Gluten Free Works: TREATMENT GUIDE Get well and stay healthy living gluten free
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Photo of Skin Rash in ITP Courtesy Wikipedia.
What Is Immune Thrombocytopenic Purpura?
Immune thrombocytopenia purpura (ITP), formerly called idiopathic, is an immune mediated bleeding disorder characterized by destruction of circulating platelets (thrombocytes) by autoantibodies in the presence of normal bone marrow and without other conditions that cause bleeding problems including many medications.
Q: How do autoantibodies destroy platelets?
A: Autoantibodies bind to normal platelet surface antigens (targets) which forms a complex that is cleared from blood by the reticuloendothelial system. Consequently, this condition results in an abnormal decrease in the number of platelets circulating in blood plasma.
Platelets are cells that are needed to stop bleeding. A normal platelet count is in the range of 150,000 to 450,000. With ITP, the platelet count is less than 100,000. By the time significant bleeding occurs, the patient may have a platelet count of less than 10,000. The lower the platelet count, the greater the risk of bleeding.
Because of inability of blood to properly clot due to lack of sufficient platelets, a distinctive purplish rash develops under the skin from blood leakage and an appearance of many small red spots of varying size can cover the skin. Depending on the number of platelets, there may be minimal to extensive bleeding in various parts of the body. Bleeding in the brain is the worst complication, causing death in approximately 1% of affected children and 5% of affected adults.
Immune thrombocytopenic purpura is common in childhood, on average 50 cases per 1,000,000 per year with same incidence in boys as girls. It may follow a viral infection or immunization and is caused by an inappropriate response of the immune system to cross react against the body’s platelets.1
The incidence of immune thrombocytopenic purpura in adults is approximately 66 cases per 1,000,000 per year. Older persons and persons with a previous history of hemorrhage are at increased risk of severe bleeding in adult ITP.
Spontaneous remission occurs in most children (80%). Remission in adults usually requires treatment.
What Is Immune Thrombocytopenic Purpura In Celiac Disease and/or Gluten Sensitivity?
- Immune thrombocytopenia purpura is an associated autoimmune disorder in celiac disease.
- The association between celiac disease and other immune disorders may be due to the sharing of a common genetic background, such as HLA antigens.
- However, in a very large study, involving 909 patients with celiac disease, it was found that the development of immune disorders in celiac disease was clearly related to the duration of exposure to gluten.2
How Prevalent Is Immune Thrombocytopenic Purpura In Celiac Disease and/or Gluten Sensitivity?
The prevalence of celiac disease was found to occur in 3.1% of German patients with immune thrombocytopenia purpura compared to 0.2% in the general population.3
What Are The Symptoms Of Immune Thrombocytopenic Purpura?
Immune thrombocytopenia purpura is marked by bleeding. Symptoms may include:
- Purpura. (the purple color of the skin after blood has “leaked” under it).
- Bruise. (blood under the skin. Persons with ITP may have large bruises from no known trauma. Bruises can appear at the joints of elbows and knees just from movement.)
- Petechia. (tiny red dots under the skin that are a result of very small bleeds).
- Nosebleeds.
- Bleeding in the mouth and/or in and around the gums.
- Blood in the vomit, urine, or stool.
- Bleeding in the head is the most dangerous symptom and can be life threatening.
How Does Immune Thrombocytopenic Purpura In Celiac Disease and/or Gluten Sensitivity Develop?
- Idiopathic thrombocytopenia purpura results from an autoimmune mechanism.4
- Idiopathic thrombocytopenia purpura also involves a genetic susceptibility.3
Does Immune Thrombocytopenic Purpura Respond To Gluten-Free Diet?
Spontaneous remission of immune thrombocytopenia purpura occurs in many patients, with or without, gluten free diet.
6 Steps To Improve Immune Thrombocytopenic Purpura 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.5
- 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.6
- 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.6
- 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.6.
- 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.6
- 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.6
- Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.6
- 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:
Many medications deplete nutrients that promote illness in celiac disease. Ask your doctor or pharmacist about this possible adverse effect if you are taking medicine. Do not stop prescribed medications without supervision.
- 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.
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 Immune Thrombocytopenic Purpura In Celiac Disease and/or Gluten Sensitivity?
