Food allergy sadly usually missed

In my clinic - just seen another food allergy muddle. A child who has been misdiagnosed as a ‘viral illness’ and ‘vomiting illness’. However, this 9-month child has classical cow’s milk allergy: with symptoms of diarrhoea, vomiting, eczema, runny nose and chesty breathing.

This little boy has already seen a dermatologist, a pediatrician and many general practitioners. They have just treated him for his symptoms, but have been blind to the fact that he has had milk allergy from the first few weeks of life.

Unfortunately mother was not able to breastfeed him. Although my skin-prick allergy testing was negative, he still likely to have a cow’s milk protein intolerance (CMPI). This is one of the major mistakes many medics make: they assume that if the skin-prick tests (or EAST/RAST tests) are negative then that child cannot have food allergy – this thinking is completely wrong. Most children with a cow’s milk protein intolerance in fact have a negative skin test. The skin-prick testing only tells you what sort of reaction is occurring.

By the way, gluten sensitivity/intolerance children have negative skin-prick tests to gluten and wheat.

This child is now on Neocate and will get better. It distresses me to know that so many paediatricians and general practitioners are ignorant about food allergies. About 10% of children react to dairy but almost no medical specialists acknowledge this fact. This is one of the reasons why I have set up the eClinic: to help the parents through the allergy maze.

Dr Rodney Ford

htpp://www.DrRodneyFord.com

Gluten Glamour – fact, fiction or fashion?

Philosophers have grappled with the concept of ‘true’ or ‘false’ or ‘maybe’ for eons. These questions are now being applied to gluten-free diets. Who has the right to be on a gluten-free diet?

It is a known fact that gluten causes some people to develop coeliac disease: this is damage to the gut which is reversible on a strict gluten-free diet (life-long). These people have a hereditary predisposition to getting coeliac disease, which is tested by the DQ2/DQ8 HLA gene. When coeliac disease was at first defined as intestinal damage (as proven by biopsy), 40 years ago, there were no blood tests to help with the diagnosis. Things have changed radically since then.

The gluten picture is now much more confused. The entity of gluten syndrome / intolerance has blurred the situation. There is now excellent data to show that gluten sensitive reactions are very common, with most estimates finding about 10% of the population to be adversely affected by gluten. Most of these gluten-sufferers do not have coeliac disease: they are negative to coeliac blood tests (tTG, EMA and DGP). However, they feel very much better on a gluten-free diet. So, now gluten syndrome / gluten intolerance has blurred the boundary between coeliac disease and non-coeliacs. There is now a grey zone between the black and white of true and false.

For the last 30 years I have been interested in people who have responded to a gluten-free but who do not have coeliac disease. This condition of gluten intolerance/sensitivity affects the bowel but also the skin and nerves. Because there is no specific test for this condition, the way to diagnose it is a trial of a gluten-free diet. And many people trying this feel so much better.

Recently, many celebrities including Madonna, have adopted a gluten-free diet … and have found it to their liking. They feel great. Being celebrities, their fans are very interested in what they are eating. This curiosity has helped spark great awareness about gluten-free diets. Lots more people have subsequently adopted a gluten-free lifestyle and are feeling the benefits of this.

Such wide-spread adoption of the gluten-free diet, without having any blood tests or endoscopies, has upset much of medical profession. Their claim is that going gluten-free without any blood tests is masking the possibility of diagnosing coeliac disease. In most medical establishments there are those who believe that coeliac disease should be the only reason (without exception) to be on a prescribed gluten-free diet. I disagree with such a stance, as do many others who have helped to define The Gluten Syndrome.

Gluten is an unnecessary protein. Nobody can digest gluten properly. Gluten is implicated in triggering many autoimmune diseases. Gluten is the cause of much disease and upset. Gluten is associated with depression and schizophrenia.

A gluten-free diet has been attributed to cure such problems as eczema, reflux disease, mental and behaviour problems, headaches ans migraines.

