Monday, January 26, 2009

PRESS RELEASE!!! California Doctors Expose “The Gluten Effect”




Find out how “innocent” wheat is ruining the health of millions
FOR IMMEDIATE RELEASE

PRLog (Press Release)Jan 19, 2009 – Sunnyvale, California – Doctors Vikki and Richard Petersen, founders of the celebrated HealthNOW method will be releasing their book, THE GLUTEN EFFECT at the HealthNOW Medical Center on Wednesday, February 11, 2009 at 7:00 p.m.
Check out our website at www.healthnowmedical.com

The Gluten Effect is the culmination of years of clinical research and case studies on gluten, the major protein found in wheat, rye and barley. Gluten can interfere with the body’s immune system and trigger attacks. The insidious effect of gluten is fast becoming recognized as the silent killer of our generation.

“The Drs. Petersen have cracked open a world hidden from view but one which causes untold suffering for millions. The Gluten Effect is a remarkable window into the innumerable ways in which gluten – that sticky little molecule found in bread, and hidden in so many other places can cause everything from autism to dementia, from depression to psoriasis and so much more. If you have nagging symptoms that just don’t go away, and you have no idea where they come from you may be suffering from The Gluten
Effect. This book can save your life!
Mark Hyman, MD, New York Times best-selling author of UltraMetabolism and The UltraSimple Diet, and The UltraMind Solution.

Millions of dollars are wasted each year in misdiagnosed health conditions, including
auto-immune diseases which affect 80% of the U.S. population. From lack of sex drive to
depression and anxiety, gluten is the most likely cause-yet it goes undetected and undiagnosed.

The Gluten Effect challenges entrenched medical convention and offers a real alternative to the drugs-for-every-ailment mentality foisted upon consumers by big pharmaceuticals.
Advanced copies of The Gluten Effect are available by calling:
408-733-0400 or by e-mail: drvikki@healthnowmedical.com.



Saturday, January 24, 2009

Interpreting Lab Work


Gluten sensitive patients not only have to do their own research regarding their symptoms but they have to self-diagnose and sometimes are forced to interpret their own lab tests!

I just received the following question:

Hi,
A lady in my group has the following blood work and I need help with
it.

Tissue Transglutaminase AB is 1.2
Endomysial Antibody is Negative
Gliadin IgA is 1
Gliadin IgG is 1
IgA (Immunoglobulin A) is 152

What does this last one mean? Is that a positive reading?

She had been previously diagnosed a few years ago with DH [dermatitis herpetiformis], but the doctor never told her about the GF [gluten-free] diet, so it was just forgotten. Fast forward a few years and now she was diagnosed with MS [multiple sclerosis]. The doctor at the Cleveland Clinic told her she should go on a GF diet because she probably also has celiac.

She met with me to learn about the GF diet. I suggested she get tested
for celiac first, which she did. Soon after she was tested and read the
information I gave her, she read about the DH and then mentioned she
had already been diagnosed with that. The diet is helping, but she would like to
know the meaning of her blood work. It looks to be negative except for the
IgA, but I don't know what the normal range is for that test.

And with DH, can you test negative via regular blood testing? According to
Dr. Green, you can, but I was wondering if anyone has come across this.
She is trying to understand all this and I want to give her the correct information.

Thanks everyone,

Bev
Mansfield, OH


What a sad story. I would like to say it’s unique and uncommon but unfortunately quite the opposite is true. The lack of understanding of the damage gluten sensitivity can cause is staggering.

Here’s a woman who several years ago was diagnosed with dermatitis herpetiformis, a very uncomfortable, unsightly skin condition for which the ONLY known treatment IS a gluten-free diet and she is never told about it. Adding insult to injury the gluten she continued to eat may very well be responsible for the autoimmune, degenerative nerve disease she is now diagnosed with, multiple sclerosis.

