Archive for Celiac Disease
I’ve had many people ask me about this “gluten free” thing and whether it’s “real.” Or is it just a fad?
First and foremost, the entity known as celiac disease is nothing new. The traditional acceptance of celiac disease is a condition where the immune system of the gut attacks the gluten containing portion of grains (namely wheat, but also to a certain degree in oats, barley and rye). This attack results in the lining of the gut (the villa) being flattened out. While a normal gut may have the area of a tennis court, in someone with celiac disease that eats gluten, the destruction of the lining of the gut leaves you with a ping pong table.
The shrinkage of the area that is needed to absorb nutrients wreaks havoc long term and leads to most of the issues associated with traditional celiac disease (osteoporosis, neurological disturbances, shortened life span, etc…). This is the far end of the spectrum and is usually diagnosed via biopsy of the lining of the gut. Moving up the spectrum (from worst to less-worser), the blood markers anti-transglutaminase and anti-gliadin antibodies will be elevated and can be checked in a blood test.
This is generally where mainstream medicine stops at the definition of celiac disease. However, as I mentioned, it is a spectrum and not a set point. As you move away from the biopsy proven gluten allergy to the other end of the spectrum, “sensitivity” becomes a much better word to use. At this end, the number of people with sensitivity to gluten is quite high and it is very real.
And the numbers of people with gluten sensitivity keep going up. But why?
A portion of this may due to a cross reaction between a protein found in the yeast Candida albicans and a protein found in gluten. This means that a prescription for antibiotics, which will increase the number of yeast in your gut, can initiate the onset of celiac disease in genetically susceptible patients.
Combine the wanton use of antibiotics with conventionally grown grains given high amounts of nitrogen-based fertilizer (more nitrogen leads to more gliadin for the gut to react to) and you’ve got a recipe for more gluten problems.
But it turns out the story may be more complicated. This particular article looks at the role of glyphosphate (the principle component of the herbicide Roundup used heavily in GMO crops) and the realionship to celiac disease. While the article is quite complex, here are the high points:
• Fish exposed to glyphosate develop digestive problems that are similar to celiac disease.
• Glyphosphate triggers imbalances in gut bacteria (reduced Lactobacillus and Bifidobacterium, which break down gluten).
• Disrupts detox P450 enzymes, interrupting the activation of vitamin A and D, the maintenance of bile acid production as well as the breakdown of environmental toxins.
• Glyphosphate chelates and leads to deficiencies in iron, cobalt, molybdenum and copper.
• Glyphosphate leads to deficiencies in the amino acids tryptophan, tyrosine, methionine and selenomethionine.
• In addition, both celiac patients and glyphosphate exposure increase risk of non-Hodgkin’s lymphoma.
• Both are associated with reproductive issues like infertility, miscarriages, and birth defects.
Making matters worse, glyphosphate residues in wheat and other crops are likely increasing due to the growing practice of crop desiccation just prior to the harvest.
So, is it glyphosphate toxicity or gluten sensitivity? I’m pretty sure that this article didn’t entirely clear things up for many of you. The bottom line is that the answer likely lies somewhere in between. Either way, it would seem smart to take away two needed changes from this article. First, living a naturally gluten-restricted diet is a good idea. This does NOT mean buying the same types of foods you have always eaten but just buying them gluten-free. Not a good idea.
Second, if you do take in any gluten-containing grains, make sure they are organic or at least GMO free to reduce the likelihood that you will be exposed to glyphosphate.
Organ-Specific Autoantibodies and Celiac Disease Patients
This is yet another example of how important it is to determine food allergies and avoid those foods we’re allergic to. Wheat is high on the list of common allergies, along with corn and milk. This article also brings to light the systemic affects of food allergies; effects are not always what a person would normally think of. No hives, no stomach upset. In this study, children allergic to gluten (a protein found in wheat) had evidence of autoimmunity to cells in the thyroid and pancreas. Would this not lead to strong evidence for every patient with suspected hypothyroidism to have a trial of wheat elimination?
