Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion, Fourth Edition (110 page)

Celiac is an advanced disease. Since so many of us have the “right” genes for celiac, many of us are on the road but do not yet have celiac disease. There are two possible theories about gluten intolerance: (1) It’s on a continuum and you just haven’t developed into celiac disease yet, and (2) there are different genetics involved with gluten intolerance that have yet to be discovered. According to Kristina Harris, Ph.D., a celiac researcher at the University of Maryland, only half of people with gluten sensitivity have the DQ2 type of gene. I see this all the time in my practice—many of my clients have normal celiac tests, yet upon going on an elimination diet they find that many of their health issues resolve. This is why genetic testing alone cannot rule out gluten intolerance.

We are just beginning to see literature in the research that delineates the differences between gluten sensitivity and celiac disease. A 2011 paper by Anna Sapone, Alessio Fasano, and a slew of other researchers has a very interesting report. They did comparisons on 26 people with gluten sensitivity, 42 people with celiac disease,
and 39 people used as controls who had neither gluten sensitivity nor celiac disease. Those with gluten sensitivity reported GI symptoms but without any abnormal inflammation when sed rate, C-reactive protein, and mucoprotein were evaluated. Fifty-seven percent of people with gluten sensitivity had genes that predisposed them to celiac disease (DQ2 or DQ8) and 43 percent did not. All three groups were given lactulose/mannitol testing to determine whether they had leaky gut syndrome. Surprisingly, gluten sensitivity was not associated with increased intestinal permeability, and results were even more normal than for people in the control group. People with gluten sensitivity had lower levels of changes in adaptive immunity (IL-6 and IL-21) but had higher markers of innate immunity, like toll-like receptor 2. Also T-regulatory cell marker FOXP3 was reduced in people with gluten sensitivity. T-regulatory cells are like the brakes on the immune system that tell it that the threat is over. Because of these differences, the researchers concluded for the very first time that celiac disease and gluten sensitivity are distinct entities that are both caused by distinct reactions to exposure to gluten-containing grains.

If you have positive food sensitivity testing for gluten, gliaden, and/or gluten-containing grains, think gluten intolerance. You can also test IgG and IgA anti-gliaden and IgG and IgA antigluten antibodies through any physician or medical lab. Positive antibodies are found in about 10 percent of the population. If you test positive for these antibodies, avoid all gluten even in minute amounts for four to six months and take gut-healing herbs, nutrients, enzymes, and probiotics. Then retest with blood testing and by reintroducing gluten into your diet. Gluten intolerance may or may not be permanent. If you can discover underlying causes in the DIGIN model, you may be able to heal your gut and tolerate gluten again. The very best method of testing yourself for gluten sensitivity is to avoid all gluten for three months. Typically, people with celiac disease have additional sensitivites that resolve once the gut is healed. For this reason, I recommend the elimination diet as outlined in
Chapter 15
.

Gastroenterologists feel that the most accurate diagnosis of celiac disease is done through jejunal biopsy. I have worked with many people who have negative biopsies yet still get sick on even small bits of gluten. The most specific and accurate blood test for celiac is antibodies to tissue transglutaminase (tTG). If positive, you have celiac disease. There are false negatives, however; tTG testing is negative 31 percent of the time in people with celiac disease. If it’s not full-blown, it’s not discovered. Genetic testing is useful but limited, since 35 percent of us have the right genetics to develop celiac disease. IgG and IgA antibodies to gluten and gliaden can help to determine whether you have gluten intolerance.

From my viewpoint, an elimination diet and exclusion of wheat from your diet for three months will give you a terrific indicator of whether gluten is your friend or not. I cannot tell you how many times I’ve worked with clients who feel miraculously better without gluten in their lives who are told by their doctors that in order to diagnose celiac they have to eat gluten-containing grains for three to six months so that the inflammation will show up. Most people seem reluctant to do that. They already know that they feel worse when they eat gluten-containing foods and don’t want to feel worse again.

People with celiac disease have malabsorption, so typically they have nutritional deficiencies. It’s useful to test for these and/or to take a good multivitamin with minerals.

Celiac panels may contain the following tests:

IgA and IgG antitransglutaminase Elisa/Act (tTG) (This test is the most accurate, although 31 percent of people with celiac test negative because they do not have enough GI damage.)

IgA and IgG antigliaden antibodies

IgA antiendomysial antibodies

IgA and IgG deaminated gliaden antibodies

Antiendomysial, antigliadin, and tissue transglutaminase antibodies

Total IgA (If total IgA is low, then specific IgA antibodies aren’t accurate.)

The following tests can help determine if there are additional factors:

Vitamin and mineral testing

Organic acid testing

Comprehensive digestive stool analysis with parasitology