Scientific American Article on Celiac Disease

[Rosie]

I just got my August issue of Scientific American, and there is a very good article on CD by Alessio Fasano. As you can expect from Scientific American, it is very nicely written with lots of helpful illustrations. It really puts the current understanding of CD all together in a easy-to-understand format. It appears to hit most of the points I've read about on this Forum.

The article describes the current treatment ideas, along with where they are at. The treatment ideas address the 3 components of CD:

1. gluten trigger
2. genetic predisposition (immunological response)
3. leaky small intestine

The most interesting treatment ideas involve the leaky small intestine, especially since this has also been linked to other autoimmune diseases such as MS, diabetes, IBS and rheumatoid arthritis where the trigger hasn't been identified and thus can't be avoided.

There was also a discussion of the possible role of microbes.

One thing that caught my attention was the illustration of how the immune system attacks the small intestinal lining of CD people. The gluten leaking through the small intestinal lining induces these cells to secrete a chemical (IL-15) that attracts lymphocytes to attack these cells. In Lymphocytic Colitis, you get patches of lymphocytes in the colon, rather than the small intestine. So I wonder if LC might be triggered by leaky sections of the colon in a somewhat analogous way to CD in the small intestine?

[tex]

That sounds like a great article, and Dr. Fasano is arguably the best researcher out there, in the area of celica disease, so that article should definitely help to get the story out in the general public. Of course, he targets the LGS aspect of gluten sensitivity, since he is getting close to being able to market a "pill", which will restrict the production of zonulin, and thereby "force" the tight junctions to remain closed, (according to his research, the release of zonulin is what actually triggers the "inappropriate" opening of the tight junctions. Did he by any chance mention that research project in the article, and/or indicate when he might be able to receive FDA approval to market the remedy?

So I wonder if LC might be triggered by leaky sections of the colon in a somewhat analogous way to CD in the small intestine?

I have felt for some time now, that this is probably one aspect of MC that is very likely present for many of us, if not for all of us. I have a hunch that someone will eventually get around to researching this concept, and verifying it to be true.

Thanks for posting that information, I'll try to locate it and read it.

Tex

[Rosie]

Tex, the article had a lot of information on his zonulin-blocking drug called Larazotide. Hi company has successfully completed 2 human safety trials, randomized placebo-controlled tests. So I assume the next step are the efficacy trials, but he didn't say how far along they were. He did say that the first 2 trails had encouraging results where" the agent reduced gluten-induced intestinal barrier disfunction, production of inflamatory molecules and gastrointestinal symptoms in celiacs patients......CD patients who received the placebo produced antibodies to tissue transglutaminase but the treated group did not." He also said that the FDA recently gave approval to expand studies to other autoimmune disorders including type 1 diabetes and Crohn's disease.

[tex]

It sounds as though he may soon be able to help a huge segment of the population, by providing a treatment that actually prevents reactions/symptoms, rather than just trying to suppress symptoms after they occur, which is the approach used by most conventional drugs.

Of course, for celiacs, in particular, the diet alone should be sufficient to maintain remission, but the popularity of his research, definitely illustrates how accustomed people have become to "popping a pill", to cure all their ills. No one wants to be forced to follow a diet, if they can take a pill, instead. If will be interesting to see what the long-term implications will be, after these hit the market. IOW, it will be interesting to see if people actually drop the GF diet, or just use the med as insurance, to guarantee that they aren't accruing any intestinal damage.

Thanks for the additional information. It's an interesting time in history to be alive, isn't it.

Tex

[Lucy]

Got mine copy today as well. We sure are getting alot of publicity lately.
Our local Fox affiliate station has been running a little sequence toward the end of the hour all week, with the exception of tonight. Friday, it's supposed to be back on. I suppose anyone interested could check the Houston Fox affiliate, channel 26 if interested. I missed the one on Monday, so I need to find their site myself, and have a look. There was some controversy among celiacs over what was said on Monday, I think, but I don't think it was all bad. Will have to have a look before I form an opinion.

Wow, just think, celiac awareness month was May, and it doesn't seem to have stopped being in the news since then.

Yours, Luce

[Lucy]

Oh, and supposedly the pathology slides look identical in both diseases -- has to be labeled to tell the difference. Luce

[tex]

Luce,

By "both diseases", are you referring to CD and MC? Are you saying that the slides made from biopsies taken from the small intestine of a patient with CD, appear to be identical to slides made from biopsies taken from the colon of a patient with MC? That would be pretty profound, to say the least.

Tex

[Lucy]

Yes, MC and CD.

It is profound, indeed. Luce

[Rosie]

I'm editing here. I re-read the comments, and realized that you are talking about small intestine biopies in both cases of CD and MC.

[tex]

Ah! That sounds more logical, but still very profound. I've long suspected that to be the case, but that's the first verification that I've seen. That's great information to have, to say the least. I would have to say that fact irrefutably establishes the link we have always assumed to exist, between gluten sensitive enteropathy, and MC.

Probably, the reason why that small intestinal histology similarity is not common knowledge, is because most GI docs will not explore further, once they find MC, and so they will almost never do an "upper", for most MC patients. Also, they are not likely to do an upper, with biopsies, (without some other compelling reason), unless celiac serology is positive, something that will never happen for someone with MC, (unless they also have fully developed celiac disease). It's like diagnosing MC itself, they will never discover that information, because it can't be found, unless specifically searched for, and they virtually never specifically search for it. It's sort of a "Catch-22" situation. (Anyone remember that old movie?)

Thanks a million for that information.

Tex

[Rosie]

Of course this leads to other questions. For example, there are cases of MC that don't appear to be gluten sensitive, admitedly in the minority. Do you see similar pathology in the small intestine, or is this just a consequence of gluten sensitivity? And what about other autoimmune disorders linked to having a leaky gut?

