, and I
      believe it's more part of human nature to cling to old beliefs and patterns
      of behavior rather than change, that it is some kind of malfeasance or
      sinister collaboration with the drug industry.

      I do blood tests, genetic testing, and the elimination diet with my patients
      with good success. I believe that several individuals in my family were
      misdiagnosed with IBS, who were really gluten sensitive. Recent writings
      about "zonulin", which may be what's making those with gluten sensitivity
      more sensitive in the first place, i.e. having a more permeable gut to begin
      with, makes a lot of sense. We must all keep open minds, read, and use a
      systems biology model of diagnosis in use, which connects the multiplicity
      of effects in different organs and physiologic processes simultaneously,
      rather than coming up with one "name" or diagnosis, and medicating for it.
      Rather than look at the broad reaching, holistic matrix of factors causing
      symptoms and diseases, medicine has been using a reductionist model of
      exclusionary diagnosis for too long, and it is now significantly outdated.

      patriciagwheeler at 08:28 AM on 07/27/09
      I'm convinced that the drug companies (to some degree) stand in the way of
      more studies about gluten intolerance. They have nothing to gain when a
      simple cure, such as change in diet, is the main remedy. I suspect that a
      change in diet for many uninformed Americans would strongly reduce the
      intake of prescription drugs throughout our society, while eliminating many
      health issues. It saddens me that more emphasis is not put on diet when we
      visit our health practitioners. What is truly unfortunate is that yesterday
      I bought one tomato that cost as much as an entire meal at McDonalds!

      hannahgreen at 08:51 AM on 07/27/09
      Many of my family members have been diagnosed with CD including my mother, 2
      brothers, my daughter and youngest son and recently myself. Some were
      diagnosed by biopsy and some by change in diet. The authors suggests that
      following a strict GF diet in infants until after age 1 may help prevent the
      onset of CD. I can say from experience, it does not. My oldest child is
      now 30 years old. Our pediatrician suggested with the family history that
      we follow a strict diet of nursing only until 6 months, then slowly
      introduce solid food with strictly GF foods until at least 12 months of age.
      His logic was not that it would prevent CD, but that an older child might
      not become so critically ill as quickly and would be easier to diagnose. We
      followed this advice strictly, even to the point that they were not placed
      in a day care setting or even with relatives until they were at least 18
      months old. The 2 youngest children still developed CD.

      Wendy Seidl at 10:40 AM on 07/27/09
      I am a mother with CD of a 5 yr old and a 1 yr old. I kept both of my
      children gluten-free for the first year for two reasons: CD is darned
      difficult to diagnose in infants and I didn't want to risk any malnutrition
      during such a critical developmental stage and it just seemed to make sense
      to me to keep something that causes ME such problems away from them early
      on. With my first child, my pediatrician sort of acted like I was a crazy,
      overcautious 1st-time Mom, but went along with it. By the time we got
      around to my 2nd son though, 4 years later, he agreed it might actually be a
      good idea. My in-laws, however, thought I was crazy both times.
      Besides the fact that this is a really nifty and informative article about
      CD in general, I get to hold up the study with infants to everyone who
      thought I was nuts and say, "SEE! I told you so!!!" By the way, both my
      sons eat wheat/gluten now and so far, so good. I don't think I developed
      the disease until later in life, though (I wasn't diagnosed until my 30's
      when I had clearly been suffering from it for years, so I'm not sure of the
      exact onset), so I'll continue to keep my fingers crossed.
      I agree with previous posters about the medical community being slow to
      adjust to new information and I think screening should be more common, given
      the repetitive studies showing CD is far more widespread than initially
      thought (1 in 133 people? Serriously? And yet the medical community is STILL
      resistant to test people, even when they ask?) I went GF on my own after
      being sick for years and told there was nothing wrong with me. Then when I
      felt better, my doctor actually told me it was all in my head because, "what
      you eat could not possibly affect an intestinal disorder". After I got
      myself a new doctor (I mean, REALLY), I was finally diagnosed with CD.
      Although I cope fairly well, I still hope I have given my children an edge
      up with their GF first year so they can avoid all this.

      digiterati at 11:20 AM on 07/27/09
      My CD symptoms included a constant vibration in my foot and leg, ataxia,
      chest pains, skin problems and to a much lesser degree, digestive problems.
      Some with CD are "neuro dominant" and I suspect get diagnosed with MS as a
      result, as my neurologist suggested I might be. My symptoms disappeared with
      gluten elmination. The foot tingling reappears when ANY gluten is consumed.
      This is in spite of the fact that I tested negative for CD. (The doctor told
      me to resume eating wheat for a month so the results would be accurate. I
      lasted 3 days before I couldn't stand it and took the test.) Even with a
      negative result, you can't convince me to resume eating gluten.

