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What Is Bronchiectasis?
Bronchiectasis is a pulmonary disorder characterized by chronic dilation of bronchi (main airways) and bronchioles (small airways) with chronic inflammation and swelling, increasing the risk of infection.
In bronchiectasis, mucus produced to trap foreign substances, such as dust and bacteria, builds-up because the ability of airways to move it out is impaired. Normally, hair-like cilia that line airways beat mucus out of the lungs. Loss of this action increases mucus in the airways which increases risk of pneumonia.
The anatomy of airways is likened to a branching tree. The trachea, or windpipe, like the trunk of a tree, branches into two primary bronchi that connect it to the lungs. One bronchus connects to the left lung and the other to the right lung. Each bronchus further divides into smaller bronchi that connect to the lobes. Lobes are large subdivisions of lung tissue: two of the left lung and three of the right lung.
Lobe bronchi divide into smaller bronchial tubes ending in small bronchioles. The ends of bronchioles are surrounded with and attached to tiny alveoli which are air sacs that look like clusters of grapes.
Q: What effect does inflammation have on the lungs?
A: Alveoli are only one cell thick, where oxygen is obtained by the bloodsteam from air breathed into them and carbon dioxide is released from the bloodstream to air that is breathed out of air sacs through the pulmonary tree. Two things happen:
- Inflammation impairs exchange of gases in alveoli, resulting in lack of sufficient oxygen (O2) for body cell functions, called hypoxia, and build-up of carbon dioxide (CO2) in blood, called CO2 retention.
- Inflammation narrows passageways, which reduces the movement of air to and from the alveoli, and this puts stress on the right side of the heart.
Bronchiectasis can affect one or both lungs or one segment or multiple segments of a lung. Treatment is with antibiotics, chest physiotherapy and good nutrition.
What Is Bronchiectasis In Celiac Disease and/or Gluten Sensitivity?
- Relationship between bronchiectasis and celiac disease. Bronchiectasis in celiac disease is an associated pulmonary disorder and may be an uncommon presenting feature of untreated celiac disease.
- Relationship between bronchiectasis and nutritional deficiencies. Bronchiectasis may result from persistant bronchitis or recurrent bronchitis associated particularly with deficiencies of iron, vitamin C, vitamin A, and zinc.
- Relationship between bronchiectasis and immunity. Bacterial infections causing bronchitis and pneumonia may result from hyposplenism in celiac disease which impairs immune function. Repeat infections often lead to progression of bronciectasis.
How Prevalent Is Bronchiectasis In Celiac Disease and/or Gluten Sensitivity?
Bronchiectasis is shown to be associated with celiac disease but prevalence is unknown.1
What Are The Symptoms Of Bronchiectasis?
Bronchiectasis is marked by these symptoms:
- Chronic cough that is worse at night.
- Fatigue.
- Regular thick sputum production, usually foul especially in the morning.
- Wheeze.
- Dyspnea (shortness of breath).
- Recurrent pumonary infections that require antibiotics.
How Does Bronchiectasis Develop In Celiac Disease and/or Gluten Sensitivity?
- Bronchiectasis in celiac disease may result from an immunological mechanism.2
- Nutritional deficiencies of zinc, vitamin A, iron, and vitamin C predispose to infection causing bronchiectasis.
- Hyposplenism predisposes to infection causing bronchiectasis.
- Immune deficiency states predispose to infection causing bronchiectasis due to decreased numbers of disease fighting leukocytes
- Gastroesophageal reflux disease (GERD) is a cause of bronchiectasis.
Does Bronchiectasis Respond To Gluten-Free Diet?
Yes. Bronchiectasis in celiac disease improves on gluten free diet.3
6 Steps To Improve Bronchiectasis In Celiac Disease and/or Gluten Sensitivity:
- 1Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:
- Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
- A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
- Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.
Correct Your Individual Nutritional Needs.
- Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
- Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.
Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the absorbing cells that make up the surface lining of your small intestine are better able to function.
- Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
- Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.4
- The intestinal lining may take up to a year to heal.
- 2 Reduce Inflammation. Foods to Eat and Foods Not to Eat:
Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).
- Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.5
- Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
- Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.5
- Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.5.
- Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.5
- Refined Sugars. Includes white sugar, corn fructose and high fructose corn syrup.
- Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.5
- Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.5
- Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
- Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
- High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
- Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
- Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
- Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
- Prebiotics/ High Fiber Foods. Food with fiber keeps our population of colonic microbes healthy.