To answer the question posed regarding lab tests, let’s take them one at a time. First I’d like to mention that if you want accurate data from a doctor regarding a lab result long distance, don’t just include the result itself but also the reference range of the test. Labs differ in this regard and a result is only as valuable as the reference range is also included.

The data below comes from our book, The Gluten Effect – available February 13, 2009.

Anti-tissue Transglutaminase Antibodies - Anti-tissue Transglutaminase Antibodies (tTG antibodies) are auto-antibodies directed against “self” tissue. After gliadin crosses the intestinal lining, a special enzyme called tissue transglutaminase binds to gliadin and takes off a portion of the protein. This portion is called glutamine. tTG antibodies are antibodies that are directed against the complex of gliadin attached to the tissue transglutaminase enzyme. tTG antibodies are 90 percent accurate in Celiac disease because they represent immune system attack at the level of the intestinal lining. Gluten sensitivity that involves minor intestinal injury or no villous atrophy will be less likely detected by tTG antibodies. Therefore, tTG antibodies correlate best with villous atrophy as several studies have supported, and a negative tTG antibody test (or EM antibody test for that matter) does not rule out gluten sensitivity when intestinal involvement is minimal or absent.

Anti-Endomysial Antibodies - Anti-Endomysial Antibodies (EM antibodies) are auto-antibodies. Gliadin is a gluten protein so therefore when the immune system attacks it, is not attacking “self” tissues but instead a foreign food protein. In contrast, as gliadin is absorbed through the intestinal lining, it attaches to the smooth muscle cells of the intestinal wall. EM antibodies are directed against proteins of these smooth muscle cells, and therefore EM antibodies are directed against “self” tissue. This defines them as auto-antibodies.Because EM antibodies attack the smooth muscle of the small intestine, these antibodies correlate better with damage to the intestine wall. Studies have supported an accuracy rate of approximately 90 percent for Celiac disease. Actually in one study, EM antibodies were present in 100 percent of individuals when total villous atrophy was present. However, EM antibodies are ineffective in detecting individuals with silent or subclinical gluten sensitivity. If minor involvement of the intestinal lining occurs or if no intestinal involvement is present, EM antibodies are much less accurate.As with Anti-Gliadin Antibodies, EM antibody testing should evaluate IgG and IgA forms of antibodies. If a gluten sensitive patient is IgA deficient, IgA EM antibodies may be falsely negative even for Celiac disease.

Anti-Gliadin Antibodies - Gliadin is the protein component of gluten that triggers the immune reactions in sensitive people, and therefore many people with gluten sensitivity have antibodies to this protein. Testing for anti-gliadin antibodies (AGA) is a simple blood test, but studies have shown that it is less sensitive for detecting Celiac disease compared to other antibodies. The confusion is that the ability of AGA to detect gluten intolerance has been defined in conjunction with a positive intestinal biopsy. While this may be a standard for Celiac disease, we now know that this is an inaccurate standard for gluten sensitivity. In fact, AGA may be the best current diagnostic test when considering all gluten related disorders. In testing for AGA, antibodies of both the IgG and IgA classes are checked since low total levels of IgA may be present. If a person has low total IgA levels, antibody tests for IgA may be falsely negative.

Total Serum IgA Level - Low total levels of IgA antibodies are rarely found in the normal population with one out of every six hundred people having this condition, but in gluten sensitivity, low IgA levels are more common. This reflects the increased IgA antibody production in the intestine to fight off gluten as it attempts to enter our bodies. If a low level of IgA is present, then certainly IgG varieties of the antibody tests described above will be more accurate in diagnosing gluten related conditions. In general, total IgA levels are not ordered often since IgG antibody tests are usually ordered concurrently. Therefore, defining a low IgA level adds little information in making a diagnosis. There is a general theory however that a lower IgA level suggests greater inflammation of the intestinal lining and greater chronicity of disease. A low IgA level may provide some insight into duration of disease.

