One of millions of minute structures of the intestinal mucosa that project into the intestinal lumen for the purpose of absorbing passing nutrients into the blood and lymph system. Villus enzymes digest the sugars lactose,… 

What Are Tremors?

[dropcap]T remors are repetitive patterns of involuntary muscle contraction and relaxation originating from disorder in the basal ganglia of the brain. See image of hand tremor (to left) courtesy of Antonio Piedade.

Rythmic shaking may affect various parts of the body including hands, arms, legs, trunk, tongue, or vocal cords.¹

Causes include malnutrition, drug adverse effects especially antipsychotics, environmental toxins, and conditions such as Parkinson disease and thyroid disease, which causes toxic levels of thyroid hormone.

What Are Tremors In Celiac Disease and/or Gluten Sensitivity?

Sources:

1. http://www.ninds.nih.gov/disorders/tremor/detail_tremor.htm [↩]

What Is Depression?

[dropcap]D epression is a mood disorder characterized by absence of cheerfulness, dejection, and loss of interest or pleasure in living, making the person dysfunctional and unable to cope with or perform tasks of daily living.

More than a feeling, this negative psychological status can range from mild to profound and can involve other parts of the body, causing physical problems such as poor digestion, constipation, weight gain or weight loss, mentrual irregularities in females, and impotence in males.

Q: How is depression identified?

A: According to the American Psychiatric Association, depression is a psychic condition that lasts for more than a month and involves four or more of these symptoms:

• Abnormal appetite.
• Diminished ability to concentrate or think properly.
• Feelings of worthlessness.
• Low energy or fatigue.
• Physical inactivity or hyperactivity.
• Sleep disturbances.
• Thoughts of death.

Grief or sadness at the loss of a loved one or a similar event or remorse for sin is normal. However, depression that is prolonged usually involves imbalances of nerve chemicals called neurotransmitters. Imbalances can result from health disorders such as hormonal imbalances, low blood sugar, stress, drug side effects, or nutrient deficiencies.

What Is Depression In Celiac Disease and/or Gluten Sensitivity?

What Is Chronic Dry Eye Syndrome?

[dropcap]C hronic dry eye syndrome is an inflammatory condition of the conjunctiva with inadequate tear production or distribution over the eye surface. It is characterized by surface damage to the conjunctiva, giving the appearance of redness.

This complex condition involves the lacrimal glands, eyelids, and tear film, as well as a variety of eye surface tissues, including epithelial, inflammatory, immune, and goblet cells.¹

Q: What is the conjunctiva?

A: The conjunctiva is the mucous membrane that lines the inside of the eyelids and covers the eyeball surface, also called the white of eye. The conjunctiva has a rich blood supply that can quickly bring microbe fighting cells to prevent invasion and overcome infection.

While infection and inflammation go hand-in-hand, they are not the cause of, but may result from, chronic dry eyes.

Dry eye syndrome develops from poor health of the conjunctiva that is associated with inadequate nutrition and poor quality of the tears that steadily lubricate the eye surface. These tears are called the tear film and are not the same as tears produced when crying or that result from irritating substances such as onions. Blinking spreads the tears that protect the surface from drying and flushes away unwanted matter.

The tear film is made up of three layers: mucous layer produced by goblet cells in the conjunctiva, aqueous (water) layer produced by the lacrimal glands, and lipid (fat) layer produced by the meibomian glands in the eyelids. Dysfunction of any of these layers impairs the the tear film. Without an adequate tear film the conjunctiva becomes dry and inflamed.

When the meibomian glands fail to produce sufficient lipid that is clear and fluid but rather cloudy and thick, the condition is called meibomian gland dysfunction (MGD). The main cause of MGD is hyperkeratinization (thickening of the glands) and its related pathogenesis (for example, ductal dilatation and acinar atrophy). Other disorders such as atopy, pemphigoid acne, rosacea, and seborrhea are related to MGD and may result in a chronic inflammation of the eye surface.²

MGD is “the most underrecognized, underappreciated and undertreated disease in ophthalmic care. It is so common as to be taken as ‘normal’ in many clinical practices,” according to Joseph Tauber, MD, an anterior segment subspecialist and refractive surgeon in Kansas City, Mo.³

Untreated dry eye progresses to xerophthalmia, a condition of extreme drying and thickening of the conjunctiva characterized by hazy, dry cornea. Other causes of dry eye, beside celiac disease, include certain systemic conditions such as Sjogren’s syndrome, an autoimmune disease.

