Gluten Intolerance Basics Schellenberg Chiropractic Inc. Dr. John Schellenberg 3445 Penrose Place Suite 260 Boulder, CO 80301
Gluten Intolerance Celiac Disease True Celiac Disease is a condition where a person cannot tolerate gluten in their diet. It is an autoimmune disorder (one in which the body attacks itself) that destroys the microvilli of the small intestine. Gluten is the general term for the peptide fractions that are found in grains that cannot be tolerated by people with the genetic marker for Celiac Disease. It is possible to have a wheat allergy, but not be gluten intolerant. A gluten allergy and gluten intolerance are different problems often with similar or overlapping symptoms The Gold Standard for diagnosis of Celiac Disease is a biopsy of the small intestine. Allergy vs Intolerance Allergy A wheat or gluten allergy primary allergy or delayed hypersensitivity reaction will cause a histamine response. Classic symptoms are: throat swelling, rash, wheezing, vomiting, runny/stuffy nose diarrhea. Food allergies most often affect the i) skin causing rash, hives or eczema and ii) intestines causing cramps, nausea or diarrhea More severe reactions cause nasal congestion and sneezing and even asthma Most severe reactions result in anaphylaxis which is a medical emergency Intolerance An auto-immune disease true celiac disease Celiac Disease is a genetic intolerance to gluten that causes the body to attack the microvilli of the small intestine. As a result, nutrients are not properly absorbed in the small intestine. When the villi are blunted or destroyed, malabsorption results leading to a leaky gut. The blunting starts in the first part of the small intestine (duodenum) and progresses along the 22 feet of small intestine. People with Celiac Disease should NEVER eat gluten NEVER, EVER! (sorry ) A blood test can screen for the antibodies to gluten, but an endoscopic procedure will allow a biopsy to confirm villi blunting and therefore confirm a diagnosis. Genetic testing is most helpful to rule out Celiac Disease if you don t have the genetic marker, it is pretty nearly impossible to get the disease. However, if you do
have the marker, and you do eat gluten, you will likely develop the disease; but if you never eat gluten, you will not get Celiac Disease. Moral of the story avoid gluten entirely if you have a couple of the symptoms listed below. I am glad you asked! What is Gluten? Gluten is the protein in wheat that makes bread doughy and elastic. It is often used as a healthy additive to many foods. Unfortunately, for many people, it is anything but healthy it makes many people sick. Doctors started recognizing that gluten makes celiacs sick. The association was born between gluten and celiac disease. Then doctors noticed that barley and rye also makes these people sick. So they said barley and rye contain gluten. This is technically incorrect, but the gluten theory seemed to stick and has become widely accepted. Technically, gluten is a general term for prolamines, which are protein fractions found in a variety of grains. The prolamines that cause damage in celiacs are gliadin (found in wheat), secalin (found in rye) and hordein (found in barley). Corn, rice and oats also have prolamines (protein fractions) but they are not problematic for people with celiac disease. (Contamination becomes a major factor, though, especially for oats that are processed in the same grain elevators as wheat, barley and rye.) Good Question! What Can I Eat and What Can t I Eat? The lists are exhaustive. For a complete list of what is safe to eat, what additives are safe and what is forbidden, visit www.celiac.com Reading food labels must become one of your greatest strengths. Do not expect to see gluten on the list of ingredients. It just isn t normally listed like that. What you may see are things like, wheat, modified food starch, malt, caramel color, dextrin, artificial color/flavor. Some of these are absolutely forbidden (wheat) and others may or may not contain gluten if it is questionable, assume it contains gluten and simply avoid it. There is one thing I have observed in many people with celiac disease that I want to mention here. Just because you find a product that is gluten free (it even says it on the label!) it isn t necessarily a healthy food choice. Many gluten free foods still have other ingredients which may be a problem: MSG, trans fats, preservatives or other chemicals. Don t be naïve in thinking that just because a restaurant offers you a gluten free meal that it is good for you or even healthy. Often it is not be careful of the food choices you make whether you are shopping or dining out. Become conscious of what you are putting into your body!
Classic Symptoms Children Diarrhea Steatorrhea (oily stools) Constipation Failure to thrive weight loss Anorexia Distended abdomen Poor muscle tone Irritability Dental disorders Listlessness Short stature Delayed onset of puberty/amenorrhea Nutritional deficiencies (calcium and iron, especially) Rickets or osteopenia/osteoporosis Classic Symptoms Adults Fatigue GI Distress (gas, bloating, discomfort, nausea, cramps) Diarrhea Constipation Steatorrhea Dyspepsia (indigestion) Anemia and/or nutritional deficiencies Poor muscle bulk Short stature Amenorrhea Weight loss / weight gain Anorexia Clubbing of finger/toe nails Dermatitis herpetiformis IgA deficiency Associated autoimmune disorders: IBS, Crohns disease, Type I diabetes, Graves and Hashimoto Disease (thyroid), lupus, and liver disease. Associated Conditions (Problems that can develop from consuming gluten when you shouldn t) ADD/ADHD Autistic/Asperberger type behavior Bone pain Canker sores Central/peripheral nerve disorders Chronic fatigue Delayed onset of menstrual cycle Early menopause Depression/irritability/inability to concentrate Epilepsy Fibromylagia Headaches Infertility, miscarriages/low birth weight babies Internal hemorrahaging Intestinal lymphoma Lactose intolerance Osteoporosis and othe bone disorders Pancreatic disorders Shortened life expectancy
What Can I Do About This? Get Educated Learn what you can and cannot eat Be disciplined - stick with it Know that you are not alone join a support group like this one at Whole Foods Get Diagnosed If you choose to, have the blood test done, followed by a biopsy to confirm or rule out diagnosis You will need a medical referral to a gastroenterologist Metabolic Testing Body Chemistry Analysis performed by Dr. John Schellenberg in office laboratory Tests for 6o different disease markers, metabolically Malabsorption / digestion indicators / microvilli indicators Allergy indicators Chronic Fatigue indicators Cancer / Heart Disease / Diabetes / Hypertension indicators Allergy Desensitization Body indicators for allergies and secondary metabolism issues (no needles!) Address emotional component of allergies / intolerances Clear Ileo-Cecal Valve issues often related to digestive disorders Body Talk Help restore communication within the body mind complex allowing for natural self healing Fastest growing health care system in the world All natural, holistic, safe system Personal Consult with a Knowledgeable Professional Schedule a complimentary consultation with Dr. John Schellenberg to help you determine your best course of action Call or Text: 720-979-4302 Website:.com
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 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 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. 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.