Dr. Abshire on Gluten and related diseases
An example of the usefulness of the matrix model for chronic disease is in dealing with the mysterious issue of gluten. Celiac disease and gluten sensitivity are more common than previously thought. Problems often go undiagnosed. Pre-disease or early disease patterns can be identified with the matrix which can prevent much suffering and expense. Pattern recognition can lead to uncovering a problem sooner even when the symptoms are subtle.
The antecedents, triggers and meditors are complex. Not everyone with the genetic predisposition DQ2/DQ8 develops celiac disease or apparent gluten sensitivity. There is likely a variety of multiple gene patterns combined with environmental triggers of perhaps a specific strain or cultivar of gluten with the correct glycolation, sugar attachment, patterns. There may need to be a co-trigger in addition to gluten. Two thirds of antibody positive patients do not have the classic gastrointestinal finding of villous atrophy but do have neurological and or autoimmune disease linked to celiac disease. Non-antibody positive patients may have profound response to the elimination diet. A variety of diseases are linked to this difficult to digest spiral shaped molecule. New research is expanding our understanding of the metabolic pathways mediating disease to include the TH 17 pathway and Interleukin 23. Emerging evidence is showing us that micro-flora in the gut can be altered by eating gluten in those not know to have gluten sensitivity. Gut flora can impact illness, so perhaps this is a mechanism of illness for some. It is postulated that perhaps certain individuals only react to gluten, or a type of gluten with a certain balance of flora present in their gut. The testing is confusing, the symptoms are confusing, the science is still emerging, but a higher index of suspicion with the functional medicine matrix model and earlier intervention may be one of the most profound ways to impact our populations health.
No matter how complex it is we need to do better, as currently there is an average 10 yr delay in diagnosis of celiac disease in this country. Some of the patients were so severely impacted by the undiagnosed cause of all their illness they have made it their life's work to raise awareness. A web site listed below is a recent addition to the cause.
Most of us doing this kind of medicine have a personal story behind our conversion to using the functional medicine matrix model. Mine is that I was the only one in my family that reversed a peripheral neuropathy with a gluten free diet. Eventually, only gluten would bring the neuropathy back. To my knowledge I am the only one that tried a change of diet, although I know one tested negative for celiac and another was found to have antibody mediated neuropathy. The rest were not tested beyond checking for diabetes. A non-celiac gluten illness is a possibility as I seemed to be antibody negative, however I was off gluten already when tested so it may have been a false negative test. Some gluten illness seem to be related to gut flora, but I do not know if that is my case. Seven of my family were or are affected with a disabling peripheral neuropathy across three generations; twelve of us with autoimmune thyroid disease which has also been shown to be linked to celiac disease. There appears to be some kind of genetic predisposition combined with other factors, and I doubt if it is only gut flora.
Many members in my family, in past and future generations could be helped by awareness of food allergies/sensitivities and gut health. It seems that providers need to be the impetus as family members of celiacs tend to prefer to not know, and surprisingly will avoid testing. Perhaps this will change as the gluten awareness restaurant memberships expand and products in stores and bakeries are more available. People want to be able to live normally, not like so and so. Being gluten free comes to sort of define you. Perhaps public education will work. It seemed to effectively drive the misguided low fat diet movement, and the public demand successfully resulted in an abundance of low fat products being produced.
At this point I would like to encourage everyone: providers, patients, friends and family members to perform, encourage or seek earlier screening for celiac and antibody testing for various autoimmune diseases if there is a family history or unexplained symptoms, and try elimination diets. Even when testing is non-definitive, symptoms may be reversed with adherence to diet.
Please see www.celiaccentral.com for more information on celiac disease.
A celiac patient initiated this site and she obtained funding from the National Institute of Health to raise the level of screening for celiac disease. She also hosts a program in several cities that provides gluten free training for local chefs that coach local physicians, not ordering enough celiac panels, to compete in a gluten free cook off.