C ardiomegaly is a non-inflammatory disorder of the myocardium (heart muscle) causing the heart to enlarge.
Q: What happens when the heart enlarges?
A:The heart enlarges because excessive growth of muscle tissue (hypertrophy) thickens the heart walls which in turn reduces the size of the lower chambers (ventricles) and impairs the filling of the heart chambers with blood. In consequence, the heartbeat quickens.
Also, the enlarging heart encroaches on lung space which impairs their ability to expand with inspiration of air.
Cardiomegaly can result in heart failure because of inability to pump sufficient blood for the needs of the body and ventricular arrhythmias (irregular or missed beats) that can stop the heart. An echocardiogram, which is a test that uses sound waves to produce a picture of the heart, is used to detect and diagnose cardiomegaly.
What Is Cardiomegaly In Celiac Disease and/or Gluten Sensitivity?
Folic acid deficiency anemia, also called folate deficiency anemia, is a macrocytic anemia characterized by defective DNA synthesis of red blood cells that results from a lack of folate in the body.
Q: How does folate deficiency cause anemia?
A: Folates are a family of B vitamins and folic acid is an active form.
Folate is required for the formation of both red and white blood cells in the bone marrow and for their maturation.
Also, folate serves as a carrier in the formation of heme, which contains iron, and is the non-protein part of the hemoglobin molecule.1
Red blood cells provide oxygen to body tissues. When there are not enough red blood cells or when they cannot properly carry oxygen, the condition is called anemia. In folic acid deficiency anemia, the red blood cells are abnormally large. Such cells are called macrocytes (macro size cells). They are also called megaloblasts (mega size cells) as seen in the bone marrow where they are produced. This is why this macrocytic anemia is also called megaloblastic anemia.2
Tests that may be done to determine folate adequacy are complete blood count (CBC), red blood cell folate level, methylmalonic acid level, and homocysteine level. Folic acid deficiency anemia shows a decrease in red blood cell folate and/or serum folate levels and normal plasma methylmalonic acid level with elevated homocysteine blood level. These levels distinguish folic acid deficiency anemia from vitamin B12 deficiency anemia.3
What Is Folate Deficiency Anemia In Celiac Disease and/or Gluten Sensitivity?
Lost patch of hair at base of scalp due to alopecia areata. Courtesy Wikimedia,
What Is Alopecia Areata?
A lopecia areata is an autoimmune attack on hair follicles characterized by sudden hair loss involving scalp or beard, although any hairy area may be affected.
Areas of hair loss have a patchy pattern with sharply defined edges.
Q: Can all hair be affected?
A: All body hair may be lost, which is called alopecia universalis although this is uncommon.
In alopecia areata, white blood cells of the immune system attack the rapidly growing cells in the hair follicles. The affected hair follicles become small and drastically slow down hair production. Fortunately, the stem cells that continuously supply the follicle with new cells do not seem to be targeted. So the follicle always has the potential to regrow hair but regrowth is unpredictable.1
What Is Alopecia Areata In Celiac Disease and/or Gluten Sensitivity?
Reproduction of a lithograph plate showing inside of the stomach from Gray’s Anatomy. Courtesy Wikipedia Commons.
What Is Delayed Gastric Emptying?
D elayed gastric emptying is a stomach motility or movement disorder characterized by abnormally slow movement of gastric contents from the stomach through the pyloric sphincter into the duodenum, causing dyspepsia.
Q: What determines how fast the stomach empties?
A: How fast the stomach empties depends on the pressure of strong coordinated muscle contractions in the top region of the stomach propelling chyme against resistance at the pylorus (base region of the stomach).
Chyme is food that has been dissolved and thoroughly mixed with stomach secretions.
In the digestion of carbohydrate, protein and fat, protein leaves the stomach first (1 hour), then carbohydrates (1 1/2 to 2 hours), and fat takes longest to digest (2-4 hours). Plain water is able to pass through the pylorus within 5 minutes.
What Is Delayed Gastric Emptying In Celiac Disease and/or Gluten Sensitivity?
Vitamin A is a family of fat-soluble compounds that are essential for health, vision, protection of the body, reproduction, and normal growth of children before and after birth.
Q: What is the family of vitamin A?
