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  Ask Dr. Aron

Jul 07


What is the difference between celiac disease and gluten intolerance? Is one more serious than the other?

The strict definition of celiac disease — positive antibodies to gliadin, intestinal endomysium, and tissue transglutaminase, together with the presence of HLA-DQ2 or HLA-DQ8 genes and an intestinal biopsy that shows at least 20-25 CD3 cells per 100 epithelial cells — will account for about 75-80% of all those sensitive to gluten.

It must be noted, however, that there are injurious grain proteins that cause damage and produce symptoms by mechanisms that are as yet obscure. As well, many other gene markers for grain-mediated injury have been described, thus placing many into the category of gluten intolerant, but not truly having celiac disease. We do know the consequences of untreated celiac disease — an increased risk for lymphomas and other solid tumors, along with a host of associated auto-immune, neurological and endocrine diseases.

It is unclear whether other people who are not celiacs but clearly cannot tolerate gluten are at risk for any other associated diseases. If you test negative for the strict criteria for celiac disease, but still cannot tolerate gluten, there is no harm in keeping to a gluten-free diet.

Health and happiness,
Dr. Aron
, MAY 26 , 2007
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How long does it take to get wheat or gluten out of your system?

No one knows for sure, but given the digestive rate, absorption of gluten and glutenin peptide fragments, and the turnover rate of the intestinal cells, about 3-7 days would be a rational guess.

How much time it takes to recover from damage done by gluten, however, depends on a number of factors: the dose of HLA DQ2, DQ8 genes that you receive from your parents, the position of the genes of chromosome 6 (genes on the same side of the chromosome-”cis” position are more potent than on opposite sides of the chromosome-”trans” position), the reactivity of your innate system at the level of the intestinal cell, and on the adaptive immune system’s pre-programmed drive.

That said, the more advanced your biopsy (Marsh III), the longer it will take to completely reverse the disease. Marsh III’s take about 2 years, while Marsh I’s may take 6 months to a year. All the more reason to have a biopsy at the time of initial diagnosis, and another one one year after being free from gluten.

Health and happiness,
Dr. Aron
, MAY 19 , 2007

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 I have read about LACTAGEN recently. Is there any chance that it might help the lactose intolerance?

I was diagnosed with Celiac Disease after a surgery for hip replacement three years ago. I had previously been diagnosed with Collagenous Colitis. I can handle the wheat restrictions, but as a result of the damage, I have a problem with even minute amounts of dairy.

I have read about LACTAGEN recently. Is there any chance that it might help the lactose intolerance?? I really miss cottage cheese, and cheddar cheese, and yogurt and….you get the picture!! I am 72 years old.


Dear Septagenarian with celiac: It is not uncommon to be lactose intolerant if you have celiac disease. With the history of collagenous colitis, it suggests that the gluten intolerance was present for a long time before the diagnosis of celiac disease was made.

The lactogen is not a bad idea, but you may also need to be reassessed for inflammation in the colon, as the addition of an aminosalicylate may help.

You may also be getting hidden gluten in your diet, so review your make-up, watch out for envelope and postage stamp glue,and other culprits.


Health and happiness,
Dr. Aron
, MAY 13 , 2007   
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I have some of the symptoms that are related to Celiac Disease. How do I find out if I have it or not?

Ask your gastroenterologist or internist to contact Prometheus Labs in San Diego, and arrange for them to run a panel called “CELIA PLUS”. This will test for all of the antibodies to gluten and your own intestine, and, if negative, the lab will automatically test for the genes associated with Celiac Disease.

If any of these tests are positive, then obtain an intestinal biopsy from your gastroenterologist, and make sure that the pathologist reading the biopsy can stain for CD3 cells, and count the number of these cells per 100 epithelial cells.

Most authorities feel that more than 20CD3/100epith cells is abnormal. These findings occur long before blunting of the intestinal villi develops, which is what a less-experienced pathologist would be looking for on a biopsy. So if blunting of the villi are required to make a positive diagnosis, many celiacs will be missed.

Health and happiness,
Dr. Aron
, MAY 5, 2007   

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I was diagnosed with Irritable Bowel Syndrome (IBS). Is it possible that I could actually have Celiac Disease?

Most certainly. Studies have shown that about 30% of patients with diarrhea-predominant IBS, and a significant, but lesser percentage who have constipation, bloating, pain and alternating forms actually have Celiac Disease.

There are many celiacs in my practice who came to see me because their “IBS” was not responding to any treatment, but have made complete recoveries when diagnosed and placed on a gluten-free diet.

Health and happiness,
Dr. Aron
, MAY 2, 2007   

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