Strike 1 against the gluten theory

[Guest guest]

Am J Gastroenterol. 2003 Apr;98(4):839-43.

High prevalence of small intestinal bacterial overgrowth in celiac patients

with persistence of gastrointestinal symptoms after gluten withdrawal.

Tursi A, marte G, Giorgetti G.

Department of Emergency, " L. Bonomo " Hospital, Andria (BA), Italy.

OBJECTIVE: Celiac disease is a gluten-sensitive enteropathy with a broad

spectrum of clinical manifestation, and most celiac patients respond to a

gluten-free diet (GFD). However, in some rare cases celiacs continue to

experience GI symptoms after GFD, despite optimal adherence to diet. The

aim of our study was to evaluate the causes of persistence of GI symptoms

in a series of consecutive celiac patients fully compliant to GFD. METHODS:

We studied 15 celiac patients (five men, 10 women, mean age 36.5 yr, range

24-59 yr) who continued to experience GI symptoms after at least 6-8 months

of GFD (even if of less severity). Antigliadin antibody (AGA) test,

antiendomysial antibody (EMA) test, and sorbitol H2-breath test (H2-BT), as

well as esophagogastroduodenoscopy (EGD) with histological evaluation, were

performed before starting GFD. Bioptic samples were obtained from the

second duodenal portion during EGD, and histopathology was expressed

according to the Marsh classification. To investigate the causes of

persistence of GI symptoms in these patients, we performed AGA and EMA

tests, stool examination, EGD with histological examination of small bowel

mucosa, and sorbitol-, lactose-, and lactulose H2-breath tests. RESULTS:

Histology improved in all patients after 6-8 months of GFD; therefore,

refractory celiac disease could be excluded. One patient with Marsh II

lesions was fully compliant to his diet but had mistakenly taken an

antibiotic containing gluten. Two patients showed lactose malabsorption,

one patient showed Giardia lamblia and one patient Ascaris lumbricoides

infestation, and 10 patients showed small intestinal bacterial overgrowth

(SIBO) by lactulose H2-BT. We prescribed a diet without milk or fresh

milk-derived foods to the patient with lactose malabsorption; we treated

the patients with parasite infestation with mebendazole 500 mg/day for 3

days for 2 consecutive wk; and we treated the patients with SIBO with

rifaximin 800 mg/day for 1 wk. The patients were re-evaluated 1 month after

the end of drug treatment (or after starting lactose-free diet); at this

visit all patients were symptom-free. CONCLUSIONS: This study showed that

SIBO affects most celiacs with persistence of GI symptoms after gluten

withdrawal.

-

[Guest guest]

Oh good grief. Talk about throwing down a gauntlet! Ok, I'll byte. ;--)

>OBJECTIVE: Celiac disease is a gluten-sensitive enteropathy with a broad

>spectrum of clinical manifestation, and most celiac patients respond to a

>gluten-free diet (GFD). However, in some rare cases celiacs continue to

>experience GI symptoms after GFD, despite optimal adherence to diet.

Note here " MOST patients respond to GFD " . MOST patients DO get

better, even on the horrid SAD diet. The folks who *don't* get better need

additional treatment -- and everyone I've heard of who believes

in " the gluten theory " agrees with that.

Their test group was ONLY the " rare cases " -- and I'm totally with

you that probiotics, finding other food allergies, etc. help in these

cases. I posted something awhile back about how fructose intolerance

had been found in many of the refractory cases -- fructose intolerance

has symptoms very similar to gluten intolerance. Casein, egg, and yeast

intolerance also produce similar symptoms.

>>The aim was to determine

if generalized disaccharidase deficiency without villous atrophy

represented latent celiac disease. METHODS: Case notes and histology of the

37 patients were reviewed. History and blood investigations including

antigliadin and endomysial antibodies were checked. Where celiac disease

was suspected, endoscopic duodenal biopsies for histology and

disaccharidase estimation were repeated. RESULTS: Of the initial 37

patients, 6 patients had had repeat endoscopic biopsies; one having celiac

disease.

Again, I've been saying this for some time -- celiac is just the

tip of the iceberg. Here they found folks with high antigliadin antibodies

in their blood ... and lo and behold, they also had *some* changes

to their intestines, but not enough to be called " celiac " . This is the

point of Dangerous Grains ... if you have the antibodies, you likely WILL

get sick if you eat gluten, but you may not have the damage yet. This is

actually a strike FOR the gluten theory! How would the " wrong bacteria "

create antigliadin antibodies (to wheat) in the blood????

>> RESULTS: Sixty-two of the 78 patients (79%) experienced diarrhea

before treatment, and 13 (17%) had chronic diarrhea (of lesser severity)

after treatment. The causes of diarrhea in 11 patients consenting to this

study were microscopic colitis, steatorrhea secondary to exocrine

pancreatic insufficiency, dietary lactose or fructose malabsorption, anal

sphincter dysfunction causing fecal incontinence, and the irritable bowel

syndrome. Only 1 patient had antigliadin antibodies detected in serum or

small intestinal villous atrophy.

Again, this is pretty much what I've been saying for a long time.

Once you have gluten damage, it doesn't always heal. Of 78, MOST of

them healed, 13 didn't heal all the way. But they had other intolerances,

pancreatic problems, and microscopic colitis ... all of which are common

after years of gluten ingestion. If the gluten intolerance was caught

EARLY they could avoid all that damage. Again, the GFD healed MOST

of them, which is a strike FOR the " gluten theory " . If the problem

was simple bacterial overgrowth, the GFD wouldn't help.

But saying that because the GFD doesn't help everyone, that gluten isn't the

problem, is like saying because a diabetic doesn't get thier eyesight

back after getting their blood sugar under control, that diabetes doesn't

cause blindness. Both diabetes and gluten intolerance are very, very

damaging and rather fatal diseases if left untreated. Most people don't

find out there is a problem until they are very, very damaged, because

there are usually no symptoms. The damage doesn't

always magically go away, a lot of it is permanent.

Which is why gluten is right up there with rat poison on my list

of things to ingest ...

However, those are good studies, thanks for posting them!

-- Heidi