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?
Pitting edema. Right photo shows that indent remains from pressing. Courtesy wikimedia.
What Is Edema?
E dema 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?
S ucrose 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?
This will be the fifth year this Examiner is attending Expo West in Anaheim, California and each year is more productive, fun, and exciting than the last. Attending as a media representative for Examiner.com means that public relations firms send information on their client’s new gluten-free products in advance. It tends to make one a little giddy, to say the least, when learning about so many new and innovative gluten-free products.
Expo West is the largest natural products expos in the United States and one of the best places to launch a natural product. Last year it saw 2,568 vendors from 102 countries and more than 65,000 attendees. That represents a lot of square footage to walk, which is how the event can be overwhelming and utterly exciting at the same time.
Here are some great tips compiled over the years to make Expo West an enjoyable experience and a productive event:
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?
My fiancee and I like to cook. We like being healthy and since we hate unnecessary pain and suffering, we avoid cross contamination. As a result, we tend to eat mostly healthy, tasty, homemade meals.
While we love cooking, we have busy lives and hate cleaning up. Every once in awhile we both wish we could just order a pizza. In fact, we were just talking about it the other day.
Pizza Hut must have heard us talking because they just launched their Udi’s Pizza Sales today! And they deliver!
Here is what Pizza Hut posted on its website today:
For some time, we’ve seen you guys do all sorts of unique and inventive things to eat pizza. From your special homemade version to cauliflower crusts to zucchini pizza boats, we’ve been impressed with your pizza spirit. But we knew you were still missing out on the simple joy of ordering pizza and having it arrive at your door. So we got together with our friends at Pizza Hut and came up with a solution.
Since we’ve shared this announcement, we’ve been listening to all of your feedback. We’re so happy to see your interest and anticipation, but we’ve also been tracking your biggest concerns and questions. Here are answers to some of the most common questions we are seeing.
Now that I am recently self-employed I have been spending my first week of freedom melting in my house. I was tempted to go to Barre class twice in one day because it was a nicely air conditioned environment. I would have really regretted that one. I can only do so much shaking and pulsing…
I have been trying out a few new meatless options for my vegan/vegetarian clients and honestly, it hasn’t been as tough as I had thought it would be! These meatless quinoa meatballs are quite a tasty alternative to the original meatball. They are just as filling, hold together well, and have great texture. I bet even the biggest meat lovers would swoon for these meatless ones.
Last weekend I made 6 sandwiches using Udi’s gluten-free whole grain bread for a picnic with friends. One of my friends mid-meal asked “CC, how are you eating this?!” When I explained the bread was gluten-free, she was shocked! Although there are a ton of great gluten-free options out there, sometimes I find myself craving something from back in my gluten-eating days that I just can’t satisfy with gluten-free alternatives. What do you do when you crave something that doesn’t have a gluten-free equivalent?
You make it happen!
Before going gluten-free one of my favorite pastries was the Crumble Cake at Starbucks. I haven’t seen any pre-made products out there that even come close to this glorious baked delicacy. Last weekend I decided to try and make it and to my surprise, it turned out to be a totally satisfying gluten-free replica!
Arrows Show Abnormal Movement of Gastric Acid in Gastroesophageal Reflux Disease.
What Is Gastroesophageal Reflux Disease (GERD)?
G ERD is an upper digestive disorder that is characterized by a decrease in lower esophageal sphincter pressure (LES,) which allows the abnormal reflux or backflow of stomach contents into the esophagus. It is also called erosive esophagitis or reflux esophagitis and is the most common disorder of the esophagus.
The esophagus is a muscular tube that transports swallowed substances to the stomach. It begins at the cricoid cartilage (Adam’s apple) as a continuation of the pharynx and ends at the lower esophageal sphincter (LES).
The lower esophageal sphincter is located at the junction of the esophagus and the stomach. It functions like a circular band to tighten after food is ingested in order to prevent its going back up the esophagus.
Q: How does reflux damage the esophagus?
