Gluten Free Works: TREATMENT GUIDE Get well and stay healthy living gluten free
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Pitting edema. Right photo shows that indent remains from pressing. Courtesy wikimedia.
What Is Edema?
Edema is an abnormal swollen condition of the skin characterized by excess extracellular fluid volume, meaning there is an increase of the fluid that normally surrounds cells. Edema may be hardly noticeable or it can become extensive.
Edema can have various appearances and can develop from various causes.
Q: What are the appearances and causes of edema?
A: Here are the appearances of edema:
- Pitting edema. It is called pitting edema if when the skin is pressed with a finger, the indent remains. This edema results from fluid leaking out of the bloodstream into the surrounding tissues. Pitting edema can be a feature of many disorders including heart disease, kidney disease, vascular disease, cancer, and malnutrition.
- Myxedema is a firm swelling or thickening of subcutaneous skin that does not pit, as seen in thyroid disease.
Here are causes of edema:
- Local edema as a response to trauma or infection.
- Lower extremity edema from poor circulation and malnutrition.
- Edema in the lungs from right sided heart disease.
- Abdominal edema from liver disease, intestinal disease.
- Body wide edema from heart disease, kidney disease, thyroid disease.
What Is Edema In Celiac Disease and/or Gluten Sensitivity?
- Relationship between edema and celiac disease. Edema is a classic sign of malabsorption of multiple nutrients, especially protein in celiac disease.
- Relationship between edema and plasma albumin. Significant or borderline significant associations with intestinal damage were found for plasma albumin (a blood protein) in patients at diagnosis of celiac disease and at follow-up in patients with non-controlled celiac disease.1
- Relationship between edema and scurvy in celiac disease. Scurvy caused by vitamin C deficiency is a cause of leg and ankle edema.2
- Relationship between edema and omega-3 fatty acid deficiency. Deficiency of omega-3 fatty acids leads to edema of the extremities.
- Relationship between edema and thiamin deficiency. Edema involving the lower extremities and lungs caused by thiamin deficiency with cardiomyopathy (wet beriberi) can be rapidly fatal without treatment.
How Prevalent is Edema In Celiac Disease and/or Gluten Sensitivity?
Edema is common in untreated patients with celiac disease.1
What Are The Symptoms Of Edema?
Edema is marked by these symptoms depending on cause:
- Weight gain due to excess fluid retention.
- Coarsening of facial features.
- Thickening of subcutaneous skin.
- Lung congestion.
- Swelling of lower extremities.
How Does Edema Develop In Celiac Disease and/or Gluten Sensitivity?
- Reduction in plasma proteins and malnutrition in celiac disease cause edema by failing to provide colloid osmotic pressure within blood vessels that is sufficient to prevent the abnormal leakage of blood plasma fluid from capillaries into tissues.
- Malnutrition involving deficiencies of any of these: EPA omega-3 fatty acid, protein, vitamin C, vitamin K, thiamin, and copper caused by malabsorption in celiac disease.
Does Edema Respond To Gluten-Free Diet?
Yes. Celiac disease-related edema resolves on a gluten free diet.
6 Steps To Improve Edema 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.3
- 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.4
- 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.4
- 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.4.
- 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.4
- 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.4
- Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.4
- 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 lettuce, kale, 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 prescription drugs can cause deficiencies of any of these nutrients: EPA omega-3 fatty acid, protein, vitamin C, vitamin K, thiamin (vitamin B1), and copper. 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.
FEMALE HORMONES disrupt intestinal permeability.
- Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Vitamin B3, Vitamin C.
- Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Vitamin C.
DIURETICS
- Loop Diuretics (Lasix®, Bumex®, Edecrin®) depletes Vitamin B1.
CHOLESTEROL DRUGS
- Colestid® and Questran® deplete Vitamin K.
CARDIOVASCULAR DRUGS
- Antihypertensives (Catapres®, Aldomet) deplete Vitamin B1.
ANTICONVULSANTS
- Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Carnitine, Vitamin B1, Vitamin K, Copper.
ANTIVIRAL AGENTS –
- Zidovudine (Retrovir®, AZT and other related drugs) deplete Carnitine, Copper.
