It’s All in the Gut… Or Is It?

Taking a look at Non-Digestive Symptoms

While it seems that “everyone” knows about gluten these days, the sad facts are that close to ninety percent of those suffering from celiac disease remain undiagnosed. As a serious condition that is known to shorten life expectancy, it is a terrible shame to realize that many thousands continue to eat gluten unaware of the damage and ill health it is creating for them. A large study that compiled data from seventeen different research studies concluded that those with celiac disease were risk of early death from all causes, especially from non-Hodgkin lymphoma, a type of cancer.

Gluten sensitivity, or non-celiac gluten sensitivity (NCGS), as it is more frequently being labeled, too suffers the problem of under-diagnosis. Not enough research has occurred on the condition to have a stable estimate of the percentage affected, but it’s clear that it’s greater than the one percent suffering from celiac disease. The Center for Celiac Research estimates that approximately six percent of the U.S. population, or eighteen million people, suffer from gluten sensitivity. Other researchers feel the number is likely much higher and my clinical experience concurs.

According to Dr Fasano, “during the past 35 years, celiac disease has doubled every 15 years in the U.S.” He feels the increase is coming from the increased damage occurring to our digestive tracts and immune system from the affects of drugs, toxins, GMO foods, and pesticides damaging the gut’s microbiome, the one hundred trillion organisms that are probiotics and give strength to the human immune system and gut. He states the decrease of the Lactobacillus population, one of many probiotics, can trigger celiac disease.

Celiac disease causes an autoimmune reaction to occur in the small intestine, damaging its ability to absorb nutrients, creating a leaky gut and inflammation that can lead to further autoimmune diseases plus other conditions including infertility, neurological problems, osteoporosis and cancer. The “classic” symptoms associated with celiac are bloating, abdominal pain, diarrhea and weight loss.

Gluten sensitivity (NCGS) is not an autoimmune condition and is associated with digestive symptoms such as bloating and abdominal pain similar to IBS (irritable bowel syndrome), plus extra-intestinal problems including fatigue, headaches, brain fog, tingling of the extremities, schizophrenia and autism.

As you can see, both conditions suffer from digestive and non-digestive symptoms alike, and both include neurological-related problems.

There are researchers who have found such a strong link between gluten and the nervous system that they surmise that if celiac disease was discovered for the first time in our current society, it would likely be classified primarily as a neurological disease and only secondarily as a digestive one due to the pervasive and primary neurological problems associated with gluten.

In 2010, the Lancet Neurology stated, “MOST patients with neurological manifestations of gluten sensitivity have few gastrointestinal symptoms.” The Journal Pediatrics found young patients with celiac disease were more prone to develop neurological disorders (51.4%) in comparison with control subjects (19.9%). These disorders include headaches, hypotonia (low muscle tone), developmental delay, learning disorders and ADHD, and cerebellar ataxia (unstable gait).

The problem of under-diagnosis, I believe, may stem from the “non-classic” symptoms associated with both conditions. The “snap answer” associated with both celiac disease and NCGS is that both conditions manifest in the digestive tract. That is both true and untrue. When symptoms are of a non-digestive nature, the suspicion of gluten being at the root cause of the problem is very low – hence a missed diagnosis.

The result? Many suffer, get sicker and often never receive the correct diagnosis. Due to the genetic nature of these conditions, a missed diagnosis in one individual, thereby continues that “miss” in other family members, children, etc. A diagnosis found, on the other hand, spreads that knowledge to more and more family members, creating increased health throughout the family tree.

I mentioned that the “classic celiac” presents with the symptoms of bloating, digestive pain, diarrhea and extreme weight loss. The problem is that many celiacs today never manifest the disease in that way. This explains why the criteria for diagnosis has changed to a quantitative approach called the “4 out of 5” rule. In 2010, the American Journal of Medicine published the criteria, stating that simple rules were better than complicated algorithms. As a side note this was the same publication that gave official recognition to the condition gluten sensitivity. Based on the culmination of meetings with more than a dozen of the top celiac researchers around the world, a celiac diagnosis was mandated to be made based on the presence of 4 out of 5 positive findings. These findings consist of:

1. A positive celiac blood test

2. Typical symptoms of the disease

3. Symptoms that improve on a gluten-free diet.

4. A positive genetic test.

5. A positive intestinal biopsy.

The big change associated with the new criteria was the intestinal biopsy no longer held the “gold standard” status it had previously. Ask most gastroenterologists about celiac disease a few years ago (and sadly still today), they would state that a positive intestinal biopsy was a mandatory finding when making a diagnosis. That is no longer the case and something all patients and their doctors should know.

This knowledge should increase the percentage of those receiving a correct diagnosis and save untold numbers from continuing to suffer from ill health. I well recall my frustration after meeting countless number of patients who had positive, the first 4 criteria mentioned, but were yet told by their doctors that they didn’t need to change their diet because their biopsy was negative. Once I enlightened them that they did indeed have the disease, they were, one for one, grateful for the diet change because they started to feel so much better!

Both celiac sufferers and those with non-celiac gluten sensitivity (NCGS) typically feel much improved once a gluten-free diet has begun. That improvement often doesn’t last, despite a vigilant gluten-free diet. It doesn’t mean that the gluten-free diet isn’t beneficial, but what it does mean is that other factors are putting such stress on the immune system, digestive tract and other organs that symptoms return.

The cause for this is something I call the secondary effects of gluten, a name we created when we wrote our book “The Gluten Effect”. The secondary effects include such things as other food sensitivities, intestinal infections, cross-reactive foods, toxicity and hormonal imbalance which can, unfortunately, reduce the effectiveness of a gluten-free diet. It’s not that the gluten-free diet isn’t needed; it absolutely is. The issue is that regaining full immune system strength and healing of the gut, along with any other affected organs or systems, does frequently require additional therapies, and addressing the secondary effects of gluten is key. The good news is that it isn’t difficult and involves no dangerous drugs or surgery.

The truth of the matter is that, according to research, there isn’t an organ or system of the human body that gluten doesn’t affect, potentially. Am I saying that gluten is the cause of all disease and ailments? No, but I am saying that with the potential adverse reactions gluten is known to incur, it definitely is warranted to rule it out as a causative agent when your body isn’t functioning optimally.

Laboratory testing is always the best first step, but what if your doctor doesn’t comply or your insurance doesn’t cover or you just can’t afford it? In that case, there is nothing wrong or dangerous in following a strict gluten-free diet for 6 weeks and evaluating how you feel. You do need to be strict, however. Adopting a “mostly” gluten free diet is a waste of time. Unfortunately it’s either gluten or no gluten – “low” gluten is fairly worthless. When considering a lifetime of food, a few weeks without a substance that could be adversely affecting your health, is most certainly worth it.

No one ever suffered adversely from the lack of gluten in their diet. Human evolution is 2.5 million years long and for 99.9% of that time we had no gluten in our diet. Remember, gluten is a complex protein that no human can properly digest, even if they don’t have celiac disease or NCGS. It is for that reason so many are suspect if any of us should be eating it. As respected researcher Dr Alessio Fasano says: “We are not born with the destiny to develop autoimmune disease. We are also not born to deal with gluten.”

The takeaway for you is that both celiac disease and gluten sensitivity can affect the human body in many ways beyond digestive. My desire is to increase our diagnosis of those suffering such that our population can lead healthier and thereby more productive lives. Get tested for both conditions. If you can’t, try a strict gluten-free diet for 6 weeks.

If you have questions or need any help, I’m here for you!

 

To your fabulous health,

Dr Vikki Petersen, DC, CCN, CFMP
Founder of HealthNOW Medical Center
Author of “The Gluten Effect”




Getting Glutened

Hidden Gluten

Maintaining a gluten free diet isn’t easy. If you’ve been “glutened” you know how miserable it can make you feel but this can be avoided by following the tips below!

Let’s begin with hidden gluten. Labeling laws have certainly helped and any issues surrounding unlabeled gluten are pretty much a thing of the past. Where we can run into trouble is primarily in three areas, two of which are completely controllable:

1. You neglect to read the ingredient label carefully. Some foods seem so “clearly” gluten free that reading the label seems unnecessary but you will be surprised at the types of prepackaged and prepared foods that contain gluten.
2. You are eating in a restaurant or visiting a friend’s home and ingredient labels aren’t readily available. You don’t want to call attention to yourself, so you just try to “guess” what is gluten-free.
3. A product labeled as gluten-free turns out to be contaminated due to a manufacturing problem. Nothing you can do about this one, although I do have some thoughts about it that I will discuss below.