Hopefully some researcher will take a close look at this. The circumstantial evidence is accumulating and at some point there will be sufficient interest in the research community.

[tex]

I'm just speculating here, of course, but if small intestinal histology is indeed the proper defining diagnostic criterion for gluten sensitive enterocolitis, (as it is claimed to be by the medical authorities), then identical histology, concurrent with MC, would have to be specific to gluten sensitivity, also. Any dissimilar histology would presumably, (though not necessarily), suggest cellular changes due to some other influence, (non-gluten related, IOW).

By the same token, I would think that if someone with MC is not gluten sensitive, then their small intestinal histology should definitely not be identical to that found with CD. This appears to me to be only logical.

Tex

[mbeezie]

Tex,

Just curious . . do you track the number of people on this site who are and are not gluten sensitive - if so, what percentage are not?

I'm just wondering lots of things about this sub-group (not necessarily for you to answer, just sparked some questions) . . . what are their intolerances, did they test non-reactive for gluten with Enterolab and are they in remission, what other AI diseases do they have . . .lots of questions, I know, but just curious.

This is all very intersting.

Mary Beth

[tex]

Hi Mary Beth,

No, I don't track that statistic, and here's why: It's sort of a sensitive subject to many members, so it can be difficult to pin down the exact numbers. Early on, at least, many members feel, (and insist), that they are not sensitive to gluten, despite the high odds against that. Some are still in a state of denial, (with MC, we all go through the "seven stages of grief", as described by Elizabeth Kübler-Ross, in relation to terminal illnesses), and aren't ready to acknowledge the consequences, while others have not yet noticed a relationship between their symptoms and what they eat.

We have 2 or 3 members, (among several hundred), who have been dealing with the disease for a number of years, and who do not feel it is necessary to alter their diet, though they do occasionally have flares, (maybe one every year or so - similar to mild cases of Crohn's or UC), and when they have a flair, they alter their diet for a short time, to regain remission, and then presumably go back to eating whatever they want. One or two others, totally deny that they are gluten sensitive, and use meds to maintain remission, (they rarely post), while one or two others, do seem to be enjoying a long-term state of spontaneous remission, (I have to guess here, since I haven't heard from them in a long time). IOW, there are precious few of us who are not gluten sensitive, but probably there are indeed a few.

Asymptomatic celaics are somewhat common, so there is no reason to doubt that the same phenomenon exists within the group of gluten sensitive individuals with MC. IOW, there are probably a few of us who may be gluten sensitive, but we simply do not show clinical symptoms.

To date, I don't believe that any of us who have been tested at Enterolab, have received a negative result on gluten sensitivity. Some would claim that such consistency would suggest that the tests are biased to a positive result, but remember that no one requests a gluten sensitivity test, unless they suspect that they are sensitive. Here's the main reason why I believe that almost everyone here is gluten sensitive - most people who join this site, do so because they have not been able to achieve remission by following their GI doc's recommended treatment. IOW, most of the "easy" cases never even look for a support group, let alone join one. Many people in the general population show the histological markers of MC, but don't even recall ever having the disease. (If you need a reference for that, I can come up with a reference -just ask). MC without food sensitivities is relatively easy to treat - any GI doc can do it. Even the Pepto-Bismol treatment will bring lasting remission, if no food sensitivity is present. IOW, in a nutshell, (with few exceptions), we see the most difficult cases on this board, and that is because we have food sensitivities, so our GI docs do not know how to treat us.

And, remember that something approaching 30% of the general population is gluten sensitive, so it's no wonder that those with the most treatment-resistant digestive diseases would test positive to gluten sensitivity. Have you ever seen this chart, from one of Dr. Fine's lectures, Early Diagnosis of Gluten Sensitivity Using Fecal Testing: Report of an 8-year study:? According to his research, only 69% of people with MC are gluten sensitive.

Prevalence of Gluten Sensitivity in Various Groups

Groups n % Positive Stool Test

Normal Volunteers 65 29%

Asymptomatic/No risk 43 44%

Autoimmune Dz 2747 62%

Abdominal Sx’s 1366 63%

Family Hx GS/Celiac 1217 68%

Microscopic Colitis 419 69%

Chronic fatigue 141 61%

All other Sx’s 604 63%

Celiac Sprue 45 100%

Obviously, since more than 69% of us seem to be gluten sensitive, either his research is flawed, or we are a special subset of people with MC. I'm pretty sure it's the latter, (IOW, we typically see the most severe cases here, IMO - the ones that the GI docs can't resolve).

Early on, we did a survey concerning autoimmune diseases, but remember, this was done after this board had been in existence for only a year, so the membership was still quite low, at that point.

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=3715)

Tex

[Rosie]

Asymptomatic celaics are somewhat common

Tex, I have a question for you about the association of CD and schizophrenia. I have read that mothers with CD are more apt to have children with schizophrenia, and that a gluten free diet sometimes helps with schizophrenic symptoms. You are such a resource, I was wondering if you have any references or more detailed information on this.

The reason I'm asking is because my daughter-in-law has CD, her mother has it, her mother's 3 siblings have it, and numerous other relatives have it. My daughter-in-law has 2 kids, and she has kept them gluten free since birth, even though they have never been tested. Her 30 year old sister has schizophrenia, but I have been told that she isn't gluten sensitive, so no effort has ever been made to keep her gluten free. It sounds to me like she has a very high probability of being a "silent celiacs". Also, she is very tiny, 4' 11'', and skinny. I feel like I should mention something to her mom about "silent celiacs", but would like more information before doing so. It seems to me that getting her checked for gluten antibodies by Enterolabs and putting her on a gluten free diet would be worth trying. She has periods with her schizophrenia where she functions pretty well, but then she gets worse and starts holding conversations with the wall