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Diagnosis / Symptoms

Information About Gluten Sensitive Enteropathy (GSE)

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Somewhere in the ballpark of two million U.S. citizens have been diagnosed with Celiac Disease (or gluten-sensitive enteropathy, GSE), which is not an allergic condition, but an auto-immune response to the gluten protein found in wheat, rye, and barley, which are not labeled “gluten-free” on the grocery store shelves.

This results due to the absence of proper immunity to Gluten (2.18 million, based on a total population of 290,356,0285; or 1 out of 133 people, according to “A Summary of Celiac Disease and Gluten Intolerance,”). Moreover, an assortment of these allergic conditions indeed exists, though avoidance of gluten in all its forms has so far been the only practical treatment available.

Additionally, 30% of U.S. citizens carry the gene that is linked to celiac disease. Therefore, 30% of the population is at risk for developing Celiac Disease. Gluten is merely a common name for the proteins Gliadin and Glutenin, which comprise those found in barley, rye, and wheat. Along with starch, these are what make up these grass-related grains.

The abundance of gluten is quite astonishing, too. Four-firths of the protein composition in the wheat seed is that of gluten, which serves as an abundant source of organic protein around the world. Gluten is merely a name for proteins gliadin and glutenin. In addition, health food authorities and chemists alike obtain gluten to build the synthetic additives currently available and for purposes of research in order to create a far broader variety.

Rice and maize proteins, however, differ from wheat gluten. Though the proteins may be considered glutens, these proteins are deficient of all gliadin; the gliadin found in wheat gives reason to why wheat has such resiliency and adaptability. Accordingly, specific allergies will differ as a consequence.

Since the U.S. Food and Drug Administration (FDA) does not require standardized labels for foods in which gluten occurs naturally, the only caution for those who carry these allergies is avoidance; again, a lifetime gluten-free diet is the only treatment discovered thus far. So those allergic must rely upon the companies which disperse the gluten-free labels.

In mid-town Sacramento, CA, a gluten-free Specialty Store has opened on J street in Sacramento. This is just west of the 99 North / 80 East overpass. This store, the first-ever gluten-free Market in Northern California, opened on the weekend of July 12th & 13th, 2008.

Realize that, aside from those with Celiac Disease, many other sub-groups exist that benefit from a gluten-free diet; there are people who are allergic to gluten; some which are intolerant to gluten (statistically, 1 out of every 10 individuals in the United States); along with people with a sensitivity to gluten.  Many medical and psychological support groups advocate for gluten-free diets for those with Autism, Aspergers, Chronic Fatigue, Rheumatoid Arthritis, Inflammatory Disorders, and many gastric issues.

Celiac Twice as Common in the Elderly

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To anyone who says they are too old to have Celiac Disease, a recent study shows that is not the case. In fact, according to a recent report over at Celiac.com, it looks like Celiac Disease is twice as common in the elderly (2.5 times to be exact) than in the younger population!

It appears the study was inspired by the lack of research which has been done on the elderly to date.   Here is a small excerpt from their post:

This study shows that celiac disease is far more prevalent in elderly people than in the general population.  To better detect and treat celiac disease in elderly populations, the doctors are encouraging the use of active case finding using blood tests, since undetected celiac disease can lead to serious complications and even early death.

I find this interesting, but it makes sense. It generally takes a traumatic event before Celiac Disease symptoms begin, so many young people may not have it yet, while the elderly have probably had at least 1 traumatic event throughout their lives.

How Soon Can Celiac Disease Be Diagnosed?

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Celiac Disease, by definition, is a digestive condition triggered by the consumption of the protein gluten, which is found in bread, pasta, cookies, pizza crust, and many other foods containing wheat, barley, or rye. Once a person with celiac disease eats foods containing gluten, an immune reaction occurs in the small intestine, resulting in damage to the surface of the small intestine and an inability to absorb certain nutrients from food. Therefore, a person must be exposed to gluten before they can ever develop Celiac Disease.

Celiac Disease is often inherited; If someone in your immediate family has it, chances are 5 percent to 15 percent that you may as well. It can occur at any age, although problems don’t appear until gluten is introduced into the diet.  However, exposure to gluten may not trigger Celiac Disease. Often for unknown reasons, the disease emerges after some form of trauma: an infection, a physical injury, the stress of pregnancy, severe stress, or surgery.

Many people who experience some, all, or non of the symptoms of Celiac Disease do not necessarily have the disease, but rather are suffering from gluten intolerance. The key factor in having a diagnosis of Celiac Disease is specific damage to the small intestine.

Celiac Disease occurs when there is damage to the villi located in your small intestine.  Villi are tiny, hair-like projections resembling the deep pile of a plush carpet on a microscopic scale. Villi work to absorb vitamins, minerals, and other nutrients from the food you eat. In a person with Celiac Disease, gluten attack and destroy the villi.  Without villi, the inner surface of the small intestine becomes less like a plush carpet and more like a tile floor, and your body is unable to absorb the nutrients necessary for health and growth. Instead, nutrients such as fat, protein, vitamins, and minerals are eliminated from your stool. Eventually, decreased absorption of nutrients (malabsorption) can cause vitamin deficiencies that deprive your brain, peripheral nervous system, bones, liver, and other organs of vital nourishment, which can lead to other illnesses. The decreased nutrient absorption that occurs in celiac disease is especially serious in children, who need proper nutrition to develop and grow.