The bottom line is you must study food a bit. When we are discussing gluten exposure in those with celiac or NCGS (non-celiac gluten sensitivity), the truth is that even small amounts of gluten pose a serious danger to your health and longevity. In the same way you would study seriously for an exam that allowed you to move forward in your career, you must take just as seriously the study of food such that you understand where gluten may potentially hide. Your health depends on you being a good student.

Let me give you a couple of examples from patients. A professional photographer had done outstandingly under care reversing chronic bronchitis and a longstanding autoimmune disease. He made every effort to avoid gluten. Suddenly his symptoms worsened again. Dissecting his diet I discovered that he “loved” ethnic Asian food and had no idea soy sauce contained gluten. He was convinced that liquids couldn’t contain gluten and this mistaken conviction resulted in a return of his illness due to a daily lunch of sushi.

A few years later after another relapse he discovered the wasabi he was mixing with the gluten-free soy sauce sometimes contained gluten. I gave him the heads up that sushi sticky rice too can contain gluten and hopefully we have now exhausted all the potential gluten pitfalls of Japanese food.

Another busy executive who ate out often due to work, liked to order a “clean” meal consisting of fish, a salad and some vegetables. It seems innocent enough but…Those of us who cook know that fish such as sole tends to fall apart when sautéed. A common culinary practice is to “dredge” fish in a light coating of egg and flour to ensure it holds together when cooked. Remember, gluten has a “glue-like” quality to it. Chefs don’t even think about it and the fish won’t be labeled as breaded on the menu. The floury coating is so thin that if you aren’t paying attention you wouldn’t notice it. Unfortunately your immune system does and this patient fell ill again as a result.

If you’re a meat eater, watch out for meatloaf, meatballs or processed meats such as sausage. In the grocery store the label would reveal the gluten content, but it you ordered them in a restaurant you would need to ask if the sausage contained gluten, as an example.

Salad dressings are another potential culprit, therefore always best to ask for ingredients or have them bring you olive oil and vinegar and you can dress the salad yourself.

French fries, a favorite American staple, are just fried potatoes, right? Unfortunately the potatoes are often coated with a blend of wheat flour and spices to make them more flavorful.

Safe Restaurant Dining

Learning about food preparation plus becoming a bit of a detective is needed to prevent getting “glutened” when eating outside your own kitchen. Even if you’re fortunate enough to find fries that have no gluten, you must think about how they’re cooked. Does the fryer also fry foods containing gluten? If the appetizer menu contains fried zucchini, onion rings or other classic gluten-containing foods, you must ask if they use the same fryer for everything. If so, the oil has enough gluten floating around to contaminate the fries.

This can seem overwhelming, I understand. In the same way that a new area of study seems confusing until you understand it, food and cooking can feel the same way, at first. However, once you learn the basics, you’ll discover it’s not difficult. You need to be willing to obtain this knowledge however. No one is going to care for your body if you don’t. Going to a restaurant and mumbling something about avoiding gluten to the wait person is not adequate. You must stand up for yourself, ask questions and ensure you are safe from gluten. Getting over any thoughts of embarrassment or sounding pushy is something you must do – your health is in your hands. Feeling great is worth the effort and soon is will become second nature to you.

There is a point where successful gluten avoiders attain their good health by making the decision that their body is more important than what anyone else may think of their dietary choices. In other words they move past any considerations that asking questions or truly ensuring their meal is gluten free is anything but the right thing for them to do.

As I learn again and again from patients, sharing your condition with others, be it friends or someone at a restaurant, typically educates that person in a way that will help them or someone they care about. Don’t be shy. You’ll help yourself and likely the person you are educating as well!

Helpful Enzymes

A “first aid” kit in the way of digestive enzymes is a good idea to have on hand if you’re eating out. First a disclaimer: please understand that taking an enzyme product designed to help the breakdown of gluten is not permission to cheat. Such enzymes are designed to lessen the blow to your immune system, gut and other related organs due to gluten contamination. They DO NOT give you permission to eat gluten intentionally. Their purpose is to lessen the negative reaction from a contaminated food, they cannot completely negate the negative effects of gluten ingestion.

You should not need these types of enzymes when you are cooking for yourself, but when eating out it would be a good idea to have them on hand. There are a variety of such products available and while I don’t want to endorse just one, a little online searching should give you all the data you require.

You’ve Been Glutened, Now What?

The effects of being glutened can be mild and uncomfortable or downright severe and debilitating. Once you have determined it’s happened, the first thing to do is to take some good quality enzymes as mentioned above. Next drink a lot of water to keep your system hydrated to assist your body to remove toxins. If you have a good probiotic product, you may take that as well. Beyond that there isn’t much you can do beyond figuring out HOW you got glutened! Whatever the culprit, try your very best to discover how you can prevent such a problem from recurring. It is absolutely key to regaining your health.

A Note On Manufactured Foods

General Mills’ recent recall of close to 2 million boxes of Cheerios is an example of a food labeled as-free being contaminated through poor manufacturing processes. My thought on this is that such things tend to occur in companies that mostly manufacture gluten containing products and those products are not particularly on my “most healthy” list. I understand the viewpoint of providing your child with something “all” the other kids are eating, but truthfully we need to strive to provide truly healthy food for ourselves and our family much more than we need to follow the status quo.

Make a chia pudding the night before or some buckwheat cereal with fresh fruit, or perhaps a yummy smoothie for breakfast. All these are 100X healthier than Cheerios, even when it is gluten-free. And if you want a boxed prepackaged cereal for special occasions, then consider a company that only manufactures gluten-free products. The odds of contamination are greatly reduced.

I hope this was helpful. Please feel free to contact me with questions or any assistance you need to improve your health. I’m here to help!

 

To your fabulous health,

Dr Vikki Petersen, DC, CCN, CFMP
Founder of HealthNOW Medical Center
Author of “The Gluten Effect”

 




Depressed? Eat This Carbohydrate, Not That One!

Can you increase or decrease your risk of depression depending on what you eat?

Yes, says a study published in the American Journal of Clinical Nutrition involving 70,000 female participants whose mental status and diets were followed.

A dietary association to depression is exciting news when you consider the amount of prescription medications prescribed for the condition is enormous. The medications are riddled with life threatening side effects including violent behavior, not to mention suicidal tendencies. Identifying the true root cause of depression is vital.

According to the study results, those who consumed highly refined carbohydrates such as white bread, pasta and soda, had a higher risk of depression and were more likely to be diagnosed with a mental illness.

Those who ate the highest amounts of fiber, fresh fruits (not fruit juice) and vegetables had a lower risk of depression.

Dr James Gangwisch of Columbia University, study author, cited the hormone insulin as a contributing factor. Insulin is secreted when one eats simple, refined carbohydrates and its levels rise sharply after the consumption of refined white flour and sugar, followed by a sudden crash of blood sugar. The crash is associated by a variety of symptoms, including depression, anxiety, fatigue and further sugar/carb cravings.

By comparison, complex carbohydrates release energy more slowly, thereby ensuring energy levels stay even and keep a person’s mood relatively stable.

Complex carbohydrates such as vegetables, fruits, beans and legumes, do not result in an insulin response. These carbohydrates are broken down slowly yielding a stable blood sugar level, not the steep rise and fall seen with refined starches and sugar. The fiber content of complex carbohydrates are stabilizing to the health of the digestive tract, the 100 trillion friendly probiotic organisms housed within, not to mention healthier hormonal balance.

It’s almost unfortunate both groups of foods are known as “carbohydrates” when they couldn’t be more different in terms of their tendencies to cause health vs. disease.

Too, it’s worth mentioning when we speak of white bread and pasta, we are speaking of gluten. It has long been known gluten creates neurological problems such as depression before digestive problems become manifest, and it’s not unusual for neurological problems to be the sole manifestation of a negative reaction to gluten. This happens in those suffering from celiac disease and gluten sensitivity (NCGS).

Depression is often categorized solely as a mental illness, causing it to be less objectively evaluated as compared to other medical conditions, such as high blood pressure or diabetes. This is unfortunate because it is a real and common health disorder affecting millions, and those suffering deserve to have its true root cause identified. In individuals with negative reactions to gluten, it appears somewhere between twenty and thirty percent are affected by depression, significantly higher than the five percent attributed to the normal population.

