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Best thing since sliced bread? A (potential) new diagnostic for celiac disease

Best thing since sliced bread? A (potential) new diagnostic for celiac disease

sliced breadSomething approaching 1 percent of people of European ancestry have celiac disease: an autoimmune intolerance to gluten, a protein found in wheat, barley and rye. That’s roughly 3 million people in the United States, only 5 to 10 percent of whom have actually been diagnosed.

As in other autoimmune disorders such as type-1 diabetes, rheumatoid arthritis and multiple sclerosis, celiac disease is marked by an immune attack on the body’s own cells (in this case, cells lining the small intestine) as if they were invading viral or bacterial pathogens. The way to avoid this condition’s discomforting, often debilitating and potentially devastating effects is to stay away from all foods that contain gluten – a major sacrifice for most, at least until the food industry began pushing gluten-free foods in earnest not too long ago.

An estimated 1.6 million Americans follow a gluten-free diet without an established diagnosis of celiac disease. Though many folks swear by that Spartan regimen, it’s safe to say that at least some of them are deriving no benefit from the sacrifice. (Let me be clear: If you tell me that since going gluten-free you’re symptom-free, I’ll take your word for it.)

Available tests for diagnosing celiac disease rely on measuring blood levels of circulating antibodies to gluten, or biopsying the intestine. But anyone who has been on a gluten-free diet long enough will test completely normal. Even if these individuals do have celiac disease, the tests won’t show it unless they kick-start their autoimmunity by continuously eating gluten-containing foods for two to four weeks – enough time for a new round of intestinal tissue damage to occur – before being tested. That’s a lot to ask of them.

Now, a team led by Stanford immunologist Mark Davis, PhD, has laid the groundwork for a way to diagnose celiac disease in a much shorter time – six days – and with a much-reduced gluten intake. In a new study published in Proceedings of the National Academy of Sciences, Davis and his colleagues asked volunteers who had previously been definitively diagnosed with celiac disease and had been on gluten-free diets for at least a month to eat  four slices of white bread per day for three days in a row. Then, using extremely sophisticated techniques pioneered in Davis’s lab, the investigators analyzed several classes of circulating immune cells from volunteers’ blood samples. These analyses were able to detect gluten-focused, gut-ward bound immune cells in the blood by Day 6 -much sooner than telltale antibodies would appear, and a whole lot less invasive than a gut biopsy.

“This might be a very easy diagnostic to use for celiac disease, and more accurate than any out there now,” Davis, the director of Stanford’s Institute for Immunity, Transplantation and Infection, told me, expressing special gratitude for “these heroic volunteers, who cheerfully agreed to eat bread and experience discomfort to advance the science of their disease.”

Previously: Chat with Stanford pediatric gastroenterologist on celiac disease research archived on Storify, Deja vu: Adults’ immune systems “remember” microscopic monsters they’ve never seen before, Living the gluten-free life, From frustration to foundation: Embracing a diagnosis of celiac disease and Gluten: The “new diet villain”?
Photo by treehouse1977

26 Responses to “ Best thing since sliced bread? A (potential) new diagnostic for celiac disease ”

  1. Jen Says:

    I wondered if the allergic reactions could be from GMO

  2. Mark Says:

    First, I agree that the volunteers suffered greatly for this experiment. I know I would be basically housebound and very ill the entire time I was eating that much bread.

    That said, hearsay plus my own experience tells me that sensitivity to gluten rises with the length of abstinence so is one month gluten free before the study an optimal choice? Was there any testing done with persons who have been Gluten free for longer or shorter periods?

    As much as earlier, reliable diagnosis is a benefit I do wish something like Lactaid could be developed that would allow me to stop worrying when eating.

  3. Lani H Says:

    I have long suspected that many who feel better not eating bread, pasta etc might instead be a signal that there is some contamination/adulteration of the vitamin B fortification of breads and other starch-containing foods.

    Perhaps it is not gluten-sensitivity after all, but rather reactions to (probably imported) “fortification” fillers or substitutes.

    I am far from a conspiracy theoriest, merely skeptical as to why so many now feel better not eating these foods.

  4. Lani H Says:

    I have long suspected that many who feel better not eating bread, pasta etc might instead be a signal that there is some contamination/adulteration of the vitamin B fortification of breads and other starch-containing foods.

    Perhaps it is not gluten-sensitivity after all, but rather reactions to (probably imported) “fortification” fillers or substitutes.

    I am far from a conspiracy theorist, merely skeptical as to why so many now feel better not eating these foods.

  5. Susan Says:

    What allergic reaction? You do realize Celiac is an auto-immune disease? Do you believe the pain and issues from lupus is an allergic reaction as well?