People with celiac disease carry higher than normal levels of certain antibodies (anti-gliadin, anti-endomysium, and anti-tissue transglutaminase).  In people with celiac disease, their immune systems may be recognizing gluten as a foreign substance and produce elevated levels of antibodies to get rid of it. A blood test can detect high levels of these antibodies and is used to initially detect people who are most likely to have the disease and who may need further testing. To confirm the diagnosis, your doctor may need to do an endoscopy to examine a small portion of intestinal tissue to check for damage to the villi.

The key to a diagnosis of Celiac Disease is exposure to gluten and damage to the small intestine.  Having a family member with the disease increases the risk of having the disease.  If you are concerned you may be at risk for the disease, even if you are not currently exhibiting symptoms you can ask your doctor for a blood test to determine if your anti-gliadin, anti-endomysium, and anti-tissue transglutaminase antibodies are elevated.

For more information on Celiac Disease, visit MayoClinic.com.

What is Dermatitis Herpetiformis?

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Dermatitis Herpetiformis (DH), also commonly referred to as Celiac Skin, is a rare skin disease that is commonly found in people with Celiac Disease. Some quick research on the subject unveiled a few interesting things.

Here is what I’ve learned so far about DH:

What are the Causes of Dermatitis Herpetiformis?

The rash is caused when gluten in the diet combines with IgA, and together they enter the bloodstream and circulate. They eventually clog up the small blood vessels in the skin, which attracts white blood cells (neutrophils), and releases powerful chemicals called complements. This is how the rash is created. Iodine is required for the reaction, so people with DH should avoid using Iodized salt if possible.

What are the Symptoms of Dermatitis Herpetiformis?
The symptoms of Dermatitis Herpetiformis are intense burning, stinging, and itching around the elbows, knees, scalp, buttocks, and back. More locations can also be affected and the severity can vary depending on the person.

What Does Dermatitis Herpetiformis Look Like?
DH looks like small clusters of red, itchy bumps. There are tiny water blisters, but these are quickly scratched off. Before they form, the area usually has a burning feeling. They scab and heal over within 1-2 weeks, but new spots continue to appear.  DH is a lifelong condition, but remission may occur in 10 to 20 percent of patients.

What are the Tests for Dermatitis Herpetiformis?
Diagnosis of DH usually requires at least one skin biopsy, and sometimes a blood test (looking for anti-gliadin, anti-reticulin, and anti-endomysial antibodies).

How Do You Treat Dermatitis Herpetiformis?
Complete elimination of gluten will often cure DH, but improvement often takes months.  This means sufferers must follow a strict gluten-free diet.  Cutting down on wheat and gluten may reduce the amount of medication needed, but will not be curative.

In the meantime, there is a very effective treatment available to sufferers of DH.  Dapsone is a drug that will improve DH in only a few days. Because there can be side effects, the dose of Dapsone is usually started at a small amount, and then raised up over a few weeks until all symptoms are suppressed. Dapsone may have adverse effects, so weekly or bi-weekly blood tests will be needed for the first three months. There are a few alternative treatments if Dapsone cannot be used (sulfapyridine, tetracycline), however, these do not work as well.

Diagnosis of Celiac Disease Continues to Evolve

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Only a few years ago the symptoms of Celiac Disease were commonly believed to be malnutrition, diarrhea, bloating, and abdominal pain. In the last few years diagnosis of the disease has continued to evolve and both studies have shown that many people with Celiac Disease do not have the classic symptoms that doctors are trained to look for.

Recently Against the Grain Nutrition published a great post about The New Picture of Celiac Disease, which goes into detail about a recent study to support this:

Research conducted a few years ago found that the majority of adults with newly diagnosed celiac disease do not have the once-considered classic symptoms of diarrhea and malabsorption. A growing percentage have silent or atypical celiac disease, with either no symptoms, or symptoms such as bone disease, anemia, acid-reflux-type conditions, constipation, or neurologic symptoms.

A 2008 study recently found that most children diagnosed with celiac disease don’t have so-called “classic” gastrointestinal symptoms either.

The new study evaluated the presentation of celiac disease in children in a pediatric gastroenterology practice in southeastern Wisconsin during a 17-year period. During that time, 143 patients were diagnosed with celiac disease. Gastrointestinal symptoms predominated in children younger than 3 years, whereas in children older than 3 years, the majority presented with nongastrointestinal conditions associated with a high risk of developing celiac disease, including type 1 diabetes, thyroid disease, Down syndrome, iron-deficiency anemia, short stature, or mood disorders – or they were tested because they were a first-degree relative of a person with celiac disease.

The classic clinical view of pediatric celiac disease, which includes malnutrition, diarrhea, bloating, and abdominal pain, should be replaced with the more typical presentation of an asymptomatic school-aged child who belongs to a high-risk group. The authors of the study recommend screening people, and first-degree family members of people, with Down syndrome, Turner syndrome, type 1 diabetes, thyroiditis, Addison disease, short stature, iron-deficiency anemia, unexplained elevation of aminotransferase levels, and other autoimmune disorders.