A high serum IgA level as seen in the above test is likely indicating an infection. Increased serum IgA is common in skin, gut, respiratory and renal infections. We know this patient has DH so secondary skin infections do make sense.

The reader also asks if blood tests can be negative with DH. Yes they can. Also remember that even those diagnosed with celiac disease via biopsy show negative blood results 15% of the time.
That’s why the moral of the story at this time is to evaluate how you feel when you eat 100% gluten-free for a couple of months. Until we have highly sensitive tests we can rely on to accurately diagnose gluten sensitivity, diagnosing will involve “building a case” by pulling together many pieces of information about the patient including symptoms, response to a gluten-free diet, lab tests, genetic history, presence of intestinal infections, etc.

This leads us to explain some things about this particular patient. She has known DH which is solely due to gluten intolerance, yet it can be present with negative blood tests. Does that make the diagnosis or need for a gluten-free diet in question? Not at all. She is now diagnosed with MS. We know that, second to the digestive tract, the most common system to be affected by gluten is the nervous system with autoimmune diseases occurring at a very high rate. Does the negative test ensure that gluten had nothing to do with the development of MS? No, it doesn’t. We’d need to know a lot more about this patient (which by the way is the most difficult part of hearing from readers long distance – I want more data.) but I wouldn’t be surprised to find other factors which point to gluten as the culprit.

To Your Good Health!

Dr Vikki Petersen

Revisiting Vitamin D


On May 4, 2008 I wrote a post on Vitamin D entitled: “Are you deficient in vitamin D? The odds are good and the risk is high…”

I recently received this response from a reader:

“Good afternoon! I read your article on Vitamin D deficiency on the internet. I've taken the prescription of 50,000 units of Vitamin D for 6 months, and my levels are still undetectable. I know someone who successfully treated their Vitamin D deficiency with a Vitamin D shot. Is that readily available in the USA?

Please note: I'm absorbing all other vitamins, calcium, etc Glucose, etc is normal. Only problem is Vitamin D.

Thank you!”

I wanted to respond to this post for two reasons:

1. I’m concerned about this individual and want to make sure that he/she gets the help they require.

2. Vitamin D deficiency is truly epidemic in this country and is further exacerbated by malabsorption which, as we know, gluten sensitivity and celiac disease causes.

So let me talk to my reader first:

Vitamin D is a fat soluble vitamin. You don’t tell me too much about your health but I’m assuming that gluten sensitivity or celiac disease is probably a component. With gluten sensitivity comes malabsorption but exactly what you’ll malabsorb and to what degree is somewhat unique to individual patients.

You mention that other vitamins and calcium and glucose are fine. But are these other vitamins water soluble or fat soluble? The villi (fingerlike projection which line the small intestine) help to emulsify and absorb fat. These villi are frequently eroded with gluten sensitivity and fat absorption is thereby compromised. The inability to adequately absorb fat will not only affect absorption of vitamins D, E and A but it will drastically affect hormone production as well. (The list is actually a lot longer but let’s not get too complicated.)

If you’ve been off gluten but are not seeing proper healing of the villi then something else is compromising your small intestine. You may have an intestinal infection or some inflammatory factor that is preventing healing. That cause must be identified and treated quickly.

On a lighter and easier note, perhaps the vitamin D you’ve been taking is of poor quality. Though with that said, one would think that even a poor quality supplement would have had some effect on your blood levels after 6 months. I recommend vitamin D3 (cholecalciferol) for my patients. The absorption is quite good. I could not find any information on vitamin D shots being available in the US. But with the attendant concern re: overall fat malabsorption, simply taking a D shot would not allay my concerns about the integrity of your small intestine and the need to repair it.

If you don’t have a doctor who is providing what you need, write back to me and we can devise a plan to get to the root of this. Having a more in-depth health history will make assisting much easier.

My second point above is simply about driving the point home of how important it is to assess your vitamin D level, especially if you’re gluten sensitive.