  6. Bruce Goldman Says:

    Hi, Jen. Rates of celiac disease in the European Union, where “genetically modified organism” (GMO) crops are all but outlawed, are the same as here in the United States, where GMOs permeate the grain supply. So I doubt GMOs have much to do with it.

  7. E Jackson Says:

    I I have been GF for 1.5yrs now. Thinking back I now believe, at 42, that I was always intolerant. I can remember hospital visits, cramps and pains, profuse sweating after meals.
    If I had beedn diagnosed earlier I might have avoided being diagnosed with a peptic ulcer at 18 and might have even been able to have more than1 child. My body rejected my baby because it was already under attack.
    I hope more parents will think about this and help their children if they see symptoms that are abnormal, especially after eating and in their toileting habits.

  8. Kendra Heiss Says:

    GMOs do have alot to do with this gluten allergy as well, I read several articles today where the gmos cause your body to react in a way that causes auto immune reaction and to attack itself and see things that normally dont harm your body as harmful, and the superbugs that are coming from this stuff and the overuse of roundup ready grains and soy are living in the intestines and gluten and high sugar diets we all survive off of keep this stuff growing. Very scary!

  9. V Turner Says:

    Is this test widely available or is this something in the future?

  10. Jerry Says:

    I congratulate anyone who is willing to go back to the pain, eating gluten again for even 6 days. I’m sorry, but I’m not willing. When I accidentally get “glutened” it’s a week of recovery for me!

  11. Bruce Goldman Says:

    The test isn’t commercially available yet. For that to happen, there will need to be large-scale, controlled, randomized studies, which take time and cost money.

  12. Gabrielle Says:

    I knew someone who had been gluten free for a few years but wanted to be diagnosed for tax purposes, it was so sad seeing her deteriorate for weeks because of it.

    I would have to take time off of work to even be able to do this test, but it would be worth it to know. I’ve been gluten free since 2007 because eating gluten made me extremely sick. Knowing if I have Celiac or not would make things easier.

  13. Bruce Goldman Says:

    Kendra, please see my comment above. Europe avoids GMOs like the plague. But rates of celiac disease and reported gluten allergies are every bit as high there as they are here. If GMOs were causing celiac disease or gluten allergies (two different things — celiac disease is an autoimmune condition, not an allergy), it would manifest in the form of much higher rates of CD or gluten allergies here. That hasn’t happened. I’m not sure what articles you’ve read, but a word of caution is in order. Don’t trust everything you read on the internet. I have yet to see any substantive evidence, reported in a respected peer-reviewed journal, confirming that GMOs have anything like the effects you’re describing. And I know of no biological mechanism whereby eating a crop with a single inserted gene from another species would result in an allergy NOT to the protein product of that specific new gene but to a totally different protein: gluten. Consider that most of the foods we eat today were unknown to our ancestors! Corn and potatoes, for instances, were restricted to Latin America. Yet when these entirely unfamiliar foods were introduced to Europe, there was no outbreak of mass allergies. That was a far more dramatic instance of large groups of people suddenly being exposed to “new proteins” from “new genes.”

  14. K. Belk Says:

    Does the European Union ever import wheat, rye, barley, or oats? Do they never buy their grain for planting from U.S. sources? Celiac/gluten intolerance is diagnosed more overseas than in the U.S. Many foods have been changed by man and are somehow different than what our Creator provided. I heard on a radio show that all papaya is now GMO. I do not mean any disrespect to Mr. Norman Borlaug, because he saved many, many lives by his work. He traveled all over the world to help people. He “developed successive generations of wheat varieties with broad and stable disease resistance, broad adaptation to growing conditions across many degrees of latitude, and with exceedingly high yield potential.” I ask you: Was that achieved by modifying the genetics of wheat? It used to take 10+ years to diagnose gluten intolerance, so it may never have been a consideration that “improving” wheat could cause a problem when it was going to help feed so many. We may need to buy our grain for planting from overseas if it in fact is non-GMO. I know of 1 corporation that has fiddled with our food for years and years, so now farmers have to buy from them instead of using the seeds from last year’s harvest as was common practice for eons. How secure that plan for profit appears to be! The love of money is the root of all kinds of evil. I side with Jen and believe in my gut that GMO has something to do with gluten intolerance.

  15. K. Belk Says:

    P.S. Have you checked out Dr. Alessandro Fasano’s body of work regarding Celiac/gluten intolerance?

  16. Christine Doherty, N.D. Says:

    This is fantastic work and a great advance! How long, would you estimate, until this test is clinically available?

