Celiac disease is a condition in which the small intestinal lining becomes damaged as a result of a reaction against a common dietary ingredient, gliadin, a protein in gluten found in wheat, barley and rye. About one percent of the U.S. population is affected by celiac disease, yet most have not been diagnosed. Celiac disease diagnosis is confirmed by biopsy of the small intestine.

Scientists are trying to determine why so many cases of celiac go undiagnosed. A recent study by Colombia University Medical Center has found one reason—improper intestinal biopsy. Celiac disease affects patches of the small intestine, not the entire intestine. Medical recommendations for intestinal biopsy suggest that at least four specimens be taken to ensure that enough areas of the intestine are sampled to detect damage. Researchers used a nationally representative database of over 100,000 individuals who had undergone intestinal biopsy for symptoms like diarrhea, abdominal pain, esophageal reflux, and anemia and found that only 35 percent had the recommended four specimens taken. Most had only two.

In those individuals in whom four specimens were taken, the diagnosis rate for celiac disease more than doubled. “The process of increasing the number of specimens from two to four takes approximately one extra minute during endoscopy,” said Dr. Lebwohl, lead author of the study.

Celiac disease is the most severe form of gluten intolerance, another condition that doesn’t involve intestinal damage—yet! If you are undergoing a biopsy to detect celiac disease, be sure to ask the doctor if they’re taking at least four specimens. If the biopsy comes back negative, however, don’t think you can jump right back into eating gluten. You may have the milder form of gluten sensitivity. A stool test from enterolab.com could help you determine if this is what ails you.

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The far-reaching effects of gluten sensitivity and celiac disease never cease to amaze me. So many conditions outside the gut are triggered by a reaction against gluten inside the gut. A recent study has brought to light one lesser-known effect of celiac disease—infertility.

It has been known for some time now that infertility and recurrent spontaneous abortion is more common among women with celiac disease. And about 4 percent of infertile women have celiac disease!  I wonder how many more of these women may have silent celiac disease or even gluten sensitivity? A large proportion of people with celiac disease are undiagnosed.

A recent study has looked a little closer at infertility and early pregnancy loss, and determined just how this may happen. It turns out that anti-tissue transglutaminase antibodies (which are antibodies that the immune system makes against gliadin, the gluten protein) bind to the developing placental lining. This can interfere with proper development of the placenta and fetus.

It is already known that these anti-tTG antibodies can attack other tissues in the body, like the thyroid, pancreatic beta cells or even brain cells. This phenomenon is known as autoimmunity. This study highlights yet one more way in which anti-gliadin antibodies can harm areas of the body that are not in the gut. And it strengthens the evidence that following a gluten free diet can benefit the entire body.

If you suspect you are gluten sensitive, you may want to be tested or try an elimination diet for a few months to see if it helps you.

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Autism is a developmental disorder characterized by severe abnormalities in communication, social awareness and skills, and behavior. Before the 1980s, autism occurred in 2 to 5 of every 10,000 children. Today about 1 in every 110 children gets autism. This rapid increase cannot only be attributed to improved diagnosis, and also indicates there is more to the disorder than simply genetics. Indeed, autism is a combination of genetic predisposition with environmental factors that triggers its development.

One aspect of contributing factors, at least in a subset of children, involves gut dysfunction. Many reports describe gastrointestinal symptoms and abnormalities in up to 84% of children with autism.[1] From constipation, diarrhea, abdominal discomfort, food sensitivities and abnormal gut flora to immune dysfunction and gut and systemic inflammation, the digestive system plays a central role in many cases of autism.

One gut abnormality—lactose intolerance—found in people with autism was recently reported in the journal Autism. Intestinal disaccharidase activity was measured in 199 individuals with autism. Disaccharidase is an enzyme that breaks larger sugars (disaccharides) like lactose, maltose and sucrose into smaller sugars like glucose. Deficiency of lactase enzyme, the enzyme that breaks milk sugar, or lactose, into galactose and fructose, was found in 58 percent of autistic children and 65 percent of autistic adults. In children, boys under 5-years-old had 1.7-fold lower lactase activity than girls of the same age, indicating the problem may be more severe in boys. The study concluded that lactase deficiency is common in autistic children and may contribute to abdominal discomfort, pain and the observed abnormal behavior seen in autism. Further, the study points out that most autistic children with lactose intolerance are not identified when doctors take a clinical history.

