Gluten Sensitivity/leaky Gut

[jasonD2]

If gluten intolerance is caused by a traumatic digestive event (e.g. viral infection) resulting in leaky gut and yeast overgrowth, is it at all possible that if the gut is healed then the sensitivity to gluten may be reduced or eliminated over time?

I'm still trying to rationalize how and why i developed a gluten sensitivity and if its related to stomach problems i developed from a course of antibiotics/subsequent viral gastroenteritis or if it is celiacs or something else.

All i know is I was in perfect health until 2002 (had an iron stomach) and after being on antibiotics for 5 months and then getting gastroenteritis everything went down the crapper...literally started with lactose intolerance, then developed IBS/Constipation then food sensitivites.

can anyone help shed some light on my situation. My history and symptoms dont present like a classic celiac patient, but I still want to get to the bottom of this somehow

thanks

[MELINE]

All i know is I was in perfect health until 2002 (had an iron stomach) and after being on antibiotics for 5 months and then getting gastroenteritis everything went down the crapper...literally started with lactose intolerance, then developed IBS/Constipation then food sensitivites.

can anyone help shed some light on my situation. My history and symptoms dont present like a classic celiac patient, but I still want to get to the bottom of this somehow

thanks

EXACTLY my case Jason......I mean EXACTLY!!!!! Completely healthy until 18 years old and then one day woke up in pain (but I was taking antibiotics or 6 years....) But untill my 29 years it was ok. Now it just went out of control and finally I found out what was wrong.

Yesterday I went to my new doc for the first time and I asked him "why now"? I mean I am 29 years old and till now I have consumed huge amounts of bread with no problem at all (just abdominal pain).What happened ? and he told me that stress or a virus or antibiotics or enviromental polution can wake up the symptoms. It doesn't mean that you were not born with it. You just did not have the symptoms. Lactose and all the other intolerances are just side effects. He told me that in 5-6 months he believes I will be able to eat most of the things I can't eat now.

The connection you are making between gluten - candida - leaky gut - antibiotics definately makes sense but I don't know if gluten sensitivity is something you can cure......I mean if it is like the other intolerances....

I don't know if that was any help for you.....

kisses

Meline

[jasonD2]

Wow- I literally thought I was the only one. No one has ever been able to relate to my situation. 6 years on antibiotics is crazy...i'm surprised your docs even let you stay on them longer than 6 months. I believe that a comibination of antibiotics, horrible stress and the viral infection set me off...was the worst time in my life.

Im sure im genetically predisposed to stomach problems just because all the women in my family have them, but mine are by far the worse. My mom has IBS and diverticulosis but she can still eat anything. My cousin has IBS, my aunt not so bad but she has problems too. grandmother and great grandmother died of stomach cancer.

Truth is I just simply dont know what to do and what to eat. ive spent years seeing countless doctors and specialists and im finally narrowing it all down. I just hope its not Celiacs but if it is i have no choice but to deal with it

[leadmeastray88]

I just hope its not Celiacs but if it is i have no choice but to deal with it

How come you hope it's not Celiac's?

I mean of course nobody wants to have it...I can understand because most of us here are going through the same thing, but in my opinion I would much rather have something that I can fix with my diet than something I have to fix with medication. Just a thought, and a look on the bright side I guess

I hope you can fix your ailments soon!

[MELINE]

How come you hope it's not Celiac's?

hahahaha....that's what I thought too.....I am so so so happy it is celiac and I know exactly who my enemy is (finally!!)

jasond2 i had 6 years of antibiotics because of serious heart problem (reymatik fever - I don't know how you call it in english...).

I hope you soon find out what it is. You will feel so great after you exclude the poison of your diet. Believe me you will not feel bad if you cannot eat bread when you know that you are not in pain any more. And I know what I am talking about when it comes to elimination (just look at my signature)

p.s. Sorry for my english I am in a hurry and I don't have time to double check my post. Hope my words make sense.