A: The natural vitamin A family members are called retinoids. Retinoids are found only in animal food sources. They include retinol (alcohol form), retinal (aldehyde form), and retinoic acid (acid form).
In the plant kingdom, pigments called carotenoids can yield retinoids on metabolism in the body. Carotenoids that can converted to retinol include β-carotene, α-carotene, and β-cryptoxanthin.1
There are hundreds of various carotenoids although only a few have been researched including beta-carotene, lycopene, lutein and zeaxanthin.
Fruits and vegetables that are a rich source of carotenoids are thought to provide health benefits by decreasing the risk of various diseases, particularly eye diseases and certain cancers (esophageal, stomach, pancreatic, bladder and cervical). In this respect, research shows that the regular consumption of fruits and vegetables may prevent 20% of most types of cancers.2
In part, the beneficial effects of carotenoids are thought to be due to their role as antioxidants. Lutein and zeaxanthin may be protective in eye disease because they absorb damaging blue light that enters the eye.3
The antioxidant effects appear to be highest in fresh fruit as compared to preserved fruit. A study of fresh peach pulps and peel in animals demonstrated highest antioxidant and anti-inflammatory effects in fresh fruits preventing against induced damage in animal tissues.4
A study investigating the specific anti-inflammatory and anti-oxidant micronutrients that reduce oxidative stress showed that adolescents with metabolic syndrome (MetS) had consistently lower carotenoid concentrations compared with their counterparts without MetS. MetS prevalence was estimated at 7% among boys and 3% among girls.5
What Is Vitamin A Deficiency In Celiac Disease and/or Gluten Sensitivity?
Sources:
Maggio M, de Vita F, Lauretani F, et al. Relationship between Carotenoids, Retinol, and Estradiol Levels in Older Women. Nutrients. 2015 Aug 5;7(8):6506-19. doi: 10.3390/nu7085296. [↩]
Gasparotto J, Somensi N, Bortolin RC, Moresco KS, Girardi CS, Klafke K, Rabelo TK, Morrone Mda S, Vizzotto M, Raseira Mdo C, Moreira JC, Gelain DP. Effects of different products of peach (Prunus persica L. Batsch) from a variety developed in southern Brazil on oxidative stress and inflammatory parameters in vitro and ex vivo. J Clin Biochem Nutr. 2014 Sep;55(2):110-9. doi: 10.3164/jcbn.13-97. Epub 2014 Sep 1. [↩]
Krinsky NI1, Johnson EJ. Carotenoid actions and their relation to health and disease. ((Mol Aspects Med. 2005 Dec;26(6):459-516. [↩]
Gasparotto J, Somensi N, Bortolin RC, Moresco KS, Girardi CS, Klafke K, Rabelo TK, Morrone Mda S, Vizzotto M, Raseira Mdo C, Moreira JC, Gelain DP. Effects of different products of peach (Prunus persica L. Batsch) from a variety developed in southern Brazil on oxidative stress and inflammatory parameters in vitro and ex vivo. J Clin Biochem Nutr. 2014 Sep;55(2):110-9. doi: 10.3164/jcbn.13-97. [↩]
TGBeydoun MA, Canas JA, Beydoun HA, Chen X, Shroff MR, Zonderman AB. Serum antioxidant concentrations and metabolic syndrome are associated among U.S. adolescents in recent national surveys. J Nutr. 2012 Sep;142(9):1693-704. doi: 10.3945/jn.112.160416. [↩]
Unexpected weight loss is unintentional loss of body mass composition or inability to gain weight marked by decreased serum proteins and increased stool fat.1
What Is Unexpected Weight Loss In Celiac Disease and/or Gluten Sensitivity?
Chronic diarrhea is an intestinal motility disorder characterized by 1) alteration in stool formation causing loose to fluid movements and quantity of movements with or without abdominal pain and 2) interference with normal carbohydrate salvage by the intestinal microbe population.
The severity of diarrhea is determined by the frequency and quantity of fluid lost.
Q: What is carbohydrate salvage by microbes in the colon?
A: Carbohydrate salvage in the colon is the necessary process whereby billions of microbes normally present in the colon work to breakdown undigestible carbohydrate foodstuffs such as fiber that continually arrive from the small intestine.
