{"id":4775,"date":"2012-06-04T08:08:17","date_gmt":"2012-06-04T13:08:17","guid":{"rendered":"http:\/\/wholehealthchicago.com\/?p=4775"},"modified":"2022-03-21T14:59:18","modified_gmt":"2022-03-21T19:59:18","slug":"six-commonly-missed-diagnoses-gluten-sensitivity","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2012\/06\/04\/six-commonly-missed-diagnoses-gluten-sensitivity","title":{"rendered":"Six Commonly Missed Diagnoses: Gluten Sensitivity"},"content":{"rendered":"\n<p>Post 06\/04\/2012<\/p>\n\n\n\n<p>The current guesstimate says roughly 20% of the population are intolerant to gluten, with about 1% of that group having a potentially fatal intestinal condition called celiac disease. The remaining 19% or so are classified as having \u201cnon-celiac gluten sensitivity.\u201d<\/p>\n\n\n\n<p>Despite the dozens and dozens of medical and psychiatric conditions linked to gluten intolerance, it\u2019s also guessed that less than 2% of all gluten-sensitive individuals ever learn of their diagnosis. With data like this, you can appreciate how even an organization as conservative as the American College of Physicians once voted celiac disease the most commonly overlooked diagnosis in internal medicine.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Let\u2019s talk about celiac disease first<\/strong><\/h3>\n\n\n\n<p>Why a person\u2019s immune system starts reacting against gluten grains (wheat, rye, oats, spelt, barley, triticale, kamut) and gluten-containing foods (omnipresent in packaged foods) is unknown, but the susceptibility does appear to run in families. In celiac disease, your immune system creates antibodies against gluten and it\u2019s these antibodies, along with exposure to the grains and other sources of gluten, that damage the cells lining your small intestine. This is quite dangerous because the small intestine is where you absorb the nourishment required for your entire body to function. As your small intestine fails to absorb nutrients, you slowly but steadily become malnourished. The process can take years, and in fact the average person with celiac has symptoms for 11 years before it\u2019s diagnosed.<\/p>\n\n\n\n<p>Over those 11 years the main symptoms are digestive (bloating, gas, poor appetite, chronic indigestion, changes in bowel movements), but you might also develop a variety of seemingly unrelated symptoms (depression, fatigue, skin rashes, hair loss, weight loss, muscle cramps, easy bruising, changes in periods) related to being unable to absorb specific nutrients. I remember a patient several years ago who\u2019d been diagnosed with anorexia nervosa because her main issue was that she just \u201cwasn\u2019t hungry,\u201d even though she knew she was dangerously underweight. I was one of several physicians who missed her actual diagnosis, but in the end she did well once an alert gastroenterologist checked her for celiac disease.<\/p>\n\n\n\n<p>One reason it can take so long to diagnose celiac is that testing is somewhat complicated. Although now there are simple and generally reliable blood tests to screen for it, the gold-standard diagnostic test is taking a biopsy of the cells lining your small intestine. The procedure is done in the outpatient department of a hospital by a gastroenterologist who inserts a gastroscope into your stomach and then threads a delicate tube into your intestine through which the cell sample is obtained.&nbsp; If celiac is present, the intestinal cells show a characteristic flattening, evidence of damage by the antibodies and gluten molecule.<\/p>\n\n\n\n<p>Treatment is avoiding gluten grains and <a href=\"https:\/\/www.the-gluten-free-chef.com\/foods-containing-gluten.html\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">countless gluten-containing foods<\/a>. Once completely eliminated, your intestine heals, malabsorption reverses, and your health is restored.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Non-celiac gluten intolerance<\/strong><\/h3>\n\n\n\n<p>Far more common (remember, almost 20% of the population) and more frequently overlooked than celiac is non-celiac gluten intolerance, a completely different condition.\u00a0 The reason it\u2019s not identified by physicians is our obsessive reliance on positive lab tests to confirm a diagnosis. Thus a frequent patient-physician conversation goes something like this:<\/p>\n\n\n\n<p>Patient: \u201cDoctor, all those chronic symptoms I had went away when I gave up wheat.\u201d<\/p>\n\n\n\n<p>Doctor: \u201cBut your blood tests for gluten sensitivity were negative. Your biopsy for celiac disease was negative. You don\u2019t have gluten intolerance.\u201d<\/p>\n\n\n\n<p>Patient: \u201cBut I\u2019ve read\u2026\u201d<\/p>\n\n\n\n<p>Doctor: \u201cLook, you don\u2019t have gluten intolerance. You\u2019re being ridiculous. Eat all the wheat you want.