New Standards for Celiac Detection

"People have preconceived ideas of what celiac disease looks like. They expect to see patients who because of nutrient malabsorption and diarrhea will end up being skinny with lots of deficiencies."
"But now we have lots of patients who haven't lost weight -- and many who are quite overweight -- but still have micronutrient deficiencies. While they are not losing calories, they are not absorbing some vital nutrients."
"It's a very common symptom [fatigue]. People come in and say they don't have the energy they used to [have], whether it's during exercise or doing daily living activities. This illustrates they might be deficient in iron because of hidden celiac disease."
"They don't have diarrhea or belly pain but they have no iron because of damaged intestines. And while a patient taking large quantities of iron might absorb enough to correct anemia, it's not going to fix the inflammation in the intestines and it's not going to prevent other complications that can occur later in life." 
"If that [blood test] comes back positive, then the patient needs to be referred to a gastrointestinal specialist since you want to make sure it's really celiac before coming to a lifelong diagnosis that will require lifelong treatment."
Dr.Joseph Murray, professor of medicine, Mayo Clinic, Rochester, Minnesota

"The message is that if you see nutritional deficiencies, you should start thinking about celiac disease."
"That way, you may save these patients from damage to the intestines."
Dr.David Whitcomb, professor, gastroenterology, hepatology and nutrition, University of Pittsburgh

Photo: Mayo Clinic

An immune reaction to gluten, a protein common to wheat, barley and rye, produces celiac disease. To avoid the symptoms of celiac disease and the condition's long-range complications people diagnosed with celiac disease follow a dietary protocol of gluten avoidance. The immune response to consuming gluten eventually will compromise the lining of the intestine, preventing it from absorbing certain nutrients. And this leads to diarrhea, fatigue, anemia and weight loss, along with other related complications.

Doctors have long become accustomed to identifying typical symptoms such as unexplained weight loss or extreme thinness in their patients to lead them toward the diagnosis of celiac disease. Now, new research findings lead to the conclusion that the hallmark signal of the presence of celiac disease may instead be seen in low levels of vitamins and other micronutrients, points out a report in Mayo Clinic Proceedings.

Doctors, in other words, need to expand their search for celiac disease symptoms, looking as well for the presence of certain micronutients at low levels, particularly iron, vitamin D and zinc. It is through blood tests that low levels of these critical nutrients are discovered and in the absence of such tests being regularly performed, it becomes incumbent on diagnosing physicians to become alert to the single most common symptom of iron deficiency -- fatigue.

If that telltale sign is there, then a blood test should be ordered as the initial screening mechanism. Should the blood test be returned positive, referral is then made to the medical specialist whose area of expertise is required to validate the initial diagnosis. Because of the long-range complications inherent in undetected and untreated celiac disease, aggressive follow-up is required. Dr. Murray is of the opinion that up to half of the adults with celiac disease are undetected because they fail to present with weight loss and other symptoms felt to typify the disease.

Alternately, should someone self-diagnose and place themselves on a gluten-free diet, the results of the blood test can be compromised. The research undertaken by Dr. Murray and his colleagues involved close scrutiny of 309 adults who were newly diagnosed -- between 2000 and 2014 -- with celiac disease, matched by age with subjects from the National Health and Nutrition Examination Survey, a national database. (NYHANES).

The researchers discovered large variances in nutrient levels on comparing the recently-diagnosed celiac patients with the NHANES participants; zinc deficient in 59.4 percent of the celiac group as compared to 33.2 percent of the control group; copper low in 6.4 percent of celiac patients, versus 2.1 percent of controls; folate low in 3.6 percent of celiac patients, compared to 0.3 percent of controls, and vitamin B12 low in 5.3 percent of celiac group, versus 1.8 percent of the control group.

Iron was low in 30.8 percent among celiac patients but no comparable iron measurements were available to compare with the controls. Weight loss was seen in 25.2 percent of patients diagnosed with celiac, contrary to traditional assumptions respecting celiac and thinness. The new study is meant to serve as a caution to primary care physicians who should take note of nutrient deficiencies in their patients. Dr. Murray cautions "just because someone is overweight doesn't mean they don't have celiac disease."

If you have celiac disease, you cannot eat grains that contain gluten, such as:

• Barley
• Rye
• Triticale
• Wheat (including couscous, bulgur, spelt and kamut)

"It was somewhat surprising to see the frequency of micronutrient deficiencies in this group of newly diagnosed patients, given that they were presenting fewer symptoms of malabsorption."
"Our study suggests that the presentation of celiac disease has changed from the classic weight loss, anemia and diarrhea, with increasing numbers of patients diagnosed with nonclassical symptoms," "Micronutrient deficiencies remain common in adults, however, and should be assessed."
Adam Bledsoe, M.D., gastroenterology fellow, Mayo Clinic, Rochester campus

Scamming The Gullible With Food Tolerance Pseudoscience

"It's a normal physiological response [the creation of IgG, a 'memory' antibody forming post-vaccine exposures, infections or any other environmental exposure, including food] to the food we eat. Even if it is elevated -- and we don't even know what a 'normal' level is -- it doesn't indicate anything bad."
"If you eat a food you will produce IgG."
"[People could become obsessed] reading labels and taking extra precautions to make sure they don't have an accidental bite of a food they're not even sensitive to in the first place."
"... There is zero indication to ever just do a bunch of tests for random foods and see what you get." 
Dr. David Stukus, pediatric allergist, Nationwide Children's Hospital, Columbus, Ohio