  17. Tonna Says:

    My son was diagnosed with Celiac Disease 9 years ago, and we have kept up on all studies since that time. My father has been a row crop farmer his entire life. He grows wheat and knows exactly what seed is available. The GMO theory contradicts all celiac studies and knowledge. It frankly falls apart in the face of medical research. Even the timeframes claimed are completely untrue. And the biggest flaw in the GMO theory is a clear understanding of what it is and what seed is even being used. As of today, July 26th, 2013, no GMO seed has ever been used to produce wheat and distribute it in the US market. Changing to a gluten free diet is not only a complete lifestyle change, but it is depriving your body of one of the most nutrient rich foods, voluntarily. I don’t know why anyone would be willing to do that, based on one book, published by one person that contradicts decades of research and well documented history. My son would give anything to be able to eat a diet with wheat in it, but he would become so violently sick and anemic that it would eventually take his life. People who have Celiac Disease have varying levels of illness, but one thing is sure, they did not choose this gluten free life. And my mind simply cannot comprehend why anyone would choose it based on such unfounded and untrue claims.

  18. Tonna Says:

    In reference to the article, Wonderful News! One of the most devastating parts of the diagnostic process, for a mother, is putting a child through two more months of illness and two biopsies. Mothers call me all the time with their fears and frustrations about making that decision. I am sure it is also very difficult to choose to go through it yourself. I think it prevents many people from being tested. This test will be a wonderful blessing to so many.

  19. Bruce Goldman Says:

    In response to queries about when a test based on these findings could become available, Mark Davis has told me: “We [Stanford] don’t have the means to develop a commercial test. [But] we have, through Stanford University’s Office of Technology Licensing, sent out info on this to companies who might. Assuming someone picks it up,” Davis figures, it will be a good two years or more for such a test to get certified. So, not right around the corner. But not infinitely far off, either, if some private company sniffs a sufficient profit opportunity to run with this.

  20. Kalisah Says:

    Why should I pay all those fees for doctors visits and tests when all that can possibly come from it is he’ll tell me, “Stop eating gluten.” I can stop eating gluten all on my own, and when my symptoms disappear – voila! Diagnosis!

  21. Scott Says:

    I found this blog when researching “cellular regeneration” and kept reading. Love the technical aspect and how this is cutting edge info. Keep it up Standford!

  22. Lewis Says:

    Perfectly good anti-endomysial and anti-tTG antibody tests are available, and should be run before withdrawing gluten.

    However, if people have already improved going gluten-free, isn’t it cruel to make them consume bread containing wheat?

  23. Bruce Goldman Says:

    Lewis, in response to your comment the study’s first author, Stanford medical fellow Arnold Han, MD, says that the antibody-assay results correlate with intestinal damage. When the antibody tests are performed on a person on a gluten-free diet and controlled disease (so that the person has no current intestinal damage), the antibody tests will generally be negative. “The antibody assays usually don’t become positive until the person eats gluten for 2-4 weeks,” says Han. “Gastroenterologists tell people who are on a gluten free diet to eat bread continuously for 4 weeks and then get retested. We can provide a diagnosis after only 1-3 days. That’s the difference.”

  24. Ben Says:

    Europeans actually ingest large amounts of GMO’s through the animals they eat that have been raised on imported GMO grains. The very good 10 year Swedish study showed that the guts of animals were changed when they ate GMO’s directly or ate animals that had eaten GMO’s.

  25. Bruce Goldman Says:

    Ben, I’d have to see that study. Here’s why I’m skeptical of what it seems to claim: Cows have four stomachs. If there’s one thing they’re good at, it’s breaking down proteins into their consituent amino acids. Regardless of any theoretically potential GMO effects in those cattle, it’s only those constituent amino acids, and not the proteins they initially constituted, that get stored and turn into new muscle (i.e., the steak and chops). There’s no theoretical way I can conceive of that a person eating that meat could possibly be exposed to even a trace of a “GMO” protein. Period.

  26. Suzette Says:

    Any further news on this test becoming commercially available?

    I recently went low carb in an attempt to help my acid reflux after having tried PPIs, low acid diet, low fat diet, dairy free and even acupuncture. (I’m already underweight so knew weight wasn’t a contributor.) And it seemed to help a lot. No more night wakings gasping for air, sore throats and camera down my throat showed my esophagus was healing. But I also found issues such as stomach upset and an inability to gain weight despite eating 2500 calories a day greatly improved. I thought such issues were caused by a hereditary condition causing increased polyp growth in my intestines (AFAP). My GI recommends testing me for celiac now but since I already gave up bread, not sure if I will have to eat bread for an accurate result. I didn’t give up ALL gluten though so was also wondering if it might still be ok as I now have an odd fear of bread. :)


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