The Food Doc Journal

Author Bio

Dr. Scot Lewey is a digestive disease specialist doctor (board certified gastroenterologist) whose medical practice focuses on digestive and food related illness. Also, known as Dr. Celiac, the Food Doc, Dr. Lewey shares his experiential knowledge for a healthy gut, healthy life on-line. He is one of the few GI doctors who also is gluten sensitive and dairy sensitive. He has nearly a quarter of century of experience in the diagnosis and treatment of food allergy & intolerance, colitis, Crohn's disease and IBS. He and his family live gluten free in Colorado.

Personal Thanks for Being Selected One of America's Top Gastroenterologists for 2010

2011-03-28T23:09:00.000-06:00

The Food Doc Website continues to be updated. I have recently added more content, including biopsy and endoscopic photos, as well as examples of Celiac and IBD blood tests and Celiac genetic results to help you understand these results better. As I have explained in past, the site is a work in progress, done after hours in the midst of a busy clinical practice. However, I am passionate about these issues and experience on a day to day basis the frustrations that many of you feel trying to find good information as well as deal with the misinformation and denial of both lay public and physicians regarding the role of food and the digestive tract health and disease. Many of you have kindly given feedback that you appreciate the content of the website.

With humility I am honored to have been selected as one of America’s Top Gastroenterologists by the Consumers’ Research Council of America for expertise Celiac and Digestive Diseases, based on evaluations that included education and continuing education, number of years practicing in the medical profession, board certifications and affiliations with professional medical associations. This honor is accepted on behalf of my patients and those of you who follow my blogs and visit my website regularly; many of you teaching me through your experiences and insights, questions and struggles. Thank you for reading this blog and visiting my website. Thanks to you have shared feedback on the survey at the website and those who have opted in to my email list to receive updates. This has been difficult week, as my sister was just diagnosed with breast cancer. My mother died of cancer at age 63. Several times a week I have to inform patients that they have cancer, some at advanced incurable stages. It is never easy and when it is one of your own family, it is especially tough.

Sincerely,

Scot M. Lewey, D.O., FACG, FASGE, FACP, FACOI, FAAP, FACOP, CPE

Clinical Associate Professor of Medicine

Rocky Vista University-College of Osteopathic Medicine

Gastroenterology Associates of Colorado Springs

4110 Briargate Parkway, Suite 100

Colorado Springs CO 80920

719 387 2110

Author Bio

Gluten Proven to Cause Digestive Symptoms and Fatigue in Non-Celiacs

2011-03-21T13:13:00.000-06:00

Gluten causes digestive symptoms and fatigue in people without Celiac disease.

In the first double blind randomized placebo-controlled study of gluten and symptoms in people without celiac disease, researchers from Australia have confirmed that gluten is a trigger of digestive symptoms and fatigue. They concede that “non-celiac gluten intolerance” may exist.

The researchers challenged and re-challenged people with IBS in whom celiac disease had been excluded whose symptoms were controlled on a gluten-free diet. These individuals were randomized to gluten-free diet with daily supplements of muffins and bread with a standard amount of gluten added or not added. Both the patients and the investigators were blinded to whether they were getting gluten containing muffins or bread and taste tests were done confirming that the two forms were indistinguishable. Symptoms were tracked by analogue scale. Patients were significantly worse within one week of gluten ingestion and had significantly worse bloating, abdominal pain, altered bowel pattern and fatigue.

In an editorial following this article in the March 2011 issue of the American Journal of Gastroenterology, Dr. Elena Verdu, MD, PhD., states “…gluten may be one of a multitude of triggers of low-grade inflammation and/or gut dysfunction in IBS” and “Gluten sensitivity could be raised as a possible cause of functional symptoms in patients with a positive anti-gliadin antibodies, and gluten restriction advised as a therapeutic trial.”

There is accumulating evidence that IBS does in fact involve low-grade inflammation and immune activation. Mast cells have been implicated for several years but only recently has there been studies showing increased activated mast cells present in the duodenum, ileum and/or colon of individuals with IBS symptoms. The trigger in these individuals is believed to be some type of immune stimulating event such as an intestinal infection (hence the post-infectious form of IBS) or proteins in the gut such as foods and/or microbes that are sensed by the body as being foreign attackers. The role of microbes is getting a lot of scientific and research attention whereas food proteins as a cause of IBS, has generally been doubted by US scientists or ignored until just recently.