Meline

[Rachel--24]

If gluten intolerance is caused by a traumatic digestive event (e.g. viral infection) resulting in leaky gut and yeast overgrowth, is it at all possible that if the gut is healed then the sensitivity to gluten may be reduced or eliminated over time?

If you are genetically susceptible this viral infection (or any traumatic event) could have triggered Celiac Disease. Sometimes there are additional problems...so that even if you are sure its Celiac (and are follwing the diet) you could still have other contributers to digestive issues and leaky gut.

If you DONT have Celiac then the same traumatic event could still lead to problems with leaky gut, yeast, etc.

If thats the case...then yes...its entirely possible to reduce food intolerances with healing. Not everyone requires a life-long diet. If the sensitivity is brought on by unhealthy conditions in the gut then its possible to coorect that with proper treatment. Unfortunately that part is usually not an easy process.

In this type of situation there are sometimes many factors involved. Generally we dont lose our health over night....even though it sometimes it "appears" that way. I'm someone who was fine until age 31 when after some dental work everything fell apart...in a BIG way. I have since been dealing with multiple food/chemical intolerances. The problem was quite severe...basically I became a "universal reactor"...meaning that I started reacting to literally *everything*.

Anyways, even though it seemed like that "event" caused everything to occur....in reality it usually doesnt happen that way. The immune system can deal with stressors...the immune system is not easily brought down to the point that it cannot effectively fight off pathogens and keep the body in a healthy state. Its when the load becomes too great that the scales begin to tip and we start showing symptoms of chronic unwellness.

It doesnt happen overnight though and its not a single event which caused the immune system to become so burdened. Its an accumulation of things that eventually overwhelm the immune defenses. This can be toxins, heavy metals, bacteria, parasites, virus, stress, antibiotics, yeast, food intolerances, etc. etc.

So generally its more than one factor...there will usually be more than one of the things I just listed contributing to the gut problems (in the absence of Celiac Disease). So eventually the immune system cannot handle the load and problems begin to develop. All of these things play a part in that process....as the body systems become impaired the immune system is dealing with more than it can handle.

Especially when leaky gut becomes an issue. This allows food, bacteria, fungi, toxins of all kinds, etc. to enter the bloodstream which puts a HUGE burden on the liver, the immune system and basically every body system/organ is affected.

Depending on the severity of the problems it can be a challenge to recover. I dont think that its ever *easy* but it can be successfully treated if everything which is contributing to the unwellness is addressed so that the immune system is no longer burdened.

I have seen several Dr.'s who specialize in this throughout my treatment and they are all in agreement that this type of situation is generally multifactorial. Whatever "event" occured at the onset of symptoms is typically the "straw that broke the camels back". It was the event which finally pushed the immune system too far.....but things are leading up to that point long before we actually start suffering symptoms.

I'm not really knowing much about your situation...or the severity of it...but what I'm describing does result in food intolerance, chronic infections, toxicity (from many sources), leaky gut and a chronic situation that does not resolve while following the strictest of diets.

So if you find that you cannot recover then I would suspect leaky gut and some of these other problems as well.

[jasonD2]

Hi rachel- thank you for all of your feedback. How do you think the dental work triggered all of your problems....mercury poisoning? Did you talk to your dentist after it happened?

[Rachel--24]

Hi rachel- thank you for all of your feedback. How do you think the dental work triggered all of your problems....mercury poisoning? Did you talk to your dentist after it happened?

Yes....I had a broken filling for two years and when I finally went in for a cleaning the dentist informed me that it needed to be replaced with a crown...and also one other filling needed replacement as well (he said it was deteriorating). I only had 4 fillings total.

I was not aware that there were any risks...or that I was about to be exposed to high amounts of mercury vapor...or that my body may have already been dealing with a heavy mercury burden for many many years.

So after those fillings were drilled out I was never the same...I started experiencing symptoms. I then went back to have my new gold crowns put in....after that things deteriorated very rapidly and about a month or so later I had to go on disability.

