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Healthcare professional Resource for Gluten Related Disorders.

Dr. Schär Institute

Expert solutions to your questions

This area of the Dr. Schär Institute website offers a very special service.
Our medical and nutrition experts are available to answer your questions on celiac disease and gluten related disorders. Whether it is questions on a specific case, genetic testing, or the use of the FODMAP diet our experts will provide the answers. The question and answer will be published anonymously on this page so that everyone can benefit from the information.

We look forward to great  discussions with you!
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Ask the expert

Is a Low FODMAP diet automatically gluten-free?
No, the Low FODMAP diet is not consistently gluten-free and so it’s not equivalent to the nutritional advice given to celiac patients. Neither does a low FODMAP diet take into account individual intolerances and it cannot replace proper nutritional counselling.
How is it that patients sometimes claim they cannot tolerate wheat, but they can tolerate spelt?
Wheat and spelt are the same as far as treating celiac disease is concerned – they have nearly the same gluten content. If somebody cannot tolerate wheat, but they can tolerate spelt, then they are suffering neither from celiac disease nor a wheat allergy. Instead, they are probably experiencing intolerance of other substances in wheat.
Is there a difference between the degree of compliance in a coeliac patient and that in a patient with a gluten or wheat sensitivity?
I’ve noticed that people who suspect they have an intolerance do not have a consistently gluten-free diet, which would be required if they had been diagnosed with celiac disease, but neither is their diet varied enough. I often find that individuals with celiac disease  initially stick very strictly to a gluten-free diet, but after four years they become lax. Only when they then suffer severe problems do they come in for a consultation. “A 3-phase nutritional therapy that begins immediately after first diagnosis and supplementary nutritional advice when problems and/or increased transglutaminase levels appear, can considerably improve compliance in the patient.“ [Körner U, Schareina A: Nahrungsmittelallergien und -unverträglichkeiten, in preparation (Haug 2015)] Corresponding recommendations for monitoring check-ups in patients with celiac disease have also been included in the current guidelines (3.11. Monitoring during the diet).
Gluten is the catchphrase of the moment. Are diagnoses really on the increase and how is the medical environment changing?
Yes, there are a lot of conferences taking place in medical and related fields at the moment and we’ve noticed that we have considerably more knowledgeable audiences in front of us now than we did two years ago. Increasingly, it’s not just the highly specialised gastroenterologists who are interested in this and that’s a good thing, because in the end it’s the family doctors we have to reach. They’re the ones who see the sufferer or potential coeliac patient first. But monitoring the diagnosis rate is unfortunately difficult: fewer screenings are undertaken in Germany than in other European countries. That’s why we can’t properly track how diagnosis rates are developing.
It’s believed there is a high number of unidentified cases of celiac disease. Where are these likely to be found?
As celiac disease is a genetically inherited condition, some are likely to be among a sufferer’s immediate relatives. We think there are many individuals with a sub-clinical degree of celiac disease, i.e. without having visible symptoms. There may also be many patients with Irritable Bowel Syndrome who would benefit from a gluten-free diet.
How useful is genetic testing?
Genetic testing is interesting in patients who have suspected coeliac disease. The guidelines recommend, for example, testing immediate relatives of a coeliac sufferer. But unfortunately coeliac disease isn’t monogenetic. It is thought that around 100 genes influence the presence of coeliac disease. At the moment, we know about 55 of these and we have seen that HLA-DQ2 and HLA-DQ8 are present in all coeliac sufferers. So we can assume that these two genes are a good indication of coeliac disease. However, they are also present in approximately 30 percent of the normal population. Therefore, a negative genetic test means that coeliac disease is extremely unlikely. However, if the test is positive, this can indicate coeliac disease, but it is not a definite result. So the test is only suitable for excluding a coeliac diagnosis.
Sometimes the biopsies are not clearly identified in the results. How can you tell how frequently and which biopsies have been taken?
There are no official regulations for the reports, but they should be clearly marked in both the medical and the histological findings. Sometimes it’s in the main text and sometimes it’s identified under the point concerning specimen material, e.g. as “Sample extraction duodenum (6x)”. In case of doubt, the histological finding is most clearly linked to the biopsies and has more detailed information.
How long should a patient be exposed to gluten so that a correct diagnosis can be made?
We recommend a period of two months. That’s difficult to maintain for some patients, and in the worst case scenario that period has to be shortened. But you should still aim for two months to be sure of revealing all potential celiac symptoms.