Quoting research findings of Wahnshaffe et al, Dr. Verdu points out the presence of genetic markers for celiac disease predicted responsiveness to a gluten-free diet (GFD) in people with IBS. This is consistent with my clinical research findings of positive responsiveness to a GFD in individuals with at risk genetics (HLA DQ2 and/or DQ8) without proven CD, though many had positive AGA tests. Furthermore, my data indicates a higher prevalence of these genetics in individuals with increased mast cells in their intestinal lining, that is so-called mastocytic enterocolitis (MCE) or as I prefer mastocytic inflammatory bowel disease (MIBD). MCE or MIBD is gaining attention as an inflammatory process in some people with IBS. Treating such with medications and a gluten free diet has resulted in very favorable response in most the patients I have diagnosed and treated.

The role of mast cells and gluten in IBS is something I will continue to explore as I have now accumulated almost 400 patients with MIBD, many of whom have had celiac genetic testing and tried a GFD. Stay tuned for more information on mast cells in gastrointestinal disease.

Selected References:

Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double Blind Randomized Placebo-Controlled Trial. Biesiekierski, J. et al. Am J Gastro 2011;106:5080514.

Can Gluten Contribute to Irritable Bowel Syndrome? Verdu, E. Am J Gastro 2011;106516-518.

Mast Cells in Gastrointestinal Disease. Ramsay D., et al. Gastro and Hepatol 2010;6(12):772-777.

Mastocytic Inflammatory Bowel Disease ( MIBD ) : Increased Prevalence of Celiac - Related HLA DQ Genetics, CBir1 and Antigliadin Antibodies Associated With Response to Gluten Free Diet. Lewey, S. Am J Gastroenterol 2009; 104:S431–S484

Scot M. Lewey, D.O., FACG, FASGE, FACP, FACOI, FAAP, FACOP, CPE

Clinical Associate Professor of Medicine

Rocky Vista University-College of Osteopathic Medicine

Gastroenterology Associates of Colorado Springs

4110 Briargate Parkway, Suite 100

Colorado Springs CO 80920

719 387 2110

Author Bio

Celiac disease and Asthma risk link

2011-03-07T21:21:00.001-07:00

Asthma is a risk for Celiac disease and visa versa according to recent published study out of Sweden. In the study, the researchers found that people with Celiac disease were 60% more likely to develop Asthma. Conversely, people with asthma were more likely to eventually develop Celiac disease.

The study is a strong one, comparing 28,000 people diagnosed with Celiac in Sweden with 140,000 controls without Celiac.

Celiac and gluten have been linked to other chronic lung diseases, such as Sarcoidosis and lymphocytic bronchoalveolitis. Ron Hoggan,Ed.D, co-author of "Cereal Killers-Celiac Disease and Gluten-Free A to Z" in which I have several chapters, writes on this topic and his personal experience with lung disease as a Celiac.

Professionally, I have several patients and colleagues with asthma who have Celiac. This includes a pediatrician who also suffers from broncholitis obliterans with organizing pneumonia also known as BOOP and a pulmonary critical care specialist with gluten sensitivity. They have both shared with me that they are convinced of a link between Celiac or gluten and lung disease.

The researchers did caution that though the study strongly supports a link between asthma and Celiac it does not support the conclusion that one causes the other. Dr. Ludvigsson did postulate that a common link besides genetics and immunity may be low levels of Vitamin D. Vitamin D ingestion has been advocated by some because of anti-inflammatory benefits but no specific recommendations can or have been made for Vitamin D supplementation in when levels are normal.

This new study confirms what we have observed in practice seeing large numbers of Celiac disease and gluten sensitive patients. It also validates the experience of many people, most of whom were told by well meaning physicians that there was no link between asthma and Celiac or gluten. If you have asthma, get screened for Celiac disease. If you have Celiac disease and have breathing symptoms get an evaluation. If your health care provider discounts any link share with them this blog, the original article, lead author J. Ludvigsson, in the Journal of Allergy and Immunology 2011.

Scot M. Lewey, D.O., FACG, FASGE, FACP, FACOI, FAAP, FACOP, CPE

Clinical Associate Professor of Medicine

Rocky Vista University-College of Osteopathic Medicine

Gastroenterology Associates of Colorado Springs

4110 Briargate Parkway, Suite 100

Colorado Springs CO 80920

719 387 2110

Author Bio