Vitamin D is a crucial component of not only healthy bones, but a protector against cancer, diabetes, and a strong immune system booster as well. Despite all these virtues, its common deficiency has gone largely unnoticed.

It’s a simple blood test to take. Get your levels checked, supplement with a high quality vitamin D and then recheck your levels to ensure they are where they need to be.

For more information on this refer to my earlier post on May 4, 20008.

To Your Good Health!

Dr Vikki Petersen

Friday, January 16, 2009

Drug Giant Pfizer Announces Major Layoffs



“Pfizer may announce $2 billion in cost cuts including plant closings and slashing up to 10% of the work force when new chairman and CEO Jeffrey Kindler announces his plan next week for a strategic overhaul of the world's largest drugmaker.”

These were headlines earlier this week and it brought two thoughts to mind. First, 70% of all the medical “research” done in this country is funded by pharmaceutical companies.

Questions about such research began to come to our attention in 2004 when the FDA did some reanalysis of antidepressants and concluded that the drugs increased the risk of suicide in children.

Merck pulled its arthritis drug Vioxx off the market when it was discovered that it doubled the risk of heart attacks. Yet in 2000 the New England Journal of Medicine had published a study of the effects of Vioxx where the risks were very downplayed.

The industry promised to do better but more and more scientists are realizing that only part of their findings are published with the “more damaging” information being glossed over or left out completely. Dr Aubrey Blumsohn, a British bone specialist contends that Procter and Gamble published a report in his name that not only he didn’t write but one that he was suspicious wasn’t accurate. He later found out that 40% of the data he submitted after doing research on an osteoporosis drug was missing, thereby skewing the results.

Who is suffering from the side effects of these dangerous drugs? We are. I’m not advocating a no drug solution for everything, so please don’t try to pigeon-hole me into that category. But the facts are that drugs have side effects and often they are dangerous, which is why a drug should be used for a very short period of time while striving to discover and remediate the root cause underlying the problem. Known drug side effects can be factored into the equation of whether taking the drug is the best solution for a given time. But what about the dangerous side effects which are unknown because they were suppressed by the pharmaceutical company?

The second thought that came to mind is that our preoccupation with drugs and masking symptoms we don’t care for along with the huge profits which pharmaceutical companies enjoy, completely explains why gluten sensitivity and celiac disease is so under- and mis-diagnosed. There’s no drug to treat it! And if there’s no drug there’s not much interest generated from the medical community.

Where does that leave us, my friends? Out of the mainstream medical model, that’s for sure. But until my dream of changing the face of healthcare comes about, I don’t mind. I’ll continue to let more and more patients know that addressing the underlying root cause of their health problem is not only a method that makes sense, but one that works. And it is my hope that it becomes more widely available as we continue to prove its efficacy.

To your good health,

Dr Vikki Petersen
www.healthnowmedical.com

Wednesday, January 07, 2009

Our Hearts Go Out to the Travolta Family


It’s difficult to lose anyone in our life, but the loss of a child is even that more tragic. Jett Travolta was only 16, the same age as my youngest child. He suffered from a severe seizure disorder.

There are many causes of seizures, some understood better than others. I wanted to discuss the known association between seizures and gluten sensitivity. Please understand that I’m making no assumptions on the part of gluten being a causative agent in Jett’s condition. It’s just that seizures are such a tragic event for the patient as well as their families and any data I can provide that may help someone is something I’d like to do.

Below is some data from our upcoming book, The Gluten Effect.

It is quite amazing how many other parts of your health can be actively affected by gluten without the presence of any digestive symptoms. Of all the other organ systems of your body, the nervous system is the area most commonly affected by gluten after the gastrointestinal system. And, because our nervous system handles so many important functions, symptoms related to the nervous system are quite varied.
Your nervous system incorporates central structures including your brain, spinal cord, peripheral structures that are made up of sensory nerves (which sense pain, hot, cold, etc.), motor nerves (allowing you to perform movements) and nerves that regulate your involuntary systems (such as your heart beating, breathing while you sleep, intestinal movements, etc.). In individuals who are predisposed to gluten intolerance, gluten triggers an immune reaction that can interfere with the function of these structures.

