Symptoms

Is the Media Fueling the Gluten free, Casein Free Autism Controversy?

The debate about autism and the effectiveness of the gluten-free, casein-free diet continues – this time due to irresponsible reporting of the mainstream news media who seem to have chosen sensationalism over objective journalism when covering an important medical paper on gastrointestinal disorders in autism.

This week, a panel of medical experts led by Timothy Buie, MD at Harvard Medical School published a consensus statement on the Evaluation, Diagnosis and Treatment of Gastrointestinal Disorders in Individuals with ASDs (Autism Spectrum Disorders) in the medical journal Pediatrics. You can find the full paper here.

The panel covered 23 topics in a document that is 20 pages in length, dealing with the diagnosis and care of individuals with autism spectrum disorders and gastrointestinal issues. The panel based its conclusions on available information which they agreed was limited and incomplete.

The Key Topic

“Individuals with autism spectrum disorders who present with gastrointestinal symptoms warrant a thorough evaluation, as would be undertaken for individuals without autism spectrum disorders who have the same symptoms or signs. Evidence based algorithms for the assessment of abdominal pain, constipation, chronic diarrhea, and gastroesophageal reflux disease (GERD) should be developed.”

Some of the other topics include recommendations for the banking of DNA samples, the complexity of diagnostic evaluation when ASD and gastrointestinal disorders present, the need for studies to determine the prevalence of intestinal permeability in neuropsychiatric manifestions of ASD, and the need for large studies to determine the effectiveness of the gluten-free, casein-free diet. Read More »

Kidney Stones (Renal Calculus): Causes & Treatment in Celiac Disease

Between 10 and 15% of adults within the United States will be diagnosed with a kidney stone.

Recurrence rates are estimated at about 10% per year, totaling 50% over a 5–10 year period and 75% over 20 years. Men are affected approximately 4 times more often than women. Recent evidence has shown an increase in pediatric  cases. The total cost for treating this condition was $2 billion in 2003.1

Kidney stones are an atypical symptom and associated disorder of celiac disease, however not all people with celiac disease will develop kidney stones. This article describes the pathway for the development of kidney stones that are seen in persons with celiac disease as well as the treatment and prevention. Read More »

Lady Gaga Jumps on the Gluten-Free Diet Bandwagon – Perhaps With Good Reason

John Libonati Gluten Free Works

lady gaga gluten free

Is Lady Gaga Going Gluten Free For Her Health??

According to a news release on MSN.com, Stefani Germanotta (a.k.a. Lady Gaga) is the newest celebrity to say she’s going gluten-free. She made the announcement on the latest leg of her ‘Born This Way Ball’ tour.

She is described as doing so in order to “make sure she is in the best shape for the grueling workout.”

Then the article drops a bombshell… “Her aim is to drop 10 lbs in a month.”

This is where celiac disease experts, bloggers and media know-it-alls usually start lobbing grenades.

Why the Big Deal?

Celiac disease and gluten sensitivity are serious medical conditions that require a gluten-free diet. Many people diagnosed with one or both disorders chafe at the fact that they cannot eat what they want. While a diagnosis is important, medical professionals and the media emphatically make the groundless claim that the gluten-free diet can be bad for your health unless you are medically diagnosed with celiac disease or gluten sensitivity.

Lady Gaga is reported to have neither celiac disease nor gluten sensitivity in the MSN article. The article emphasizes her aim to use the diet to get Read More »

Magnesium Deficiency in Celiac Disease – Common and Dangerous

Magnesium is the fourth most abundant mineral in the body, providing an indication of just how important this nutrient is for the body.

Magnesium keeps us moving, thinking and behaving normally. Magnesium is a cofactor for more than 300 enzymes involved in the metabolism of food components and many products such as protein synthesis. It balances calcium in the body to maintain normal muscle and nerve function and works in concert with calcium to keep bones strong. It keeps heart rhythm steady and supports a healthy immune system. Magnesium is required for parathyroid hormone secretion, helps regulate blood sugar levels and promotes normal blood pressure.1

Studies show that magnesium deficiency is common in those with celiac disease. Read More »

Making the Connection – in Celiac Disease

Advance For Nurses Magazine
Vol. 9 •Issue 11 • Page 21

Making the Connection

Underdiagnosed in the U.S., celiac disease can be identified and treated if the condition is understood

By Cleo Libonati, RN, BSN

Celiac disease is a common food sensitivity that can be the underlying source of hundreds of health problems mistakenly attributed to other causes. This insidious disorder has the potential to disfigure, disable and destroy lives at any age. Yet, of the 3 million affected Americans, only 3 percent are diagnosed and treated.1 Prevalence rates are higher in certain populations, such as blood relatives of a person with celiac disease and those with autoimmune disorders.

