Testing for Non-Celiac Gluten Intolerance Dr. Stephen Wangen Founder, IBS Treatment Center www.IBSTreatmentCenter.com What Keeps Me Awake At Night What is wanted is not the will to believe, but the wish to find out, which is the exact opposite. Bertrand Russell (1872-1970)
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Dr. Stephen Wangen
Founder, IBS Treatment Center
What is wanted is not the will to believe, but the wish to find out, which is the exact opposite.
Bertrand Russell (1872-1970)
Sceptical Essays, 1928
Villous atrophy is damage to the surface of the small intestine.
This damage is a sign of gluten intolerance.
First we must understand and define celiac disease in order to put this issue into the proper perspective.
Celiac disease is defined by villous atrophy.
Without villous atrophy, you can’t have celiac disease.
But villous atrophy must be put into its proper context
What are all of the signs and symptoms associated with celiac disease and gluten intolerance?
Steatorrhea (fatty stools)
Enamel defects in teeth
IBS (irritable bowel syndrome)
Apthous ulcersSigns and Symptoms Associated with Gluten Intolerance
Liver enzymes, elevated (ALT, ALK, ALP)
Primary biliary cirrhosis
Primary sclerosing cholangitis
Occult blood in stool
Hepatic t-cell lymphoma
Pancreatic exocrine function may be impaired
Villous atrophy (celiac disease)
Dark circles under eyes
Inability to gain weight
Failure to thrive
Up and downs
Brain white-matter lesions
Ataxia/difficulty with balance
Epilepsy (with or without brain calcifications)
Multifocal axonal polyneuropathy
Neuropathy, peripheral (numbness or tingling of hands or feet)
Dental enamel defects
Loss of strength
MS (multiple sclerosis)
Shortness of breath
Infertility (also male infertility)
Alopecia (hair loss)
Vitamin B12 deficiency (pernicious anemia)
Vitamin K deficiency
Eosinophils elevated (in blood test)
Autoimmune chronic hepatitis
Diabetes, type 1
Hypoparathyroidism, idiopathic autoimmune
ITP (idiopathic thrombocytopenic purpurea)
Small bowel adenocarcinoma
Esophageal and oro-pharyngeal carcinoma
We know that many signs and symptoms can be found associated with gluten intolerance and celiac disease.
Villous atrophy is only one possible end product of gluten intolerance.
Celiac disease = villous atrophy.
Most of these are also signs and symptoms that can be associated with gluten intolerance even when villous atrophy is not present.
Gluten intolerance is not always celiac disease (villous atrophy).
Small-bowel mucosal inflammation in reticulin or gliadin antibody-positive patients without villous atrophy. Scandinavian Journal of Gastroenterology, 33, 944–949. Kaukinen, K., et al. (1998).
“CONCLUSIONS: IgA-class … antigliadin antibody-positive patients with normal small-bowel mucosal morphology … implies that they may be gluten-sensitive.”
“Allergy to cereals [other than celiac disease] should be considered even in adults.”
Celiac disease without villous atrophy: Revision of criteria called for.Digestive Diseases and Sciences, 46, 879–887.Kaukinen, K., et al. (2001).
“10 adults suspected to have celiac disease, but evincing only minor mucosal inflammation … showed a clinical, histological, and serological recovery on (a gluten free) diet.”
Discovery is to see what everyone else has seen and to think what no one else has thought.
Albert Szent Gyorgyi
1937 Nobel Prize in Medicine
Emerging new clinical patterns in the presentation of celiac disease. Arch Pediatr Adolesc Med. 2008 Feb;162(2):164-8. Telega G, Bennet TR, Werlin S
[A review of] the medical records of all patients diagnosed with celiac disease at the Children's Hospital of Wisconsin between 1986 and 2003…[demonstrated that patients] with celiac disease usually do not present with classic symptoms; they are more likely to be asymptomatic…”
“We studied the effect of a gluten-free diet in patients with idiopathic sensorimotor axonal neuropathy and circulating antigliadin antibodies. A total of 35 patients participated in the study, with 25 patients going on the diet and 10 not doing so. There was a significant difference … with evidence of improvement in the [treatment] group and deterioration in the control group.”