      As to why gluten intolerance is skyrocketing
      http://www.celiac.com/articles/21859/1/Celiac-Disease-Rates-Skyrocket-Up-400-in-Last-50-Years/Page1.html )
      I suspect several factors beyond the increase from 2% gluten in wheat in the
      1950s to 18% today. Scientific American wrote about wheat fungus threatening
      the world's wheat supply
      http://www.scientificamerican.com/article.cfm?id=global-wheat-crop-threatened-by-fungus )
      Meanwhile, fungicides have been applied, no doubt to the wheat many are
      eating today for breakfast, lunch and dinner.

      A friend told me that her children became gluten intolerant -- and highly
      sensitive to many foods -- during a time when she lived in a house that had
      mold in the attic insulation. A couple of years after moving, their health
      dramatically improved and their food sensitivities disappeared.

      Those of us with CD may be the canaries in the coal mines. Antibiotics,
      pesticides, exposure to mold, fungicides in food, environmental pollution --
      where's the tipping point for a person's health?

      Hang in there, folks. Just yesterday I was in a deli, and the man next to me
      was asking about the ingredients in a dish because he was "allergic to
      wheat." As more people learn what is really wrong with them, the general
      public and food purveyors will stop asking what gluten is and have
      increasingly more choices for us.

      Soccerdad at 11:43 AM on 07/27/09
      The following is a direct response to this comment.

      Enlighten us as to how the drug companies could possibly "stand in the way
      of more studies about gluten intolerance". I feel this mistrust of drug
      companies, while it may come naturally to some, is unfortunate.

      These drug companies have done wonderful things over the past several
      decades to develop cures and treatments for many previously debilitating and
      crippling diseases. True that there hasn't been equal progress against all
      diseases, but drug development is somewhat serendipitous. It's a big
      universe of diseases so uneven progress is to be expected. I don't believe
      it's intentional, and I believe the men and women who work for these
      companies are doing their best on our behalf. Let's just hope our
      government, in the name of containing costs, doesn't destroy this industry.

      EMed at 12:30 PM on 07/27/09
      The following is a direct response to this comment.
      I currently work at Johns Hopkins in one of the two labs that test for
      clinically diagnostic celiac antibodies. I can tell you that MDs are
      required to participate in "Continuing Medical Education," at this hospital
      at least. I attended a seminar on celiac last year, and I can say that
      since I began working here (only 2 years ago) the number of physician test
      requests for celiac (my lab tests for endomysial Ab, the other lab performs
      many other related including tissue transglutaminase) has close to tripled,
      and we find on average about 1 in 100 requests we receive are positive.
      This is only slightly higher than the incidence reported in this article
      which leads me to believe that physicians here are beginning to include
      these tests for more people with milder or atypical symptoms.

      EMed at 12:40 PM on 07/27/09
      digiterati: the most common diagnostic test detects antibodies which
      disappear pretty much as soon as you begin a gluten free diet, which is why
      you may have tested negative. Also, these tests generally test for a
      sub-type of antibody called IgA, but a very very small population of celiac
      patients are IgA deficient, in which case IgG antibodies should be tested
      for. Again though these only appear when you are consuming gluten in your

      ecstatist at 02:01 PM on 07/27/09
      Possibly many answers lie in the article's reference that humans had nomadic
      diets. Adaptations evolved over tens (or hundreds) of thousands of years
      to cope with this diet. It would perhaps be wise to keep as close as
      possible to this as a base diet (especially in a diagnostic setting).
      As I understand it (memories of The Ascent of Man by Bronowski) wheat was
      a chance hybridization of two wild grasses which was then adopted by early
      man because of its productivity and easier processibility. He probably ate
      neither before this. Similar caveats lie with domesticated milk and meat
      consumption. (Note the bred for characteristics of higher fats in both and
      who knows what else considering the unnatural diet these animals are fed)
      (The extreme example is pate de foeie where one consumes dis_eased (sic)
      goose liver)
      Processed food primarily adds value to the producer and retailer through
      longer shelf life and cheaply manufactured taste enhancers. Simple guide
      lines for diet follow.
      Eat a wide variety of food. This dilutes any high level toxin that exists
      in any particular food.
      Eat (buy) unprocessed food that somebody's great grandmother would
      Do not keep high calorie food that is quickly and easily available.
      Significant effort (exercise?) should be required before eating. This
      ensures that one builds up a significant hunger before consumption.