I didnt make a connection for several months. I really didnt understand what was happening until I started thinking that something was going on with my teeth. I did an online search and found out that gold crowns and mercury fillings in the same mouth is a very bad thing. I still had 2 mercury fillings and they were in direct contact with the gold crowns. Dissimilar metals cause a battery-type reaction (with saliva as a conductor)...and large amounts of mercury + other metals are leached from the fillings/crowns.

I immediately went back to the dentist and told him what was going on....he already knew I had become ill shortly after seeing him. I wanted the gold crowns taken out right away. He was arguementive when I suggested mercury toxicity and very much of the belief that the fillings are safe. He also told me that the battery reaction (galvanic reaction) was no different from licking a 9 volt battery....and not in any way harmful.

Personally, I dont think anyone in their right mind would keep a 9 volt battery in their mouth indefinately...and I dont think anyone in their right mind would think its "safe" to do so. I dont think that having *any* amount of mercury exposure is safe...let alone the high and rapid exposures caused by dissimilar metals.

Anyways, yes....I now have mercury toxicity and major problems as a result. This was the "event" that pushed my immune system too far...and it was a BIG event...which is why my symptoms didnt appear gradually over a long period of time. It happened very rapidly.

My mom had 11 fillings while she was pregnant with me and my Dr.'s feel that my burden was always high...as I went through life with my own 4 fillings leaking mercury on a daily basis that burden increased. Also, there is the exposure to all other toxins which the body has to deal with on top of it. I did not have the best diet (lots of processed foods), I smoked, I pushed myself to the limit with everything I did, did not get enough sleep, I had times where my stress levels were high, I had a couple vaccines containing mercury in my late 20's...etc. etc.

All of things played a role in the decline of my health...but without the mercury burden its unlikely that this would have ever occured. My immune system probably would have been strong enough to deal with the other factors.

Its been over 5 years now and yes...I've talked to people from the dentist office on a few occassions. I have not been able (or allowed) to talk to the dentist since he removed my crowns more than 4 years ago.

I had my 2 remaining mercury fillings removed by a mercury-free biological dentist who used safety precautions to minimize my exposure.

It was about a year ago that I spoke to someone who was representing the dental office. She was very knowledgable about mercury and we had an intelligent discussion...but of course they do not accept responsibility...nor are they liable. I wanted the dentist who had made this error in judgement to be aware that there is a risk involved....that lives can be affected.

She said she believed that at some point the fillings will be banned...but until that day comes this particular dentist will continue to use them in his practice.

She also said that because of the nature of mercury...and the fact that it accumulates in the body from many sources...it cannot EVER be proven that this would not have occurred at some point even if I had never met this dentist. I may have lost my health at some point regardless...because I had already had those fillings for nearly 3 decades before he even touched them.

She said I could indeed be very mercury toxic from exposure which occured in that office.....but we cannot ever prove that for sure. Even if the mercury levels are high....we cannot prove where it came from...or how long its been there. She was correct in all of her statements because in reality....it cannot be proven that *this* event caused ALL of the toxicity to occur.

The point is...the fillings leak mercury and mercury is a neurotoxin which is proven to be extremely toxic and a risk to human health.

This was in yesterday's news.

WASHINGTON (June 5) - Silver-colored metal dental fillings contain mercury that may cause health problems in pregnant women, children and fetuses, the Food and Drug Administration said on Wednesday after settling a related lawsuit.

As part of the settlement with several consumer advocacy groups, the FDA agreed to alert consumers about the potential risks on its website and to issue a more specific rule next year for fillings that contain mercury, FDA spokeswoman Peper Long said.

As the result of a lawsuit, the Food and Drug Administration has agreed to warn consumers that metal fillings, which contain mercury, pose risks to children, fetuses and people who are sensitive to the chemical.

Millions of Americans have the fillings, or amalgams, to patch cavities in their teeth.

"Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses," the FDA said in a notice on its Web site.

"Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner," the agency said.

The FDA said it did not recommend that people who currently have mercury fillings get them removed.

