Recognizing the Signs of Gluten Intolerance

Transcription

1 Recognizing the Signs of Gluten Intolerance Schellenberg Chiropractic Inc. Dr. John Schellenberg 3445 Penrose Place Suite 260 Boulder, CO 80301

2 Introduction Gluten Intolerance (celiac disease) is a life-long inflammatory disease of the upper small intestine caused by intolerance to the gluten affecting many genetically susceptible individuals worldwide. Gluten is a protein found in wheat, and other similar proteins found in rye, barley and triticale. (Oats are considered gluten free, however they are normally contaminated by the other grains in processing) These proteins damage the small finger-like projections (villi) that line the small intestine (see Figure 1), resembling a pile in a carpet, and play a significant role in digestion. When damaged and inflamed, the villi are unable to absorb water and nutrients such as vitamins, folic acid, iron and calcium. This causes the person to be susceptible to a variety of other conditions related to malabsorption, including lactose intolerance. Symptomatic and intestinal recovery after adopting a gluten free diet is evidence that gluten is the cause. Figure 1: Healthy villi of the small intestine seen under the microscope. Mechanism Gluten is a mixture of two proteins, gliadin and glutenin which when mixed with water it becomes sticky and so forms the familiar texture of dough made from wheat, and rye flour. As gluten is ingested and comes into contact with the villi covering the lining of the small intestine the immune system mistakenly attacks the villi by antibody production as if it was a 'foreign' organism. Antibodies are important defense proteins that have the ability to attach themselves to unfamiliar antigens, the enemy, such as bacteria or cancerous cells and trigger other reactions in order to destroy the offending organism or cell. In this case and in all other autoimmune diseases, a 'friendly fire' occurs the immune system fails to recognize the villi. Figure 1 shows a microscopic view of healthy villi attached to the lining of the small intestine. The antibodies are so potent that with immediate effect damage occurs (see Figure 2) and unless gluten is removed from the diet they are eventually destroyed (see Figure 3). Apart from the inability to absorb nutrients, damaged lining to the small intestine has other negative results. It is unable to produce sufficient digestive enzymes essential to break down foods for complete digestion and absorption, such as lactose and carbohydrates. Large components of foods remain in the digestive tracts unabsorbed which are in turn fermented by bacteria living naturally in our digestive tract and ideal conditions causing cramps, gas, bloating, flatulence and diarrhea. Figure 2: Damaged villi of the small intestine. Figure 3: Villi completely destroyed by the immune system.

3 Symptoms & Signs Celiac disease has many and varied symptoms, and adult symptoms are different from those of children. A range of symptoms and signs may be associated with untreated celiac disease. Diarrhea is one of the most common symptoms to affect people of all ages with celiac disease. Children may not gain weight or grow properly, while adults may find they lose weight. Malabsorption may also leave people tired and weak, because of anemia caused by iron or folic acid deficiency. Babies chronic diarrhea abdominal distension poor feeding poor weight gain muscle wasting Children chronic diarrhea or constipation vomiting poor weight gain or growth poor feeding irritability muscle wasting Adults chronic diarrhea weight loss anemia weakness fatigue Other notes: Rather than suffering from bowel problems, half of celiac sufferers approach their doctor because of extreme tiredness and psychological problems such as depression, bone pain and sometimes even fractures (due to thinning of the bones), ulcers in the mouth or a blistering, itchy skin rash mostly on the elbows and knees (called dermatitis herpetiformis). Celiac disease may be the cause for some women having difficulty getting pregnant. Recurrent miscarriage (spontaneous loss of a pregnancy) may also be attributed to celiac disease. Women with celiac disease may become diagnosed during pregnancy because their bowel cannot absorb enough iron and vitamins to keep up with the demand of being pregnant, making them severely anemic. Babies who are small for their age in the womb (intrauterine growth retardation) are more frequently born to mothers with celiac disease