Children don’t escape gluten’s impact on emotional health. Research evaluating twenty-nine children and adolescents with celiac disease (an autoimmune disease caused from gluten consumption) conducted assessments for depression and behavior disturbances. Compared to twenty-nine children without celiac disease, thirty-one percent of the affected children had depression compared to seven percent of the control group. Additionally, twenty-eight percent had disruptive behavior problems compared to three percent of the healthy group. The researchers noted depression was the presenting symptom for many of the children who eventually were diagnosed with celiac disease.344

There are many such studies and they are included in our upcoming “The Gluten Effect 2” book. The concept that depression, anxiety and other mental symptoms are due to a chemical imbalance of the brain, have not been born out. Fortunately the association with diet has been documented quite vigorously through research. It’s much easier to change what’s on the end of your fork as opposed to swallowing a pill with hazardous, life-threatening side effects.

Our goal here at HealthNOW is to identify and treat the true root cause of the problem – it’s something we specialize in. If you have symptoms of depression, anxiety or mood swings, consider contacting us for a FREE health analysis – call 408-733-0400. We can diagnose the true root cause underlying the symptom – there always is one. We are here to help!

To your fabulous health,
Dr Vikki Petersen, DC, CCN, CFMP
Founder of HealthNOW Medical Center
Author of “The Gluten Effect”

 




Are You Confused About Your Celiac Disease Lab Results?

We at HealthNOW Medical Clinic San Jose know that, as if it wasn’t hard enough to convince some doctors to do a celiac disease test—let alone one for gluten sensitivity—once you finally DO get tested, the interpretation of the results can be faulty.

While you shouldn’t have to question your doctor, unfortunately when it comes to the interpretation of lab tests relating to celiac disease or gluten sensitivity, you may have to learn some test interpretation lingo in order to save your own health.

Don’t worry about it being difficult to learn this data. I’ll make it easy to understand. The important thing to know is that if you don’t feel well, there is a reason. It may be a problem with gluten, it may be something else, but it IS something. Don’t give up. If you need my help, I’m here for you!

Celiac Disease Test: What You Need to Know

Before jumping into the lab test, I wanted to clear up a couple of words you commonly hear regarding tests—and that is their sensitivity and specificity. The definitions of these words are as follows:

Sensitivity simply means the true positive rate or the proportion of positive results are correctly identified. If 90% of celiacs were correctly identified by a certain test, it would be said to have a high sensitivity.

Specificity is the opposite and is often called the true negative rate. It is the proportion of negative results which are correctly identified. If a test identified correctly 90% or more of healthy people as having a negative result, that test would be considered to be highly specific.

A perfect test (it doesn’t yet exist) would be one that was 100% sensitive and 100% specific.

The tests we are about to discuss detect autoantibodies which are substances the body auto creates as part of an immune response to dietary proteins it considers are toxic (antibodies)—such as gluten and gliadin. These autoantibodies can cause intestinal inflammation and damage in the lining of the intestinal wall as well as other parts of the body, resulting in autoimmune disease.

Below are some commonly used lab tests for celiac disease and gluten sensitivity. Feel free to use this section as a reference for the later section which discusses real life examples that people have shared after receiving a celiac disease test:

tTG Celiac Disease Test

Anti-tissue Transglutaminase Antibodies, IgA – abbreviated tTG-IgA.[Note: these are substances produced by your immune system that are directed or targeted against “self” tissue – meanng parts of your own body. After gliadin (the destructive part of the gluten protein) 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 made up of gliadin attached to the tissue transglutaminase enzyme.

When positive this test is considered 90 percent sensitive at accurately diagnosing celiac disease because the presence of these antibodies correlates highly with the immune system attacking and destroying the intestinal lining, known as villous atrophy.

The test is not only sensitive (90%) but highly specific (98%), the latter meaning that it won’t tell you that you have celiac disease if you don’t. There is a “loophole” to the sensitivity feature however. Much damage needs to occur to the lining of the small intestine before this celiac disease test shows positive, making it a poor early marker for celiac disease. One doesn’t want to have to wait until they are at an advanced state of intestinal destruction. This test won’t show positive until damage is severe. Additionally not all celiac sufferers demonstrate villous atrophy and therefore this wouldn’t be the best celiac disease test for them. TTG- IgA is also not a test for gluten sensitivity.

Another liability to this most common celiac disease test is that typically only immunoglobulin A (IgA) is evaluated. IgA, a part of the immune system primarily found in mucous membranes, such as the small intestine, is the most sensitive for antibody testing, but only when a patient has normal functioning.

Total IgA

Total Immunoglobulin A, abbreviated total IgA, is an adjunctive test that should be done to prevent false negative test interpretation. IgA deficiency is 10 to 15 times more common among patients with celiac disease than in the general population. Thus, total IgA levels should be quantified in a separate “total IgA” test to ensure that IgA function is normal. If a deficiency is present, all tests utilizing IgA could be falsely negative, causing one to miss the presence of celiac disease or gluten sensitivity. Low IgA level s suggest inflammation of the intestinal lining and greater chronicity of disease. A low IgA level may provide some insight into duration of disease.

If IgA sensitivity is suspected or confirmed, measuring IgG in the form of a DGP test is the best alternative, or Cyrex Labs, mentioned below also offer great alternatives. Knowing this data is critical to ensure that you are not told that a test is negative when it’s a false negative.

DGP Celiac Disease Test

Deamidated gliadin peptide, IgA and IgG, abbreviated DGP – IgA/ IgG has a high specificity and is considered a useful test among patients who have selective Immunoglobulin A (IgA) deficiency.

EMA Celiac Disease Test

Endomysial antibody, IgA, abbreviated EMA-IgA. [Note: endomysium is a thin connective tissue layer that covers muscle fibers. These antibodies develop in reaction to damage to the intestinal lining. When the immune system attacks gliadin, 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. Due to their attack of the smooth muscle of the small intestine, EM 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, and therefore like the tTG test, it suffers from a lack of accuracy when only mild damage has occurred to the intestinal lining.

This is highly specific celiac disease test but it has variable sensitivity of 70 to 100 percent, due to the technical difficulty associated with performing the test. This liability associated with a higher expense makes it more of an adjunctive or follow-up test rather than a first line screening tool.

AGA Celiac Disease Test and Gluten Sensitivity Test

Anti-Gliadin Antibodies, IgG and IgA, abbreviated AGA –IgA/IgG. [Note: Gliadin, the most abundant protein in wheat, is part of the gluten protein (similar proteins are found in rye, barley). Gliadin is broken down in the intestine to segments of protein (polypeptides) called exorphins. These exorphins can be responsible for many of the “extra-intestinal” symptoms associated with gluten sensitivity as they can cross into the brain creating behavioral changes, outbursts, inattention, mania and other symptoms associates with schizophrenia, bipolar, ADHD and autism. According to Dr Davis, ingesting gliadin increases one’s caloric consumption by 400 calories per day!]

Antibodies to gliadin can bind to nervous system tissue and contribute to many of the neurological symptoms associated with gluten sensitivity such as ataxia, migraine, mood swings and more.

There is no official test that has been approved for testing gluten sensitivity, but many feel that AGA is one of the best we have and both IgA and IgG are tested. AGA isn’t typically used to diagnose celiac disease but it is recommended as a follow-up test to help ensure the celiac patients are following their gluten-free diet. A positive AGA test on a celiac patient can indicate poor adherence to the diet.

Genetic Celiac Disease Test

Genetic testing – a simple swab of the cheek can tell you if you carry the genes for celiac disease (HLA-DQ2 or HLA-DQ8). If you do not carry the genes it is impossible for you to ever develop the disease. Upon that point everyone is in agreement. However, beyond that there are some varying opinions. Many doctors point out that if you aren’t showing signs of the disease there’s no reason to implement a gluten-free diet. Personally I think having one gene, let alone two, is more than enough reason to embark on a gluten-free diet if you are experiencing any health issues. Of course following up a positive genetic test (there are some genes that are thought to predispose one to gluten sensitivity vs celiac disease and we often see patients who are clearly sensitive to gluten possessing one of each type. More research needs to occur in this area.) with available blood tests for both celiac disease and gluten sensitivity, along with the presence of typical symptoms and the improvement of said symptoms once a gluten-free diet is embarked on, all total to a valid diagnosis, without the need of an intestinal biopsy.

Anti-Reticulin Antibodies, IgA, abbreviated ARA-IgA. This test is not ordered as frequently due to its lack of sensitivity and specificity as compared to other autoantibodies. It is found in about 60% of celiac disease patients and about 25% of patients with dermatitis herpetiformis, the skin condition associated with celiac disease. When used, ARA is ordered along with other celiac disease tests as part of a panel.

