Tag Archives: celiac disease

Big Bad Wheat

 

English: Bread from India

 

Gluten, one of the main proteins found in wheat, is a troublesome little guy. The human gastrointestinal tract has a very hard time completely digesting it AND our immune systems don’t like it.

 

In addition to being found in wheat, gluten can also be found in rye, oats and barley. These are best avoided if you have celiac disease.

 

Celiac disease, present in as many as 2% of us, is a disorder in which gluten causes an autoimmune reaction and atrophy of the GI system is the result.  As the condition continues, more and more cells inside our GI tract are killed with resulting malabsorption of vitamins and nutrients. In serious cases it can be deadly. For many, however, the symptoms include weight loss, diarrhea, gas, bloating and pain.

 

Celiac disease is not to be confused with gluten sensitivity. For many years doctors believed that a patient had celiac disease or nothing. They fervently denied the possibility that someone could simply be sensitive to gluten.  This has changed.

 

According to Dr. Peter Green, director of the Celiac Disease Center at Columbia University:

 

“Recent studies are showing the gluten sensitivity may be much more common than previously thought. It may, in fact, be a separate disease entity that involves different organs and different mechanisms than celiac disease. While there is no doubt that the condition exists, the lack of definite criteria for a diagnosis has resulted in a skeptical attitude on the part of many doctors.”

 

Further, according to a study in the Lancet Neurology in 2010:

 

“Gluten sensitivity is a systemic autoimmune disease with diverse manifestations. This disorder is characterised by abnormal immunological responsiveness to ingested gluten in genetically susceptible individuals. Coeliac disease, or gluten-sensitive enteropathy, is only one aspect of a range of possible manifestations of gluten sensitivity.”

 

Basically this is saying that people may have gluten sensitivity and over time this may manifest as celiac disease. However, there are many other ways that gluten sensitivity may present. Other symptoms might include:

 

  • Fatigue
  • Eczema
  • Anemia
  • Hypothyroidism
  • Osteoporosis
  • Epilepsy
  • Neuropathy
  • Cerebellar ataxia
  • Infertility
  • Fatty liver

 

This list is by no means all-inclusive either. When a patient presents with a list of symptoms that don’t seem to fit together, have not responded to traditional types of treatments and have been long standing, one of the first things I do is check for gluten sensitivity. If it’s not there we move on to the next treatment strategy. However, for many in my practice, eliminating gluten has proven to be a very effective treatment.

 

If you’ve had a chronic health condition that has not responded to various treatment types, consider being checked for gluten sensitivity through a specialist with knowledge of the most recent research in this fascinating field.  It just might be the cure you’re looking for.

 

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What’s all the hype over wheat and milk allergies anyway?

Wheat.

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Wheat and milk are staples in most Americans’ diets.  The dairy and grain industry like it that way to be certain.  But what exactly is all the hype over eliminating these potential allergens from our diets?  And is there really any research to support all of our concerns?

Well, in one word, yes.  The short explanation of why is that both wheat and dairy are extremely prevalent in our diets.  Wheat consumption in this country is quite high – about 137 pounds per year per person.  Dairy consumption is even higher with 605 pounds consumed per year per person!  The high amounts of these in our diets leads to high levels of exposure and, therefore, higher levels of allergies and sensitivities.  What exactly do these substances do to our bodies?  This is a good question and to properly answer it we will have to break down both wheat and dairy a little further.

Wheat

Saying that a person is allergic to wheat is actually a bit inaccurate.  What people are allergic or sensitive to is the protein in wheat called gluten.  Gluten is also found in rye, oats and barley to name a few.  This protein is allergenic for good reason.  In many people it is incompletely broken down in our gut and is absorbed in a format that the body cannot recognize or use.  When this happens the immune system kicks in and there’s your allergy.  Most of the time proteins are broken down into their individual amino acids.  Amino acids are the building blocks of protein.  If we take several amino acids and hook them together we get something called a peptide.  If we take several of those peptides and hook them together we get our protein.  The body must do this in reverse order if you will when it digests our foods – protein to peptides to amino acids.  If this does not occur properly your body may absorb the peptides.  The problem with this is that the body cannot recognize the peptides as useful and actually sees them as an invader.  Invaders must be destroyed and our army (the immune system) takes over and destroys these peptides but leaves us with the after effects.  A gluten allergy causes many of the traditional allergy symptoms:

  • Swelling, itching or irritation of the mouth or throat
  • Hives, itchy rash or swelling of the skin
  • Nasal congestion
  • Itchy, watery eyes
  • Difficulty breathing
  • Cramps, nausea or vomiting
  • Diarrhea
  • Anaphylaxis

In children, changes in behavior might also be seen.  This happens because the undigested gluten peptide is known to circulate in the blood and bind to receptors in the brain altering behavior.  It is a complex cascade of events but many parents have noticed significant improvements at school and at home after eliminating gluten from their child’s diet.

Gluten is also the offender in people who have celiac disease.  Celiac disease and gluten allergy or sensitivity are two separate entities.  Celiac disease is a chronic digestive condition is triggered by eating gluten.  Abdominal pain, cramping, diarrhea and maldigestion are the signs and symptoms.  While celiac disease involves an immune system response, it’s a more complex food reaction than a food allergy.