A decrease in activity of a variety of carbohydrate-digesting enzymes has been reported in children with autism.[2] Carbohydrase and disaccharidase enzyme deficiency results in the incomplete breakdown of carbohydrates in the small intestine. These partially undigested carbs move into the colon where they are greeted by a large supply of “hungry” bacteria—including potentially pathogenic bacteria. This may explain the increased presence of Candida and Clostridia species found in the guts of autistics.[3][4]

Carbohydrate-digesting enzymes are not the only digestive enzymes that may cause problems in autism. Fat malabsorption is seen in some autistic children, resulting in fatty, loose, floating, foul-smelling stools, also known as steatorrhea. Further, a particular enzyme known as dipeptidyl peptidase-4 (DPP4) may be deficient in those with autism. This enzyme breaks a specific peptide bond in gluten and casein proteins. In fact, it is thought that a deficiency in this enzyme is responsible for the incomplete breakdown of casein and gluten peptides (known as gluteomorphins and casomorphins) that act as opioids in the central nervous system and are thought to contribute to autistic symptoms. Following a gluten-free and casein-free diet has been found helpful in many autistics because it eliminates exposure to these peptides, often relieving symptoms. Supplemental DPP4 can be given in cases where accidental ingestion of gluten- or casein-containing foods is suspected, but it is not recommended as a replacement for the gluten-free, casein-free diet.

In all, we see a variety of enzyme deficiencies in autism and it would be wise to supplement with a digestive enzyme formula that includes a variety of enzymes. Further, due to the many digestive abnormalities seen in autism, the HOPE Formula (High-fiber, Omega oils, Probiotics and digestive Enzymes) is a wise daily maintenance program to support gut health.

[2] Horvath K, et al., “Gastrointestinal abnormalities in children with autistic disorder.” J Pediatr 1999;135:559-63.

[3] Finegold SM, et al., “Gastrointestinal microflora studies in late-onset autism.” Clin Infect Dis. 2002 Sep 1;35(Suppl 1):S6-S16.

[4] Shaw W, et al., “Assessment of antifungal drug therapy in autism by measurement of suspected microbial metabolites in urine with gas chromatography—mass spectrometry. The Clinical Practice of Alternative Medicine Magazine. 2000;1:15-26.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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I’m really excited about a couple of new studies on gluten sensitivity. I have been talking about this condition for so long, knowing that it contributes to many different health conditions in the body. The science is only beginning to scratch the surface of what clinicians have been seeing for years in patients who suddenly feel better after removing gluten from the diet.

A new study published in the American Journal of Gastroenterology (yes, you heard me—gluten sensitivity is hitting the “big time” folks) has validated the fact that gluten sensitivity is not just “all in their heads.” This double-blind randomized placebo-controlled trial recruited people with irritable bowel syndrome (IBS) whose symptoms improved after following a gluten free diet. These patients, in whom celiac disease was ruled out, were then put into two groups: one group was re-challenged with foods containing gluten and the other group was given “placebo” foods that did not contain gluten.

The results? In the group receiving the gluten-containing foods there was a significant increase in bloating, abdominal pain, altered bowel pattern and fatigue. Surprise, surprise! This is something that I have seen in people for years, and that the natural health community has known for a long time. But to see it published in this prestigious journal gives me hope that we will be taken more seriously with regard to the knowledge we are spreading about the damage that gluten can cause in many people.

This study is only the beginning, and will surely trigger many new studies that seek to discover just what is occurring in gluten sensitivity and why. The study helps to not only put gluten sensitivity on the map, so to speak, but also to explain one of the triggers to the ever-elusive IBS. We have known that gut infections can trigger IBS, and now we know that gluten sensitivity may also be a trigger. Again, this is something that I have been saying for many years.

And that’s not all! Another study reported in the Wall Street Journal and published in BMC Medicine has determined that gluten sensitivity and celiac disease involve two different branches of the immune system. Gluten sensitivity involves the innate immune system, which is responsible for the initial inflammatory response that occurs when the body encounters a “foreign” invader—in this case, gluten. Celiac disease, on the other hand, was found to involve the adaptive immune system, which involves a more complex secondary immune response that identifies the foreign invaders so that they will be recognized each time they are subsequently encountered.

Very interesting is that the difference between these two conditions was related to intestinal permeability—leaky gut. Those people with celiac disease were more likely to have leaky gut, while those with gluten sensitivity had not developed leaky gut—YET! What I think they will find is that gluten sensitivity is the first, milder reaction that worsens, increases leaky gut, and becomes full blown celiac disease. It’s a progression, and if you don’t take control of it early, it can lead to many different health conditions.

If you think you are gluten sensitive, try a gluten-free diet (no cheating—I’m not kidding!) for at least six weeks (even up to 6 months or more depending on your condition) to see if you begin to feel better. Today, there are many gluten-free options. Be sure to include plenty of fruits and vegetables, lean proteins, good fats, and whole, gluten-free grains. You’ll be on your way to wellness.