The FDA must issue the new rules in July 2009, Long said.

Such a rule could impact makers of metal fillings, which include Dentsply International Inc and Danaher Corp unit Kerr.

The new rule will give the agency "special controls (that) can provide reasonable assurance of the safety and effectiveness of the product," Long said.

The lawsuit settlement was reached on Monday with several advocacy groups, including Moms Against Mercury, which had sought to have mercury fillings removed from the U.S. market.

While the FDA previously said various studies showed no harm from mercury fillings, some consumer groups contend the fillings can trigger a range of health problems such as multiple sclerosis and Alzheimer's disease. In 2006, an FDA advisory panel of outside experts said most people would not be harmed by them, but said the agency needed more information.

Mercury has been linked to brain and kidney damage at certain levels. Amalgams contain half mercury and half a combination of other metals.

Charles Brown, a lawyer for one of the groups called Consumers for Dental Choice, said the agency's move represented an about-face. "Gone, gone, gone are all of FDA's claims that no science exists that amalgam is unsafe," he said in a statement.

J.P. Morgan Securities Inc. analyst Ipsita Smolinski said the FDA is not likely to outright ban the fillings next year but will probably call for restrictions.

"We do believe that the agency will ask for the label to indicate that mercury is an ingredient in the filling, and that special populations should be exempt from such fillings, such as: nursing women, pregnant women, young children, and immunocompromised individuals," Smolinski wrote in a research note on Wednesday.

Fewer patients have been opting for mercury fillings in recent years, instead choosing lighter options such as tooth-colored resin composites.

Only 30 percent of fillings given to patients were mercury-filled ones as of 2003, according to the American Dental Association (ADA). Other options include glass cement and porcelain as well as other metals such as gold, but they cost more and are less durable, the group has said.

This is all a little too late for me...but I think progress is being made with regards to this very important issue. Hopefully the fillings will eventually be banned completely.

[jasonD2]

Thats quite a story! You have me concerned now because i had a filling replaced back in the 90s and one completely drilled out and replaced with a cap in 2003. cant say I noticed anything dramatic after, but my system was already in a weakened state from my digestive trauma. I had a hair analysis last year and my mercury was a bit elevated (probly cause of my fillings), but not too high. I do have 4 fillings now but am afraid to have them removed because 9/10 times a non-amalgam replacement filling will crack the tooth and a crown will be needed. I might consider it if and when they come out with a good replacement for amalgams.

[CarlaB]

Jason, I had a whole slew of health problems that caused gluten intolerance for me ... I did not have celiac disease .... celiac disease is permanent.

As I fixed my other health issues, many of them having to do with the gut, my gluten intolerance went away completely. I was severely intolerant before to even a crumb. I frequently got glutened if I ate out, etc.

So, yes, it can be caused by something else, but if it's celiac disease, it's lifelong.

I had my fillings replaced in 1991 with white colored fillings and have not had trouble with any of them. Every one of my molars has a filling. If you were to have it done, be sure you have a biological or mercury-free dentist do the work .... a regular dentist will take no precautions and will not help you chelate the metals left behind. A regular dentist can do more harm by removing them than good.

[jasonD2]

Hi Carla- How did you fix your health problems and reverse the gluten intolerance? When you were intolerant did you test positive on the antibody tests? how did u know for certain you didnt have Celiac?

[CarlaB]

I tested negative by blood tests and biopsy for celiac. I tested positive (IgA and Ttg) by Enterolab. Of course, Enterolab can only diagnose gluten intolerance, not celiac. I do not have a celiac gene.

I knew I was no longer sensitive when I stopped getting glutened by restaurants when we were traveling. I was 100% gluten-free for over two years.

I have been treated for Lyme Disease, bartonella, babesia, parasites, heavy metal toxicity, bacterial dysbiosis, and low thyroid. I am still treating Lyme and babesia (and still take thyroid meds). My GI issues cleared up mostly with the bartonella and parasite treatments. I tested negative for parasites, but visibly saw them when they were eliminated.