Is Your Brain “On Fire”?There is an abundance of evidence that inflammatory changes occur in the brain and nerves that cause a variety of symptoms. These can range from clumsiness to headaches to numbness to mood disorders to memory problems. It has been reported that only thirteen percent of patients with neurologic symptoms from gluten sensitivity may have digestive symptoms, and, often, neurological symptoms in gluten-sensitive patients precede digestive symptoms by months to years when they do occur. For this reason, it is important to keep gluten in mind as a root cause when dealing with disorders of the nervous system.
Remember, symptoms are the body’s way of getting your attention and directing you toward the site of a problem. If standard tests and exams cannot reveal a cause, dietary factors, toxins, lifestyle issues and other stresses deserve your attention.
This is where gluten should be a strong consideration. Because gluten affects so many people silently, and because most of those symptoms are not related to the digestive tract, it needs to be an early consideration when addressing many health care problems. Examining the different way in which gluten affects your nervous system is an excellent way to appreciate the scope with which gluten results in a variety of symptoms. It also highlights the importance of your diet in relationship to your health.

Gluten’s Relationship to Seizures
An excellent study was evaluated with 171 patients who suffered seizures and likewise had gluten sensitivity/celiac disease and calcifications in the brain. The overwhelming majority had gliadin antibodies in the spinal fluid (which circulates around the brain and spinal cord), and, likewise, most had the gene for having gluten sensitivity. Though many were unresponsive to treatment in general, it was notable that some did respond well to a gluten-free diet.
Why would gluten cause seizures? And are the calcium deposits in the brain related to gluten? Likely, the answer is “yes” to both questions. The presence of calcium deposits reflects chronic inflammation in some tissues. When inflammation has been present for years, calcium forms scars where the inflammation is located. Additionally, brain calcifications can form as a result of a folic acid (a B vitamin) deficiency, which may have been a contributing cause to the calcium deposits in these patients. Since gluten causes digestive malabsorption, then, folic acid may indeed have been low due to that.

The Mechanism ExplainedRegardless, the root cause is most likely an immune system attack triggered by gluten sensitivity. Antibodies that are made to attack gluten get confused (due to a process known as cellular mimicry) and attack normal tissue that looks similar to gluten’s protein structure. In the brain, once the tissue is inflamed chronically, calcium can deposit and form a hardened scar.
Because of this scar, seizures develop and can be difficult to control with normal seizure medications. Seizures are basically short circuits of the brain. Suppose there were an electrical pole knocked down onto the ground. The electrical wires tore and were lying unprotected, sending out sparks from their broken ends. The electrical connection had been severed. Calcium deposits and scars in the brain essentially do the same thing. They send off electrical “sparks” that can develop into seizures if enough brain tissue becomes involved. Medication may help the sparks from spreading, but with gluten-related seizures, medicines work less well.

Case Study: A Lovely Girl Who Leaves Her Seizures Behind
T.S. is a beautiful, vibrant, nine-year-old girl who had begun having seizures at the age of four. She had undergone standard medical testing without a cause of her seizures being found. We first saw her when she was four years old. Not only did we find that she was sensitive to gluten, but that she also had many intestinal infections, a Candida yeast infection, and an essential fatty acid imbalance. The infections were greater in number in her than in most adults we treat, and some were very resistant to treatment, requiring two rounds of antibiotics instead of the usual one. She was treated with fatty acids in addition to a gluten-free diet.
T.S. has had absolutely no seizures for two years. She told her mother recently that she knows that the gluten created her seizures, and she is more than happy to keep it out of her diet. It is noteworthy that her mother, also diagnosed by us as gluten-sensitive, never ate much gluten until her twenties because as a child, she had sensed that it bothered her. But, recalling when she was in college and consumed a lot of gluten, she remembered suffering from “brain fog” during that time.