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Celiac disease is an autoimmune disease involving a reaction in the gut to gliadin, the gluten protein found in wheat, barley and rye. This gut reaction destroys the body’s own intestinal lining cells, a process known as autoimmunity. The treatment of celiac disease is complete avoidance of gluten and gluten-containing foods. If not treated properly, the autoimmunity can manifest in other areas of the body, like the joints or the thyroid gland.

A recent study set out to determine at what age people develop celiac disease. Every 15 years since 1974 the number of people with celiac disease has doubled. As it turns out, the incidence of celiac disease in the elderly is almost two and a half times higher than the general population. This counters the previous perception that celiac disease usually develops during childhood.

So what factors may be leading to this late-life loss of tolerance to gluten?

Studies will need to be done to determine the exact environmental triggers, but I suspect that these people may have been living for years with either silent celiac disease (yes, celiac can exist in the gut with no symptoms at all) or the milder form of gluten sensitivity.

So many people improve their health status when they eliminate gluten. Why wait until you’re elderly to find out what it might do? Try a gluten-free diet if you think that you might be sensitive.

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Celiac disease involves an autoimmune gut reaction to gluten proteins found in wheat, barley and rye. This reaction destroys the intestinal villi. Villi are the finger-like projections that line the small intestine, increasing the surface area of the intestine so that absorption of nutrients can be maximized. When the villi are destroyed, nutrient absorption is hindered, which can lead to serious health complications.

How serious? The autoimmune reaction of celiac (basically, the immune systems mistakes parts of the body as a foreign invader, and attacks the body’s own tissues) can lead to other autoimmune conditions like rheumatoid arthritis or thyroid dysfunction.

A recent study has determined that the incidence of celiac disease has doubled every year since 1974, and it also increases with age. If people can develop celiac disease in their 50s and 60s, it indicates that the condition is likely caused by environmental factors.

One important possible environmental trigger of the disease that may be causing late-onset celiac is changes in the composition of gut bacteria. Researchers suggested that a greater understanding of these changes in the gut may allow for the development of a way to keep the disease on hold.

Our gut health is truly related to the health of the rest of the body. Start by healing your gut, and maintaining that health to build a strong foundation that the rest of the body can benefit from, well into our golden years.

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Doing what I do, I have a lot of folks come to me with problems like heartburn, constipation, gas and bloating—things that make you think right off the bat, “That’s a digestive issue.” But what about problems like fatigue or weight gain? Even allergies, joint pain or skin problems? What a lot of people don’t realize is that all of these things are connected, and they all come back to your gut.

I have a new book coming out called The Road to Perfect Health, and in it I talk about the vast numbers of bacteria in your body, especially in your digestive tract (which is where roughly 80 percent of your natural defenses are found). And when a healthy digestive balance is upset because of things like poor diet, stress or other factors, the result can be not only poor digestion, but a total breakdown in health.

If you’ve been having persistent health problems that you and your doctor just can’t seem to figure out no matter what you try, it may be time to look at what’s going on in your gut. And to do that, there are two absolutely essential tests that I recommend starting with. One is called a comprehensive stool analysis (CDSA or CSAP) and it’s really pretty remarkable. It evaluates your poop (now don’t cringe, this is important!) and looks at things like how you are digesting your food, as well as your levels of good and bad bacteria, whether pathogenic organisms such as C. difficile are present, what your yeast levels are, and if there are parasites in the gut.

The CDSA will also show you whether you have Leaky Gut Syndrome or inflammation in your digestive system, and it will show you how well your gut immunity is working, along with important gut health markers such as pH, blood, short-chain fatty acids and even how well your pancreas is functioning. These are all extremely important aspects of gut health that together can help you get to the bottom of what is going on in the rest of your body. Again, I can’t stress enough how connected your overall health is to what’s going on in your gut!

The other test is a gluten sensitivity test. Why gluten sensitivity? Because wheat gluten is a major (if not the worst) food irritant to the digestive system, and it is in a huge number of products on the market today—not just bread. Seriously folks, more than 40 percent of Americans are gluten sensitive and most don’t even know it, and 2 million of those have a serious autoimmune disorder called celiac disease, which causes the body to try to attack gluten in the system. And because even a lot of GI doctors don’t understand the difference between gluten sensitivity and celiac disease, most will either label you as having celiac or nothing, which can be extremely frustrating when you don’t feel well and are trying to figure out what’s wrong (read more about this here).The bottom line is that people are having all these problems which could lead to bigger problems later on, and the reality is those problems can be helped.