Cyrex Labs

Cyrex Labs – 11 Arrays. Saving the best for last, I want to mention Cyrex Labs that are fairly new on the scene as a lab but are, to date, offering some of the best insights to how a body is being affected by gluten, be it celiac disease or gluten sensitivity. The lab offers many “Arrays” that shed light on not only a reaction to gluten but secondary effects of gluten as well in the form of cross-reactive foods, leaky gut autoimmune tendencies and many more.

I mention this lab last as it is a specialty lab and therefore not available from most traditional medical doctors and I dare say that most gastroenterologists have likely never heard of them. But they provide excellent tools that are currently unavailable elsewhere.

6 Stories: Real People Write In for Help with Celiac Disease Test Interpretation

Below are some real life examples that have come to my attention via my blog and practice regarding a celiac disease test and what patients have had to endure regarding faulty interpretation of their tests.

“Was told I’m not celiac….But I feel horrible. Below is my celiac disease test, what do you think?”

First are my old results:

Gliadin Antibody IgG 31 – High Range Normal = <11
Gliadin Antibody IgA 6 – Normal = <6
Tissue Transglutaminase IgA <3 – Normal = <5

Then last year everything was pretty much the same but Gliadin IgG 23.4 High Range , Normal = <10

What does it mean and if I’m not celiac why does gluten seem to make me feel so horrible? Help!

It hurts my heart to see such things. To interpret, this gentleman tested positive for non-celiac gluten sensitivity years ago. His doctor interpreted his celiac disease test as negative for celiac, an evaluation with which I don’t disagree. However, and this is a BIG however, the doctor neglected to mention that his immune system was definitely having a negative reaction to gluten – something we call non-celiac gluten sensitivity (NCGS). Of course since he didn’t eliminate gluten his test continued to be positive, which we see in the later results.

The poor man feels horrible and it could have been completely prevented by correctly interpreting the celiac disease test correctly the first time.

Moral of the story: get the most comprehensive test you can. If you see anything abnormal, find someone who can correctly interpret the test. Don’t ignore what your body is telling you. If you need my help, I’m here for you.

oOo

Here’s another one:

My daughter recently had the following blood work results. These were ordered by her General Doctor as she was experiencing diarrhea. No other major symptoms. The results were/are:

Endomysial Ab IgA – Negative
Tissue Transglutaminase Antibody (tTG) 23 – Normal is 0-20.
She was advised that she is allergic to all glutens. Is that correct?
She has been referred for an endoscopic examination with a specialist.

Let’s look at this one. Realize this is a mom writing about her child so the phrase “allergic to all glutens” isn’t exactly correct, but that’s fine. Where the potential problem lies is in the outcome of the endoscopy test with the specialist. If it’s negative, is the specialist going to tell the mom that there isn’t any damage so therefore she shouldn’t subject her child to the rigors and severity of a gluten-free diet? I’ve seen that happen on many occasions.

The tTG test above is clearly positive and that indicates celiac disease. The child has diarrhea which is a classic symptom of celiac disease. If she removed gluten from her diet and was shown to have the genes for celiac disease, the outcome of the endoscopy would be moot. It would mean that four out of five necessary criteria for a celiac diagnosis would be met without the need for either doing the endoscopy or having a positive result.

Too often doctors are unaware of these criteria, which were published world-wide several years ago, by leading research experts from around the world in the area of celiac disease. About twelve different experts agreed on these criteria while also validating the presence of non-celiac gluten sensitivity as a valid condition.

I truly hope this child is put on a gluten-free diet before more damage can occur to her body.
Moral of this story: Do some research and know what it takes to receive a positive celiac disease test result, as well as a positive NCGS diagnosis. Actually your research is done right here by reading this blog! If you need more help, feel free to contact us through HealthNOW Medical Clinic San Jose.

oOo

Patricia V said…
I have been having stomach issues. I went for a blood test and this is the result of the celiac disease test:
Transglutaminase IgG <15
Transglutaminase IgA 27.3
Gliadin IgG: <15
Gliadin IgA <15

My primary Dr. said he thinks I might have Celiac Disease (and so does my mother). He wants me to make an appt with a Gastroenterologist. Just by the numbers (after all my research) it looks like Celiac. Transglutaminase is elevated – isn’t that indicative of Celiac? I am just confused by the “might” comment. Any thoughts?

I include this one as it is a classic example of something we see often. Now this particular patient is very pro-active. She did her own research and correctly, I might add, diagnosed herself. She’s correct, her test is highly indicative of celiac disease with the transglutaminase value (tTG) being elevated. As I mentioned in the previous example, many doctors don’t know that a biopsy doesn’t have to be positive in the face of adequate criteria that make the diagnosis of celiac disease.

Let’s imagine this patient wasn’t so pro-active. Let’s imagine she didn’t have the wherewithal to go to see a specialist – the gastroenterologist. What if the thought of seeing a specialist, let alone the cost of doing so was overwhelming to her? What if there was a 6 to 9 month (or more) wait to see the specialist? In other words, there could be many reasons a patient who very likely has celiac disease is not going to pursue it further. And because the doctor was keeping it all so vague, an individual could very likely leave with the idea that they “might” have something but since the doctor wasn’t emphatic they can brush it off.

If this sounds unlikely, let me assure you that I have run into this scenario more times than I’d like. The result is a person who becomes more and more ill from a disease that they later find could have been prevented by removing gluten from their diet. If they had only had their lab test interpreted correctly, they could have stopped eating gluten and prevented the development of a disease that is now shortening their life.

oOo

Here’s another real life example:

A woman had been previously diagnosed from her doctor with DH (dermatitis herpetiformis), a very unsightly and uncomfortable skin condition and a form of celiac disease. DH is absolutely known to be caused by gluten, yet this was never told to this patient. Fast forward a few years and this woman has now developed more health problems, specifically multiple sclerosis, an autoimmune disease of the nervous system.

Gluten is known to create autoimmune disease. Further, gluten is known to affect the nervous system more than any other system in the body, including the digestive tract..

Upon seeking help after her M.S. diagnosis, a smart doctor noted that she had DH and recommended a gluten-free diet. She is feeling better gluten-free but she now has M.S., a disease she could have avoided developing.

Can we state categorically that if she had eliminated gluten upon first being diagnosed with DH that she would not have developed M.S.? No, we can’t. But it does cause one to wonder what could have occurred if, once the “skin manifestation of celiac disease” (DH) was first diagnosed, a gluten-free diet was implemented.

The reader also asks if blood tests can be negative with DH. Yes they can and frequently are. 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 to have DH which is solely due to gluten, 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 has now been 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 celiac disease test ensure that gluten had nothing to do with the development of MS? No, it doesn’t, since that often happens with DH patients. 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.

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!

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 can cause is staggering.

oOo

The next example is another classic example of where, in my opinion, our medical profession “falls down” when diagnosing celiac disease. The individual below has a positive celiac disease test, yet after 4 months on a gluten free diet, feels no better. As confused as she is, how long do you think she will continue the diet when she feels no better? Let’s take a look and then I’ll explain what is likely going on.

These are my test results:
Gliadin Ab (IGA) 49 units (<20)—[Is it very high? What would be the highest number?]
Gliadin Ab (IGG) 13 units(<20)
Endomysial Ab : Positive

Those were tests I had for celiac. Doctor told me to go on gluten free diet since tests are positive for celiac disease. But what does it mean that IGG is negative? And IGA 49 confirms celiac?
I didn’t have a biopsy performed. I am 4 months on gluten free diet and I am not feeling better. 🙁
Thank you
Ada

It is the positive endomysial test that has caused her doctor to diagnose celiac disease. The AGA – IgA test is also positive, giving us strong evidence that her body is having a negative reaction to gluten. We humans are so funny sometimes. In an effort to justify why we can go against the result of a positive test, we ask “how positive is it’? It’s like getting a positive pregnancy test back and asking “how pregnant am I?” It’s an all or nothing proposition. When a test is positive it’s positive, period.

I further went on to explain to her that a body either has celiac disease or it doesn’t. There’s no such thing as ‘mild celiac’ or ‘a little celiac’.
With that said, I don’t blame her for questioning the diagnosis when she’s not feeling any better following the diet. This individual wrote in from a blog. Since she wasn’t a patient, I had no more data to hand than what was provided. But since the EM test is so highly accurate, it’s unlikely that Ada is not being negatively affected by gluten. The reason she doesn’t feel better likely lies in the area of the secondary effects of gluten that haven’t been addressed that are perpetuating her symptoms. I speak often on this topic, feel free to search the blog for more information.

oOo

We mentioned earlier when reviewing celiac disease test options that a low IgA can potentially falsely affect test results. Below is such an example.

