Celiac Disease Vs. Gluten Sensitivity (And ACTUALLY how prevalent they are)

The disease called celiac disease is an autoimmune disease of the small intestine that is triggered by these gluten molecules essentially inflaming the lining of the small intestine. Hey, it's Dr. A. Is celiac disease the same as gluten sensitivity? So this is a really good question. It kind of goes back to How do we name things? What do things mean when we say them? And also just the statistics around disease. Celiac disease and gluten sensitivity. Celiac disease is a gluten enteropathy, a disease of the digestive system and immune system. Gluten is a combination of a couple types of proteins that are gliadin or gliadin, depending on how you like to say that, and then— glutinin, and those 2 together are the glutinous part of grains like wheat. Now, these are proteins that bind together, and they're what give bread and doughy substances the elastic nature that they have. So if you have a lot of gluten in your bread dough or whatever other dough you're making, it will be sticky and pulley and stringy. It comes in grains such as wheat and spelt and barley and rice, not just wheat. If you are gluten sensitive, you do You need to really look at what has gluten and what doesn't have gluten. The disease called celiac disease, it used to be called celiac sprue, is an autoimmune disease of the small intestine that is triggered by these gluten molecules essentially inflaming the lining of the small intestine. When we look at celiac disease, We see that we have intestinal damage. We have a decrease in absorptive capacity, which can change our immunology in the GI tract, our GI nervous system, our micronutrient absorption, a whole bunch of things that we don't want. And also celiac is associated with type 1 diabetes and also Hashimoto's thyroiditis. There's also in extreme cases, some types of intestinal lymphomas. Okay.

Doctors say, well, you know, celiac disease is pretty rare. You know, I don't think that's what you have. Sometimes that's an artifact of when they were educated.

As for example, when I was educated in medical school, we believed that celiac disease was in about 1 in 800 to 900 people.

And that was not just like we made the number up and we were just super wrong.

Celiac disease and gluten enteropathy is on a spectrum.

If you look at the end of the spectrum where people have all, they check all the boxes of disease state, they have swelling of the small intestine, you biopsy it and you see that, they have malnutrition, they have these large, bulky, greasy stools every time they go to the bathroom because they're not absorbing the food that's going through, they have all these other problems. You get someone that checks all those boxes, They have celiac sprue. That was about 1 in 800 people. But what we learned over time, over the last 30 years, where we've got better science and better detection methods, et cetera, that's an end of the spectrum that is celiac, but there's also gluten enteropathy that occurs at a low end of the spectrum where you might not get all those problems. The problem is you probably still are not absorbing well. You might have a lot of chronic GI problems, a lot of chronic absorptive problems, et cetera. But now the statistics, if you go Pathology books are 1 in 40 to 100 people. So like tenfold more people have gluten-sensitive enteropathy than we used to believe. So sometimes, you know, that's part of the doctor's calculus too, is they just remember the statistics from before. Mostly in the world of gastroenterology, the specialty around digestive health, et cetera, gluten enteropathy is something that is very well known and looked for. There are tests that can be done with respect to endoscopy where they put the scope in and they take samples. The thing you want to remember about that is usually those tests are better if you are not avoiding gluten, because if you're eating gluten, the histology will look a little bit more diagnostic. There's also blood tests that can be done. There's genetic testing that can be done. The kind of the proof of how much it affects you though is if you find any of these things or you have high suspicion, you do the, the work or you work with the, the dietitian, etc., to look at all the sources of gluten, take them out of your diet, and you give your body time to heal up and see what things get better. Now, the further you are in this spectrum and the more you are towards celiac sprue, the more likely, uh, you need to be extremely careful to remove everything because it is a life-shortening disease to have that level of immune dysfunction and, uh, and poor, you know, malnutrition, et cetera. But even if you have a lower level of gluten sensitivity, you want to avoid as much gluten as possible. So you want to remember, of course, wheat, spelt, barley, and rye are big sources of it, but there's also a lot of gluten that's used in binders in certain— it's used in candy making, uh, it's used sometimes in pills. There are patients that we have that we have to order, uh, compounded medications made without gluten sources in it because they're very, very sick from taking not the medicine, but the binder. So a So there's a lot of things that go on with respect to removal. Removal is your big thing. The other thing that people get confused about is they might be allergic to wheat. They might have a histamine response to wheat, an IgE-type allergy to wheat, or a G or whatever. And that can be not a gluten problem. That's just that your, your body does not like the proteins that are in wheat, but it is not the reaction to the gliadin and glutenin that creates the enteropathy. So you can also have a non-celiac type of reaction to wheat as well. And some people have both, in which case you just don't need any gluten in your life. So I hope this answers the question that, you know, it used to be we, that we believed it was 1 in 800 or 900 people had celiac. Now we realize with more modern diagnostics and watching people, it's about 1 in 40 to 1 in 100 people that have gluten-sensitive enteropathy. And it's a spectrum all the way from mild to moderate problems to very, very severe disease. All right, I'm Dr. A. This has been fun. Thank you for those questions. Thank you, all you subscribers. Thanks to new ones. Please do like, share, subscribe, and do notifications. It really helps the channel. If you have friends that, you know, want to look into the content, please do share it. We've got a lot of content up and there's a lot more content coming. But please do. And thank you again for the questions. Thank you for subscribing, and I will see you all on the next video.