“Among seven patients not on immunosuppressive treatment, four showed clinical improvement of the myopathy with a gluten-free diet. The myopathy progressed in one patient who refused the gluten-free diet. Myopathy may be another manifestation of gluten sensitivity and is likely to have an immune-mediated pathogenesis.”
Gluten sensitivity masquerading as systemic lupus erythematosus. Ann Rheum Dis. 2004 Nov;63(11):1501-3. Hadjivassiliou M, Sanders DS, Grünewald RA, Akil M.
“Three patients are described whose original presentation and immunological profile led to the erroneous diagnosis of systemic lupus erythematosus. The correct diagnosis of gluten sensitivity was made after years of treatment…The presence of an enteropathy is no longer a prerequisite for the diagnosis of gluten sensitivity, which can solely present with extraintestinal symptoms and signs. Knowledge of the diverse manifestations of gluten sensitivity is essential in avoiding such misdiagnosis.”
Dietary treatment of gluten ataxia. J Neurol Neurosurg Psychiatry. 2003 Sep;74(9):1221-4. Hadjivassiliou M, Davies-Jones GA, Sanders DS, Grünewald RA.
“Gluten ataxia is an immune mediated disease, part of the spectrum of gluten sensitivity, and accounts for up to 40% of cases of idiopathic sporadic ataxia. Twenty six patients (treatment group) adhered to the gluten-free diet and had evidence of elimination of antigliadin antibodies by one year. CONCLUSIONS: Gluten ataxia responds to a strict gluten-free diet even in the absence of an enteropathy.”
(Visit www.IBSTreatmentCenter.com for more info).
The clinical significance of food specific IgE/IgG4 in food specific atopic dermatitis. Pediatric Allergy and Immunology, 18(1), 63–70. Noh, G., et al. (2007).
“Specific IgE and IgG4 concentration were measured ... Double blinded placebo controlled food challenge test (DBPCFC) was performed. Mean IgE/IgG4 levels in DBPCFC (+) subjects is higher than those in DBPCFC (-) subjects in all food items studied. Allergen-specific IgE/IgG4 may provide one of the clues to understand the mechanism of food allergy in atopic dermatitis.”
Food-specific IgG4 antibody-guided exclusion diet improves symptoms and rectal compliance in irritable bowel syndrome. Scandinavian Journal of Gastroenterology, 40, 800–807. Zars, S., et al. (2005).
“IgG4 antibodies to common food antigens are elevated in IBS. The aim of this article was to evaluate the effect of exclusion diet based on IgG4 titres… CONCLUSIONS: Food-specific IgG4 antibody-guided exclusion diet improves symptoms in IBS and is associated with an improvement in rectal compliance.”
Food-specific serum IgG4 and IgE titers to common food antigens in irritable bowel syndrome. American Journal of Gastroenterology, 100, 1550–1557. Zars, S., et al. (2005).
“No significant difference in IgE titers was observed between IBS and controls. Serum IgG4 antibodies to common foods like wheat, beef, pork, and lamb are elevated in IBS patients. In keeping with the observation in other atopic conditions, this finding suggests the possibility of a similar pathophysiological role for IgG4 antibodies in IBS.”
Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut. 2004 Oct;53(10):1459-64.Atkinson W, et al.
“150 outpatients with IBS were randomised to receive, for three months, either a diet excluding all foods to which they had raised IgG antibodies (enzyme linked immunosorbant assay test) or a sham diet excluding the same number of foods but not those to which they had antibodies.
CONCLUSION: Food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research. (The compliant patients experienced significant benefit).”
The therapeutic effects of eliminating allergic foods according to food-specific IgG antibodies in irritable bowel syndrome. ZhonghuaNeiKeZaZhi. 2007 Aug;46(8):641-3.Yang CM, Li YQ.
“CONCLUSIONS: Abnormal immune reactions mediated by IgG antibodies coexisted in patients with IBS. It is of great significance in treating IBS by eliminating the allergic foods according to the serum level of food-specific IgG antibodies.”
IgG = gray bar, IgE = black bar
Thorough stool testing can measure most of the organisms in the digestive tract.
in “The Irritable Bowel Syndrome Solution”
by Dr. Stephen Wangen