My results are:
Transglutaminase Ab (Iga) <3
IgA SERUM 52 low
C-reactive is high
Feel awful, weight gain, have high blood pressure, inflammation and pain.

When the total IgA results are low, any test utilizing that immunoglobin will be false. Therefore we cannot tell whether this person has a positive tTG or not. It’s too bad that the lab did not also measure IgG in the form of other tests. The high C-reactive protein shows inflammation, so it is important to figure out where that it coming from.

We definitely cannot state for sure that the individual has celiac disease but we do know that inflammation is present and something is overwhelming his/her IgA, a key constituent of the immune system. And of course we know that he/she feels terrible.

Having done this job for decades, what I too often witness is a patient such as this one walking away from such a celiac disease test result with the feeling that they: a) looked for a disease, b) it wasn’t found and now, c) they just need to “get used to” feeling terrible. It may sound silly but believe me it’s a very common occurrence. It makes me want to scream, honestly, but it happens a lot. Helping such people get to the root cause of their problem is what I specialize in.

The stable datum is that if the body is feeling terrible there IS a reason for it. Finding out the root cause of why is not terribly difficult when you know how.

We see patients local to our area, as well as those from across the country and internationally at our destination clinic where we get to the root cause of their problems.

If your health is not to the level you desire, whether it involves a celiac disease test or not, consider contacting us at HealthNOW Medical Clinic San Jose for a FREE CONSULTATION. Just call 408-733-0400 to schedule.

See you soon!

To your best health,

Dr. Vikki Petersen, DC, CCN, FMCP

Functional Medicine Certified Practitioner
Founder of HealthNOW Medical Center
Author of “The Gluten Effect”
Author of eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”




What Nexium and Prevacid Have in Common with Celiac Disease

You know that all drugs have side effects. I don’t need to tell you that. But did you know that one of the most prescribed medications in the US increases your risk for celiac disease? We at HealthNOW Sunnyvale Functional Medical Clinic have done the research.

Proton pump inhibitors or H2 blockers are prescribed for acid reflux, heartburn and ulcers (both of the stomach and the intestine). The common names that you may be familiar with are: Nexium, Prevacid, Prilosec, Aciphex and Protonix. These drugs are some of the most common drugs prescribed in the US. In 2009 they were the third-largest class of drug sold with $13.6 billion in sales, representing more than 110 million prescriptions.

And They Seem to be Over Prescribed…. by Alot!

Dr Mitchell Katz, director of the San Francisco Department of Public Health estimates that a full 60-70% of the patients taking proton pump inhibitors don’t actually need them and should try lifestyle changes instead. I couldn’t agree more.

Handling heartburn and acid reflux are symptoms that we find handle readily, easily and quite quickly when you institute the proper lifestyle changes. And those changes are typically diet related. Often during the first week or two of care, patients are positively amazed to find their chronic heartburn or acid reflux gone. And all they’ve changed is their diet.

There is a Better Solution – a Natural Solution

Why then do we over-medicate millions when a simple dietary change would do? I think the biggest problem lies in the way we ‘do’ healthcare in this country. People expect a pill; they anticipate receiving a drug, and they don’t particularly want to have to change their diet. Does anyone want to change their diet, really? We like what we like and eat what we like and we’re not keen on someone asking us to change.

Believe me, as a clinical nutritionist who’s been doing this for over two decades, I truly understand. How many hundreds, thousands of patients have I had to convince of the benefit of at least trying a hypoallergenic diet. Yes, there have been many and I have had lots of practice at convincing people. It’s not hard for me because I know what awaits them on the other side – better health! So I hold their hands through the changes and struggles and we are both delighted at the results.

The problem with mainstream medicine is that isn’t part of their vocabulary – dietary change to prevent the use of medication just isn’t what they do – to their patient’s detriment in my opinion. HealthNOW Sunnyvale Functional Medical Clinic focuses on finding and solving the root cause of a patient’s illness, then solving it as simply and naturally as possible.

An Increased Risk of Celiac Disease is One Side Effect

A recent study (September 2013) out of Sweden published in Digestive and Liver Disease revealed that patients on these medications had a higher risk of developing celiac disease than those individuals who didn’t take these drugs. Why?

It’s not a particular stretch when you appreciate one of the well known side effects of the drugs, and that is a lowering of the immune system resulting in an increased incidence of bacterial infection along with bone fractures. This data was disclosed in a study published in the Archives of Internal Medicine.

An Increased Risk of Serious Bacterial Infection is Another Side Effect

Two studies revealed that a particularly dangerous bacterium, Clostridium difficile, often called C. diff, occurs at an increased rate in those taking these drugs. C. diff can be an extremely difficult to treat and dangerous bacterial infection, occurring in the intestines. What then is the association between this infection and proton pump inhibitors? Very simply, the natural acid produced in the stomach tends to kill the bacteria. When that acid is being suppressed by the drug, the bacteria go on to infect the intestine, sometimes with life threatening consequences. It is the likely the mechanism of lowering the immune system of the gut that also increases the incidence of celiac disease.

Recall that we now understand the initiation of celiac disease requires 3 factors:

• the presence of the genes

• the ingestion of gluten

• an unhealthy gut – it is here that these drugs cause their negative influence.

The takeaway is to certainly avoid any medication when at all possible, as they all have side effects. But especially when it comes to these drugs that according to experts are extremely over-prescribed, try to find a doctor who can work with you to get to the true root cause of your symptoms and, if possible, utilize a natural approach to address them. I hope you found this helpful.

Are You Tired Of Taking Too Many Prescription Medications?

If you’ve been struggling with symptoms that cause you to take any of these medications—contact us at HealthNOW Sunnyvale Functional Medical Clinic for a FREE CONSULTATION. Call (408) 733-0400 to schedule. We are located in Sunnyvale, CA. If you are not local to us, our DESTINATION CLINIC treats patients from across the country and internationally. We will help you find the underlying root cause!

To your health,

Dr. Vikki Petersen
DC, CCN
IFM Certified Practitioner
Founder of HealthNOW Medical Center
Author of “The Gluten Effect”
Author of eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”




Want to Be Smarter and Avoid Heart Disease? Try Gluten Free!

At HealthNOW Medical Center, we’ve experienced that going gluten free has some powerful benefits! If that sounds a little too good to be true, I promise I’m not exaggerating. We will be looking at the result of two research studies that confirm that those who follow a gluten-free diet do reap some nice rewards.

In the first study published in Digestive Diseases & Sciences entitled “Characteristics of patients who avoid wheat and/or gluten in the absence of celiac disease”, the authors wanted to look at the characteristics of patients with gluten sensitivity in the U.S. They found that patients with gluten sensitivity were similar to patients with celiac disease in regards their BMI (body mass index that measures levels of obesity) and hemoglobin levels. Those with gluten sensitivity had a lower BMI than controls. The group also showed a lower incidence of hypertension and an improved cardiovascular profile similar to those patients with celiac disease when following a gluten free diet.

Gluten Free = A Healthier Heart

In other words, gluten sensitive patients from our clinic who follow a gluten-free diet were less obese and had healthier hearts than their gluten-eating counterparts. The researchers didn’t know whether to cite the diet alone or a combination of eating gluten-free and having a certain genetic profile. We have learned that almost half of those suffering with gluten sensitivity have the same genetic profile as those with celiac disease, so there may be some validity in the gene theory.

A Gluten Free Diet Made Celiacs Smarter

The next study was published in the Journal of Gastroenterology & Hepatology, Volume 28, 2013. The article title was a mouthful: “Cognitive performance improves in concert with histological and serological improvement over the first 12 months of a gluten-free diet in patients with newly-diagnosed celiac disease”. Basically all it means is that newly diagnosed celiacs got smarter during their first 12 months on a gluten-free diet and that change was associated with blood tests improving and their gut healing.

Eating Gluten Created the Same Deficits Mentally as Being Drunk

As we and our San Jose Nutritionists have spoken of many times, gluten affects more than just the GI tract. There is a well established correlation between the inflammation associated with celiac disease and changes in behavior, mood and cognitive function. This study looked at the cognitive function in patients newly diagnosed with celiac disease and tracked it as they implemented a gluten-free diet over their first year. Cognitive ability in memory, visual/spatial acuity, motor function and attention was all measured.

The results were rather fascinating: A newly diagnosed celiac has such diminished cognitive function that it was comparable to someone with a blood alcohol level above the legal limit. In other words, cognitive ability was equivalent to someone who was drunk.