- Protective Herbs and Spices. See below #6 below for examples.
- 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:
- 4 Manage Your Medications Safely:
Certain medications used to treat bronchiectasis deplete nutrients. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.
This is not a complete listing.
ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.
- Gentomycin, Streptomycin, Cephalosporins, Penicillins deplete B Vitamins, Vitamin K, Probiotics, Vitamin C.
- Tetracyclines deplete Calcium, Magnesium, Iron, Vitamin B6, Zinc, Probiotics, Riboflavin.
- Cipro depletes Zinc.
BRONCHODILATORS
- Beta agonists like Albuterol inhalers that are breathed in on a daily basis as a long term therapy and also for quick relief as rescue inhalers to open airways depletes potassium.
- Theophylline by mouth as a long term therapy to open airways depletes potassium.
- 5Nutritional Supplements To Help Correct Deficiencies:
The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.
- Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
- B-Complex vitamins as prescribed.
- Calcium citrate is the best absorbed of calcium supplements. Calcium carbonate is a poor choice.
- Vitamin D3 as prescribed following blood test for status.
- Vitamin C.
- Ferrous fumarate or gluconate as prescribed following blood test for iron status.
- Chelated magnesium as prescribed.
- Potassium must not be taken as a supplement unless prescribed by a physician after blood test for status. Over dosage can be life-threatening.
Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.
- 6Manage Natural Remedies:
- Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
- If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
- Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
- What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.
Carminative Food Remedies:
- Raspberry.
- Carrot is also a cleansing digestive tonic.
- Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
- Redbeets also stimulate and improve digestion and are easily digested.
- Cabbage also stimulates and improves digestion and is also a liver decongestant.
- Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
- Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.
Carminative Herb Remedies:
- Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. Drink as tea or use in cooking.
- Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
- Parsley also relieves indigestion.
- Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
- Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.
Carminative Spice Remedies:
- Cloves are also antispasmodic.
- Nutmeg is also useful for indigestion.
- Ginger.
Exercise improves circulation and rids the body of toxins.
- Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
- Weight training builds muscle. Read more about Exercise and Fitness.
- Stretching improves flexibilty. Read more about Exercise and Fitness.
Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal.
What Do Medical Research Studies Tell About Bronchiectasis In Celiac Disease and/or Gluten Sensitivity?
CASE REPORT SUMMARIES
“Recurrent rhinitis and pulmonary infections revealing celiac disease: case report.” This case report describes diagnosing celiac disease revealed by bronchiectasia in a 39-year-old man. The patient reported a history of recurrent pulmonary infections and intermittent intestinal symptoms in childhood. Wegner granulomatosis was initially suspected because of rhinopulmonary involvement. The patient’s serum’s was tested for ANCA and anti-tissue antibodies. The latest test was performed on histological sections from rat and revealed the presence of anti-reticulin antibodies. Further testing, for anti-tissue transglutaminase and anti-endomysium antibodies, revealed positive results. Celiac disease was confirmed by histological examination of intestinal biopsy. Pulmonary symptoms were improved on a gluten free diet suggesting a causal relationship between celiac disease and respiratory symptoms.3
“Bronchiectasis in association with celiac disease.” This case report describes the course of a 48 year old woman who presented with a history of fatigue, regular sputum production, and wheeze. High resolution computed tomographic scanning of the thorax demonstrated widespread bronchiectasis and this was the presenting sign of celiac disease. The temporal relationship of the brochiectasis and celiac disease, and the subsequent stabilization of her clinical symptoms and improvement in pulmonary physiology following treatment with inhaled corticosteroids, suggests a relationship between the two conditions which may be due to immunological mechanisms.1
- Mahadeva R, Flower C, Shneerson J. Bronchiectasis in association with coeliac disease. Thorax. Jun 1998;53(6):527-9. [↩] [↩]
- Mahadeva R, Flower C, Shneerson J. Bronchiectasis in association with coeliac disease. Thorax. Jun 1998;53(6):527-9. [↩]
- Kallel-Sellami M, Laadhar L, Zitouni M, Makni S. Recurrent rhinitis and pulmonary infections revealing celiac disease: case report. Rev Pneumol Clin. 2008 Feb;64(1):27-9. doi: 10.1016/j.pneumo.2008.06.003. [↩] [↩]
- Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
- Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]