Gluten Free Works: TREATMENT GUIDE Get well and stay healthy living gluten free
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The spleen is the darkish oval organ in the lower middle of this photo.
What Is Hyposplenism?
Hyposplenism is the condition resulting from having lost spleen tissue, called atrophy of the spleen. Spleen atrophy impairs splenic functions or activities because there are insufficient tissues to do the work required.
Q: What splenic functions are impaired?
A: The spleen, apart from acting as a phagocytic filter, thus removing aging and damaged cells, is crucial in regulating immune homeostasis by linking innate and adaptive immunity, and in protecting against infections by encapsulated bacteria.1
Impaired function of the spleen therefore increases risk of infections with encapsulated bacteria because of inability to mount a proper defense and to filter and remove bacteria from the circulation.
The spleen is a highly vascular and solid organ about the size of a fist. It has a delicate structure inside that is enclosed by fibrous, elastic layers consisting of connective tissue.
The tissues within are made up of two different types of tissues, called white pulp and red pulp. White pulp carries out lymphoid functions. Red pulp filters and cleanses the blood. The spleen is situated above the stomach on the left side of the upper abdomen and firmly fixed in place by ligaments and ribs.
The spleen is an important organ of the lymph system, having the largest collection of lymph tissue in the body. It functions to produce antibodies (immunoglobulins) and white blood cells (T-cells and B-cells), help control the amount of blood in the body, keep body fluids in balance, destroy and filter out old and damaged cells2 and salvage the iron needed for producing new blood cells, and lastly, clear bacteria through production of substances that enable phagocytosis (engulfing bacteria and other unwanted particles, such as antigens, from blood).
Children and adults with hyposplenism are at risk for overwhelming infections. Management of hypospenism is directed towards preventing pneumonia by immununization against pneumonia and meningitis and treating bacterial infections as they arise, which may require hospitalization. For some patients, life-long treatment with antibiotics, such as erythromycin and penicillin, are recommended.
What Is Hyposplenism In Celiac Disease and/or Gluten Sensitivity?
- Hyposplenism is a common complication of celiac disease and in the reverse, celiac disease is the most frequent disorder associated with splenic hypofunction or atrophy.3
- Hyposplenism secondary to celiac disease is characterized by low lymphocyte count and presence of Howell-Jolly bodies in red blood cells, which may not be present in mild cases. Celiac disease, with or without dermatitis herpetiformis, is one of two most common causes of hyposplenism.4
- Splenic atrophy is related to the severity of celiac disease and degree of dietary control (adherence to gluten-free diet).
- Autoantibodies were detected in significantly more patients with hyposplenism than in healthy controls, and in significantly more celiacs with hyposplenism than celiacs with normal blood films. The increased incidence of autoantibodies in celiacs with hyposplenism compared with other celiacs was not associated with a difference in the incidence of HLA-B8.5
- Although splenic atrophy predisposes to infection with encapsulated bacteria, mortality studies indicate that infection with these organisms is not a major cause of death in patients with celiac disease.6
- Children are especially at risk of infection because they often have lower levels of specific antibodies against encapsulated organisms.4
- Because splenic macrophages (white blood cells) have a major role in phagocytosing (engulfing) bacteria and aging blood cells from the circulation and the spleen is the major producer of antibodies, unimmunized patients who have functional hyposplenism should be immunized as soon as their conditions are identified. However, sporadic cases of pneumococcal and other vaccine failures have been reported in appropriately immunized persons. For this reason, a vaccination program, by itself, should not confer a false sense of security.7,8
How Prevalent Is Hyposplenism In Celiac Disease and/or Gluten Sensitivity?
Hyposplenism is significantly increased in adult celiac disease.5
82.4% of celiac disease patients had hyposplenic changes at diagnosis.9
What Are The Symptoms Of Hyposplenism?
- Hyposplenism is marked by lifelong susceptibility to serious infections,4 especially meningococci, which causes meningitis, and pneumococci, which causes pneumonia.
How Does Hyposplenism Develop In Celiac Disease and/or Gluten Sensitivity ?
- Hyposplenism results from celiac disease, with or without, dermatitis herpetiformis.
Does Hyposplenism Respond To Gluten-Free Diet?
There is a non-significant tendency to improve morphologic (tissue) changes on strict gluten free diet.9
6 Steps To Improve Hyposplenism 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.10
- 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.11
- 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.11
- 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.11.
- 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.11
- 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.11
- Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.11
- Cocoa and Black Tea increase blood sugar.
- Rosemary. Increases blood sugar levels and should not be used by persons with insulin resistance or diabetes.
- 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 hyposplenism deplete nutrients that aggravate malabsorption problems in celiac disease. Ask your doctor or pharmacist about this possible adverse effect and how to supplement 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.