After a year on a gluten-free diet however, those participants who showed a fully healed intestine (and that’s a point worth repeating—only those who fully healed received this benefit) revealed a normal cognitive function level. The improvement, cognitively speaking, paralleled the improvement in their blood values and gut healing. As you can see, I wasn’t exaggerating with my title for this post. Frankly, the more we learn about gluten the less I like it for almost everyone, regardless of their celiac or gluten sensitive status. But that’s a discussion for another post.

Do You Want To Go Gluten Free?

If so—contact our San Jose Nutritionists for a FREE CONSULTATION. Call (408) 733-0400 to schedule. We are located in Sunnyvale, CA. If you are not local to us, our DESTINATION CLINIC treats patients from across the country and internationally. We will help you find the underlying root cause!

To your health,

Dr. Vikki Petersen
DC, CCN
IFM Certified Practitioner
Founder of HealthNOW Medical Center
Author of “The Gluten Effect”
Author of eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!




Want Good Health? Following a Gluten-free Diet is Not Enough

When it comes to the area of celiac disease and gluten sensitivity, I and the rest of the staff at HealthNOW San Jose Wellness Center
have had a pet peeve for a long time. And that is the recommendations associated with a celiac disease or gluten sensitivity diagnosis. What are those recommendations? A gluten free diet and that’s it.

There is nothing wrong, of course, with the recommendation of a gluten-free diet but when that is all that it recommended that is where I have a problem – a big problem. Why? Solely instituting a gluten-free diet is never (at least 95% of the time) enough to cause a person to completely regain their health. It’s hard enough to eliminate gluten from your diet without at least reaping the benefits of feeling great as a result. After all, the goal is to vastly improve a patient’s health.

The Results of an Ongoing Study Reveals…

It is for this reason we created the term “Secondary Effects of Gluten”. It is what we use, after a diagnosis, to address everything else that needs to be taken care of after one has begun a gluten-free diet. We have seen the value of addressing the secondary effects of gluten for the past two decades. Yet I continue to be surprised at the lack of awareness associated with only implementing a gluten-free diet with this group of individuals. I was therefore happy and vindicated to see the results of an ongoing clinical trial for celiac patients. The study followed 117 adults in the United States with a diagnosis of celiac disease. These individuals were adhering to a gluten-free diet as “best they could”. On average they were individuals who had received their diagnosis over six years prior – meaning they were not new to following a gluten-free diet.

Despite their ‘veteran’ status and efforts at following a gluten-free diet, the researchers discovered that the following:

• 95% or 111 of the 117 participants showed evidence of ongoing inflammation of the lining of their small intestine.

• In 65% of the individuals the inflammation was so extensive that is was consistent with patients whose celiac disease was untreated – meaning it looked as if the person wasn’t following a gluten-free diet at all, even though they were.

• Even in those whose blood tests were negative for antibodies (meaning their blood test for active celiac disease was negative) they still demonstrated significant inflammation of their small intestine similar to the damage seen before adopting a gluten-free diet.

What does this all mean? Exactly what I and my fellow clinicians here at HealthNOW San Jose Wellness Center have been stating for almost two decades – instituting a gluten-free diet cannot be the only action that a person diagnosed with celiac disease or gluten sensitivity takes. More must be done and that ‘more’ is the implementation of the secondary effects of gluten.

What are the Secondary Effects of Gluten?

  1. Testing for the presence of infections in the intestinal tract
  2. Isolating if other food sensitivities exist – common are dairy, corn, soy
  3. Testing to see if there are any cross-reactive food reactions occurring
  4. Ensuring that the probiotic population in the small intestine is healthy and robust
  5. Ruling out any enzyme or nutritional deficiencies
  6. Normalizing any adrenal or hormonal imbalance
  7. Ruling out any other sources of toxins such as Lyme’s disease or heavy metal toxicity.
  8. Ensuring that the individual is on a healthy diet, not just a gluten-free diet – and that’s saying a lot in our era of gluten-free ‘junk food’. You can be gluten-free and still not eat your 9 servings of fruits and veggies every day, as an example.

That’s the list. As you can see it’s not terribly long, nor does it involve the use of any scary drugs or surgery. But if you don’t address the factors that are pertinent to the individual in front of you, you’ll end up like the participants of this study – with an inflamed gut and therefore at an increased risk of lymphoma (cancer), not to mention other serious health complications.

It’s Just Not Fair!

Recommending solely a gluten-free diet to these individuals is unacceptable. I realize that the reason for this problem lies squarely in the arena of pharmaceuticals. Doctors in this country really don’t know what to do for a disease that doesn’t have a drug to control it. Because celiac disease has no medication to treat it and is known to respond to a gluten-free diet, that’s what they recommend. And that’s all they recommend. The secondary effects as delineated above are not typical actions in traditional medical environments and I think that’s why we don’t see them occurring. But it is to the detriment of the patient and this research supports my view.

Want To Get To The Root Cause?

If you want more than just a Diet—contact us for a FREE CONSULTATION. Call (408) 733-0400 to schedule. Our medical clinic is located in Sunnyvale, CA. If you are not local to HealthNOW San Jose Wellness Center, our DESTINATION CLINIC treats patients from across the country and internationally. We will help you find the underlying root cause!

To your health,

Dr. Vikki Petersen
DC, CCN
IFM Certified Practitioner
Founder of HealthNOW Medical Center
Author of “The Gluten Effect”
Author of eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”




Is there a Problem with Diagnosing Yourself with Gluten Sensitivity?

It’s Not Easy to Receive a Correct Diagnosis

We live in an interesting time as regards celiac disease and gluten sensitivity, and we at HealthNOW San Jose Medical Center know this better than anyone. On the one hand we are still getting an “F” when it comes to diagnosing either condition, but on the other hand we are sometimes chastised if we take matters into our own hands and change our diet. Let’s look at the upside and downside of self-diagnosis.

Last week Nutrition in Clinical Practice published an article entitled, “Characterization of Adults with a Self-Diagnosis of Nonceliac Gluten Sensitivity”. While I’m excited about any studies that focus on gluten sensitivity, there were some points I wanted to take up regarding the conclusions reached by the authors.

New Study Evaluates Those with Self-Diagnosed Gluten Sensitivity

Of those 248 individuals willing to participate in the study, a full 72% were excluded because they either had never adequately ruled out celiac disease as a potential diagnosis (62%), they had uncontrolled symptoms despite their gluten restriction (24%), or they were not following a strict gluten-free diet (27%). Certainly one of our bigger challenges is effectively and accurately diagnosing celiac disease and gluten sensitivity. It’s a bit of a conundrum when we appreciate that there is no perfect test for either. We have decent blood tests and criteria for the diagnosis of celiac disease, it’s true.

Even though with those criteria we miss diagnosing about 95% of those who suffer due to ill informed doctors who don’t know the 4 of 5 criteria that must be met, or ill informed doctors who don’t perform the lab test to those who are suffering. In any case, the final analysis is that grade of “F” we mentioned earlier, because at best we diagnose maybe 7% of those who suffer – very poor indeed.

Ruling Out Celiac Disease is Always a Good Idea… If Possible

Is it important to test for celiac disease before embarking on a gluten-free diet? Absolutely, in a perfect world where testing is abundant and easily accessible and doctors are amenable, it’s the best course of action. But what about when it’s not affordable or the doctor refuses to order the test? What are those patients supposed to do? Should patients who cannot be tested continue to eat gluten and destroy their health and lessen their lifespan?

Of course not. It’s a much better strategy to figure out for yourself that gluten isn’t your friend, eliminate it and improve your health. And, while it can be said that the best way to fully and accurately diagnose celiac disease is to be eating gluten at the time of testing, there are some alternatives if one has already gone gluten-free.

One alternative is genetic testing. If an individual is maintaining a gluten-free diet and sees a dramatic change in their health, they are left with the question of whether they have celiac disease or gluten sensitivity. An easy way to rule one out is to have a genetic test, when feasible. If you suspect celiac disease and don’t carry the genes for it, you can safely assume you don’t have it and never will. Therefore by a process of elimination, you can deduce the problem to be gluten sensitivity in light of no celiac genes.

Why is Gluten Free Sometimes Not Enough?

What about the point made that individuals were being excluded from the diagnosis of gluten sensitivity when they continued to have symptoms despite their gluten restriction? That could be accurate, but it could also be due to other issues.

