Scot M Lewey DO - Colorado Springs
Dr. Lewey, a gastroenterologist with Gastroenterology Associates of Colorado Springs, thinks there are many more people who do not meet the criteria for full-blown celiac disease but who are gluten-sensitive.
“For every identified celiac disease patient, there are three to ten more with clinical histories consistent with celiac who don’t test positive,” Dr. Lewey writes in an article at www.celiac.com. “This concept of non-celiac gluten sensitivity (NCGS) or gluten-related disease (GRD) may be hard for some people to swallow, but I suggest that it affects as much as 10% to 30% of the population.”
People with celiac disease have high levels of certain antibodies, which are detected with blood tests. The diagnosis may be confirmed with an intestinal biopsy to check for damage to the villi—the folds inside the intestines. Genetic testing also provides clues to the presence of celiac disease. More than 90 percent of confirmed celiac patients, and 35 to 45 percent of all Americans, carry one or both of the risk genes associated with celiac. Celiac disease is present in only 1 percent of those people, and it has been reported in people who do not carry the genes. However, anyone with a family history of celiac disease should be screened, Dr. Lewey says.
Non-Celiac Gluten Sensitivity
Dr. Lewey’s personal experience has led him to take a wider view of gluten-related conditions. In medical school, he diagnosed himself with irritable bowel syndrome and lactose intolerance. But after his wife was diagnosed with full-blown celiac disease, he underwent testing and found that he carried one of the celiac genes. Other tests also were positive.
When Dr. Lewey adopted a gluten-free diet, his IBS symptoms resolved and his lactose tolerance improved dramatically. His 22-year-old son, whose only symptoms were seizures after drinking beer or eating bread, also underwent blood testing and a biopsy that confirmed celiac.
Dr. Lewey began consuming what he calls “a daily diet” of articles about celiac disease and gluten sensitivity. These articles opened his eyes to a spectrum of gluten-related illnesses, which were beginning to be named: Non Celiac Gluten Sensitivity (NCGS) or Gluten-Related Disease (GRD).
“I was already aggressively looking for celiac disease, but I began considering NCGS or GRD in all my patients,” he says. He started recommending stool antibody testing and genetic screening to patients who had symptoms suggesting gluten sensitivity. He found that patients who adopted a gluten-free diet experienced dramatic improvements in their intestinal and extra-intestinal symptoms and overall health.
One interesting question is why gluten sensitivity appears to be on the upswing. Better diagnostic tools may explain part of that, but Dr. Lewey notes that modern food production may be a factor.
“One theory says we have too many substances that make us too clean,” he says. “The ‘rain’ at Safeway is not just to make produce look good; it contains antibiotics. Antibacterials and antibiotics are fed to animals, and we treat our water so it’s safe to drink. But are we also knocking out our normal, healthy gut microbes? There is a complex interaction between foreign proteins in our environment, our gut microbes, and the integrity of the intestinal wall, as well as genetics.”
Another perspective is that the gluten we consume today is not the same as it used to be.
“It has gone from wild to domesticated,” Dr. Lewey says. “The downside of that is that grains now are higher in gluten content, and that probably has contributed to the rise in gluten sensitivity.”
High-gluten flours are used to give the baked goods and pastas the texture Americans like. Many other processed foods contain gluten, which is used as a thickener, stabilizer, and preservative in items from hard candy to frozen dinners. It may be contained in additives such as modified food starch, hydrolyzed vegetable protein, mono and diglycerides, protein hydrolysates, and artificial colors. Gluten also is found in medications, supplements, hygiene products such as toothpaste and mouthwash, and even shampoos. Food manufacturers are starting to add gluten to even more products, such as rice, which already has been introduced in the United States.
“I think we’re going to see more celiac disease because of this gluten prevalence in foods, along with the high prevalence of the genes and stress, which makes the gut more leaky,” Dr. Lewey says. “The human body is going to have difficulty handling foreign proteins.”
Although it has not been scientifically proven, there is some evidence that probiotics break down gluten. Digestive enzymes also may help make gluten less toxic, Dr. Lewey says. He advises his patients to take probiotics before going out to eat in case of accidental exposure.
A couple of medications that reduce gut leakage and break down gluten into less toxic forms are undergoing clinical trials and may be available in next few years.
For now, however, people with diagnosed celiac must be militant about gluten. Gluten-free foods are becoming more widely available, and support groups such as the Celiac Sprue Association can educate you about a gluten-free lifestyle.
You may have discovered on your own that a gluten-free diet relieves your symptoms. But Dr. Lewey warns that your test results may not be accurate if you’ve already adopted a gluten-free lifestyle.