A: Damage to the lining of the esophagus is induced by the caustic, chemical action of acid and pepsin in gastric juice and, in severe cases, also bile salts, that back upwards from the stomach through an impaired LES. Gastric acid combined with pepsin or bile salts seems to be more harmful to the esophageal epithelial layers than gastric acid alone.1
Pepsin is normally produced by the stomach to dissolve protein in swallowed food. Unfortunately, when the esophagus is inflamed, pepsin will act on it to break down the protein in its sore wall. These sores are called erosions.
Importantly, refluxate to the esophagus in patients with acid suppression therapy is different from those in patients without. Higher levels of secondary bile acids are detected in patients with acid suppression therapy. Even if acid suppression is successful, weakly acidic reflux with bile acids can damage the esophagus.1
Damage starts at the luminal surface (inside where food passes through) of the squamous epithelium (tough surface cells) and progresses through the underlying layers into the submucosa.
One of the primary functions of the esophageal epithelium is to protect the underlying tissue from mechanical and chemical damage by acting as a barrier. The epithelial layers of the distal esophagus need to withstand reflux from the stomach and its contents. When the epithelium fails to protect the underlying tissue from this damage, it leads to erosions, esophagitis, and may lead to Barrett’s esophagus.1
Barrett’s esophagus and esophageal small cell cancer are severe complications of GERD that can be fatal.
GERD can result from too much, or more commonly, too little stomach acid.
What Is Gastroesophageal Reflux Disease (GERD) In Celiac Disease and/or Gluten Sensitivity?
Sources:
Chen X, Oshima T, Tomita T, Fukui H, Watari J, Matsumoto T, Miwa H. Acidic bile salts modulate the squamous epithelial barrier function by modulating tight junction proteins. Am J Physiol Gastrointest Liver Physiol. 2011 Aug;301(2):G203-9. doi: 10.1152/ajpgi.00096.2011. Epub 2011 May 26. [↩] [↩] [↩]
O bnoxious gas, or flatus, is gas that is not only offensive when passed but also lingers in the air longer than ordinary gas does.
Gas is a natural digestive product within the colon that is composed mainly of hydrogen and carbon dioxide gases. These gases are given off in the necessary bacterial breakdown of undigested fermentable food entering the colon from the small intestine.
Q: What makes gas obnoxious?
A: The production of obnoxious gas depends on the type and quantity of undigested food residue that is passed into the colon from the small intestine, dysfunctional motility instead of normal peristalsis, and dysbiosis. Dysbiosis is the condition of having unhealthy or insufficient populations of microbes responsible for digesting (fermenting) foodstuffs in the lower gut or colon.
Gases produced by intestinal microbes may modulate intestinal motor function (muscle movement) in individuals with functional bowel disease. Methane, produced by enteric bacteria in the human gut, is associated with slowed intestinal transit and constipation.1
What Is Obnoxious Gas In Celiac Disease and/or Gluten Sensitivity?
Sources:
Jahng J, Jung IS, Choi EJ, Conklin JL, Park H. The effects of methane and hydrogen gases produced by enteric bacteria on ileal motility and colonic transit time. Neurogastroenterol Motil. 2012 Feb;24(2):185-90, e92. doi: 10.1111/j.1365-2982.2011.01819.x. Epub 2011 Nov 20.
Methane is produced in the colon by intestinal methanogens (microbes) that metabolize hydrogen, one of the end products of normal anaerobic (meaning without oxygen) bacterial fermentation. Fermentation of the undigested starchy part of carbohydrates produces hydrogen in the intestine, which is the food for methane production by intestinal methanogens.
Hydrogen and methane are excreted in the flatus and in breath giving the opportunity to indirectly measure their production using breath testing. ((Triantafyllou K, Chang C, Pimentel M. Methanogens, Methane and Gastrointestinal Motility. J Neurogastroenterol Motil. 2014 Jan;20(1):31-40. Epub 2013 Dec 30. [↩]
This will be the fifth year this Examiner is attending 