- Penicillins deplete Vitamin B2, Folic Acid, Vitamin B12, Biotin, Vitamin K, Probiotics.12
- Erythromycin depletes Vitamin B2, Folic Acid, Vitamin B12, Biotin, Vitamin K, Probiotics.13
- 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 to restore adequate levels of vitamin B2, vitamin B12, biotin, and folic acid as needed.
- Vitamin K as prescribed following blood test for status.
- Probiotics to maintain necessary populations of friendly microbes in the colon.
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. However, because it increases blood sugar levels, it should not be used by persons with insulin resistance or diabete.
- 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 Hyposplenism In Celiac Disease and/or Gluten Sensitivity?
“Hyposplenism, adult celiac disease, and autoimmunity.” This study aiming to estimate the need for a small intestinal biopsy in the investigation of hyposplenism, and to assess the relationship of autoimmunity to hyposplenism and celiac disease found that small bowel biopsy should be carried out in the investigation of unexplained hyposplenism.
During one year, 40,000 routine blood films were scrutinized for the features of hyposplenism (Howell Jolly bodies, acanthocytes, giant platelets and target cells.) Of these blood films, 27 patients who had not had a splenectomy (removal of spleen) were found to have functional hyposplenism. Ten patients were already known to have celiac disease. Intestinal biopsy was performed in another 13 patients; celiac disease was diagnosed in six. Of the 23 patients biopsied, celiac disease was present in 16 (70%). Autoantibodies were detected in significantly more patients with hyposplenism than in healthy controls, and in significantly more celiacs with hyposplenism than celiacs with normal blood films. The increased incidence of autoantibodies in celiacs with hyposplenism compared with other celiacs was not associated with a difference in the incidence of HLA-B8.5
“Hyposplenism in celiac disease. Role of a gluten-free diet.” This study investigating splenic function in 17 adult patients with celiac disease was performed both before and during treatment with a gluten-free diet. Researchers found that 82.4% of patients had hyposplenic changes and that there was a non-significant tendency to improve such changes by a strict adherence to gluten-free diet.
Splenic hypofunction was assessed evaluating morphological changes in red cells (Howell-Jolly bodies, spherocytosis, achantocytosis). The hyposplenic changes were compared with: age of patients, duration of symptoms previous to diagnosis, severity of the clinical picture and histological response to treatment.14
- Di Sabatino A, Brunetti L, Carnevale Maffè G, Giuffrida P, Corazza GR. Is it worth investigating splenic function in patients with celiac disease? World J Gastroenterol. 2013 Apr 21;19(15):2313-8. doi: 10.3748/wjg.v19.i15.2313. [↩]
- http://www.nlm.nih.gov/medlineplus/spleendiseases.html [↩]
- Di Sabatino A, Brunetti L, Carnevale Maffè G, Giuffrida P, Corazza GR. Is it worth investigating splenic function in patients with celiac disease? World J Gastroenterol. 2013 Apr 21;19(15):2313-8. doi: 10.3748/wjg.v19.i15.2313. [↩]
- Brigden ML. Detection, education, and management of the asplenic or hyposplenic patient. American Family Physician. Feb 1, 2001;63(3):499, 8p, 1 diagram, 1bw. [↩] [↩] [↩]
- Bullen A W, Hall R, Gowland G, Rajah S, and Losowsky M S. Hyposplenism, adult coeliac disease, and autoimmunity. Gut. 1981 January; 22(1): 28–33. [↩] [↩] [↩]
- Wright DH. The major complications of coeliac disease. Bailliere’s Clinical Gastroenterology. Jun 1995;9(2):351-69. [↩]
- Brigden ML. Detection, education, and management of the asplenic or hyposplenic patient. American Family Physician. Feb 1, 2001;63(3):499, 8p, 1 diagram, 1bw. [↩]
- Di Sabatino A, Brunetti L, Carnevale Maffè G, Giuffrida P, Corazza GR. Is it worth investigating splenic function in patients with celiac disease? World J Gastroenterol. 2013 Apr 21;19(15):2313-8. doi: 10.3748/wjg.v19.i15.2313. [↩]
- Vazquez H, Martinez C, Xavier L, Mazure R, Boerr L, Bai J. Hyposplenism in celiac disease. Role of a gluten-free diet. Acta Gastroenterologica Latinoamericana. 1991;21(1):17-21. [↩] [↩]
- 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. [↩] [↩] [↩] [↩] [↩] [↩]
- https://umm.edu/health/medical/altmed/depletion/antibiotic-medications-penicillin-derivatives. [↩]
- http://umm.edu/health/medical/altmed/depletion/antibiotic-medications-macrolides [↩]
- Vázquez H, Martínez C, Xavier L, Mazure R, Boerr L, Bai J. Hyposplenism in celiac disease. Role of a gluten-free diet. Acta Gastroenterol Latinoam. 1991;21(1):17-21. [↩]
