To Your Health: Celiac Disease

To Your Health: Celiac Disease

Dr. Alan Safdi was one of the most popular speakers at the Telluride First Foundation’s inaugural Integrative Wellness Summit. He is scheduled to speak again at the 2nd annual conference at the Telluride Conference Center in Mountain Village. The intensive takes place September 9 – 11 and also features Deepak Chopra (streaming live); Dr. David Agus; Dr. George Pratt, Dr. Marc Siegel, and more. Jewel is the Friday night keynote; she will tell her story of personal growth through words and music. For more about the speakers, go here. To purchase tickets, go here.

A regular contributor to Telluride Inside… and Out, Dr. Safdi’s column is entitled “To Your Health.” (Search under the column name or Safdi’s name on our home page to find all his eye-opening posts.)

In the run-up to the Wellness Summit, Telluride Inside.. and Out is hosting a series of posts and podcasts on subjects in medical headlines today, including exercise, supplements, longevity, diet and nutrition, break-throughs in cancer research. 

This week, Dr. Safdi looks at celiac disease.


Celiac disease (gluten-sensitive enteropathy), sometimes called sprue or celiac, is an immune reaction to eating gluten, a protein found in wheat, barley, and rye. The self-diagnosis of this condition and over-diagnosis can be a problem. Celiac disease affects about 1 out of every 100 individuals; people with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing the condition.

Celiac disease can be defined as a small bowel disorder characterized by mucosal inflammation, villous atrophy, and crypt hyperplasia, which occur upon exposure to dietary gluten and which demonstrate improvement after withdrawal of gluten from the diet. Over-diagnosis of celiac disease or a complete removal of all gluten in patients who do not have celiac may have consequences.

In the Nurses’ Health Study II, researchers investigated individual grain-containing foods and whole and refined grain intake during adolescence, early adulthood, and premenopausal years in relation to breast cancer risk. The outcome proposes that high whole grain food intake may be responsible for lower breast cancer risk before menopause, while fiber in whole grain foods may mediate the association with whole grains. Grains are an important part of a healthy diet. A good source of healthy carbohydrates, various vitamins and minerals, and fiber. They are also naturally low in fat.

Some people experience symptoms found in celiac disease, such as abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, yet do not test positive for celiac disease. There are recent studies with this group of individuals and when blinded to their diet ingredients, their symptoms did not often correlate with the gluten intake in their diet. We need to continue to research the patients we describe as having non-celiac gluten sensitivity and non-celiac wheat sensitivity. That is a condition, when removing gluten from the diet, appears to resolve symptoms.

Who should be tested for celiac disease?

Testing for celiac disease should be considered in the following groups of patients:

• Those with gastrointestinal symptoms including chronic or recurrent diarrhea, malabsorption, weight loss, and abdominal distension or bloating. This includes patients with symptoms suggestive of irritable bowel syndrome or severe lactose intolerance.

• Individuals without other explanations for signs and symptoms such as iron deficiency anemia, folate, or vitamin B12 deficiency, persistent elevation in serum liver function tests, delayed puberty, recurrent fetal loss, low birth weight infants, reduced fertility, persistent aphthous stomatitis, peripheral neuropathy without a known cause, or recurrent migraine headaches.

• Patients with type 1 diabetes mellitus and first-degree relatives of individuals with celiac disease if they have signs, symptoms, or laboratory evidence of possible celiac disease. Testing for celiac disease may be considered in asymptomatic first-degree relatives of patients with confirmed diagnosis of celiac disease, particularly children.

There is some debate about screening patients with osteoporosis; currently it is not recommended routinely.

We can test for celiac disease in a variety of way, but our first test is usually done using an antibody called TTG-IgA while the patient is maintained on gluten. If the individual is on a strict gluten-free diet, the test can be misleading, coming up negative even when they are actually afflicted. A biopsy of the lining beyond the stomach in the duodenum is also used to confirm the diagnosis. Genotyping can be helpful, with blood taken to look at the HLA DQ2 and DQ8 genotype.

As a general rule, there are six key elements in the management of patients with celiac disease, summarized with the following acronym:

Consultation with a skilled dietitian.

Education about the disease.

Lifelong adherence to a gluten-free diet.

Identification and treatment of nutritional deficiencies.

Access to an advocacy group.

Continuous long-term follow-up by a multidisciplinary team.

How do you get enough nutrition if we leave out wheat, rye, and barley?

Whole grains are even better for you than wheat, rye and barley, and with celiac disease we continue to recommend whole grains. These include brown, black or wild rice, quinoa, amaranth, pure buckwheat, corn, cornmeal, popcorn, millet, gluten-free oats, sorghum and teff.

Editor’s Note: 

Our relationship with Dr. Alan Safdi started several years ago when we attended a Wellness Conference at The Peaks Resort & Spa. Dr. Safdi, is a gastroenterologist with a talent for offering evidence-based medical findings for healthy living in easily digestible sound bytes. We next heard him speak at Telluride First Foundation’s inaugural Integrative Wellness Conference, where the audience got just a taste of his encyclopedic knowledge of mind-body wellness with an emphasis on prevention.

More about Dr. Alan Safdi:

Dr. Alan Safdi
Dr. Alan Safdi

Dr. Alan Safdi is a speaker, contributor, and serves on the advisory board of the Telluride First Foundation.

He is board certified in Internal Medicine and in Gastroenterology and a Fellow of the American College of Gastroenterology. A proven leader in the healthcare arena, Safdi has been featured on the national program “Medical Crossfire” and authored or co-authored numerous medical articles and abstracts. He has been an investigator in over 581 studies and is President of both the Consultants For Clinical Research and the Ohio Gastroenterology and Liver Institute.

Dr. Safdi has been involved in grant-based and clinical research for about 35 years and is passionate about disease prevention and wellness, not just fixing what has gone wrong. He is an international lecturer on the subjects of wellness, nutrition, and gastroenterology.

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