Evidence of these inflammatory changes can be seen in some gluten-sensitive patients via MRI. This was supported in another study examining patients with gluten sensitivity and seizures, which demonstrated deep-tissue inflammation in at least twenty percent of the children studied who had seizures. In addition, none of these seizure patients had folic acid deficiency, which suggests that gluten was the primary cause of their problem.

It’s Worth Giving Gluten-free a TryWhile, thankfully, seizures are an uncommon manifestation of gluten sensitivity, it is extremely important to recognize it as a cause because the only effective treatment may be a gluten-free diet. If you never think of gluten as a cause, then you will never test for its presence. It would be miserable to have to suffer, or see someone else suffer, with seizures when a potential cure may exist with a simple dietary change.

We Still Have A Lot of Work to Do!


With The Gluten Effect’s publishing finally on the horizon, we’ve been contacting various groups who support those patients with celiac disease. It is my hope to educate those groups on the difference between celiac disease and gluten sensitivity such that we can help their family and friends who, while perhaps not celiac, may very well be suffering from the many problems gluten sensitivity creates.

While we have received many positive responses I chose to share the one “negative” response I received as an example of the pervasive attitude in the medical community which we have to overcome to help the millions of people suffering with gluten sensitivity.

Here’s the letter: (I have left out the person’s name and the specific group in order to respect confidentiality.)

Dear HealthNOW staff,

Thank you for your email. While I appreciate the importance Dr. Petersen places on the diagnosis of gluten intolerance, and her commitment to her patients, I must decline the request to add your links to our web site at this time.

We are affiliated with the Celiac Disease Foundation, and generally advise physicians and patients to follow the guidelines for celiac diagnosis and treatment recommended by university celiac disease centers, including those at U.C. San Diego, Columbia University, University of Maryland and University of Chicago. This approach appears to differ in significant ways from the one described on your web sites. For example, the use of Enterolab stool testing, and the dismissal of the intestinal biopsy as a misguided approach advocated by "several" clinicians, is inconsistent with our philosophy (8/26/08 entry in her blog).

While alternative approaches to diagnosis may prove fruitful in the future, we feel we will have the greatest impact in our local medical community at this time by using the resources of universities and peer-reviewed medical journals that mainstream physicians trust. We do, however, strongly support the use of integrative medicine in the treatment of celiac disease and gluten sensitivity.

There is a great deal yet to be discovered about celiac disease and gluten sensitivity, and I wish your colleagues well in the path they have chosen.


And here's my response:

Dear ________ (name left out to protect identity),

Thank you for your response. I would like to thank you for all the
good work you're doing in the field of celiac disease. Hopefully you will grant
me a few minutes of your time so that I can "state my case" for the work I'm doing with gluten sensitivity.

My upcoming book is heavily referenced and peer review literature is
among those over 400 references. Once such reference is from The
New England Journal of Medicine, October 2007 article by Peter Green,
MD.

Below are some quotes from the article and some comments from me.

"The diagnostic criteria developed by the European Society for
Pediatric Gastroenterology and Nutrition require only clinical
improvement with the diet, although histologic improvement on a
gluten-free diet is frequently sought and is recommended in adults
because villous atrophy may persist despite a clinical response to the
diet."

[In my experience of over 20 years I frequently see dramatic changes
in patient's health from a gluten-free diet despite a negative
intestinal biopsy. I believe the opinion of the above European
Society whereby clinical improvement on a gluten-free is sufficient,
is a trend that will soon be more prevalent here in the US.]