J Pediatr 2000;137:263-265 Patients with celiac disease have high levels of diabetes- and thyroid-related autoantibodies that “disappear” when the patients are placed on a gluten-free diet. The finding confirms the high prevalence of organ-specific autoantibodies in patients with celiac disease, and supports the theory that these antibodies are gluten-dependent, Dr. Alessandro Ventura, of the Universita di Trieste, Italy, and colleagues say in the August issue of the Journal of Pediatrics. The investigators tested 90 children with celiac disease for serum antibodies to islet cells, glutamic acid decarboxylase, insulin, and thyroperoxidase. The overall prevalence of diabetes- and thyroid-related autoantibodies was 11.1% and 14.4%, respectively.
Increased Prevalence of Celiac Disease in Patients With Dyspepsia
This study found that, in people with dyspepsia (stomach upset) they were twice as likely to be allergic to wheat.
Classic Presentation of Celiac Disease Is Not Most Common
This interesting portion of this article is that one third of patients in this study were originally identified as having irritable bowel syndrome. Most patients had seen three physicians before the correct diagnosis was made. Celiac disease is an allergy to one of the proteins found in certain grains, principally wheat. The take home message here is that any patient with IBS (and any GI complaints in general) needs to be put on an elimination diet devoid of the common allergens wheat, dairy, corn and soy.
66th Annual Scientific Meeting of the American College of Gastroenterology The classic presentation of celiac disease, severe malabsorption symptoms beginning in childhood, is actually not the most common presentation, according to study findings presented Monday at the 66th Annual Scientific Meeting of the American College of Gastroenterology. Dr. Robert D. Zipser, from Harbor-UCLA Medical Center in Torrance, California, and colleagues surveyed 1032 patients with biopsy-proven celiac disease to determine the most common presentations. The median age at diagnosis was 46 years and 14 patients were over 80 years when first diagnosed, the investigators note. Only 12% of patients were diagnosed before 10 years of age. Most patients had normal weights at diagnosis. While diarrhea was a common initial symptom, a few patients presented with constipation. Anemia, fatigue, flatus, bloating, and abdominal pain were also frequent presentations. Five percent of patients were asymptomatic. Most patients saw three physicians prior to being diagnosed. More than a third of patients were initially diagnosed with irritable bowel syndrome, the investigators report. The median time from initial presentation to biopsy-proven diagnosis was 1 year. However, 19% of patients had symptoms for more than 10 years before being diagnosed. “The goal of the study was to help physicians recognize celiac disease,” says Dr. Zipser. “Physicians often think of it as a rare malabsorptive disease limited to childhood,” he said. “However, the current findings indicate that celiac disease usually presents in adulthood with symptoms mimicking those of irritable bowel syndrome,” he added. While the findings indicate that adult onset is common, Dr. Zipser pointed out that for a small minority of patients the disease was probably missed during childhood. “Many symptoms which are typical of the childhood form are relatively uncommon in the adult form,” Dr. Zipser stated. For example, “weight loss is common in the childhood form, but uncommon in the adult form,” he noted. In fact, he added “some of the patients were actually obese,” he added. While all of the patients in the current study underwent small bowel biopsy, Dr. Zipser noted that it is now quite easy to diagnose celiac disease. “A simple blood test can determine whether antibodies to wheat products are being made,” he explained.
Celiac Disease Overlooked as Cause of Iron-Deficiency Anemia
Celiac disease (gluten insensitivity; an allergy to certain proteins in wheat, barley and rye) does occur at a surprisingly high percentage in our population (one in 100 to 300, depending upon whom you ask…), and anemia is only a small portion of the potential deleterious effects; Alzheimers, autoimmune diseases, dental caries and osteoporosis are but a few others on the list. Remember that food allergies, no matter the type, can upregulate the immune system and lead to excessive inflammation. One chaep, easy way to begin to cut down on some of your food allergies is to add betaine HCL (stomach acid) to your meals–the better we break down proteins to amino acids, the less likely those proteins are to invoke an allergic response.
