Visit the Microscopic Colitis Foundation Website
Some interesting slides
http://fnce.eatright.org/fnce/SessionDe ... sionID=411
Mary Beth
Dr. Fasano's Powerpoint from ADA Convention
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Dr. Fasano's Powerpoint from ADA Convention
"If you believe it will work out, you'll see opportunities. If you believe it won't you will see obstacles." - Dr. Wayne Dyer
Very interesting. Dr. Fasano seems to draw a clear distinction between celiac disease and gluten sensitivity. It seems that he emphasized it in his presentation. Most curious is his "puzzle" on page 7 where he shows that celiac has four characteristics: gut inflammation, increased permeability, restructuring of intestinal mucosa, and enhanced neutrophil recruitment (can't read). But in gluten sensitivity, he omits gut inflammation. How can that be? Aren't all of our guts inflammed? Or am I misreading the graph?
Gloria
Gloria
You never know what you can do until you have to do it.
Gloria,
No, I don't believe you're misreading the graph. Is my memory playing tricks on me, or is it not true that the last time we heard from Dr. Fasano, he was still denying the existence of non-celiac gluten sensitivity? Suddenly NCGS does indeed exist, but it does not involve gut inflammation. Really? In view of his somewhat archaic exclusion criteria, it's difficult to see how that logically follows, due to the fact that many of the test procedures he cites have very poor sensitivity/reliability:
It's no wonder he included the bit about the critic's role, (which is totally irrelevant to his presentation, otherwise), because I find myself in the unexpected position of being very critical of that presentation, due to the ambiguous and confusing way the facts are presented. I assume you had to be there, to get the "real story", because what I see in that "handout", appears to be a hodgepodge that includes a lot of irrelevant and confusing gibberish.
IMO, if they actually found that NCGS does not involve inflammation, then they need to fine-tune their procedure, because it appears to be sorely lacking in accuracy.
I'm guessing that this may be a face-saving baby step in the direction of realigning his mistaken claim for all these years that NCGS does not exist. Apparently he is beginning to "see the light", but he doesn't want to do an embarrassing about-face, so he will feed us the updated information in little bits and pieces. (That way he gets to publish more articles, also, and he reduces the risk of upsetting the other "celiac snobs", who also have been denying the existence of NCGS, but are not quite ready to own up to their mistake, yet).
At least, that's the way it appears to me. Of course, I could be all wet.
Tex
No, I don't believe you're misreading the graph. Is my memory playing tricks on me, or is it not true that the last time we heard from Dr. Fasano, he was still denying the existence of non-celiac gluten sensitivity? Suddenly NCGS does indeed exist, but it does not involve gut inflammation. Really? In view of his somewhat archaic exclusion criteria, it's difficult to see how that logically follows, due to the fact that many of the test procedures he cites have very poor sensitivity/reliability:
For one thing, negative CD serology is the result of such an unreliable test, (due to the ridiculous number of false negative results), that it's pretty much meaningless for anything less than fully-developed celiac disease, and even has questionable reliability in the case of fully-developed celiac disesase. Furthermore, it has been reliably demonstrated that duodenal histopathology is apparently unrelated to the clinical symptoms of celiac disease. Is he saying that resolution of the symptoms upon the implementation of a GF diet falls outside the categories of both allergic and autoimmune mechanisms? That doesn't make much sense, since that is precisely the way that gluten-sensitive enteropathy is effectively treated. What is he trying to say?Gluten Sensitivity:
Definition
Cases of gluten reaction in which both allergic
and autoimmune mechanisms have been ruled
out (diagnosis by exclusion criteria)
• Negative immuno-allergy tests to wheat;
• Negative CD serology (EMA and/or tTG) and in which IgA
deficiency has been ruled out;
• Negative duodenal histopathology;
• Presence of biomarkers of gluten immune-reaction (AGA+);
• Presence of clinical symptoms that can overlap with CD or
wheat allergy symptomatology;
• Resolution of the symptoms following implementation of a
GFD
It's no wonder he included the bit about the critic's role, (which is totally irrelevant to his presentation, otherwise), because I find myself in the unexpected position of being very critical of that presentation, due to the ambiguous and confusing way the facts are presented. I assume you had to be there, to get the "real story", because what I see in that "handout", appears to be a hodgepodge that includes a lot of irrelevant and confusing gibberish.
IMO, if they actually found that NCGS does not involve inflammation, then they need to fine-tune their procedure, because it appears to be sorely lacking in accuracy.
I'm guessing that this may be a face-saving baby step in the direction of realigning his mistaken claim for all these years that NCGS does not exist. Apparently he is beginning to "see the light", but he doesn't want to do an embarrassing about-face, so he will feed us the updated information in little bits and pieces. (That way he gets to publish more articles, also, and he reduces the risk of upsetting the other "celiac snobs", who also have been denying the existence of NCGS, but are not quite ready to own up to their mistake, yet).
At least, that's the way it appears to me. Of course, I could be all wet.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I wasn't at the meeting so I can't say anything about how he presented. I was surprised by the "no inflammation" slide, but otherwise felt more positive about his admission that NCGS does exist. Remember, he was presenting to dietitians, some of which can be as skeptical as gastroenterologists. I rather like his last slide and admission that he was wrong. I also liked that he used the term Leaky Gut since that term has been so disregarded by the medical community as hogwash. While some of what he presented doesn't add up for us, he has clearly opened the door for things to move in the right direction. His admission that it even exists can really shake up the old boys club quite a bit.
Mary Beth
Mary Beth
"If you believe it will work out, you'll see opportunities. If you believe it won't you will see obstacles." - Dr. Wayne Dyer
Mary Beth,
I wholeheartedly agree with you, and I applaud Dr. Fasano for taking this step, because as you say, it's a very important step, with far-reaching implications. And yes, maybe his position will finally lend some validity to the leaky gut concept.
It will be interesting to see how his peers react to this. Considering his credentials, I don't see how they can ignore it, or dispute it. This could definitely get the ball rolling, and maybe the official medical position in the celiac realm will begin to change much more rapidly.
Many thanks for posting the link.
Tex
I wholeheartedly agree with you, and I applaud Dr. Fasano for taking this step, because as you say, it's a very important step, with far-reaching implications. And yes, maybe his position will finally lend some validity to the leaky gut concept.
It will be interesting to see how his peers react to this. Considering his credentials, I don't see how they can ignore it, or dispute it. This could definitely get the ball rolling, and maybe the official medical position in the celiac realm will begin to change much more rapidly.
Many thanks for posting the link.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.