Unfortunately, people in the U.S. with this condition actively seeking help for their symptoms can go a lifetime without diagnosis and proper treatment. Typically, worldwide diagnosis is faster.
Genetic Susceptibility & Gluten

Celiac disease is also called celiac sprue, nontropical sprue, gluten-sensitive enteropathy or simply celiac by the public.

This immune-mediated disorder stems from an inherited lifelong intolerance to the gluten protein found in wheat, barley, rye and oats. When ingested, gluten resists the breakdown action of normal digestive enzymes into harmless amino acids. Undigested peptides precipitate hyperpermeability of the small intestinal lining (so-called “leaky gut”) to breach the intestinal barrier defense system. In this way, gluten unnaturally gains entrance to the lamina propria.

Within the lamina propria, gluten peptides encounter the enzyme transglutaminase and the local immune system. Transglutaminase deamidates, or breaks off, the rich glutamine residues in gluten. This deamidation creates the toxic molecular compounds, or epitopes, the immune system identifies as foreign.

These epitopes trigger autoimmune antibodies in genetically susceptible individuals. Ensuing inflammation swells affected portions of the small intestinal lining and damages its delicate structures, interfering with its function to finish digestion and absorb nutrients.

While gluten itself is the environmental cause for antibody development, some stressors that can trigger active disease include gluten overload, pregnancy, viral gastrointestinal infection, surgery and severe stress.
Recognizing Celiac Disease

Despite dramatic advancements in knowledge and testing procedures, recognition of this multifaceted disorder is lacking.1Celiac disease often is undiagnosed due to ignorance of the following:

Pathophysiology — The traditional description of celiac disease as an intestinal disorder with malabsorption as the primary defect is a shadow of the real condition.

Prevalence — In contrast to the historic belief celiac disease affected just one in 5,000 individuals, antibody testing demonstrated prevalence of one in 100.

Diagnostic tests — Healthcare providers are unfamiliar with new and improved testing methods.

Manifestations — Many patients do not have diarrhea and wasting symptoms of classic celiac disease. Extraintestinal symptoms predominate in people with atypical symptoms.
How It’s Diagnosed

Diagnosis of celiac disease is made by a positive serologic antibody study and confirmed by histological findings of small-bowel biopsy specimens obtained by endoscopy and improved clinical response following a gluten-free diet.

The single most important step in diagnosing celiac disease is to recognize its myriad clinical features. No single test can definitively diagnose or exclude celiac disease in every individual; there also is a continuum of laboratory and histopathologic results.1

Positive anti-endomysium antibodies and positive anti-tissue transglutaminase antibodies show celiac disease. Positive antigliadin antibodies demonstrate sensitivity to gliadin itself, the gluten in wheat.

Not all patients have positive antibodies at presentation. When symptoms are present but test results are negative, further testing is warranted, including selective immunoglobin A deficiency. In the event the patient started a gluten-free diet prior to testing, suggest a gluten challenge of 3 months or longer in the expectation of antibody development.

Positive small intestinal biopsy shows the degree of villous atrophy, yet this is not foolproof either. The gastroenterologist must be skilled in taking accurate specimens from multiple sites, and the pathologist must be skilled in examining them properly. In addition, damage may be submicroscopic, returning a level not yet detectable by histological examination.

Additional studies include sonogram and genetic testing. Sonogram shows edema and abnormal appearance of the bowel wall. This is especially helpful for children or those who cannot undergo an endoscopy.

More than 97 percent of people with celiac disease share the same genetic human leukocyte antigen (HLA) haplotype markers, HLA-DQ2 and HLA-DQ8. While HLA genotyping is not specific for celiac disease, it has a very high negative predictive value. If the markers are not present, genetic testing essentially rules out the disease.

Annual follow-up testing is warranted for patients with negative test results who continue to show symptoms.
Recognizing Symptoms

There are no typical symptoms of celiac disease, although the most common clinical presentation is unexplained iron-deficiency anemia with or without gastrointestinal symptoms.

Celiac disease, by way of malnutrition, immunity or the direct toxic effect of gluten on cellular structures, has the potential to produce a broad range of symptoms, associated disorders and complications that may affect any organ or body system. Manifestations vary and may appear at any age.

Nutrient deficits are responsible for many seemingly unrelated conditions, such as depression, inability to concentrate, anxiety, insomnia, defective tooth enamel, coagulopathies, hypertension, obesity, anorexia and excessive thirst.

Associated autoimmune disorders may affect any body tissue, including type I diabetes mellitus, hypothyroidism and Grave’s disease, to name a few. Further, severe complications include various cancers such as B-cell non-Hodgkin lymphoma, cryptic intestinal T cell lymphoma and enteropathy-associated T cell lymphoma.