What Is Chronic Dry Eye Syndrome In Celiac Disease and/or Gluten Sensitivity?

Sources:

1. Liu A, Ji J. Omega-3 essential fatty acids therapy for dry eye syndrome: a meta-analysis of randomized controlled studies. Med Sci Monit. 2014 Sep 6;20:1583-9. doi: 10.12659/MSM.891364. [↩]
2. Oleñik A, Jiménez-Alfaro I, Alejandre-Alba N, Mahillo-Fernández I. A randomized, double-masked study to evaluate the effect of omega-3 fatty acids supplementation in meibomian gland dysfunction. Clin Interv Aging. 2013;8:1133-8. doi: 10.2147/CIA.S48955. Epub 2013 Aug 30. [↩]
3. Rethinking Meibomian Gland Dysfunction: How to Spot It, Stage It and Treat It. Linda Roach, PhD. OPHTHALMIC PEARLS. [↩]

What Is Osteoporosis?

[dropcap]O steoporosis is a metabolic bone disorder characterized by diminished bone mass (density) with normal cell appearance but fragile bone strength that prediposes to broken bones, and with high bone turnover.

This condition usually goes undetected until late when loss of height or a bone fracture occurs. In fact, each year  1.5 million fractures mainly of the hip, spine and wrist are attributed to osteoporosis. Compression fractures of vertebrae bones are the most common, accounting for 700,000 cases.

Bone is composed of specialized connective tissue called osseous tissue. Osseous tissue is made up of living bone cells (osteocytes) that are embedded in a hard matrix (framework) of calcified substance.

Bone matrix contains collagen fibers and the minerals calcium phosphate and calcium carbonate, which provide strength to bone. The copper enzyme, lysyl oxidase, is involved in the cross-linking of collagen in forming the framework for depositing calcium and other minerals to build and repair bone.

Q: How do osteocytes function in bone?

A: Osteocytes maintain the health of bone by their metabolic activity in regulating normal bone turnover. Bone turnover is the breaking down and removal of old or damaged bone and rebuilding or remodeling of healthy bone that is ongoing throughout life. The bone formation process takes about 3 months to complete.

Osteoporosis develops from failure of the body to maintain health and to provide bone tissue with adequate nutrition for proper function. Risk factors that can be modified include: low calcium intake, sedentary lifestyle, smoking, drinking alcohol excessively, eating a diet with excessive caffeine, protein, and phosphate, and taking certain medications over a long time such as steroids, thyroid preparations, the anti-convulsive drug phenytoin, aspirin, antacids, anticoagulants, some diuretics, and some chemotherapeutic drugs. See below for a fuller description.

In addition to celiac disease, osteoporosis is associated with advancing age, family history, nulliparity (no pregnancies) and post-menopause in females, certain disorders such as hyperthyroidism, hypogonadism, inflammatory bowel disease like Crohn’s disease, multiple myeloma, anorexia nervosa, and Cushing’s disease.

Bone strength is easily measured by testing bone mineral density (BMD). BMD is evaluated by DEXA scan (dual-energy X-ray absorptiometry).  DEXA at the femoral neck and lumbar spine is considered the gold standard to confirm the diagnosis of osteoporosis.  Results are expressed as T and Z scores. T scores compare the result with a 20 to 40 year old helathy person while  Z scores compare the result with persons in the same age group. Both are measured in standard deviations (SD).

According to WHO criteria (World Health Organization), a T-score of -1 SD or greater denotes normal bone, a T-score between −1 to −2.5 SD denotes osteopenia, and a T-score of −2.5 or more denotes osteoporosis.¹

Treatment is aimed to preserve and increase bone density, minimize symptoms for better quality of life and reduce risk of bone fractures.

What Is Osteoporosis In Celiac Disease and/or Gluten Sensitivity?

