THE ROAD TO WELLNESS: Gluten enteropathy
I had a patient in the other day who had been having gas/bloating/indigestion/ alternating constipation/diarrhea for years. After ten years of this they were tested for Celiac disease. The first biopsy was inconclusive and the second was positive. This is a typical scenario that often presents in my clinic, because often what people eat is not considered.
One of the issues is testing. The studies show that the blood transglutaminase test is not very accurate and misses many patients and the anti-gliadin antibody test is similar. In the past, the “gold standard” for diagnosis was a duodenal biopsy, but, again, that has been found to also miss many positive patients.
problem is symptoms. They are not necessarily digestive symptoms. A person may feel lethargic/moody/irritable for instance, or have a hard time focusing and concentrating on their task. There may not be digestive symptoms at all.
So, many people are told they don’t have issues with gluten and go on eating as they did before, but, still experience problems.
It becomes even more confusing because a person can react to wheat or the wheat family (spelt and kamut), but, tolerate barley/oats and rye. These folks are reacting to gliadin, a protein found in the wheat family. Other folks react to wheat (and the wheat family), barley, oats and rye. Those folks are reacting to gluten and possibly gliadin as well. So, it’s tricky to sort out.
Unfortunately, with gluten issues, cross-reactivity with other foods often occur. Therefore, I find it easiest if I test for all the foods that people typically eat- approximately 100-120 and see what the body likes or dislikes and remove those from the food intake for a minimum of four weeks. Studies have shown that it requires a minimum of four weeks to clear the system of the irritant and therefore symptoms.
My next article will discuss treatment options.