[Rachel--24]

I've had my composites in for about 4 years without any problems. Originally, when the dentist who drilled out my first 2 amalgams discussed my options for crowns....he gave me a choice of gold or white composite. I said I wanted the composites....because they'd be white and would look better than the gold.

He then gave me a big speech about how the composites do not last long and break easily. He said the gold is more "forgiving" and does not break.....they will last longer, etc. etc. I chose the gold because I trusted his words and thought he had my best interest in mind.

Obviously not...because he drilled out my mercury fillings without using any safety precautions (not even a rubber dam) AND he talked me into the gold crowns which ended up causing even MORE mercury to be released and at a much faster rate.

Because of his ignorance I lost my health, I lost 2 years of work, I almost lost my house, I lost my relationship, I lost my sanity for awhile, I lost my ability to eat most foods, I lost my ability to tolerate everyday chemicals/toxins, etc. etc.

I'm still working very hard to regain what has been lost and it has cost me more than I would ever want to know as far as the finances go.

All of this suffering and all of the money spent trying to restore my health....because of the dentist's ignorance with regards to how toxic these fillings really are. All of this could have been prevented had I been more aware and had I known the correct procedures. Had I went to a dentist who acknowledges the risks and removes these fillings properly... following a strict protocol to PROTECT the patient (as well as himself) from exposure to mercury....I would probably be healthy today.

Its very sad when so many lives are affected by something which is totally unecessary...there are safer alternatives.

I would have prefered to replace my composites every couple of years (if that were really the case) then to lose my health in this way. It wasnt worth it....my quality of life has been affected in every way.

Yes...its true that my mercury burden was probably already very high. I had developed Graves Disease a few years prior to this "event". The broken filling itself was probably leaking quite a bit of mercury. The fillings leak mercury every minute of everyday. They leak much larger amounts everytime we chew, or smoke, or drink something hot.

However, If I been informed and done things differently I could have corrected this situation the right way...and without losing my health in the process. I could have had the fillings removed safely, without using any metals as replacements...and then I could have went about addressing the mercury which had already accumulated in my body for 30 years. I could have done it that way and I could have remained healthy.

The damage to the gut caused by mercury vapor is well documented. It can alter the intestinal environment, it can promote yeast overgrowth, it can lead to antibiotic resistant bacteria, it can cause enzyme deficiency, we can become more susceptible to pathogens in the gut, we are more susceptible to furthur damage as a result of antibiotic treatments, etc. etc.

As far as elevated mercury in a hair analysis...heres an explanation.

If the reading for mercury is HIGH (red) on a hair test, this probably indicates the person has mercury poisoning.

On the other hand, if the reading for mercury is normal (or even very low), this indicates nothing one way or another about whether the person has mercury poisoning. Mercury can still be present in the brain and organs, doing lots of damage there, and NOT be present in the hair. THIS IS VERY COMMON.

Mercury usually interferes with the body's ability to use, process, and store minerals. Regular minerals: stuff like calcium, magnesium and sodium. (On a hair test, these are called "essential elements".) While this is a very bad thing in terms of health effects, it is "helpful" for the purpose of determining mercury poisoning, because it is a pretty predictable result.

To be just slightly more technical about it, mercury poisoning usually causes impaired "mineral transport". Mineral transport is the ability of cells to pull minerals into themselves and pump minerals out of themselves selectively.

If mineral transport is normal then someone with too much mercury will have high hair mercury levels. This happens with about 1 person in 10 who have a mercury problem. This person will have a HIGH reading for mercury. In this case, it is easy to see they have a problem with mercury. These people have normal mineral transport, and can move mercury from the large pool in the body into the hair.

For the other 9 people who are mercury toxic, it is harder to figure out if they have a problem or not. The normal level of mercury present in their hair could mean they don't have much mercury in their body (they are okay), or it could mean they have impaired mineral transport due to mercury poisoning, and that is why there is little mercury in their hair.

