Villous Atrophy is not Required for Diagnosis


Father of Intestinal Biopsy Classification System Speaks Out

Interesting news in the medical field, brought to you by HealthNOW San Jose Functional Medicine Clinic. Imagine being the ‘father’ of the intestinal biopsy and having your opinion ignored. It would be rather frustrating, not to mention heartbreaking, when your entire life’s work was dedicated to helping individuals with celiac disease and gluten sensitivity.

A recent interview with Dr Michael Marsh, the founder of the Marsh Classification System of intestinal biopsy, revealed that Dr Marsh himself is in total disagreement with the standard utilized by gastroenterologists to determine whether a patient should be diagnosed with celiac disease and begin a gluten-free diet.

In a fascinating discussion led by Dr Thom O’Bryan from the Gluten eSummit, Dr Marsh revealed that he created his classification system in 1982 and in 1992 formally spoke out at an international conference, making it quite clear that to not recommend a gluten-free diet for a patient with positive blood work but a negative biopsy was a medico-legal situation in the making.

Meaning that doctor who refused to recommend a gluten-free diet could be held accountable should that patient later develop severe nutritional deficiencies, osteoporosis or cancer, to name a few of the many possible negative scenarios. Dr Marsh stated that he had met individuals in their 20s who were celiac but hadn’t initiated a gluten-free diet and already, at their young age, had developed cancer. He went on to cite the work of several other researchers:

• Dr Kaukinen from Finland who found antibodies (immune system reactions) to gluten a full 7 years before villous atrophy

• Dr Not who showed elevated fatty acid binding protein, revealing cell death, when a biopsy was completely normal

• Dr Ludvigsson who discovered increased mortality with those showing intestinal inflammation despite no change in the intestinal lining, a mortality rate that exceeded those WITH intestinal damage.

All these researchers have proven what traditional, current gastroenterologists seem to refuse to admit and that is that waiting for complete destruction of the lining of the small intestine is dangerous and even reckless for the patient.
Did Your Doctor Mislead You with Faulty Test Interpretation?

Have YOU been told that you don’t have to stop eating gluten even though a blood test said otherwise because your biopsy was normal or not a Marsh 3 (meaning total villous atrophy)? If so, you were told wrong. And that is straight from the founder of the system himself!

Dr Marsh feels that all stages found in a biopsy should be taken seriously. And, the type of biopsy he recommends might interest you, especially if you’ve ever had one. His research is in the area of rectal biopsies that require little to no ‘down’ time from work or daily activities.
30% of the Population Should be Gluten-Free

When asked what percentage of the population fell into the ‘at risk’ stages of Marsh 1, 2 or 3, Dr Marsh stated a full 30%! 1% have Marsh 3, full villous atrophy, but 29%, in his opinion, fall within Marsh 1 or 2 meaning partial atrophy and therefore needful of a gluten-free diet.

The doctor also placed strong emphasis on noting that celiac disease and gluten sensitivity are not solely the domain of the small intestine, but in fact are also large intestinal diseases. This was great to hear from such an esteemed source, but I often am chastised when I mention that we have excellent success treating Crohn’s disease or colitis by, in great part, removing gluten from the patient’s diet. I’ve been chastised that such a treatment makes no sense when gluten doesn’t affect the large intestine, but only the small intestine.

Not being a researcher, all I could fall back on was my own and fellow doctors’ experience here at HealthNOW San Jose Functional Medicine, but we DO see excellent results. It’s nice to have Dr Michael Marsh’s support in the area. He made it quite clear that gluten affects the mesenteric immune system and that is found in the intestines – both large and small.
Is it Okay to Drink Beer? Yes?

Does gluten-free mean no beer? You’re thinking ‘of course’. Me too, however Dr Marsh has always allowed his celiac patients to drink English beer. Despite being warm in temperature, is English beer any different than American beer?

I truly have no idea, but Dr Marsh was quite adamant about the fact that he never saw any negative reactions in his beer drinking celiac patients. Please don’t ask me for my opinion on this one yet – I’m going to have to do some pondering.
Is Your Celiac Blood Test Reliable?

Lastly, Dr Marsh spoke out strongly against the tTG blood test – another ‘gold standard’ of celiac testing. While the test is 97 to 99% sensitive and specific within a patient who has a positive Marsh 3 biopsy, when it comes to those with partial atrophy, the test quickly gets a failing grade at only 27 to 33% accurate.

This is why I utilize the Cyrex Lab – I have no personal affiliation with this lab, I only recommend it because it’s the most comprehensive testing currently available. It gives ten times the information of traditional testing and looks at multiple potential reactions of the immune system against gluten.

We all want accuracy and early diagnosis, thus far this is the best testing I know of and it’s therefore what we use here at our clinical nutrition and medical department.

The bottom line is that celiac disease and gluten sensitivity are killing people – not the people who know and diligently follow their diet, but the people who don’t know or the people who suspect but are erroneously being told by their doctor that they’re ‘fine’ when they are not.
We Need to Share this Information

Let’s spread the word! Show this post to your doctor. We’ll start a dialogue and perhaps make some inroads into the proper and early diagnosis of these important conditions.
Do You Have Any of the Above Symptoms?

If you want to feel healthier—contact us for a FREE CONSULTATION. Call (408) 733-0400 to schedule. If you are not local to us, our DESTINATION CLINIC treats patients from across the country and internationally. We will help you find the underlying root cause!

To your health,

Dr. Vikki Petersen
IFM Certified Practitioner
Founder of HealthNOW Medical Center
Author of “The Gluten Effect”
Author of eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”