The cumulative effects of gluten-induced inflammation, treatment delay, and malabsorption result in lower bone density and bone fragility.²

Sources:

1. Pantaleoni S, Luchino M, Adriani A, Pellicano R, Stradella D, Ribaldone DG, Sapone N, Isaia GC, Di Stefano M, Astegiano M. Bone mineral density at diagnosis of celiac disease and after 1 year of gluten-free diet. ScientificWorldJournal. 2014;2014:173082. doi: 10.1155/2014/173082. [↩]
2. Grace-Farfaglia P. Bones of Contention: Bone Mineral Density Recovery in Celiac Disease-A Systematic Review. Nutrients. 2015 May 7;7(5):3347-3369. [↩]

What Is Unexplained Adult Male Hypogonadism?

[dropcap]H ypogonadism in males is a distressing reproductive disorder characterized by inadequate production of male andogen hormones and/or spermatozoa by the testes.

Q: How do andogens affect reproductive health?

A: Male androgen hormones control the development and maintenance of male sex organs and masculine secondary sex characteristics and are required for health, especially bone health. 

Testosterone is the major andogen hormone. While most of this steroid is produced by the testes, some is also produced by the adrenal glands. In hypogonadism, the testosterone level in blood is 300 ng/dl or below. 

Hypogonadism in men 45 years or older is significantly higher in men with hypertension, hyperlipidaemia, diabetes, obesity, prostate disease, and asthma or chronic obstructive pulmonary disease.¹

Interestingly, a 2014 study by Shortridge et al. on experiences and treatment of men with hypogonadism seeking care found that some symptoms continued despite treatment, and therapy was discontinued at a high rate, which men generally attributed to cost and perceptions of efficacy.² Compare this to the reversal seen in celiac men on gluten free diet.

Who is Affected in the General Population? Prevalence rate of hypogonadism was 38.7% in a study of 2162 primary care patients; 836 were hypogonadal, with 80 receiving testosterone.¹

What Is Unexplained Adult Male Hypogonadism In Celiac Disease and/or Gluten Sensitivity?

Sources:

1. Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006 Jul;60(7):762-9. [↩] [↩]
2. Shortridge EF, Polzer P, Donga P, Blanchette CM, Fang Y, Burudpakdee C, Carswell B. Experiences and treatment patterns of hypogonadal men in a U.S. health system. Int J Clin Pract. 2014 Mar 28. doi: 10.1111/ijcp.12418. [↩]

What Is Refractory Iron Deficiency Anemia In Childhood?

[dropcap]R efractory iron deficiency anemia (IDA) is a microcytic (small cell) type anemia.

It is characterized by formation of abnormally small, pale red blood cells and iron depletion, or inadequate iron content in the body, that does not respond to prescribed treatment with oral iron supplementation as expected.

Q: How is iron content in the body determined?

A: Iron content in the body is determined by measuring the ferritin level in blood. Ferritin is a protein within cells that stores iron and releases it as needed.

According to the World Health Organization (WHO) mild anemia corresponds to a hemoglobin (Hb) of  9.5 g/dL, moderate anemia to a Hb of  8 g/dL but less than 9.5 g/dL, and severe anemia to a Hb of less than 8.0 g/dL.

What Is Refractory Iron Deficiency Anemia In Childhood In Celiac Disease and/or Gluten Sensitivity?

What Is Fecal Occult Blood In Children?

[dropcap]T he presence of fecal occult blood in children is caused by minimal bleeding of less than a tablespoon a day in the gastrointestinal tract which leads to iron deficiency.

Bleeding is abnormal and needs to be corrected by locating the source.

Q: What does occult blood mean?

A: Occult means the small amount of blood in the stool cannot be seen by the eye when inspecting it. Therefore, suspect bleeding is found through a simple test performed on stool because stool would carry the blood away from the site of bleeding.

A fecal occult blood test is inexpensive and can be done at home or in the doctor’s office.  Most types involve smearing a stool sample onto a test card that either contains a chemical that turn blue if blood is present or else requires applying the chemical to the sample.

What Is Fecal Occult Blood In Children in Celiac Disease?

A blockage of the cystic duct, often caused by gallstones.

Abbreviation for deoxyribonucleic acid, the molecule that contains the genetic code for all life forms except for a few viruses. It consists of two long, twisted chains made up of nucleotides. Each nucleotide contains one…