And now being gluten-free is becoming a celebrity status. In my opinion this is an excellent thing to be happening. It has allowed lots more people to hear about the idea of going gluten-free and feeling better from their chronic ills. Of course, there will be many people who adopt a gluten-free diet for whom it is not necessary, but his is okay. A gluten-free diet is a healthy diet, and there is no detriment of being gluten-free diet, as long as you adopt it by eating in a wholesome way (the majority of the population eat an unhealthy diet … most people eating gluten-free eat a lot better). Time will tell whether this celebrity status persists. My prediction is that it will. I also predict that in another decade, a third of the population will be on a gluten-free diet.

Adoption of the gluten-free diet by celebrities has just hastened the inevitable. The fact is that gluten-free will continue to regarded as both glamorous and a healthy food choice.

Dr Rodney Ford

Author of The Gluten Syndrome

Gluten-free: is it only way to manage celiac disease?

Well, the simplistic answer to this question is “yes”. However this is a complex question. To narrow the question, I will first assume that coeliac disease means that ‘a diagnosis has been made by endoscopy showing the characteristic flatness/atrophy of the small bowel mucosa’ (I will address the question of how early you can diagnose coeliac disease in a later blog).

Yes, a gluten-free diet is the central management strategy for coeliac disease. But what does gluten-free mean? A gluten free diet means zero gluten for life. No exemptions. Certainly there are many people who suggest that people can eat gluten to tolerance. I disagree. Any gluten has the potential to cause you harm.

But does zero gluten literally mean non-at-all? The most complex part of answering this question is “what does a zero-gluten-diet mean in terms of every-day practicality?” Recently, there has been a lot of debate about how many parts per million (ppm) of gluten is acceptable in food. Pragmatically, because it is so difficult to get rid of cross-contamination in food production and processing, the number of 20 ppm is now surfacing as a reasonable level of gluten to be consumed (some countries have 200ppm, and the FDA likely to agree to 20ppm). This seems to be a negligible amount. However, there are still concerns for some people who seem to be exquisitely sensitive to gluten.

For me zero-gluten means no gluten. This can be achieved if you eat fresh fruits and vegetables, unprocessed meat and fish, uncontaminated rice, corn and other alternate grains, and unprocessed dairy foods and eggs, nuts also. This means no packet or processed foods.

But it is a lot more that ‘just’ going gluten-free. Yes, there are a lot more things to do for healing someone with coeliac disease. The longer that you have had coeliac disease, the worse your body will be. More healing will be required. You may need additional minerals, vitamins and probiotics. There are a number of routine health checks to take. You should also ensure that your gut has healed (via blood test and maybe repeat endoscopy).

There is talk about vaccines for coeliac disease. I think these are a long way off. On top of this gluten is a trigger for many autoimmune diseases and neurologic conditions. So giving pharmaceutical treatment for coeliac disease will still not remove the threat of gluten to your body.

Zero gluten is the main stay of treatment for coeliac disease. I do not see this changing much in the future. I do see the gluten-free lifestyle being very widely adopted over the next decade. I do see better non-gluten grains. I do see a generation in much better nutritional health.

http://www.DrRodneyFord.com

Dr Rodney Ford, Author of The Gluten Syndrome

For clinical guidance, check out the eClinic

Gluten-free is not always healthy

Was sent a message advertising the gluten-free benefits of a “Natural alternative healthy energy drink”. This is misleading and dishonest.

It is just a sugar (sucrose) drink with a few added vitamins. Much better to eat fruit and veggies. Better value to buy and eat healthy whole foods and drink water. Sugar has fructose in it: this is potentially a bad thing (see Sweet Poison).

Being a "gluten-free" product does not automatically mean that it is healthy, or good for you. Often it is not. For example, Coca-Cola is also gluten free (and fat free too). However, I do not recommend it.

By the way, a "Healthy Sugar" drink is an oxymoron!

