Gluten and celiac disease

Rolling in Dough

Different health concerns can interact in unusual ways.

In last Friday’s e-Alert I told you about a thread on the HSI Forum that carries a discussion about how to manage triglyceride levels; one of the primary markers that indicates risk of heart attack and arteriosclerosis. An HSI member named Eileen offered a personal experience in which she lowered her triglycerides by cutting back on carbohydrates. But it wasn’t quite that simple. She was also having digestive difficulties, so she did some research and found out why. Eileen writes:

“I figured out that the gluten in certain foods was the culprit. This is called celiac disease. The gluten flattens out the villi in the small intestine and prevents the normally secreted digestive juices in the small intestine from being able to help. I ceased my intake of gluten foods, no wheat, rye, oats, barley, modified food starch, or spelt for me. This in effect took care of the triglycerides. I am 99.99% rid of the problem. I can always tell when an offender sneaks into my food.”

Eileen is fortunate that she successfully brought her triglyceride level under control. But controlling celiac disease (CD) is just as important, because when this problem becomes chronic, it opens the door to very serious health risks.

Developing sensitivity

To understand celiac disease, first we need to look at gluten.

Gluten is a typical component of several different grains. As a primary ingredient of flour, gluten delivers protein and gives bread a higher rise. The problem with gluten is that many people don’t tolerate it well – complicated by the fact that a good number of these people aren’t even aware of their sensitivity.

I asked HSI Panelist Allan Spreen, M.D., for his insights on gluten basics, and here’s what he had to say:

“The high-gluten grains are within the mnemonic BROW (Barley, Rye, Oat, Wheat). When completely unrefined, these grains in and of themselves are not the problem. It’s when sensitive individuals run into them that trouble can occur (not counting the dangers of refining them into low- nutrient, low-fiber, high-starch blood sugar stressors). Most often, reactions can involve swings in blood sugar, which can manifest as irritability, headache, difficulty concentrating, fatigue, increased appetite, and subsequently weight problems.

“Constant exposure to one food can cause a person to become ‘sensitized.’ This is most common in the case of wheat, since wheat is absolutely everywhere. If a person craves grains, cereals, breads, etc., or eats them every day, I often test them by avoiding the potential offending agent for 7 days (21 for dairy). Sometimes the results are remarkable.”

An underestimated disease

Celiac disease is an auto-immune disorder in which gluten creates an obstruction to the absorption of nutrients in the small intestine. When CD goes untreated, malnutrition develops, followed by a chronic condition that may trigger other dangerous ailments, including gastrointestinal cancer.

Last year, the Archives of Internal Medicine published a report of a large celiac disease study conducted in several different medical centers throughout the U.S. Knowing that CD is often genetically inherited, the researchers set out to compare the prevalence of CD in an at-risk group to a not- at-risk group.

The scientists took blood samples from more than 13,000 adults and children. Almost 75 percent of the subjects were thought to be at risk for CD because of family history or prior symptoms. In this at-risk group, celiac disease proved to be present in almost 4 of every 100 subjects. In the not- at-risk group, one in every 133 subjects was shown to have CD.

These results suggest the possibility that more than one and a half million people in the U.S. have celiac disease – far more than previously believed. Given the knowledge that this is not as rare a disease as previously thought, the researchers hope that doctors will be more inclined to test for it, increasing the possibility that a greater number of cases will be caught in the early stages.

Lessons from history

The problem with diagnosis of CD is that the symptoms are sometimes directly related to digestion (as with abdominal cramping, unexplained weight loss, and chronic diarrhea), but sometimes not (as with osteoporosis, joint pain, and depression). If any of these symptoms occur in a patient with family history of CD, this should stand out as a red flag for any physician.

The primary treatment for celiac disease is adherence to a strict non-gluten diet – but this is easier said than done. As Dr. Spreen has pointed out, refined “BROW” grains are the primary culprits and should be completely avoided. But gluten may be hidden in some foods such as soups, soy sauce, low-fat or non-fat products, and even in candies such as jelly beans. Some common food ingredients that may contain gluten include: modified food starch, hydrolyzed vegetable or plant protein, and some binders and fillers, as well as malt and natural flavorings.

Fortunately, if diagnosed early and addressed before it has a chance to do serious damage, celiac disease is relatively easy to treat. If you believe that you may be experiencing symptoms of celiac disease (especially if the family history is there), ask your doctor or dietician to provide you with specific strategies for recognizing and avoiding hidden gluten in your diet.

In addition, a number of studies have shown that a plant- based enzyme called Aspergillus oryzae may be effective in protecting the intestine from the effects of gluten. Enzyme formulas containing Aspergillus oryzae (such as Similase and Zest for Life Enzyme Boost Formula) are available from sources on the Internet. However, anyone with celiac disease or other serious digestive problems should first discuss the use of enzyme supplements with a health care provider.

Sources:
“Gluten Disorder More Common Than Thought” Lindsey Tanner, Associated Press, 2/10/03, ap.org
“Prevalence of Celiac Disease in At-Risk and Not-At-Risk Groups in the United States” Archives of Internal Medicine, Vol. 163, No. 3, 2/10/03, archinte.ama-assn.org
“About Celiac Disease” Celiac Disease Foundation, celiac.org