Since mercury impairs mineral transport, examining hair for the level of many minerals lets us determine if mercury has left its signature in the hair's biochemistry even if the mercury itself doesn't show up.

If you ever decide to remove the fillings....make sure you do it the right way. Make sure you go to a biological dentist who will follows a strict safety protocol. Its better to leave them in then it is to have them removed unsafely. If you already have a heavy mercury burden....any additional exposures could push you over the edge. I actually had no symptoms prior to the dental work....I could eat whatever I wanted and I was not sensitive to chemicals. The only thing going on was that my thyroid would go overactive during times of stress....but I was managing that without any difficulty.

If you are already suffering digestive problems I would not do anything with the fillings that could cause your situation to progress. If you do take them out....the single most important thing is to have it done SAFELY. That way you are not putting yourself at furthur risk.

There are very specific things which can be done before, during and after the removals to ensure that exposure is very minimal and that whatever you do get exposed to is easily excreted before it has a chance to be stored in tissue.

[grommet]

Hi Jason,

I only started being gluten intolerant in my late thirties/early forties. This was after a miscarriage, an ectopic pregnancy, an op to be sterilised i.e. a series of hospital visits. My brother only started after a bout of glandular fever. My mum started at age 65 - not sure of one particular trigger but she has been ill probably since her forties without knowing what was causing it. Mu daughter has been ill all the way through her teens - again can't remember what triggered it. None of us are diagnosed Coeliacs - negative bloods negative biopsies.

As far as scientific research on what triggers this off you might want to read this (particularly the 2 paragraphs I have highlighted) :

News on Celiac Disease: Where Are We? Where Are We Going?

Posted 05/21/2008

Alessio Fasano, MD

Author Information

San Diego, California; Wednesday, May 21, 2008 - The trend of exponential growth in the reports and special sessions on celiac disease continued at this year's Digestive Disease Week (DDW) meeting. A total of 75 American Gastroenterological Association-sponsored sessions (Clinical Symposia, Meet-the-Professor Lunches, Focused Clinical Updates, Research Roundtables, and Sunrise Discussions) and abstracts were presented throughout the course of the meeting and were summarized, as is the tradition, by Drs. Carol Semrad and Robert Anderson at a well-attended Sunrise Discussion on advances in celiac disease.[1] The wealth of basic, translational, and clinical information reported this year and the quality of these data are testimonial to the fact that celiac disease is closing in on other gastrointestinal disorders that have historically been at the forefront of the field.

Celiac disease is now considered an autoimmune disorder triggered by the ingestion of gluten and similar proteins of barley and rye in genetically susceptible subjects. It is the gliadin fraction of wheat gluten and similar alcohol-soluble proteins in other grains that is associated with the development of intestinal damage. The interplay between genes and environment (ie, gluten) leads to the onset of intestinal and/or extraintestinal symptoms. The major breakthroughs reported at DDW 2008 were in regard to the pathogenesis of celiac disease and, most important, focused on new strategies for its prevention and treatment.

Celiac Disease: Where Did It Come From and How Does It Work?

For most of the history of the human race, gluten was not part of the equation. About 10,000 years ago, a fraction in the 2.5 million years of human history, gluten made its appearance with the advent of agriculture, providing the second "ingredient" (the first being genetic predisposition) necessary to develop celiac disease. However, we are still struggling with a key unanswered question: Why, despite the fact that 30% to 40% of the population worldwide has the necessary HLA DQ2/DQ8 genes (ie, class II human leukocyte antigen HLA genes DQ2 or DQ8) and despite that virtually everyone is exposed to gluten, do only 1% of individuals develop celiac disease? Several studies presented at this year's DDW meeting attempted to answer this question. Three of these studies advocated a third element, the loss of the intestinal barrier function, as an integral part of the problem.

