We live in a society where medical treatment efficacy is gauged by two major standards: (1) make a diagnosis and (2) find the drug best suited to treat the symptoms associated with that diagnosis.

With as much as 80% of all medical research funded by pharmaceutical companies, where does celiac disease fit into this paradigm?  Considered to be a rare disorder with no drug to treat it, celiac is unfortunatley low on the hierarchy of most medical practitioners.  In addition, the “face” of celiac that most doctors are taught to look for in a patient is chronic diarrhea and severe weight loss.  Is it any wonder that little emphasis is put on its diagnosis?  Sadly, it is only after the patient with severe weight loss has been ruled out for cancer and other serious diseases, that their doctor might consider celiac.

• What’s the difference between celiac disease and gluten sensitivity?
  In my opinion, nothing.  The problem we have encountered is that celiac disease is the only manifestation of gluten sensitivity that medicine has been able to diagnose.  And not very well at that considering it takes the average celiac patient 11 years before they’re given the proper diagnosis.So what is the problem?  That something that is “rare” is not often looked for?  Partially.  The fact that there’s no drug to treat it, so there’s no “easy” fix?  Partially.  The fact that the only treatment is a dietary change and no one really wants to “condemn” a patient to never eating wheat, rye or barley again?  Definitely!

• Celiac disease is just a subset of gluten sensitivity. Celiac is just the tip of the iceberg of the greater issue called gluten sensitivity.  In this case the tip is 1/40 of the whole iceberg because current research tells us that while celiac disease affects 1% of the population, gluten sensitivity’s incidence is about 40%. And that takes it right out of the “rare” category and puts it squarely in the category of obesity which is considered to be an epidemic!

• Diagnosis: The “gold standard” for diagnosing celiac disease is a positive intestinal biopsy revealing severe degradation of the surface of the small intestine.  Damage has to occur for many years before such a test is positive, not to mention all the secondary problems that have likely arisen during that time.  Yet we wait and wait for that positive test while in the meantime it’s considered perfectly fine to tell a patient to continue eating gluten if their test is negative.I have stated that within the decade the current protocols being used to diagnose and treat celiac disease will be looked upon as malpractice.  Is that too strong a statement?  I don’t think so. Do we wait for a patient to have a heart attack before we assess risk factors for cardiovascular disease?  Of course not.  So why is it acceptable to allow a patient to get to the point of severe atrophy of their intestine with concomitant malabsorption, inflammation, and risk of autoimmune disease before we make a diagnosis?  It isn’t!

I’ve been working with gluten sensitive patients for over 15 years and this year co-authored my first book on the subject, The Gluten Effect.  What I have come to find out through research and clinical experience has taught me that we have an obligation to our society to change our procedures and strategies.  We are creating many ill patients by missing the diagnosis of gluten sensitivity. Such things as: obesity, depression, anxiety, fatigue, migraines, IBS, and autoimmune diseases such as arthritis, lupus, diabetes, thyroid disease, and osteoporosis are all implicated with gluten sensitivity.  The list is long and growing as we learn more.

I believe everyone should be screened for gluten sensitivity.  It involves a simple lab test which should be evaluated by an experienced clinician.  The reasoning behind this is that interpretation of these tests requires some experience and it’s often not a simple yes or no proposition.  Labs such as Enterolab offer an on-line home version which is a stool test.  There are some researchers who prefer also using a blood test.  Personally I use blood and saliva testing for my patients with the stool test recommended for those living too far away to come into the office.  What if the test is equivocal?  What if it’s in the gray “suspicious” but not confirmed area?  The true “gold standard” is evaluating a dietary change – it’s called elimination and provocation.  Eliminate gluten completely from your diet for a minimum of 6 to 8 weeks and see how you feel.  If you notice a change that is proof enough.