The Spectrum of Gluten Sensitivity
The
concept of Gluten Sensitivity Spectrum is an evolving one;
some believe it exists, some do not. Most of the mainstream
medical community recognizes Celiac Disease by it's gold
standard diagnosis [damaged villi]. However, studies are
showing that
gluten affects far more than just the
gut.
Even as far back as 1966, it was shown that only 9 of 12
Dermatitis Herpetiformis patients had enteropathy [villi
damage]. Dr. Michael Marsh also demonstrated that you can
have gluten sensitivity with normal bowel mucosa [currently
villi damage is now graded using the "Marsh
Classification"].
Sadly, because many mainstream doctors don't subscribe to
the fact of The Gluten Sensitivity Spectrum, people fall
thru the cracks and don't get diagnosed.
Luckily doctors like
Dr. Marios
Hadjivassiliou,
Dr. Michael N. Marsh,
Dr. Kenneth Fine,
Dr. Scot Lewey,
Dr. Rodney Ford
and a host of others have delved into
Non Celiac Gluten Sensitivity
and have proven it's existence. Hopefully in time this
knowledge will get into the hands of those that need it -
doctors and patients alike.
Amber
waves of illness
Celiac Disease
is often misunderstood and misdiagnosed disease. It has
been called "The Great Imitator" due to it's 250+ symptoms.
To make matters even more difficult, this disease presents
differently in each person.
Classic
Celiac
manifests with classical gastrointestinal symptoms of
diarrhea and weight loss from malabsorption. Ironically
Classic Celiac is not typical. Only about 50% of diagnosed
Celiacs presented with gastrointestinal issues. Testing
results: positive serology, positive biopsy, improvement on
a gluten free diet.
Celiac with Atypical Symptoms
presents mainly with symptoms outside the gastrointestinal
tract. In fact, there can be little to no GI symptoms!
Patients usually seek medical attention for other reasons:
iron deficiency, osteoporosis, short stature, infertility.
Neurological symptoms off ataxia, peripheral
neuropathy, seizures, headaches, hypotonia,
depression, ADHD,
and developmental delay have also been found. Because the
patients are "asymptomatic" from a gastrointestinal stand
point, correct diagnosis is often missed [or at best -
found years later]. Testing results: positive serology,
positive biopsy, improvement on a gluten free diet.
Silent
Celiac
is categorized by those that are completely asymptomatic.
It can be found by screening high risk groups, or by
accident when biopsies/endoscopies have been performed for
other reasons. These patients are clinically silent, in
that they do not present with any clear GI symptoms or any
symptoms of Atypical CD. Testing results: positive
serology, positive biopsy, improvement on a gluten free
diet.
Latent Celiac
often found in people with a previous diagnosis of CD that
responded to a gluten free diet and retained a normal
mucosal histology upon later re-introduction of gluten.
Latent CD can also represent patients with currently normal
intestinal mucosa who will eventually develop damaged
mucosa. Testing results: positive serology, negative
biopsy.
Refractory Celiac
is found in people who do not or no longer respond to a
gluten free diet. The most common reason for failure to
respond to a gluten free diet is non compliance. Non
compliance can come from cheating or exposure to a source
unknown to the person [hidden gluten]. Refractory CD can
also develop as a complication such as
ulcerative-jejunoiletiis or enteropathy-associated
lymphoma.
Non Celiac Gluten Sensitivity
is classification that is not widely accepted by the
mainstream medical community...yet.
NCGS presents itself in any number of the symptoms
described above, but when it comes to testing, often times
blood work and biopsy results are inconclusive or negative.
This puts those suffering in "No Man's Land" because
current medical standards say they do not have Celiac
Disease, but gluten still is at the root of their problems.
We have seen the enemy