      Concerning the medical, pharmaceutical conspiracy.
      This no doubt occurs to some degree (consciously and subconsciously)
      (internal memos of tobacco companies). Note that the law ordains that
      company directors' prime responsibility is to their companies' share
      holders' profits. This would be a good policy (for all) in an evolved free
      market where the LONG term profits are the aim. However because of natural
      greed of directors'/role players' personal short term profits/reputations
      and consequent political (and market) manipulation, this free market does
      not exist. History has taught us that we cannot rely on self administered
      ethics. Consumers need to be protected by checks and balances which are
      being steadily eroded by political manipulation. Note budget allocations
      (and appointments) for FTC (Federal Trade Commission) and FDA whose supposed
      aim is to protect consumers from unfair trade practices.

      JD at 02:45 PM on 07/27/09
      I found the article very informative, but lacking a few things I would like
      to know. How does the gluten intolerance trigger bone loss and arthritis?
      Is there any more info available on how the connection works? Is anyone
      doing any research on reversing bone loss if wheat is eliminated?

      royozanne at 04:18 PM on 07/27/09
      For readers that want to have excellent, effective diet therapies and a very
      complete explanation of the autoimmune triad of genetics, intestinal health
      and diet, please see The Gut and Psychology Syndrome by Dr Natasia

      This is a fabulous book be a doctor that has helped thousands of autistic
      and CD childrren to an excellent recovery and includes the science that
      makes the picture understandable.

      We must come to understand our illnesses in a greater ecological context,
      including the ecology of our gut and its interaction with our outer ecology
      which includes all the farm chemicals, ecology disrupting antibiotics,
      endocrine disrupting industrial chemicals, chlorinated water, GMO foods,

      I am really not an extremist either. I have just been a practicing
      physician for 44 years and have consistently seen that poisoning nature
      poisons ourselves and by living in harmony with nature we restore harmony in

      If we only focus on gluten, there will arise another set of illness to keep
      reminding us!

      Best wishes,

      Roy Ozanne, MD,HMD

      josepheh at 06:17 PM on 07/27/09
      The following is a direct response to this comment.
      I would just like to note that not all problems people might have with wheat
      in the diet are due to CD, and the person overheard saying they were
      "allergic to wheat" may have been telling the simple truth and not
      simplifying the complexities of CD for easy communications. I myself have
      an allergy to wheat as well as to several other foods. I am reasonably well
      informed about CD and am confident it doesn't lie at the root of my
      particular dietary challenges. Just as there is such a thing as convergent
      evolution, there are also convergent dietary nuisances.

      Finally, kudos to the author and to SA for such a well written, well
      informed and downright useful article. You have done a great service the
      public's education about this important topic.

      Yael3 at 10:19 PM on 07/27/09
      My husband was first diagnosed with CD when he was less than a year old,
      after months of illness. Because of his CD, avoided solids until our
      children were 6 months old (exclusively breastfeeding) and off gluten for
      the first year. I also continued nursing until they were at least 2 years
      old. As others have written, we had friends and family members who thought
      we were a little crazy and over-cautious. We don't expect that they are now
      immune from developing CD - in fact whenever any of them has a stomach
      problem or frequently other illnesses, the first thing our family doctor
      does is test them for CD - but it is nice to see evidence that we did the
      right thing as far as trying to protect them.

      frgough at 10:46 AM on 07/28/09
      The following is a direct response to this comment.
      Good grief. The marxist conspiracists crawl out of the woodwork at the drop
      of a hat.

      Folks, it's the FDA that is not approving the home test. That's government.
      The funny thing is, even though it's the government holding this back,
      people will still blame corporations for somehow evilly influencing said

      As always, the state loves it when you think some business is the real
      threat to your freedom and prosperity.

      rronca at 02:27 PM on 07/28/09
      My son has CD and he was exclusively breast-fed until he was over a year old
      (he was not interested in food until then). He and I were simultaneously
      diagnosed; he was age 8 and I was age 39. It was a great day because we are
      so much healthier and happier.

      I don't think avoi<br/><br/>(Message over 64 KB, truncated)
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