4 Tests & Diagnoses There are various blood tests that can be used to support the diagnosis of CD. 1. The anti-gliadin antibody (AGA) assay, which measures the amount of IgA and IgG antibody produced against the gliadin component of cereals 2. The anti-reticulin antibody (ARA) test, in which IgG antibodies are viewed in an immuno-fluorescent microscope examination 3. The anti-endomysial antibody (AEA) assay, which identifies IgA antibodies against the endomysium tissue. These tests offer simple and fast tools to investigate patients with suspected CD. They are particularly recommended for screening relatives of CD patients or patients who are affected by a related disease such as Malabsorption or Diabetes Mellitus, and for monitoring the compliance to a gluten-free diet. There are many false positives and false negatives. None of these tests has shown 100% accuracy, and a small-intestinal mucosal biopsy remains the cornerstone for diagnosis. Any provisional diagnosis of Celiac Disease must be confirmed by this biopsy. The procedure is safe and usually performed at the time of gastrointestinal endoscopy. Non Celiac Gluten Intolerance Many times when a person is screened for celiac disease and the tests indicate that the disease is not present, despite that these persons suffer from symptoms upon digesting food containing gluten. This is very interesting or perhaps confusing to many. But put simply, this person may be Non Celiac Gluten Intolerant (NCGI). It is estimated that around 15% of the world population is NCGI as opposed to less than 1% of Celiacs. Gluten consists of many long elastic chains of proteins (gives it the characteristics of a dough) lined along each other. Not all of them cause Celiac disease, but some can cause irritation to the small intestine, enough to hinder the cells of the small intestine to produce digestive enzymes to break down foods. To confirm if you are NCGI do an elimination test. Avoid all gluten food for at least two weeks and then introduce it. If symptoms return, and previous tests were negative or inconclusive then you know that you are NCGI. Prevention Breastfeeding and delaying the introduction of foods containing gluten until after six months is suggested to prevent children from developing celiac disease. This would avoid exposure to gluten as a young baby before the gut barrier has developed fully. In European countries all babies are tested for Celiac Disease and most recommend not introducing gluten into their child s diet until after two years of age

5 What is a Wheat Allergy? Wheat allergy refers specifically to adverse reactions involving immunoglobulin E (IgE) antibodies to one or more protein fractions of wheat, including albumin, globulin, gliadin and glutenin (gluten). The majority of IgE-mediated reactions to wheat involve the albumin and globulin fractions. Gliadin and gluten may also, rarely, induce IgEmediated reactions. Allergy to wheat may occur in any individual, unlike Celiac Disease, which is hereditary. Allergic reactions to wheat may be caused by ingestion of wheat-containing foods or by inhalation of flour containing wheat (Baker's asthma). What are the Symptoms of a Wheat Allergy? Allergic reactions to wheat (IgE-antibody mediated) usually begins within minutes or a few hours after eating or inhaling wheat. In worst cases, exercise induced life threatening anaphlyaxis can result. Most symptoms are milder & affect the skin, gut & respiratory tracts. Skin Hives Eczema Angioedema (swelling due to allergy) Gastrointestinal Tract Abdominal cramps Nausea and vomiting Oral allergy syndrome Respiratory Tract asthma allergic rhinitis How is a wheat-allergy diagnosed? The diagnosis may be easy if a person has the same reaction repeatedly after eating wheat-containing food. More often the diagnosis is difficult because wheat is usually consumed with other food. Diagnosis usually entails clinical evaluation, supported by appropriate laboratory tests (CAP RAST blood tests, skin prick-testing). An elimination-challenge test may be employed to make the diagnosis.

6 Prognosis The majority of young children with wheat allergy will outgrow it. Individuals who develop the allergy later in life will probably retain it. There is some evidence that individuals who remove wheat from their diet for a year or longer may be able to tolerate wheat upon re-introduction. This is not the case with the Gluten Intolerant.