3 ms·

It may be perverse, but my first thought upon reading this was "Why would he stop eating gluten if he thinks it is Celiac disease? Wouldn't it be a more effect

It may be perverse, but my first thought upon reading this was "Why would he stop eating gluten if he thinks it is Celiac disease? Wouldn't it be a more effective test to double or triple the gluten intake, and see if things get worse?"

chipsy 16y ago
The percentage difference between 0 and 1 is greater than the difference between 1 and 2. That is, if Celiac is it, eliminating it will cause a more dramatic change, since we can assume that most diets will contain some daily wheat. It's almost impossible to unconsciously avoid.
- eru 16y ago
  At least in western society. On for example a classic Mongolian diet, it is possible `by accident'. (That is, lots of diary products and meat. Mongolia doesn't have a lot of arable land.)
eru 16y ago
Even from a pure scientific point of view: If you _had_ a binary reaction to Gluten (either it's there or it's not), then tripling your input wouldn't tell. Although I have a relative with celiac, I am not sure how the reactions to different quantities of gluten work. (She's generally avoiding gluten, understandably.)
jerf 16y ago
The way Celiac works is that it triggers an immune response to the gluten when it is in your villi in your small intestine, causing your immune system to attack them and basically blunt them, simultaneously ruining their ability to absorb, and lowering the effective absorption surface. Villi are structures in your small intestine that, like your lungs, are primarily there to increase the effective surface area for absorption of nutrients. In my experience, it actually pulses over a period of time. Presumably as your villi get a coincidental chance to heal as you just happen to eat a couple of gluten-free meals accidentally (which I would used to do with salads, not all of which have croutons), then they get hit with a fresh load of gluten in the next meal. So the point here is that doubling your gluten load may merely move your villi from "effectively destroyed" to "effectively destroyed", that is, no real change at all. (One downside of celiac is that while it is fairly treatable simply by avoiding gluten, you tend to get more sensitive over time, as if any does get through you've literally got a lot more to lose, and the fact that your small intestine is under attack is much more clear. I can literally feel it pulsing with inflammation-induced blood flow. I think maybe I used to be able to feel that sometimes but didn't realize that was Wrong(TM).) The way to diagnose it is to stop eating it for a long period of time, then have a load about three weeks in. You'll know then, because your healed villi will have an epic hissy-fit as your immune system tears into them. Based on what I've read this seems likely to be more determinative than any other test, including the colonoscopy ones; broadly speaking I'm a defender of Western medicine and procedures but I'm not sure that there isn't a bit of "if it isn't a lab procedure it's not a real test" bias here; colonoscopy and biopsy does not seem to be very reliable but it is still used a lot. Even my father, who definitely has it and is how I realized what I had was only told that it was "indicative but not conclusive". Much like the poster here, in fact. Like I said, I trust medicine in general but I'm inclined to set the threshold a bit lower than they do here, especially given the ease of a followup diet test. (If you're into medical stories on TV, I recommend some time with the Celiac page on wikipedia. It's a legitimately interesting disease; it's considered autoimmune, but it's unusual in that it's attacking the body for having a foreign protein. It's sort of an allergy, but differs in significant ways. It resists conventional classifications quite effectively.)

chipsy 16y ago

The percentage difference between 0 and 1 is greater than the difference between 1 and 2. That is, if Celiac is it, eliminating it will cause a more dramatic change, since we can assume that most diets will contain some daily wheat. It's almost impossible to unconsciously avoid.

eru 16y ago
At least in western society. On for example a classic Mongolian diet, it is possible `by accident'. (That is, lots of diary products and meat. Mongolia doesn't have a lot of arable land.)

eru 16y ago

Even from a pure scientific point of view: If you _had_ a binary reaction to Gluten (either it's there or it's not), then tripling your input wouldn't tell. Although I have a relative with celiac, I am not sure how the reactions to different quantities of gluten work. (She's generally avoiding gluten, understandably.)

jerf 16y ago

The way Celiac works is that it triggers an immune response to the gluten when it is in your villi in your small intestine, causing your immune system to attack them and basically blunt them, simultaneously ruining their ability to absorb, and lowering the effective absorption surface. Villi are structures in your small intestine that, like your lungs, are primarily there to increase the effective surface area for absorption of nutrients. In my experience, it actually pulses over a period of time. Presumably as your villi get a coincidental chance to heal as you just happen to eat a couple of gluten-free meals accidentally (which I would used to do with salads, not all of which have croutons), then they get hit with a fresh load of gluten in the next meal. So the point here is that doubling your gluten load may merely move your villi from "effectively destroyed" to "effectively destroyed", that is, no real change at all. (One downside of celiac is that while it is fairly treatable simply by avoiding gluten, you tend to get more sensitive over time, as if any does get through you've literally got a lot more to lose, and the fact that your small intestine is under attack is much more clear. I can literally feel it pulsing with inflammation-induced blood flow. I think maybe I used to be able to feel that sometimes but didn't realize that was Wrong(TM).) The way to diagnose it is to stop eating it for a long period of time, then have a load about three weeks in. You'll know then, because your healed villi will have an epic hissy-fit as your immune system tears into them. Based on what I've read this seems likely to be more determinative than any other test, including the colonoscopy ones; broadly speaking I'm a defender of Western medicine and procedures but I'm not sure that there isn't a bit of "if it isn't a lab procedure it's not a real test" bias here; colonoscopy and biopsy does not seem to be very reliable but it is still used a lot. Even my father, who definitely has it and is how I realized what I had was only told that it was "indicative but not conclusive". Much like the poster here, in fact. Like I said, I trust medicine in general but I'm inclined to set the threshold a bit lower than they do here, especially given the ease of a followup diet test. (If you're into medical stories on TV, I recommend some time with the Celiac page on wikipedia. It's a legitimately interesting disease; it's considered autoimmune, but it's unusual in that it's attacking the body for having a foreign protein. It's sort of an allergy, but differs in significant ways. It resists conventional classifications quite effectively.)