RESEARCH STUDY SUMMARIES
“Autoimmune disorders in patients with idiopathic thrombotic thrombocytopenic purpura.” This study investigating 76 German patients suffering from thrombotic thrombocytopenic purpura (TTP) found unexpected rates of co-occurring autoimmune disorders. In order to analyze a possible association of TTP with the questioned diseases, a comparison of prevalence rates between the patient group and the general population has been made for each disease.
Compared to the estimated prevalence rates, the statistical analysis revealed an unexpected high occurrence of the following disorders within the patient group: Hashimoto’s thyroiditis (23.5% within the patients compared to 0.7% within the general population, systemic lupus erythematosus (SLE) (6.5% in patients to 0.025% in the general population, immune thrombocytopenic purpura (ITP) (6.3% in patients to 0.02% in the general population, psoriasis (9.4% in patients to 2.5% in the general population, and celiac disease (3.1% in patients to 0.2% in the general population).
CONCLUSION: These findings confirm the mentioned tendency of autoimmune diseases to co-occur in one individual and argue once more for a genetic susceptibility in immune thrombocytopenic purpura as well as in autoimmune disorders.3
“Inclusion body myositis associated with celiac sprue and idiopathic thrombocytopenic purpura.” This case report of a patient with inclusion body myositis associated with celiac disease and idiopathic thrombocytopenic purpura purports presence of all three disorders may share an interrelated immune mechanism with celiac disease.7
CASE REPORT SUMMARIES
“Concurrent celiac disease, idiopathic thrombocytopenic purpura and autoimmune thyroiditis.” This case report of a patient with idiopathic thrombocytopenic purpura also having autoimmune thyroiditis (AT) a disease that occurs due to autoimmune mechanisms. Celiac disease associated with autoimmune thyroid disease is well known, but the association of celiac disease, autoimmune thyroid disease, and ITP has been reported very rarely in the literature. In the current report, we have presented a case with celiac disease, AT, and acute ITP, because this association is rarely seen, and to emphasize that celiac disease and AT should be kept in mind in patients with ITP.8
“Celiac sprue, idiopathic thrombocytopenic purpura, and hepatic granulomatous disease. An autoimmune linkage?” This case report of a patient with celiac disease in whom idiopathic thrombocytopenic purpura and associated granulomatous disease developed. The three processes appear linked through autoimmune mechanisms.4
- Dogan M, Sal E, Akbayram S, Peker E, Cesur Y, Oner AF. Concurrent celiac disease, idiopathic thrombocytopenic purpura and autoimmune thyroiditis. Clin Appl Thromb Hemost. 2011 Nov-Dec;17(6):E13-6. doi: 10.1177/1076029610378502. Epub 2010 Aug 3. [↩]
- La Villa G, Pantaleo P, Tarquini R, Cirami L, Perfetto F, Mancuso F, Laffi G. Multiple immune disorders in unrecognized celiac disease: a case report. World J Gastroenterol. 2003;9(6):1377-1380, Available at: http://www.wjgnet.com/1007-9327/9/1377.asp. Accessed Jan 3, 2005. [↩]
- John ML, Scharrer I. Autoimmune disorders in patients with idiopathic thrombotic thrombocytopenic purpura. Hamostaseologie. 2012;32 Suppl 1:S86-9. [↩] [↩] [↩]
- Kahn O, Fiel MI, Janowitz HD. Celiac sprue, idiopathic thrombocytopenic purpura, and hepatic granulomatous disease. An autoimmune linkage? Journal of Clinical Gastroenterology. Oct 1996;23(3):214-6. [↩] [↩]
- 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. [↩] [↩] [↩] [↩] [↩] [↩]
- Williams SF, Mincey BA, Calamia KT. Inclusion body myositis associated with celiac sprue and idiopathic thrombocytopenic purpura. Southern Medical Journal. Jul 2003;96(7):721-3. [↩]
- Dogan M, Sal E, Akbayram S, Peker E, Cesur Y, Oner AF. Concurrent celiac disease, idiopathic thrombocytopenic purpura and autoimmune thyroiditis. Clin Appl Thromb Hemost. 2011 Nov-Dec;17(6):E13-6. doi: 10.1177/1076029610378502. [↩]
