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Paging Dr. Frischer - Celiac disease
WRITTEN BY :   Dr. Alan Frischer

Today’s topic may not be widely discussed, but this disease affects at least 3 million Americans. It’s tough to diagnose because a number of other disorders share its symptoms, and as a result, the correct treatment is either delayed or never started. Today we will address celiac disease.
Celiac disease, also known as Sprue, or gluten intolerance, is an inherited disorder. If you have celiac disease, the odds that an immediate family member does as well are dramatically increased. It appears to be most prevalent among people of Northern European decent, (although it also affects the Black, Hispanic, and Asian populations), and more women than men suffer from it.
The cause isn’t clear, and it can appear at any age. Its victims become malnourished and may have significant gastrointestinal symptoms. The longer it goes undiagnosed, the more likelihood there is of developing autoimmune diseases including rheumatoid arthritis, diabetes, thyroid disease, and cancers of the intestine. It can be a cause of infertility, miscarriage and more.
Those with gluten intolerance are unable to digest gluten – a protein found in wheat, rye, and barley. The immune system attacks the lining of the small intestine, causing damage that shortens and flattens out the tiny villi. The villi are finger-like protrusions that provide most of the surface area for nutrient absorption.
Interestingly, damaged intestines can then lead to additional dietary intolerances. For example, lactase, the enzyme necessary to break down lactose in dairy foods, is produced in the tips of the villi. Damage to the villi can affect the ability to digest milk and milk products, which is known as lactose or dairy intolerance.
Gluten is one of the most complex proteins that we consume, and is therefore extremely difficult to digest. This is why, when we first introduce our babies to solid foods, we don’t give them wheat. Instead, they might begin with a thin porridge of rice so that their immature digestive tract can process it easily.
Celiac disease was the first type of gluten sensitivity for which diagnostic testing was devised, back in the 1940s. Today, a blood test screens for AGA (Antigliadin) and EmA (Andomysium Antibodies). Although this is typically the first test for gluten sensitivity, it picks up only the percentage of gluten-sensitive people who are celiac, missing a much larger population who test negative.
The other diagnostic method used is to perform a colonoscopy and obtain a biopsy. However, the most straightforward test of all to identify gluten intolerance is to simply eliminate gluten from the diet, which often produces dramatic results.
When the diagnosis is not made early and correctly, the consequences can be quite serious. For example, if a person with the disorder continues to consume gluten, studies have shown that he or she will increase their chance of gastrointestinal cancer by a factor of 40 to 100 times that of the “normal” population. Gastrointestinal cancer or lymphoma develops in up to 15 percent of patients with untreated celiac disease.
No drugs or therapies are available to treat gluten sensitivity. The only treatment is to dramatically alter eating habits in order to exclude gluten and maintain a gluten-free diet. Avoiding gluten, however, is not an easy matter. Many products contain hidden gluten, such as medicine, vitamins, and even the glue on stamps and envelopes. It is absolutely critical to be well informed.
Once the diet is free of gluten, it’s surprising how quickly the small intestine can recover. Soon, nutrients from food become absorbed more effectively, because the villi heal and the digestive tract can get back to doing its job again. Remarkably, after only a few weeks, patients find that they are free of a host of symptoms they suffered from over the years, including flatulence, abdominal cramps, tiredness and a tendency to catch ‘bugs’ and viruses easily.
The challenges to controlling celiac disease are making a successful diagnosis, and eliminating gluten from the diet. Get your physician involved. Get books and refer to websites to help change your diet. Now is the time to get started!
Good health to you all.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: February 10, 2011 – Volume 9 – Issue 43



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