FEBRUARY 27, 2012 GLUTEN INTOLERANCE

"Adopt to circumstances in order to make progress."

When we adopt to changes in circumstances in order to move forward, this is called progress. How many of us are stuck in a situation? Many of us are in limbo or on cruise control. Whether this involves a relationship, a job, or an illness. Many of us are stuck in our old habits. I am one of those individuals. When I get resentful or feel hurt, I tend to shut down. I would rather say no to everything or not speak at all. This is not good. I do this because I am at a loss. I also do not want to say something that I may regret in the future. So I stay quiet. At least now in these quiet times, I pray and meditate to change. Change and progress do happen. I have to be willing.

Sometimes a change happens in conventional medicine that is mind blowing. For instance, just the other day in the Annals of Internal Medicine (http://www.annals.org/) under the Ideas and Opinions section there was an article entitled, "NonCeliac Gluten sensitivity: Sense or Sensibility." Sounds like the title of a movie. Perhaps those who only need statistics and double blind studies should be called the Iron Lady.

This is how the article opens... "Recent studies support the evidence of a new condition, nonceliac gluten sensitivity, which manifests as intestinal and extra intestinal symptoms that improve or disappear after gluten withdrawal in individuals with normal small bowel mucosa and negative results on serum transglutaminase and endomysial antibody testing."

A new condition... this must be a misprint. This has been known for a long long time. I doubt the writers of this article see many gluten sensitive patients if they think this is a new condition. The article then goes on to say, "Although the clinical value of this concept is under debate, the prevalence of of nonceliac gluten sensitivity in the general population is supposed to be many times higher than that of celiac disease."

Well of course it is. In the same way that insulin resistance and the pre diabetes population is a much larger group than the actual diabetics. This is called talking to the patient and studying your own practice group.

I believe that more than 80% of the population is nonceliac gluten sensitive. The symptoms of bloating, abdominal pain, diarrhea and flatulence all disappear if you remove gluten. If the symptoms do not disappear, then remove milk/dairy and ask the patient how he/she feels. You do not need double blind studies. Remove the gluten from the patient's diet and watch them improve.

It is also not a disease limited to the gut. The first sign of gluten sensitivity could be a neurological one. There are more than 100 papers in well respected journals that discuss the extra intestinal symptoms such as arthritis, autoimmune disease, thyroid disease, hepatitis and diabetes with gluten. Celiac has a genetic component whereas this new term nonceliac gluten sensitivity does not have a genetic HLA gene. Studies suggest celiac disease affects 1% of the general population. I believe nonceliac gluten sensitivity or gluten intolerance prevalence is much higher.

I believe that gluten intolerance or nonceliac gluten sensitivity is characterized by the activation of an innate stress response unlike celiac's immune pathway.

Although I am a cardiologist, I am foremost an internist. I am an integrative internist who looks at the person as a whole, not by a system The doctor should be like The Artist. Medicine is a form of art.

Although the photographs are all men with bloating, women suffer from bloating. Men do not admit they are bloated whereas women do!

Until tomorrow...