Certainly it’s more common for patients to eliminate gluten and see dramatic positive changes in their symptoms. However, as a clinical nutritionist I’ve seen patients at our San Jose Medical Center with celiac disease, who eliminated gluten and felt no change in how they felt. Does that mean they don’t have celiac disease? Or does it mean they shouldn’t follow a gluten-free diet? Of course not; it just means that an additional stressor underlying the troublesome symptoms has been missed.

Look to the Secondary Effects of Gluten

This is why we created the concept, “Secondary Effects of Gluten”. Whether secondary to gluten sensitivity or celiac disease, the body that reacts to gluten is susceptible and vulnerable to other negative conditions occurring. These “secondary effects” consist of such things as infections, cross-reactive food reactions, poor nutrient status, inadequate enzyme and probiotic levels, hormonal imbalance and a hypervigilant immune system that can create autoimmune-type reactions.

Each individual has their own set of secondary effects, but if they’re not properly addressed the person will continue to have symptoms. The most common manifestation of this is someone who eliminates gluten and initially feels a lot better but within several months or even as long as a year or two, the symptoms return despite maintaining their gluten-free diet. The reason why symptoms return lies squarely on the shoulders of untreated secondary effects. It’s a grossly misunderstood area and we are one of the few clinics I know of that have not just coined a term for it but have a protocol that works!

Cheating is Always a Bad Idea

Getting back to the study, a full 27% of the participants who volunteered were not following a gluten-free diet. We too find this commonly amongst those who know better. For some reason it is human nature to want to cheat. We like to push the envelope to see how far we can go and not feel too badly. This mentality is a dangerous one and I find it based on a poor education of the condition. If no one ever told you that gluten creates much of its damage silently, you’d never know it. Once you do, you see the liability of cheating, even when you don’t “feel” it.

I understand the concept: “If I have a bite of this or that and I don’t seem to feel bad, then it’s okay, right?” Wrong! It’s far from okay. If you have celiac disease or gluten sensitivity you are playing Russian roulette with you health and your very life – and that’s no understatement.

The researchers further discovered that of those participants who had received an intestinal biopsy, almost a third of them had been ingesting no or very little gluten at the time of the test. This could result in a false negative and rule out celiac disease in someone who was actually suffering from it.

Here at HealthNOW Medical Center we too run into this situation often. A patient has either received a positive blood test for celiac and subsequently ceased eating gluten, or, as in the cases we are discussing here, they have self-prescribed a gluten-free diet after noticing a big improvement in their health when eating gluten-free.

Is a Biopsy Mandatory for a Diagnosis of Celiac Disease?

In the case of the positive blood test, if they fulfill other criteria needed to diagnose celiac disease, they are definitely not required to also have a positive biopsy – unfortunately many doctors are still not aware of that fact. In the case of the patient embarking on the diet themselves, we have a hard and fast rule here at the clinic when it comes to reintroducing gluten in order to perform a lab test – DON’T!! Why?

If one is truly gluten sensitive, reintroducing it can create effects that can be quite serious, including autoimmune disease and cancer. It’s just not worth it to reintroduce gluten, ever. Now if you are pretty convinced that gluten doesn’t bother you, that’s another story. Reintroduce at your own risk and definitely, after reintroduction, try to get a comprehensive blood panel that looks for celiac and gluten sensitive findings. It’s best to know for sure before you make gluten a regular part of your diet.

Finally, the authors concluded the following:

  1. 25% of those participating fulfilled the criteria for gluten sensitivity. [So self-diagnosis isn’t all bad.]
  2. Initiation of a gluten-free diet without adequately excluding celiac disease first is common.
  3. 25% of participants had poorly controlled symptoms, despite avoiding gluten. [Note: that’s where the secondary effects of gluten may be playing a role.]

Was this a great study? No, not particularly in my opinion. But it did point out some good things and the fact that researchers are spending time in the arena of learning more about gluten sensitivity is definitely a step in the right direction.

Here’s Our Takeaway Advice

  1. Try to get tested before going gluten-free.
  2. If you can’t get tested, definitely try a 30 day trial of gluten avoidance and see how you feel.
  3. If you do see benefits from going gluten-free, NEVER reintroduce it to perform a lab test – it’s dangerous.
  4. Remember that you can always perform a gene test, even if you’re not eating gluten.
  5. Find a clinician aware and savvy of the secondary effects of gluten so that you can ensure a full recovery. If you need help with this one, let me know.

Do You Want To Have Visibly Better Health?

If so—contact us at HealthNOW San Jose Medical Center for a FREE CONSULTATION. Call (408) 733-0400 to schedule at our medical center in Sunnyvale, CA. If you are not local to us, our DESTINATION CLINIC treats patients from across the country and internationally. We will help you find the underlying root cause!

To your health,

Dr. Vikki Petersen
DC, CCN
IFM Certified Practitioner
Founder of HealthNOW Medical Center
Author of “The Gluten Effect”
Author of eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”




Is Low Vitamin D Causing You a Leaky Gut?

Vitamin D written in the sand with foam from a wave washing up

Low Vitamin D Increases Risk for Disease

You’ve likely heard that vitamin D is important. We hear of its association with osteoporosis or loss of bone density, when it’s deficient. But did you know that there are vitamin D receptors (VDR) on many tissues in the body such as the heart, skin, brain, kidney, immune cells, breast and prostate?

Vitamin D goes way beyond affecting bone health only. When deficient, it’s been linked to severe kidney disease, heart disease, cancer, inflammation and a leaky gut. It turns out that there are few areas of the body vitamin D doesn’t touch.

A little background information: Vitamin D, not really a vitamin but a hormone, is manufactured in the body from the combination of sunlight and cholesterol. It is then, in its D3 state, that it becomes activated in the liver and kidney to its active D form, known as calcitriol.

What Does Vitamin D Do?

Vitamin D, as mentioned does keep bones strong. Therefore, when deficient, osteoporosis or brittle bones can result.

Vitamin D activates the natural killer cells; the beautiful immune defense army that kills ‘bad’ guys, including viruses, bacteria and cancer cells.

A good hint for the flu prevention is to ensure your vitamin D level is optimal.

Vitamin D influences the function of the ‘gate keeper’ system in the gut. Deficiency of D has been associated with a leaky gut, a known link to autoimmune disease and other degenerative diseases. Anything that leads to a leaky gut should be addressed urgently.

Inflammation and vitamin D are very tied together. We understand that chronic inflammation is the initiator of most of the degenerative diseases we are trying to avoid including heart disease, cancer, autoimmune and diabetes, to name a few.

Vitamin D is anti-inflammatory, which presents another incredibly strong reason to make sure levels are normal. The ‘fire’ of inflammation has to be quelled in order to prevent and/or heal these degenerative conditions. Vitamin D is such a substance and it is needed in sufficient quantities to perform this very important function.

Vitamin D Deficiency Raises Risk of Breast Cancer 6X

A recent study, July 2013, from the American Journal of Clinical Nutrition, published findings that there is a greater risk of breast cancer among women with deficient levels of serum (blood) vitamin D.

Low vitamin D is common in countries where little sun exposure occurs due to climate, clothing or increased skin pigmentation – all acting to reduce vitamin D production. When women whose vitamin D levels were less than 10 ng/mL were compared with those whose levels were greater than 20 ng/mL, the risk of breast cancer was more than six times higher. In a disease that is promoted as having little ‘rhyme nor reason’, this study gives women something they can truly DO to lessen their risk of this devastating disease.

Vitamin D Causes a Leaky Gut?

A leaky gut can be caused by drugs, chemicals, infections, and most often the presence of gluten in the diet. The degree and chronicity of a leaky gut can move the body towards autoimmune disease, inflammation and other chronic degenerative diseases. The intestine’s ‘intelligence’ that allows it to open its gates for good, digested food and close it against toxins, pathogens and other perceived ‘bad guys’ is truly brilliant and one of the many amazing abilities of the human body. But when that intelligence is thwarted, the result is disease.

An important tool against leaky gut is vitamin D. It turns out that D is needed for the gatekeeper system of the small intestine and when D is deficient, a leaky gut is the result. When we appreciate how closely vitamin D is tied into the body’s immune system and its correct functioning, it’s perhaps not a surprise that D would play a role in a healthy gut where 70-80% of the human immune system is housed. And it’s also not a surprise that vitamin D is frequently deficient in patients with celiac disease, gluten sensitivity and other chronic digestive diseases. It’s important for everyone to get their vitamin D levels tested, and its especially important for those who already know they have any sort of compromised immune or digestive system. We do extensive testing at HealthNOW Medical Center to ensure we don’t miss this kind of deficiency.