Cheers, Dr Rodney Ford

Glutened skin DH & eczema

Itchy skin could be caused by gluten - check it out

Dermatitis herpetiformis (DH): is one of the many problems caused by gluten-sensitivity.

Dermatitis herpetiformis is a very itchy skin condition. It can start suddenly. It tends to affect the elbows, knees, buttocks, scalp, and back. It begins as little bumps that then change into little blisters.

The condition is thought to be caused by tiny clumps or deposits under the skin. These deposits are made up by a combination of IgA-gliadin and gluten (these deposits are known as immune-complexes). These deposits occur as a result of eating gluten. These deposits take a very long time to clear up once you start on a gluten-free diet. It can take up to ten years before you make a full recovery.

To make a definite diagnosis, you need to have a skin biopsy. Which, if positive, will show these clumps of immune complexes of gluten/gluten antibody. A skin biopsy cannot diagnose celiac disease. For that you need the gut biopsy.

Most people with dermatitis herpetiformis do not have troublesome gut symptoms. However, most (about 80%) do have some damage in their intestine when it is looked for. So, all DH sufferers should be tested for celiac disease (that means relevant blood tests and then a small bowel biopsy via endoscopy). About 5% of celiac patients will develop dermatitis herpetiformis. Sometimes it can even develop after starting the gluten-free diet. This is probably due to the long lasting nature of the IgA immune-complex deposits in the skin

Eczema : The skin is often a target organ in gluten-sensitivity: eczema can also be precipitated by gluten. Therefore, people with persistent eczema should get a blood test for their IgG-gliadin levels. This is a common manifestation of gluten-sensitivity.

Bottom line:

If you have on-going itchy skin / eczema - think about gluten. You might be able to trade your itch for a GF diet.

Cheers Dr Rodney Ford

Gluten in cow’s milk?

Heidi asks: “If gluten passes through into human breast milk (http://www.ncbi.nlm.nih.gov/pubmed/9867098?dopt=Abstract), couldn't it also pass into cows milk? Any thoughts?

Reply: “Yes, I have been asking this question for a decade - but too scared to get the research done! Yes, gluten does get through breast milk. As do cow’s milk protein and all other food proteins.

And in cows? Yes, almost certainly the same goes for cow's milk. With the focus on high production, in NZ, cows are now routinely fed barley and wheat grain. There is gluten in their feed, and so, yes, some gluten proteins will get through into the milk/dairy food chain. So, yes, that will make gluten sensitive/ celiac people sick. Yes, we need to think about it. Yes, research is needed. Then there will be a big market for not-fed-gluten-grain-dairy-cows.

This is another reason why gluten sensitive people should avoid cow’s milk if they are still getting symptoms and/or their blood tests remain abnormal. This is a subtle cross-contamination of the food chain with gluten

Cheers, Dr Rodney Ford

PS – a comment on t eh web stated: “Gluten is from wheat/grain… why would it be added to any milk?
 Well, it is already in the milk via the cows being fed gluten grains.

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Medical Gluten Awareness takes time

I am not a conspiracy theory supporter. My belief is that most GPs do the best job that they can. They are hampered by two opposing forces: their lack of up-to-date knowledge; but in the middle of an information overload. The natural thing to do is to just keep on doing what you have been doing and feel safe. To make it more complex, the gluten/celiac tests have changed radically over the last 15 years - so this makes getting up-to-date all the more difficult. My approach is to encourage the community (patients) to educate their doctors. Doing this by facebook, blogs, writing books, lecturing and creating the eClinic.

Facebook friend Al says: “I have seen change over the years and I feel it will continue change for the better. The gluten-free community has seen rather large changes over the past 1 - 2 years in research. Will it change as quick as we'd like? I'm afraid not. It will take time for this info to filter down to frontline medical professionals.

Yes, it takes time to "change direction" in world of medicine/science.

Cheers, Dr RodneyFord

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