Br J Haematol 2000;111:898-901 Especially in menstruating women, celiac disease appears to be underinvestigated as a potential cause of iron-deficiency anemia. Dr. D. J. Unsworth of Southmead Hospital in Bristol, UK, and colleagues identified 483 blood samples from prospective blood donors who met study criteria for anemia (hemoglobin <11 g/dL for women, <13.5 g/dL for men in order to recruit enough men). Of the donors, 28 women (26 premenopausal) and 4 men tested positive for IgA anti-endomysial antibodies and were asked to undergo further followup for celiac disease. Of the 25 subjects who underwent endoscopic small intestinal biopsy, 22 “had histological changes compatible with celiac disease,” the researchers write. Twenty-one of these were women, and Dr. Unsworth’s team notes that none of the women had been previously investigated for the possibility of celiac disease. The research team reports that their screening of anemic adults for celiac disease resulted in a detection rate of over 6%, compared with 0% detection of celiac disease using EDTA blood samples from 250 nonanemic blood donors. “Celiac disease serology is easy, cheap and reliable,” the authors write. “We recommend that all cases of anemia of uncertain cause, including all women with anemia ascribed to menstrual blood loss or poor diet, be checked for celiac disease-associated autoantibodies.”
Screening for Celiac Disease in Healthy 2.5-Year-Old Children
This study points to a higher than previously believed incidence of gluten allergy (found primarily in wheat). Throw in dairy, corn and soy sensitivities and the numbers of infants and toddlers would grow. So why do many patients look at me strange when I suggest that allergies may be contributing to their child’s ear infections, constipation, asthma or frequent colds? Allergies do not always manifest as overt rashes and hives–the sooner we get this idea out of our heads and realize that food allergies/sensitivities are major contributors to disease, the better our overall health will be.
Pediatrics — Abstracts: Carlsson et al. 107 (1): 42
Risk of Non-Hodgkin Lymphoma in Celiac Disease
Allergy to gluten, a storage protein found in several grains (most notably wheat), has been all over the medical literature lately. Here we see a 3x increased risk for NHL. We need to start evaluating more regularly for celiac disease. Currently, a blood test called transglutaminase is one of the best ways to evaluate for this condition.
Brain White-Matter Lesions in Celiac Disease
If this article does not give you an idea of how important it is to recognize the impact of food allergies on our overall health, I’m not sure what will. Reactions to food allergies can range from minor GI irritation to irreversible brain damage. Physicians need to begin to recognize the impact that the GI tract has on our overall health. The author suggests that this response is mediated through an upregulation of the immune system leading to focal damage in the brain. Consider this…many people crave the foods they’re allergic to and so eat them very often. That leaves opportunities on almost a daily basis to wreak havoc on our immune systems…
Pediatrics — Abstracts: Kieslich et al. 108 (2): e21
With the virtual avoidance of the fact that food allergies exist and are major contributors to chronic disease, this study has the potential to change the way many doctors view allergies. Unfortunately, they would have to read the article first….
This article reminds me of a patient I had awhile back that had been diagnosed with dermatitis herpatiforms–a skin condition closely linked to celiac disease–10 yrs prior. When he asked his doctor if he should avoid wheat, the doctor said that would be too hard and put him on a drug used for leprosy. Forget the long term damage that a food allergy like this could cause on other organ systems.
Neurology — Abstracts: Chin et al. 60 (10): 1581
No harm from five year ingestion of oats in celiac disease
Oats do contain some gluten which has always prompted the recommendation to stay away from oats in patients with celiac disease. I have always found these tough recommendations and have allowed patients to eat oat on an elimination diet. I am glad that current research seems to support this concept. Given how prevalent gluten insensivity is and how hard it is to eliminate just wheat without any thought to also eliminating oats, this finding will make life a little easier on some patients.
Gut — Abstracts: Janatuinen et al. 50 (3): 332