Serologic [Blood] Testing

"Typical indications for serologic testing include unexplained
bloating or abdominal distress; chronic diarrhea, with or without
malabsorption or the irritable bowel syndrome; abnormalities on
laboratory tests that might be caused by malabsorption (e.g., folate
deficiency and iron-deficiency anemia); first-degree relatives with
celiac disease; and autoimmune diseases and other conditions known to
be associated with celiac disease."

"The most sensitive antibody tests for the diagnosis of celiac
disease are of the IgA class. The available tests include those for
antigliadin antibodies, connective-tissue antibodies (antireticulin
and antiendomysial antibodies), and antibodies directed against tissue
transglutaminase,"

[Serologic testing of an IgA and IgG nature is what I utilize in my
practice and recommend for patients. Enterolab is mentioned for those
patients not local to our area who have doctors whom refuse to order
the serologic testing. While the limitations of the stool testing of
Enterolab are mentioned in our upcoming book, if it's the only
possible choice available, it may well provide the data a patient needs to make the important change to a gluten-free diet. And if that dietary change results in health improvement, it’s certainly worthwhile.]

"Although no studies have examined the number of biopsies required
for diagnosis, we believe that at least four to six endoscopic-biopsy
specimens should be obtained from the duodenum [small intestine], given the patchy
nature of the disease and the difficulty of orienting the small pieces
of tissue taken during biopsy for assessment of villous morphology."

"The spectrum of pathologic changes in celiac disease ranges from
near-normal villous architecture with a prominent intraepithelial
lymphocytosis to total villous atrophy. Pitfalls in the pathological
diagnosis include overinterpretation of villous atrophy in poorly
oriented biopsy specimens and inadequate biopsy sampling in patients
with patchy villous atrophy."

"Celiac disease occurs in nearly 1% of the population in many
countries. The diagnosis, which is straightforward in most cases, is
usually established on the basis of serologic [blood] testing, duodenal [small intestine] biopsy, and observation of the response to a gluten-free
diet. A poor response to the diet is common."

[This is the area where I know our opinions diverge but please hear me
out for a moment. There are 23 feet of small intestine and a biopsy
is attempting to identify small patches of villous atrophy. I have
many, many patients who are extremely gluten sensitive whom have been
told that they are absolutely fine to eat gluten. Why are they told
such a thing? Because their biopsy was negative. Are we really
helping our patients condemning them to lifelong suffering based on a
test of such a gross nature? I don't believe so. Much of the poor
response to diagnosis may very well occur because so much damage has
been done when a diagnosis is finally confirmed. By the time the villi
are flattened, often irrevocable damage has occurred to the digestive tract or some other organ system. Once autoimmune disease occurs, complete remediation is often not possible. Below Dr Green mentions the importance of early diagnosis. I don't believe that for the majority of people suffering from gluten sensitivity that early diagnosis is going to occur based on the use of intestinal biopsy alone. It’s too gross of a test for many patients and too insensitive at time to detect subtle changes of the villi. This is the very reason I utilize the testing I do, including the response of from the patient upon elimination of gluten from their diet. Early diagnosis is exciting because a patient discovers that they are gluten sensitive while they still have good functioning of their small intestine. A true early diagnosis should occur long before intestinal villi have been severely damaged. And that in sum is what I believe will be looked back on as our current greatest mistake - waiting for villous atrophy on biopsy before diagnosis is akin to waiting to diagnose risk for cardiovascular disease until the patient has suffered their first heart attack. As doctors we promise to do no harm. I believe we must seriously rethink and readjust our diagnostic criteria for diagnosing celiac disease and gluten sensitivity.]

"Increasing awareness of the epidemiology and diverse manifestations
of the disease, as well as the availability of sensitive and specific
serologic [blood] tests, especially among primary care physicians, will lead
to more widespread screening and diagnosis, which in turn will lead to
greater availability of gluten-free foods and efforts to develop drug
therapies that relieve patients of the burden of a gluten-free diet.
In addition, earlier diagnosis may lead to a reduction in the
complications of the disease."