Chronic diarrhea in childhood should provoke screening. Pediatric presentation for celiac disease could involve hypotonia, failure to thrive, growth retardation, short stature, convulsions, poor bone and tooth development, thymic atrophy and delayed puberty.
Treatment

Treatment is a gluten-free diet. Excluding gluten usually results in rapid healing of the small intestinal mucosa, resolution or improvement of nutritional deficiencies, and disappearance of many manifestations of celiac disease.

The gluten-free diet is challenging due to the plethora of gluten-containing foods in the standard American diet. To succeed, patients need detailed diet instruction, including how to read food labels and identify hidden sources of gluten, such as in medications and supplements. Refer patients to a qualified dietitian if possible; otherwise, nurses can teach appropriate information.

Inform patients about community help such as celiac support groups, which offer practical advice on how to shop and cook, and where to dine. Many support groups hold their meetings at local hospitals.
Prognosis

Clinical outcome depends on duration of exposure to gluten. The longer gluten is consumed, the more the body is damaged, and the greater the likelihood of health disorders and complications developing.

Intestinal permeability improves within 2 months of starting a gluten-free diet. Despite a good clinical response, abnormal endoscopic and histologic appearances persist in the majority of patients.2Patients who receive adequate education about celiac disease and treatment with the gluten-free diet are better able to prevent intestinal damage and improve their health by dietary self-management. Clearly, nursing intervention that uncovers hidden celiac disease, provides nutritional education and promotes regular follow-up will considerably improve prognosis. n
References for this article can be accessed at www.advanceweb.com/nurses. Click on Education, then References.
Cleo Libonati is author of Recognizing Celiac Disease, and co-founder, president and CEO of Gluten Free Works Inc., Ambler, PA.
This article copyrighted to Advance For Nurses and can be accessed online at their website at http://nursing.advanceweb.com/Editorial/Search/AViewer.aspx?AN=NW_08may12_n4p21.html&AD=05-12-2008

May is Celiac Disease Awareness Month. Spread the Word!

celiac disease awarenessCeliac disease awareness is desperately needed – now more than ever. 

While the gluten-free diet has exploded in popularity, celiac disease remains massively under-diagnosed.

Why? Two Reasons: 

1. The public has shifted its focus to the gluten-free diet and away from celiac disease due to the media. The media likes diets. Diets sell. Oddly named diseases that are difficult to describe in catchy sound bites don’t sell.

2. Doctors do not have the information they need to recognize, diagnose and treat this common disorder. The information exists but there is no authority that actively ensures Read More »

MEDICAL RESEARCH: Vitamin D Deficiency is Associated with Insulin Resistance and ß cell Dysfunction

 

Editor’s note:

In the following medical research study, healthy participants were enrolled to examine the effects of vitamin D on insulin production and use in the body. This research shows that:

1) Vitamin D plays an important role in insulin sensitivity in the body, and deficiency of vitamin D hampers production of insulin hormone by beta cells in the pancreas.

2) People with vitamin D deficiency are at risk for developing type 2 diabetes mellitus. Type 2 diabetes mellitus is characterized by lack of insulin sensitivity in body tissues and inadequate production of insulin hormone in the pancreas. Read More »

MEDICAL RESEARCH: Vitamin D Necessary for Preserving Cognitive Function

 

Editor’s note: Promising research published January 8, 2007 shows that adequate levels of vitamin D in the elderly are important to maintain cognitive function or thinking skills that include use of language, awareness, social skills, math ability, memory, reasoning, judgment, intellect, learning, and imagination. This study is called a retrospective review because the researchers did not actually examine anyone. Instead they reviewed data from records of 32 older adults who had been examined for memory Read More »

MEDICAL RESEARCH: “Copper Deficiency in Infants with Active Celiac Disease.”

Editor’s note: In this case report of infants with severe malabsorption from celiac disease, the treating physicians found copper deficiencies based on blood studies that showed severe low copper levels and white blood cell count.  Treatment required copper supplementation in addition to the gluten-free diet.  Normally, in the last few months of gestation, an infant  stores a large amount of copper in their liver.  This storage must last about 6 months because infants must derive their nourishment from copper-poor milk.  This case report shows dramatically the terrible effect of malabsorption coupled with a naturally occurring huge demand for copper that could not be satisfied through digestion. Read More »

MEDICAL RESEARCH: “Pediatric case series evaluating a standardized Candida albicans skin test prod

 

 Editors’ note: This study investigating the value and safety of Candin for clinical use in children demonstrated effectiveness and safety.  Candin is a reagent or skin test for sensitivity to Candida albicans, a yeast microorganism that can cause infection.  The study recommends using Candin in combination with other reagents in infants with anergy to see if they react to antigens other than Candida albicans.  Anergy is described in Taber’s Cyclopedic Medical Dictionary as the impaired or absent ability to react to common antigens administered through skin testing. Antigens are markers on the surface of cells that stimulate production of antibodies.  In this study, Candin was tested at the same time as a skin test for tuberculosis (purified protein derivative tuberculosis) for comparison of results. Read More »

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