Wheat Belly Review: Part 2

Why Pick On Wheat??

1) The "history" of wheat farming.
2) What's an Exorphin?
3) Wheat and Celiac Disease
4) Wheat and your cholesterol!
5) The Glycemic Index trouble (Diabetes)

3) Wheat and Celiac Disease/GI tract

Since our diets have become extremely wheat based Celiac disease has become a big problem. The symptoms attributed to Celiac disease were first attributed to wheat in 1953.  It is estimated that today 1% of our nation has Celiac Disease.  (Although retrospective studies are not readily available there are two studies that suggest the rate of Celiac disease has indeed doubled or even quadrupled since the 1940's, rather than the increase diagnoses strictly being related to better diagnostic tools.) 

What is it?

Celiac disease is an inflammatory reaction to gluten (a protein in wheat, barley, rye, etc.)  that affects the GI tract (causing malabsorption).  It also can cause a number of other inflammatory problems including a skin rash called dermatitis herpetiformis, lymphoma (if celiac disease is untreated), infertility, etc.  

Patients with Celiac disease are also more likely to develop other autoimmune diseases including thyroid disease, rheumatoid arthritis, anemia, and IBD.  

Dr. Davis also mentioned that 50% of people with unexplained loss of balance and coordination have elevated celiac serology.  Other neurologic findings have been attributed to untreated/undiagnosed Celiac disease as well.  (Lancet: From Gut to Brain 2010)

How do I get Celiac Disease?

It does have a genetic base (90%+ of celiac patients have either HLA DQ2 or HLA DQ8 genetic markers).  That being said, 40% of the general population has one of these markers and most don't develop Celiac Disease so there has to be an environmental/infectious trigger as well.

How do you diagnose it?

Celiac disease is initially screened for via labwork looking for antibodies specific to celiac disease (TTG and Anti-endomysial antibodies).   If lab work is positive then the gold standard is to undergo an EGD.  This is a very simple 15 minute procedure (I've had it done).  I think the need for an EGD is under some debate currently but that's the gold standard for now.  I asked my supervising physician his take on this and he feels it is necessary, not so much for the confirmation of Celiac disease (as he would recommend a gluten free diet to patients with positive Celiac serology and normal intestinal biopsies) but in order to rule out gastric/intestinal lymphoma.  I really can't imagine that is seen very often but for now an EGD is the recommendation I will be giving patients with positive celiac serology. 

How do you treat it?

Luckily, the treatment is pretty simple.  You have to abstain from gluten 100% of the time.  When gluten is removed from the diet (and lifestyle - gluten can be found in medicines, make-up etc.) the gut repairs itself and risk factor for other problems (lymphoma, rashes, infertility) return back to a more normal baseline.

I have "IBS" and celiac type symptoms but my Celiac serology is negative.  What do I do?

Obviously, the Wheat Belly book advises everyone to entertain the idea of a wheat free diet.  Clinically, 5 years ago in the GI clinic this school of thought wouldn't have been supported (at least were I worked) but things may have changed.  The doctor I am currently working with said that almost ALL of his patients with nonspecific abdominal pain and even those with IBD do better on a wheat free diet.  He frequently makes this recommendation to people.  As I have been seeing patients in the clinic I have also noticed that his partner (who is currently in FL doing an advanced endoscopy fellowship) recommended a similar diet to many of his patients.  This is a pretty big difference in practice philosophies from my old practice.  I don't know if things have changed there but 5 years ago I was fairly frustrated at the lack of interest from the GI doctors regarding celiac disease and the role food plays in our health.  

More to come when I get another free moment!