The microbial action releases energy to the body that would otherwise be lost with defecation, generates short-chain fatty acids, and stimulates sodium and fluid absorption. In this important process, butyrate and proprionate are produced which nourish the colonocytes (cells that line the colon), and acetate is produced for the liver.
While diarrhea may be a common symptom of small bowel mucosal disease, the consequent malabsorption can lead to substantial malnutrition and nutrient deficiencies. The small intestine, unlike the colon, has been relatively inaccessible, and systematic evaluation is often necessary to identify and treat small intestinal mucosal diseases that lead to diarrhea. All patients with severe diarrhea or diarrhea associated with features suggestive of malabsorption may have a disease of the small intestinal mucosa that requires careful evaluation and targeted management.1
What Is Chronic Diarrhea In Celiac Disease and/or Gluten Sensitivity?
Sources:
Murray JA1, Rubio-Tapia A. Diarrhoea due to small bowel diseases. Best Pract Res Clin Gastroenterol. 2012 Oct;26(5):581-600. doi: 10.1016/j.bpg.2012.11.013. [↩]
T ransient erythroblastopenia is a rare disorder of red blood cell formation characterized by brief, reversible disappearance of erythroblasts (red blood cell precursors) in the bone marrow of children.
Q: What do the red blood cells look like?
A: Circulating red blood cells appear normal so that the anemia which develops is a normocytic (normal cellular) anemia in contrast to microcytic (small cell) anemia in iron deficiency or macrocytic (large cell) anemia in vitamin B12 or folic acid deficiency.
Because new red blood cells are failing to mature, packed red blood cell transfusions may be necessary in severe anemia.
In adults, this disorder is called pure red blood cell anemia.
What Is Transient Erythroblastopenia In Celiac Disease and/or Gluten Sensitivity?
P ruritic skin is a symptom of a primary disease that may involve only the skin or a systemic disorder with other features and is characterized by chronic itching.
Q: What part of skin is affected by itchiness?
A: Itching may arise from any layer of skin, depending on the cause.
In the image to the right, the outermost protective surface layer, or stratum cornem, is shown as a thin tan line. It is the top dead layer of the epidermis that normally sloughs off as new cells move up to replace it. The epidermis is shown as a dark pink layer. It is composed of five layers of keratinocytes that flatten as they move upward.
The pink layer under the epidermis is the dermis, or true skin, which is composed of collagen and elastin tissue. It contains oil glands that lubricate skin, sweat glands, blood vessels, nerve endings, lymphatics, and hair follicles. Under the dermis is subcutaneous tissue containing fat cells here colored yellow on the bottom of the image.
What Is Pruritic Skin In Celiac Disease and/or Gluten Sensitivity?
Sucrose intolerance is the inability to digest sucrose, a widely available sugar, while sucrosemia is the abnormal presence of sucrose in the bloodstream.
Q: Why cannot the body digest sucrose?
A: Sucrose, such as cane or beet sugar, is a double molecule sugar which must first be digested before being absorbed from the gut into the bloodstream. That is, sucrose must be split into its component single molecules of fructose and glucose, which are then properly absorbed.
The inability to properly digest sucrose results directly from low production and activity of sucrase in the small intestine. Sucrase is the specific enzyme that splits or digests sucrose.
Undigested sucrose does not remain idle. Its presence acts osmotically to draw water from the body into the intestine, causing watery diarrhea.
Meanwhile, microbiota (normal bacteria) in the colon eagerly ferment the abnormally present sucrose that arrives from the small intestine. Fermentation generates short-chain fatty acids and hydrogen gas, which results in bloating pain.1
In sucrosemia, sucrose molecules abnormaly pass through an unhealthy small intestinal lining and enter the bloodstream where there presence is abnormal. Sucrose in the blood is filtered out by the kidneys and excreted in urine.
Positive response to a breath hydrogen test (BHT), involving 1 – 3 hours of time post ingestion of sucrose test dose, signifies malabsorption in the small intestine and fermentation in the colon. If BHT is positive before 60 minutes, the result implies bacteria is abnormally present in the small intestine, causing fermentation there. Endoscopy is used to measure sucrase activity in tissue samples.
What Is Sucrose Intolerance And Sucrosemia In Celiac Disease and/or Gluten Sensitivity?
What Is Cardiomegaly?