ANTI-INFLAMMATORIES disrupt intestinal permeability.
- Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Vitamin C.
- Aspirin and Salicylates deplete Vitamin C.
ANTIBIOTICS disrupt intestinal permeability.
- Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete Vitamin C.
ANTACIDS / ULCER MEDICATIONS
- 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 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. Contains thiamin.
- Vitamin K as prescribed following blood test for this vitamin status.
- Ester-C as prescribed following blood test for this vitamin status.
- Thiamin as prescribed following blood test for this vitamin status.
- Copper as prescribed following blood test for this mineral status.
- Fish oil to obtain EPA and DHA (omega-3).
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. Fish oil supplements go in the refrigerator.
- 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 Edema In Celiac Disease and/or Gluten Sensitivity?
RESEARCH STUDY SUMMARIES
“Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage.” This study reporting data on long-term control of celiac disease and its correlates demonstrated that celiac disease is often poorly controlled in the majority of patients on long-term treatment with a Gluten Free Diet due to lack of adherence to strict gluten free diet. Intestinal damage at follow-up was absent in only 43.6% and EMA were present in the serum of 24.9%.
In patients with noncontrolled celiac disease, albumin level in long-term treatment was low and/or lower than pretreatment and correlated with the presence of intestinal damage.5
CASE REPORT SUMMARIES
“Pericardial effusion in celiac disease.” This case report describes diagnosis of celiac disease in a 40-year-old woman with progressive fatigue and pitting edema in her lower extremities. Iron deficiency anemia and celiac disease were diagnosed on the basis of low serum ferritin, elevated serum level of IgA endomysial and tissue transglutaminase anti-bodies and histologic findings in small bowel biopsies. Pericardial effusion in her evaluation was detected incidentally. Asymptomatic pericardial effusion in this patient was only detectable with imaging.
After starting of gluten free diet and iron supplement fatigue, peripheral edema and pericardial effusion on echocardiography decreased. It should be noted that asymptomatic pericardial effusion may be seen in adults with celiac disease.6
“Celiac disease manifested by polyneuropathy and swollen ankles.” This is a case study revealing celiac disease in a 27-year-old male who started to have his ankles swollen during his military service. He was examined at a military hospital where electromyoneurography showed the signs of distal sensory-motor polyneuropathy with axon demyelinization and weak myopathic changes, whereas histopathological examination of gastrocnemius muscle biopsy revealed some mild and nonspecific myopathy. Besides, he was found to have subcutaneous ankle tissue edemas and hypertransaminasemia. Due to these reasons, he was dismissed from the military service and examined at another hospital where bone osteodensitometry revealed low bone mineral density of the spine. However, his medical problems were not resolved and after the second discharge from hospital he was desperately seeing doctors from time to time.
Finally, at our institution he was shown to have celiac disease by positive serology (antitissue transglutaminase and antiendomysial antibodies) and small bowel mucosal histopathological examination, which showed total small bowel villous atrophy. Three months after the initiation of gluten-free diet, his ankle edema disappeared, electromyoneurographic signs of polyneuropathy improved and liver aminotransferases normalized. Good knowledge of celiac disease extraintestinal signs and serologic screening are essential for early recognition and therapy.7
- Ciacci C, Cirillo M, Cavallaro R, Mazzacca G. Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage. Digestion. 2002;66(3):178-85. [↩] [↩]
- Krause’s Food, Nutrition, & Diet Therapy. 10th Edition. Kathleen Mahan, Sylvia Escott-Stump. 2000. W.B. Saunders Company. [↩]
- 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. [↩] [↩] [↩] [↩] [↩] [↩]
- Ciacci C, Cirillo M, Cavallaro R, Mazzacca G. Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage. Digestion. 2002;66(3):178-85. [↩]
- Ashrafi F, Darakhshandeh A, Heidarpour M, Tavakoli T, Najafian J. Pericardial effusion in celiac disease. Int J Prev Med. 2014 Mar;5(3):356-9. [↩]
- Djuric Z, Kamenov B, Katic V. Celiac disease manifested by polyneuropathy and swollen ankles. World J Gastroenterol. 2007 May 14;13(18):2636-8. [↩]