A group from the University of Adelaide in Australia reported that gliadin causes increased intestinal permeability by inducing redistribution of claudins, proteins that are an integral part of the tight junction complex that governs intestinal permeability.[2] By using a transgenic mouse model of celiac disease, another group from McMaster University in Canada presented 2 abstracts in which they showed that gluten ingestion in sensitized animals caused an increased intestinal permeability that was aggravated by the administration of nonsteroidal anti-inflammatory drugs[3] and attenuated by treatment with an inhibitor of zonulin, a molecule that regulates intestinal permeability.[4] It is interesting to note that correction of the intestinal barrier defect caused a decrease in intraepithelial immune cell infiltration (a sign of celiac disease activation),[4] suggesting that increased intestinal permeability is an integral part in the pathogenetic cascade of the disease.

The intestinal microbiota has also been hypothesized as an additional element involved in the pathogenesis of celiac disease. A group from Italy showed that the duodenal microbiota of children with celiac disease who were exposed to gluten was radically different from the microbiota of children with celiac disease who were on a gluten-free diet.[5]

Both the innate and adaptive immune responses seem to be involved in the pathogenesis of celiac disease. Junker and Schuppan[6] provided convincing evidence that the innate immune response elicited by not yet identified gliadin peptides involves the signal transduction molecule MyD88. Also intriguing were data reported by a group from Stanford University suggesting that transglutaminase 2, the enzyme that potentiates the adaptive immune response to gluten, is constitutively inactive and is transiently activated upon tissue injury.[7] A Hungarian group presented very provocative data suggesting that haptoglobin, once considered a marker of acute inflammation, may represent a novel genetic risk factor involved in the development of celiac disease.[8]

Diagnosis: Can We Eliminate the Intestinal Biopsy?

Still today, a small intestinal biopsy showing the typical celiac enteropathy is considered the gold standard for proper diagnosis of celiac disease. However, several studies presented at DDW 2008 suggested that the histologic findings may not be so conclusive. In this context, a report from Argentina, which suggested that a very accurate serologic algorithm may obviate the need for an intestinal biopsy in selected celiac disease cases,[9] should be welcomed as a provocative finding to stimulate a debate on the need to revise the diagnostic criteria for celiac disease.[10]

Reaction to Gluten: Not Always Celiac Disease

Many patients report that their symptoms resolve once they embrace a gluten-free diet even when celiac disease has been ruled out. Growing clinical evidence, still awaiting rigorous validation studies, suggest that these cases may be related to gluten sensitivity, a new form of food reaction. Preliminary data presented this year suggest that this form of disease may be related to activation of the innate immune system without the involvement of the adaptive immune response.[11]

Potential New Therapy Alternatives to the Gluten-Free Diet: The Future Is Coming

The cornerstone of treatment of celiac disease for decades has been a lifelong adherence to a strict gluten-free diet devoid of proteins from wheat, rye, barley, and related cereals. However, gluten is a common (and in many countries, unlabeled) ingredient in the human diet, presenting a great challenge for patients with celiac disease. Further complicating the situation is the evidence that a high percentage of patients with celiac disease who are on a gluten-free diet, are symptom-free, test negative for celiac disease serology show persistence of severe intestinal damage. Therefore, there is a strong demand for alternatives to the gluten-free diet.

During this year's DDW meeting, 3 groups presented different yet complementary approaches for the management of celiac disease. A group from Ireland showed that the combination of bacterial- and barley-derived proteases given orally to celiac disease patients can degrade gluten to nontoxic fragments and therefore may represent a good treatment strategy.[12] Similar promising results were obtained by a Finnish group that showed that proteases from germinating wheat decrease the toxic effects of gliadin in vitro.[13] A third group from the United States presented data from a phase 2b study using the same zonulin inhibitor used in an animal model of celiac disease as mentioned above; it showed promising efficacy and a reduction in gluten toxicity.[14] These studies were elegantly summarized by Dr. Khosla in a State-of-the-Art-Lecture.[15] Finally, an intriguing study from an Italian group showed preliminary data suggesting a protective role for delayed gluten introduction on the onset of celiac disease in genetically at-risk infants.[16]