"Many patients suffer from physical, psychological, and psychosomatic conditions for which conventional medicine cannot provide diagnosis or treatments."
"Such patients understandably turn to practitioners who tell them that these ailments are the result of ingestion of certain foods [assuring them that eliminating those foods based on sensitivity testing will erase symptoms. Many people feel better] because they feel like they have an explanation for their illness."
"Although it is important to be sympathetic with these patients, as scientists, it is also important for us to gently explain that these tests have not been validated by science."
Dr. John Kelso, Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif. Journal of Allergy and Clinical Immunology: In Practice

"It's just kind of thrown around loosely [food sensitivity], it's not a specific medical diagnosis."
"The labs are charging hundreds of dollars for these tests. I heard from one patient recently who paid $900 for this test by her naturopath. She was referred to us to rule out allergies to the 40 or 50 different foods that were picked up."
"I think it should be the responsibility of the regulators, the government, the laboratories, and the medical people at the laboratories to say, 'You know what? I don't think we should be doing this because it's not scientifically validated and it doesn't seem like the right thing to do."
Dr. Harold Kim, president, Canadian Society of Allergy and Clinical Immunology

"Dynacare relies on the professional expertise of the ordering professional to determine the appropriateness of ordering a particular test."
"While debate exists, there are peer-reviewed articles suggesting there is use for the food IgG test."
Dynacare, Ontario

A study published in 2004 involving 150 people with irritable bowel syndrome found an improvement in symptoms in those who excluded foods to which they had raised IgG antibodies after 12 weeks, while other studies suggest IgG-based 'elimination diets' can relieve migraines and symptoms of Crohn's disease. As far as Dr. Kelso is concerned, he believes that to be a classic placebo effect; people reacting to what they believe will be useful to them.

Dr. Stukus has a more immediate self-help suggestion, that people should themselves eliminate any food they suspect may be the cause of a problem, see if it avoiding it makes any difference, then to reintroduce it to their menu to determine whether the symptoms troubling them return. Simple, effective, no intermediaries required. In a test of his own, Dr. Stukus took home a food sensitivity test, then mailed off his dried blood sample.

To be rather taken aback when the results were returned informing him of sensitivities to sesame, sunflower, black walnuts, cashews, watermelon, yogurt, carrots, cottage cheese, asparagus, tarragon safflower, tomatoes, brewer's yeast, broccoli, chicken, barley, soy beans, baker's yeast, white potatoes, cow's milk, cheddar and mozzarella cheese. "I've never eaten [cottage cheese] in my life", he said disbelievingly.  "It even broke down mozzarella versus cheddar cheese, which is just ridiculous."

Dr. Stukus produced a video and shared it on Twitter, highlighting his experience with the IgG test, meant to identify immunoglobulin G, an antibody that happens to be the most common found in blood and other body fluids. IgG tests make the claim that through its presence they are enabled to identify food sensitivities associated with headaches, lethargy, brain fog, memory problems, depression, insomnia, ADHD, bloating and puffiness -- along with a host of other symptoms.

Such sensitivity tests that are meant to identify 'reactive' food in the diet to relieve people's bothersome symptoms have developed a huge following in the population even while immunology and allergy specialists everywhere consider the test to be no more and no less than a slick marketing gimmick helped along with pseudoscience to convince the gullible. Even so, allergists are seeing an increasing number of patients referred to their offices bringing 'proof' of their problems' origins in the results of IgG food tests.

The entire marketing system surrounding these tests and their legitimacy gets a huge boost from bringing on board celebrities to help market the concept, incorporating the issue that seems to have started the ball rolling; gluten 'intolerance'. Along with it goes the paring away of grains, dairy, meat or shellfish as everyone and her uncle indulges in self-diagnosis as a reflection of a risk-obsessed society. This, despite true food allergies being the cause of a true immune response producing another type of antibody: immunoglobulin E; the reaction occurring swiftly each time the offending food is eaten.

Food sensitivity on the other hand is a term vague enough to draw people in but not commit to a true analysis and diagnosis with scientific accuracy. It is a term beloved of naturopaths and allied alternative medicine practitioners, because it sounds authoritative even while it defines nothing in particular. Food intolerances do exist; there are those who cannot digest certain foods, among the most obvious is lactase intolerance where a lactase deficiency exists leaving the person unable to break down the lactose in milk sugars.

As for gluten disability, it represents an autoimmune disorder damaging to the small intestines, the condition known as celiac disease, where people suffering from it are unable to tolerate even trace amounts of the gluey protein found in wheat, barley and rye and known as gluten. But a mere one percent of Canadians have celiac disease, while over 20 percent of Canadians have taken steps to eliminate or reduce dietary gluten.

Critics of the trendy sweep to laboratory tests for food 'sensitivities' point out the tests are expensive and virtually without merit. Not only do they lack biological plausibility but they run the risk of increasing irregular ideas around eating, producing people who have a hyper-preoccupation with food: "nutrichondriacs". Experts in the field are concerned that IgG testing has the potential to increase anxiety, leading to utterly pointless food avoidance diets, ultimately producing nutritional deficiencies.