Top Celiac Researcher Speaks OutAbout Gluten Sensitivity

The researcher who established that celiac disease is much more common in the United States than long thought is now speaking about gluten sensitivity.

Alessio Fasano, M.D., Medical Director of the University of Maryland Center for Celiac Research, is known for conducting landmark research that showed that celiac disease is a common gastrointestinal disease in the United States, with prevalence rates comparable to those in Europe. Now is he conducting research and speaking about gluten sensitivity, a non-celiac intolerance to gluten. Gluten sensitivity is a condition that many people who have tested negative for celiac disease have long suspected but that most traditional celiac disease researchers have not acknowledged.

At a medical conference known as Digestive Disease Week, Dr. Fasano presented an abstract that he coauthored entitled, “Role of the innate immune system in the pathogenesis of gluten sensitivity: Preliminary study.” He also recently answered questions about gluten sensitivity from Tricia Thompson, M.S., R.D. Here are excerpts – his answers to her questions – from her post Celiac Disease vs. Gluten Sensitivity (I put the key concepts in bold):

Gluten sensitivity is a non-allergic, non-autoimmune reaction to gluten that can cause symptoms similar to those experienced by people with celiac disease…

Because gluten sensitivity is not a food allergy (like wheat allergy), or an autoimmune process secondary to exposure to gluten (like celiac disease), the diagnosis is based on exclusion criteria. In other words, people that experience symptoms that are suspected as being related to gluten exposure will be tested for wheat allergy and celiac disease. If they are negative for both, gluten sensitivity is considered. The diagnosis will be confirmed if symptoms resolve following the embracement of a gluten free diet…

As mentioned above, celiac disease is a true autoimmune disease (like type 1 diabetes and multiple sclerosis) in which both innate and adaptive immunity are involved. Conversely, gluten sensitivity is a non-autoimmune reaction to gluten in which only the innate immune system is involved.

The innate immune system is the most ancestral form of defense we have against “invaders,” while the adaptive immune system is a more recent branch of our immune system. Once our body comes in contact with a substance from the environment that may represent a signal of danger, the innate immune system reacts immediately to try to eliminate the “attacker.”

At the same time, the adaptive immune system will intervene with a more sophisticated, long process, during which the attacker is studied, its conformation evaluated, and a “customized response” to that particular molecule is engineered (i.e. specific antibodies). Further, the adaptive immune system will save this information as immune response memory, so that at the next encounter there is no need to re-do the job.

In autoimmune diseases, like celiac disease, there is a coordinate response between innate and adaptive immune system, a response that ends up in the wrong direction (i.e.; attacking its own body rather than the “invader”). In gluten sensitivity, there is only an innate immune response, since the adaptive immune system seems not involved.

Melissa’s Comments:

It has taken a while but it is really gratifying to see a big-name traditional celiac disease researcher now speaking about gluten sensitivity! It means more research will be conducted, more doctors should become aware that gluten sensitivity is a legitimate condition, and more people will be diagnosed with it (or believe the diagnoses they receive from labs such as Enterolab).

It’s important to note that Dr. Fasano is not the first to research or speak about gluten sensitivity. Numerous other doctors and researchers, including Kenneth Fine, M.D., of Enterolab, and Marios Hadjivassiliou, Richard A, Grunewald, G.A.B. Davies-Jones, and others, have written about, spoken about, or conducted research into gluten sensitivity for years. These gluten sensitivity researchers describe a spectrum of reactions that can occur with gluten sensitivity – and celiac disease is just part of that spectrum. To the best of my knowledge, I was the first to write about the spectrum of gluten sensitivity in a mainstream book when I wrote Going Against the Grain in 2002. Now traditional celiac researchers are putting their focus on this condition, which is all the better for those of us who develop uncomfortable symptoms from eating gluten but don’t have the autoimmune condition, celiac disease.

Dr. Fasano describing how the innate immune system but not the adaptive immune system is involved in gluten sensitivity dovetails nicely with other research I wrote about in a previous post in July, Gluten Stimulates Innate Immune System in People without Celiac Disease.

Research in this area is coming from many fronts, all pointing to gluten sensitivity affecting many more people than celiac disease does. So, for those of you who have friends or family members who have gluten-related symptoms but have tested negative for celiac disease, be sure to point them to the information in this post, to my book, and to my 2002 article, “Is Gluten Sensitivity Derailing Your Health?” Gluten sensitivity is real, affects many people, and results in countless symptoms. The only way to treat gluten sensitivity is the same way you treat celiac disease – with a strict gluten-free diet.

© Copyright 2008 Melissa Diane Smith

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