What You Need to Know

First, you have to be tested to know what your vitamin D status is. The name of the test is vitamin D, 25-Hydroxy and it’s a blood test. There is no way to guess what your levels are, you need to get them tested to know. Once you receive your result see how close it is to 50 ng/mL. About ‘50’ is the sweet spot for vitamin D according to most experts. The Vitamin D Council says it could be as high as 60 or 80 ng/mL and I don’t think there’s any problem with that. Vitamin D levels can be too high, but that’s not a problem we typically see.

Which Vitamin D Supplement is Best

If you find that you are deficient or just want to maintain a good vitamin D level you can do the following:

1. Get some rays – some sunlight is good for you. No, you don’t need to go out at high noon, but about 20 minutes per day with your arms and chest exposed and/or in shorts is enough to produce about 10,000 IUs (international units) according to the vitamin D council.

Other factors to take into consideration is the latitude in which you live and the color of your skin. The farther you are away from the equator, the more difficult it is to get adequate, D-producing sunshine year round. Additionally, darker skin tones cannot absorb enough UV to turn it into adequate vitamin D. Therefore, there’s point #2.

2. Supplement with vitamin D3 (not D2) in a fatty medium. Vitamin D is a fat soluble vitamin so it’s best delivered with some fat for easier absorption. Here at the clinic we have a liquid in a base of olive oil that makes it very palatable. Each drop is equivalent to 2,000 IUs so most patients are just taking a few drops per day, making compliance a breeze.

3. It’s important to take vitamin K with your vitamin D. Read the importance of why here.d3-with-k2

Here at HealthNOW in the clinical nutrition department, we tend to utilize 1 drop per every 10 points we want to raise the D level.

Maintenance is typically 2 drops per day, but it depends on the individual.

Remember, you’ll need to retest to monitor your levels. You don’t want to fool around with low D, it causes too much damage!

4. A severe deficiency may require a prescription for higher doses of vitamin D for a period of time until the level is normalized. Some patients require 50,000 IUs one or more times per week. Such levels are high and should not be embarked upon without a doctor’s recommendation.

5. A chronic deficiency that is not responding to treatment typically means that absorption is quite poor within the gut and fat absorption is especially compromised. This is where root cause medicine shines. In this scenario you wouldn’t just continue to give an individual more and more vitamin D when their levels aren’t improving; you need to find out why they’re not improving.

In patients with celiac disease, gluten sensitivity or other disorders of the GI tract, healing of the gut must occur such that normal absorption can occur. If you find yourself in this position, you’ll need to find a clinician who truly understands how to get to the root cause of a problem and resolve it.

Contact Me if You Need Assistance

If you think your vitamin levels are low—contact us at HealthNOW Medical Center for a FREE CONSULTATION. Call (408) 733-0400 to schedule an appointment. If you are not local to us, our DESTINATION CLINIC treats patients from across the country and internationally. We will help you find the underlying root cause!

To your health,

Dr. Vikki Petersen
DC, CCN
IFM Certified Practitioner
Founder of HealthNOW Medical Center
Author of “The Gluten Effect”
Author of eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”




Celiac Disease? Villous Atrophy is not Required for Diagnosis

Father of Intestinal Biopsy Classification System Speaks Out

Interesting news in the medical field, brought to you by HealthNOW San Jose Functional Medicine Clinic. Imagine being the ‘father’ of the intestinal biopsy and having your opinion ignored. It would be rather frustrating, not to mention heartbreaking, when your entire life’s work was dedicated to helping individuals with celiac disease and gluten sensitivity.

A recent interview with Dr Michael Marsh, the founder of the Marsh Classification System of intestinal biopsy, revealed that Dr Marsh himself is in total disagreement with the standard utilized by gastroenterologists to determine whether a patient should be diagnosed with celiac disease and begin a gluten-free diet.

In a fascinating discussion led by Dr Thom O’Bryan from the Gluten eSummit, Dr Marsh revealed that he created his classification system in 1982 and in 1992 formally spoke out at an international conference, making it quite clear that to not recommend a gluten-free diet for a patient with positive blood work but a negative biopsy was a medico-legal situation in the making.

Meaning that doctor who refused to recommend a gluten-free diet could be held accountable should that patient later develop severe nutritional deficiencies, osteoporosis or cancer, to name a few of the many possible negative scenarios. Dr Marsh stated that he had met individuals in their 20s who were celiac but hadn’t initiated a gluten-free diet and already, at their young age, had developed cancer. He went on to cite the work of several other researchers:

• Dr Kaukinen from Finland who found antibodies (immune system reactions) to gluten a full 7 years before villous atrophy

• Dr Not who showed elevated fatty acid binding protein, revealing cell death, when a biopsy was completely normal

• Dr Ludvigsson who discovered increased mortality with those showing intestinal inflammation despite no change in the intestinal lining, a mortality rate that exceeded those WITH intestinal damage.

All these researchers have proven what traditional, current gastroenterologists seem to refuse to admit and that is that waiting for complete destruction of the lining of the small intestine is dangerous and even reckless for the patient.

Did Your Doctor Mislead You with Faulty Test Interpretation?

Have YOU been told that you don’t have to stop eating gluten even though a blood test said otherwise because your biopsy was normal or not a Marsh 3 (meaning total villous atrophy)? If so, you were told wrong. And that is straight from the founder of the system himself!

Dr Marsh feels that all stages found in a biopsy should be taken seriously. And, the type of biopsy he recommends might interest you, especially if you’ve ever had one. His research is in the area of rectal biopsies that require little to no ‘down’ time from work or daily activities.

30% of the Population Should be Gluten-Free

When asked what percentage of the population fell into the ‘at risk’ stages of Marsh 1, 2 or 3, Dr Marsh stated a full 30%! 1% have Marsh 3, full villous atrophy, but 29%, in his opinion, fall within Marsh 1 or 2 meaning partial atrophy and therefore needful of a gluten-free diet.

The doctor also placed strong emphasis on noting that celiac disease and gluten sensitivity are not solely the domain of the small intestine, but in fact are also large intestinal diseases. This was great to hear from such an esteemed source, but I often am chastised when I mention that we have excellent success treating Crohn’s disease or colitis by, in great part, removing gluten from the patient’s diet. I’ve been chastised that such a treatment makes no sense when gluten doesn’t affect the large intestine, but only the small intestine.

Not being a researcher, all I could fall back on was my own and fellow doctors’ experience here at HealthNOW San Jose Functional Medicine, but we DO see excellent results. It’s nice to have Dr Michael Marsh’s support in the area. He made it quite clear that gluten affects the mesenteric immune system and that is found in the intestines – both large and small.

Is it Okay to Drink Beer? Yes?

Does gluten-free mean no beer? You’re thinking ‘of course’. Me too, however Dr Marsh has always allowed his celiac patients to drink English beer. Despite being warm in temperature, is English beer any different than American beer?

I truly have no idea, but Dr Marsh was quite adamant about the fact that he never saw any negative reactions in his beer drinking celiac patients. Please don’t ask me for my opinion on this one yet – I’m going to have to do some pondering.

Is Your Celiac Blood Test Reliable?

Lastly, Dr Marsh spoke out strongly against the tTG blood test – another ‘gold standard’ of celiac testing. While the test is 97 to 99% sensitive and specific within a patient who has a positive Marsh 3 biopsy, when it comes to those with partial atrophy, the test quickly gets a failing grade at only 27 to 33% accurate.

This is why I utilize the Cyrex Lab – I have no personal affiliation with this lab, I only recommend it because it’s the most comprehensive testing currently available. It gives ten times the information of traditional testing and looks at multiple potential reactions of the immune system against gluten.

We all want accuracy and early diagnosis, thus far this is the best testing I know of and it’s therefore what we use here at our clinical nutrition and medical department.

The bottom line is that celiac disease and gluten sensitivity are killing people – not the people who know and diligently follow their diet, but the people who don’t know or the people who suspect but are erroneously being told by their doctor that they’re ‘fine’ when they are not.

We Need to Share this Information

Let’s spread the word! Show this post to your doctor. We’ll start a dialogue and perhaps make some inroads into the proper and early diagnosis of these important conditions.

Do You Have Any of the Above Symptoms?

If you want to feel healthier—contact us for a FREE CONSULTATION. Call (408) 733-0400 to schedule. If you are not local to us, our DESTINATION CLINIC treats patients from across the country and internationally. We will help you find the underlying root cause!

To your health,

Dr. Vikki Petersen
DC, CCN
IFM Certified Practitioner
Founder of HealthNOW Medical Center
Author of “The Gluten Effect”
Author of eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”