\u201d<\/p>\n\n\n\n<p>Patient: \u201cMy chiropractor (or acupuncturist, nutritionist, food allergy test, medical intuitive) says I should give up gluten.\u201d<\/p>\n\n\n\n<p>Doctor: \u201cNonsense. Gluten grains form the base of the healthy food pyramid. You\u2019ll probably end up malnourished without them.\u201d<\/p>\n\n\n\n<p>I\u2019ve lost count of the number of patients who\u2019ve related variations of this to me.<\/p>\n\n\n\n<p>In his book <a href=\"https:\/\/www.amazon.com\/Dangerous-Grains-Gluten-Cereal-Hazardous\/dp\/1583331298\" target=\"_blank\" rel=\"noreferrer noopener nofollow\"><em>Dangerous Grains<\/em><\/a>, James Braly, MD, lists upward of 200 conditions (no typo, it\u2019s 200) linked to gluten intolerance. A number as high as this means if you\u2019re experiencing virtually any chronic physical or emotional condition for which a diagnosis is not obvious (obvious like a slipped disc, for example), then it\u2019s unequivocally worth testing yourself for gluten intolerance. \u00a0One patient recently told me how she\u2019d been trying to get pregnant and was scheduled for in vitro fertilization (IVF). A nutritionist suggested that she try going completely gluten free. Six weeks later, and after two years of trying, she ambled into her fertility specialist\u2019s office, proudly harboring her very own embryo and all without his help.<\/p>\n\n\n\n<p>Dr. Braly points out (and I very much confirm) patients who, by going gluten free, are able to discontinue medications that had been prescribed to keep gluten induced symptoms in check. &nbsp;These include: anti-inflammatories, blood pressure meds, diabetes meds, mood stabilizers, ADD meds, and more, all as a result of giving up gluten.<\/p>\n\n\n\n<p>If you think you might be sensitive to gluten but aren\u2019t sure, try this elimination-reintroduction test:<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li><strong>Eliminate all sources of gluten for at least three weeks<\/strong>. You\u2019ll need to read labels, if you eat food with labels. Or build your menu on vegetables, fruits, and lean protein and you\u2019ll end up healthier in the process. If you rely on packaged foods, shop the gluten-free section at Whole Foods.<\/li><li><strong>At the end of three weeks, if you\u2019re gluten sensitive you\u2019ll be feeling better<\/strong>. I realize \u201cbetter\u201d sounds vague, but it can be anything: better digestion, more energy, crisper mental clarity, easier breathing, a rash that clears up, less achiness in your muscles and joints. Conversely, if you don\u2019t feel an iota better after gluten elimination, you\u2019re likely not sensitive to it.<\/li><li><strong>If you\u2019re feeling better, make doubly sure it\u2019s gluten by reintroducing gluten into your diet.<\/strong> If symptoms return, you\u2019re probably gluten-sensitive.<\/li><li><strong>People who feel better off gluten need to differentiate between celiac disease and non-celiac gluten sensitivity.<\/strong> Ask your doctor to test your blood for gluten antibodies. If the result is negative, you need no further testing. If positive, keep eating gluten until instructed to stop. Your doctor will recommend a small-intestine biopsy to confirm celiac disease, and quitting gluten before the biopsy will invalidate the test.<\/li><li><strong>People with celiac disease need to give up gluten completely<\/strong>. Those with non-celiac gluten sensitivity are at less of a health risk eating small amounts of gluten, but generally feel best when they avoid it altogether.<\/li><li><strong>If you need help with the self-testing or going permanently gluten-free<\/strong>, schedule a visit with one of our nutritionists, Marla Feingold,\u00a0Seanna Tully\u00a0or Marcy Kirshenbaum.<\/li><\/ol>\n\n\n\n<p>Be well,<\/p>\n\n\n\n<p><em>David Edelberg, MD<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Post 06\/04\/2012 The current guesstimate says roughly 20% of the population are intolerant to gluten, with about 1% of that group having a potentially fatal intestinal condition called celiac disease. The remaining 19% or so are classified as having \u201cnon-celiac gluten sensitivity.\u201d Despite the dozens and dozens of medical and psychiatric conditions linked to gluten [&hellip;]<\/p>\n","protected":false},"author":2087,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,195,211,130,2331,3,70],"tags":[1115,1395,1117],"class_list":["post-4775","post","type-post","status-publish","format-standard","hentry","category-blog","category-diseases","category-g","category-integrative-medicine","category-internal-medicine","category-knowledge-base","category-s","tag-celiac-disease","tag-gluten-intolerance","tag-gluten-sensitivity"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\r\n<title>Six Commonly Missed Diagnoses: Gluten Sensitivity<\/title>\r\n<meta name=\"description\" content=\"Those with non-celiac 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