Thank you for your time. I'd be happy to send you a copy of
our upcoming book, The Gluten Effect. And I'd would love to hear your
feedback.

Yours in health,

Dr Vikki Petersen

Friday, January 02, 2009

Where did my flat tummy go?


Below is a case study from our upcoming book, The Gluten Effect. J.W. had some very common complaints, but the "common treatment" she was receiving was having no effect. I think she speaks for many.

No, I’m Not Pregnant!

J. W. is a classic example of weight complaints typical of adrenal exhaustion. She had developed a big belly that she could not get rid of. She felt bloated all the time, and no matter how often she exercised or how closely she watched her caloric intake, her weight remained the same. She felt constantly four months pregnant.

We diagnosed her with gluten sensitivity, and after being off gluten for several months, she went from a size fourteen to a size six, with a thirty-pound weight loss. She not only lost the weight, but it came off her “problem areas” first—her stomach and her face. She now had a flat belly, which she had never enjoyed before. J.W. also noted that her bloating was gone, and that she felt “clean” inside.

We diagnosed several infections, which were treated successfully as well, which also removed other chronic stressors from her system. In J.W.’s case, the distribution of weight around the mid-region of the body was typical of excessive cortisol production with adrenal exhaustion. Once gluten was removed, the stress on her body subsided, and a normal weight distribution returned.

Does this sound like you? Have you developed a “spare tire” (or, I’m told the more politically correct description is “muffin top”)?

What we’ve discovered after working with patients for over 20 years is that much of that “tire” can be due to swelling of the small intestine and the resulting adrenal fatigue from malabsorption of nutrients. You have about 23 feet of small intestine. Look down - that’s a lot of track to be laid down in a relatively small space.

Now imagine that 23 feet is swollen due to irritation created by a diet that doesn’t suit your body, or an infection. When it swells it has to go somewhere – welcome spare tire!

So the solution is to discover the underlying cause of the swelling. Now I’m not against exercise, quite the contrary. But I can promise you that all the crunches in the world will not flatten a tummy that’s swollen from a food intolerance or irritation from an untreated parasite or bacteria.

What do you need to do?

1. Discover if you’re gluten intolerant for starters. There are tests available for this and remember we’re talking about finding out if you're sensitive to gluten, not just if you have celiac disease.
Enterolab has a test you can order yourself (http://www.enterolab.com/ ) or you can work with your doctor providing they understand the difference between gluten sensitivity and celiac disease.
2. If you already know that you’re sensitive to gluten then realize that you must be perfect about removing it from your diet. Being good “most of the time” is just not enough.
3. If you have not had a comprehensive stool analysis to check for the presence of infectious organisms this really is something you should look into. As was mentioned in an earlier post, it is rare that a gluten sensitive individual DOESN’T have some type of infection due to years and years of assault on the immune system from eating gluten.
4. Get an idea of how your adrenal glands are functioning. We're not talking about adrenal gland disease which is very serious, but rather adrenal fatigue or exhaustion which is quite common. There will be an upcoming post specifically on the adrenal glands soon but suffice to say adrenal fatigue is very associated with malabsorption of nutrients which as you know is definitely an effect of being gluten sensitive. The good news is that with some natural nutrition and lifestyle management, adrenal function is not difficult to restore.
5. Lastly if you’ve already done all of the above and still don’t have the flat tummy you desire, you most likely are suffering from a “leaky gut” which needs some extra support to get completely healed. This support could come in the form of strong probiotics, the amino acid glutamine (not to be taken until you’re assured of not having an infection, however) or a medication called ketotifen which has a local effect to reduce irritation in the gut. This last medication would only be used for a short period of time.

I hope this is helpful.

Happy 2009! Our book “The Gluten Effect” will be out next month and it is one of our new year’s resolutions to have gluten sensitivity "come out of the closet” this year and be recognized for how common and hazardous it is to millions of people's health.

To your good health,

Dr Vikki Petersen