Dairy

Dairy allergies can be just as problematic.  They often cause the same signs and symptoms as a gluten allergy.  The main problem comes from the protein in milk called casein.  Casein has the same issues with under digestion as gluten.  When the break down is incomplete, allergies result.  New research seems to point to the type of casein that is present in most Americans’ diets.  There are many types of casein and the difference is only the order in which the amino acids are arranged.  That order, however, seems to be critical for developing allergies.  Most milk consumed in this country is called A1 milk.  A1 stands for the type of casein in the milk.  This is the most prevalent type of casein in our milk supply.  This is the case because almost all of our cows in this country are of European decent and genetically they produce the A1 casein.  Cows of African or Asian decent produce a different kind of casein called A2.  This type of casein has not been linked to allergies as has the A1 variety.  If you or your child are allergic to milk, options are available.  Goat’s milk is a great option.  It contains casein but it contains the A2 version.  It is a great option for people suffering with milk allergies.

I must touch on lactose intolerance for a moment.  Lactose is the sugar present in milk.  Being lactose intolerant is not a milk allergy.  Lactose intolerance stems from an enzymatic deficiency.  The lactase enzyme is not present to break down the sugar in the milk.  The immune system is not involved and therefore it is not an allergy.  The symptoms include gas, bloating and diarrhea.

In my practice I often see people who have undiagnosed allergies.  They can cause many disturbing symptoms and by eliminating the offending foods people often feel much better.  If you suspect a milk or a wheat allergy the gold standard for testing is an elimination diet.  In this you completely eliminate anything from the diet that might contain wheat or milk, for instance.  I have people avoid it for 3 weeks and then reintroduce the offending foods in full force to see if there’s a change.  You must add them back in at a high level so there can be no mistake as to whether it affects you.  Also, be sure to eliminate either wheat or dairy, not both at the same time.  That way you’ll be sure you’ve found the right (or wrong!) food for you.  Blood tests that test whether your immune system has reacted to wheat and dairy are also available and stool tests work as well.

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Can What You Eat Cause Infertility?

Apparently, the answer is yes.  Recent research has shown that women who have celiac disease are much more likely to have trouble getting pregnant than women who are not gluten sensitive.

Celiac disease is a genetic disorder in which gluten, the main protein found in wheat, is not properly processed.  It causes an autoimmune reaction in the body leading to ulceration and inflammation in the gut.  Symptoms include diarrhea, gas, bloating and fatigue.  A person with celiac disease may be asymptomatic or may have very severe symptoms.  Although wheat is the main offender, gluten is also found in rye, barley and oats.

The reaction the body forms to gluten causes the lining of the small intestine to atrophy.  This problematic because this is the portion of the digestive tract that is most responsible for absorbing nutrients.  If you cannot absorb nutrients your body cannot thrive.

Women with untreated celiac disease are more likely to have problems getting pregnant.  They also will have higher incidences of miscarriage and premature births.  Believe it or not, men will also have issues with fertility if they have celiac disease.  There are also other problems associated with untreated celiac disease for women.  Dr. Sheila Crowe, a professor in the division of gastroenterology and hepatology in the department of medicine at the University of Virginia lists the following problems.

  • Later onset of menstruation
  • Earlier menopause
  • Secondary amenorrhea (a condition in which menses starts but then stops)

These menstrual problems cause a woman to ovulate less which results in a smaller chance of getting pregnant.  Men may also have trouble with fertility as mentioned above.

  • Abnormal sperm (reduced sperm count, altered shape, and reduced function)
  • Reduced testosterone levels

Dr. Crowe recommends that if you and your partner are having trouble getting pregnant, you should both be screened to see if celiac plays a role.  Remember, you may not have symptoms and still have celiac disease.  The test is a relatively simple blood test.  Be sure to continue to eat gluten throughout because if you go gluten free before the blood test it may not show up.  If the blood test comes back positive, a tissue biopsy may be performed to confirm the diagnosis.  The pathologist will look at the cellular lining of the small intestine to confirm that there is in fact atrophy.

Treatment for celiac is relatively simple.  Avoid gluten.  This is becoming more and more common place and grocery store chains are starting to carry more foods that are gluten free.  A simple diet change is enough to solve this problem.

Low Carb is Still the Way to Go

A large portion of carbohydrate products are made from grain.  The most common grain used is wheat and wheat contains large amounts of gluten.  I am huge proponent of low carbohydrate diets for overall health.  While celiac disease might cause auto-immune reactions that disrupt fertility, obesity is also a known risk factor for infertility.  Women who are obese are 43% less likely to conceive a child than normal weight or even overweight people. If you think about this in terms of evolution it makes sense.  A woman who is obese is less likely to survive child birth because of the strain it puts on the body.  It is not unreasonable to assume that the lower rates of pregnancy in obese women is some sort of protective measure, evolutionarily speaking.

Research has shown that low carbohydrate diets are more effective for losing weight and improving measurable health outcomes over the traditional low fat diet.  See our old post. If you are having trouble conceiving a child and you are significantly overweight you should try losing weight and possibly think about getting tested for celiac disease.  These are efforts you should undertake before considering fertility treatments.

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