Both of these tests are non-invasive and can be done right at home (visit www.labtestingdirect.com and www.enterolab.com for more information). Then, all you have to do is send the tests to the lab for analysis (prepaid envelopes are provided) and hopefully take the first step toward getting your health back on track. If they seem expensive, think about it this way: how much money do you spend each week or each month on frivolous things you really don’t need? Isn’t your health a hundred times more important than a $4 latte every morning? And even if your insurance doesn’t cover the cost right away, you may be eligible for reimbursement, so I beg you—make this investment in your health. It’s worth it to get to the root of your problems and start enjoying the vibrant health and energy you deserve!!

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There was a study done recently that got a lot of press, and I have to say it really got under my skin. Researchers looked at the effects of a gluten-free, casein-free diet in kids with autism, and what they said was that it didn’t have any behavioral effects on them. But I thought, “No way—something isn’t right here.” And it looks like I wasn’t the only one.

Nutrition Director Kelly Barnhill from the Autism Research Institute also had some pretty interesting things to say about this particular study. Check it out:

• First, only fourteen children participated in the study…fourteen! Common sense alone says that’s not nearly enough to make such broad conclusions.
• Second, the kids who participated in the study didn’t even have any gastrointestinal complaints. This is a big one, since most autistic children do have digestive problems of some sort—a good sign that gluten and casein (a protein found in milk) sensitivities are involved. But the children in this study were specifically chosen because they did not have digestive complaints. What?!
• Third, the children only followed the prescribed diet for four weeks, even though it takes at least six weeks to really get all of the gluten protein out of the body. Four weeks just isn’t enough time to call this an effective study, folks.
• And finally, the diet the children followed wasn’t even 100% gluten- and casein-free. This is important because some kids are sensitive to even the smallest amounts of gluten, so strict adherence to a gluten- and casein-free diet is absolutely necessary in order to see beneficial results.

Obviously this issue is far from over. So many parents of autistic kids report benefits after removing gluten and casein from the diet. No, it doesn’t cure autism—but it can alleviate the often debilitating digestive symptoms that these children endure, and as a result their behavior often improves. Don’t knock it till you try it!

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Lactose intolerance. It’s one of those phrases we hear a lot, but the truth is, a lot of folks don’t really know what it means. Case in point? I was reading an article in the newspaper the other day in which the author concluded that most Americans misunderstand lactose intolerance…but my own conclusion was that the author herself misunderstood the condition!

In the article she stated that many people avoid dairy products “because they mistakenly think they’re lactose intolerant”. But really, that’s only half the story. Lactose intolerance involves an inability to digest lactose, which is the sugar found in dairy products, but the reason so many people avoid dairy has more to do with an allergy or sensitivity to casein—a protein found in milk—and not because of lactose intolerance.

And yes, while the author expressed a valid concern about people avoiding dairy when they may not even be lactose intolerant, she failed to talk about the possibility of looking into milk protein sensitivity (similar to gluten sensitivity) in order to address the problem…and the differences between the two are pretty significant if you’re used to avoiding an entire food group!

Essentially, people who are allergic to or sensitive to casein usually need to avoid all dairy products, but those who are lactose intolerant can sometimes eat dairy in small portions, or with the help of natural lactase enzymes. Imagine thinking you couldn’t eat dairy at all and then finding out that you still may be able to enjoy some of your favorite foods—I’m sure it would be welcome news to a lot of people. So hopefully this clears up a little of the confusion folks have about lactose intolerance, and maybe it’s even helped you see things differently in your own diet!

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We all know how uncomfortable constipation can be, so imagine what it must feel like for little kids…ugh! That’s why a recent study published in the American Journal of Gastroenterology caught my eye.

The study suggests that a combination of two things may be involved in higher incidences of constipation in children: 1. introducing gluten in the first year of life, and 2. an allergy to cow’s milk.

This is not surprising when you consider that the digestive tracts of infants are still very sensitive, especially in the first months of life. Not only that, but their immune systems are weaker, which means they are more susceptible to pretty much everything.

So the bottom line? When it comes to little tummies, it’s better to wait on the gluten and cow’s milk until they are more ready to handle it. And yes, some children may eat it and be fine (or appear fine), but I say better safe than sorry! There are plenty of substitutes for gluten and cow’s milk these days, even for infants.

All this is important because childhood constipation has been linked to irritable bowel syndrome (IBS) in adults, so if your child has chronic constipation, be sure to take a look at his or her diet. Other dietary factors to think about are fiber intake (since fiber helps promote regular bowel movements) and intestinal balance. In babies who are not breast fed, who were delivered by cesarean section, or who have been treated with antibiotics, there is a greater risk for an altered intestinal flora balance, so a daily probiotic supplement may be helpful in these situations.

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