Friday, September 04, 2009

Gluten, The Cold, Hard Facts

Recently I’ve been hearing the expression “soft science” and a possible relationship to gluten sensitivity. These same individuals conclude that the only “hard science” applies to celiac disease. They maintain that suggesting a benefit may be achieved from a gluten-free diet for anyone who is not diagnosed as a celiac is not only dangerous, but misleading and downright cruel!

So let’s take a look at these claims and accusations and see if they have any merit.

I believe that new ideas and new findings, be they in the field of health or anywhere else, are frequently not embraced. We are critical and cautious of change. Is the “soft science” of today the “hard science” of tomorrow? I think we have seen this on many occasions. It brings to mind the bacterium Helicobacter pylori. This bacterium can infect the stomach and cause not only ulcers but cancer. My clinic has been looking for and addressing H. pylori infections for many years. But we, and other clinics like us, were accused of treating a “normal constituent” of the stomach and it was claimed that the bacterium was definitely not a danger. Fast forward about 5 years from that point and “every” GI doc is currently testing for it. Why? Because it can be dangerous.

Getting back to gluten sensitivity vs celiac disease, if the information regarding celiac is so clear cut, why do we as a nation only diagnose 5% of those suffering? And why does it take about a decade to get properly diagnosed?

The presence of “hard science” does not equate to efficient diagnosis nor effective treatment.

I try to stay abreast of all the most current research as regards celiac and gluten sensitivity. Dr Harris out of the University of Maryland Medical School works with Dr Fassano, a long time researcher in the area.

Dr Harris stated that gluten sensitivity was a condition where the combination of genes for it and celiac disease may very well be the same but other insults hit the celiac creating that disease and autoimmunity.

She feels that gluten is initiating an innate immune response but that it somehow gets regulated such that the intestinal epithelium remains more intact than in the celiac. But she continued to say that they did see infiltration of lymphocytes in the epithelium. (Note: some researchers states that infiltration of the epithelium by lymphocytes is the precursor to villous atrophy.)

Dr. Harris has already published several articles about her work. Specifically a 2008 article published in The Journal of Immunology was co-authored by Dr. Fasano. Shall we accuse Dr Harris, one of the leading researchers in the field, of practicing “soft science” because she believes that gluten sensitivity is a real thing?

One of the problems we encounter with celiac is diagnosis. While intestinal biopsy has long stood as the gold standard of diagnosis, it currently is considered antiquated. Why? It’s too gross a measurement of such a large and complex structure. In a biopsy one is taking a few snips of small intestine that has the surface area of a tennis court. What is the likelihood of missing an affected area and giving a false negative diagnosis? Quite high obviously since we only effectively diagnose 5% of those affected with the disease.

Everything happens on a continuum. Does villous atrophy happen suddenly or slowly? It’s a slow erosion as inflammatory factors affect the small intestine. Is it correct or “kind” to wait until someone’s intestinal lining is completely eroded before diagnosing them? Talk about cruel and unusual!

What’s wrong with an early diagnosis? What’s wrong with trying to prevent autoimmune disease, the third leading cause of death? I say nothing.

While I appreciate the role of a researcher needing “proof” and hard evidence before going forward with a statement of fact, as a clinician I have a duty to help my patients to enjoy better health. Should I put all my patients “on hold” because there is still some discrepancy in the research? Should I ignore the miraculous results patients have experienced going gluten-free because they don’t have a definitive celiac diagnosis?

What’s right? I think if you’re a researcher waiting for more support of your hypothesis is acceptable. But if you’re a clinician and the benefits so vastly outweigh the liabilities (there is absolutely no proof that a gluten-free diet can in any way be dangerous) then I think the answer is obvious.

I’m a clinician and I will continue to utilize gluten-free diets for those patients whom have positive laboratory tests identifying an immune system reaction to gluten and those patients who, upon elimination and provocation, have a positive reaction to gluten. And if you want to call that “soft science” so be it.

To your good health,

Dr Vikki Petersen
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect

1 comment:

Anonymous said...

I agree that there's nothing dangerous about a GF diet, but it sure helps to have a "proper" diagnosis. The blood tests for gluten were all negative, but they were positive for dairy, eggs and soy. If my spouse avoids all 4 of those foods, he feels great. Not sure what will happen if he ever ends up in the hospital.