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Constipation, Chronic

Constipation in a young child as seen on X-ray. Lowest circle shows hard feces in the pelvis. Source, James Heilman, MD.

What Is Chronic Constipation?

[dropcap]C[/dropcap]hronic constipation is an intestinal motility disorder characterized by abnormal stool formation, consistency, and evacuation.

Motility disorder means the normal rhythmic movement of intestinal muscles, called peristalsis, that moves food matter through the gut is hampered or dysfunctional.

Studies show that methane gas present in the colon induces constipation by delaying transit time, which is the time it takes for stool to pass through the colon.

Researchers investigating the relationship between methane and constipation found that methane positivity was detected in 75% of patients with slow transit, 44% of patients with normal transit and and 28% of the patients who were controls. However, methane positivity was not related with stool consistency.1

Other researchers investigating the total amount of methane produced found that there was significantly more methane production in patients with constipation (21.1 ppm vs. 6.1 ppm, respectively) than in controls without constipation.2

Q. How does methane get into the colon?

A. 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 substrate (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. Methane is detected in 30%-50% of the healthy adult population worldwide.3

Other common causes of constipation include not getting enough exercise, not drinking enough fluids, not eating enough fiber in the diet, not eating foods that supply microbes needed by the colon (probiotics), not eating foods that nourish the good microbe population (prebiotics) and supply minerals needed for healthy movement of stool, and food sensitivities. Too much cows milk is a common cause of stool that forms into balls.

Who is Affected in the General Population? Chronic constipation is a remarkably common and costly condition that can negatively impact the quality of life and result in a major social and economic burden. Based on the definition, either self-reported or using Rome criteria, chronic constipation can affect up to 27% of the population. There is strong evidence that constipation occurs more frequently in women.4

What Is Chronic Constipation In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Triantafyllou K, Chang C, Pimentel M. Methanogens, Methane and Gastrointestinal Motility. J Neurogastroenterol Motil. 2014 Jan;20(1):31-40. Epub 2013 Dec 30. [↩]
  2. Triantafyllou K, Chang C, Pimentel M. Methanogens, Methane and Gastrointestinal Motility. J Neurogastroenterol Motil. 2014 Jan;20(1):31-40. Epub 2013 Dec 30. [↩]
  3. Triantafyllou K, Chang C, Pimentel M. Methanogens, Methane and Gastrointestinal Motility. J Neurogastroenterol Motil. 2014 Jan;20(1):31-40. Epub 2013 Dec 30. [↩]
  4. Sanchez MI, Bercik P. Epidemiology and burden of chronic constipation. Can J Gastroenterol. 2011 Oct;25 Suppl B:11B-15B. [↩]

Dementia

DementiaWhat Is Dementia?

[dropcap]D[/dropcap]ementia is the term used to describe a group of symptoms that show significant deterioration of an individual’s intellectual and social abilities.

The deterioration in intellectual function is progressive and is characterized by memory and cognitive impairment involving deficits in reasoning, judgment, abstract thought, comprehension, learning, use of language, and task execution.

Some types of dementia can be reversed,  while most types of dementia are degenerative or nonreversible.

Q: What causes dementia?

A: There are  many differing causes of dementia.  Here are some causes according to nonreversible and reversible:

  • Nonreversible dementia may not be turned back due to these conditions:
  • Alzheimer’s disease is the most common type of degenerative dementia caused by abnormal protein structures in certain areas of the brain. 
  • Lewy body disease is a leading cause of dementia in elderly adults.
  • Vascular dementia due to many small strokes.
  • Medical conditions: Huntington’s disease, multiple sclerosis, infections that can affect the brain, such as HIV/AIDS and Lyme disease, Parkinson’s disease, Pick’s disease, and progressive supranuclear palsy.
  • Reversible dementia may be stopped or reversed if these conditions are found soon enough:
  • Brain injury.
  • Brain tumors.
  • Chronic alcohol abuse.
  • Changes in blood sugar, sodium, and calcium levels.
  • Changes that can occur with celiac disease, diabetes, thyroid disease, and other metabolic disorders.
  • Nutritional deficiencies.
  • Use of certain medications, including cimetadine and some cholesterol-lowering medications.1

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

Sources:
  1. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001748/ [↩]

Muscle Spasm And Muscle Cramps 

Muscle spasm and cramping in celiac disease and gluten sensitivity symptomWhat Are Muscle Spasm, Muscle Cramps?

[dropcap]M[/dropcap]uscle spasm and muscle cramps are  disorders of muscle function caused by painful involuntary contractions of affected skeletal muscles characterized by limited movement.

Q: What is the difference between muscle spasm and cramps?

A: Cramps are stronger and more painful than spasms, occurring while the muscle is in its most shortened state.

Skeletal muscles are those that move the body skeleton to do work as we choose. Examples are muscles that move the mouth, arms,  hands, legs, and feet.

What Are Muscle Spasm, Muscle Cramps In Celiac Disease and/or Gluten Sensitivity?

Chronic Fatigue / Lassitude / Tiredness

Chronic FatigueWhat Is Chronic Fatigue?

[dropcap]C[/dropcap]hronic fatigue or lassitude is a state of weariness not relieved by rest and the inability to do normal physical or mental work.

Q: What are causes of chronic fatigue?

A: Chronic fatigue can be a feature of many disorders including nutritional problems like poor diet or malabsorption, sleep problems, systemic conditions like anemia or heart disease, respiratory disorders like COPD or asthma, infectious disease like tuberculosis, endocrine disorders like diabetes, autoimmune disease like thyroid disease, and cancer.

Fatigue greatly reduces quality of life in all aspects including the desire and ability to socialize and find fullfillment in new and interesting ways.

What Is Chronic Fatigue In Celiac Disease and/or Gluten Sensitivity?

Muscle Wasting 

muscle wastingWhat Is Muscle Wasting?

[dropcap]M[/dropcap]uscle wasting, or atrophy, is a muscle disorder resulting from the loss of muscle tissue which is characterized by thin muscles that have reduced strength and endurance.

What Is Muscle Wasting In Celiac Disease and/or Gluten Sensitivity?

Muscle Weakness 

Muscle fiber anatomy. Courtesy NIH.
Muscle Fiber Anatomy. Courtesy NIH.

What Is Muscle Weakness?

[dropcap]M[/dropcap]uscle weakness is the impaired status of muscle function characterized by decreased or low muscle strength and inability to perform normal work such as lifting a pot off the stove.

Q: How do muscles work?

A: Muscles do their work by contracting or shortening. For example, to move the foot up and down at the ankle, muscles attached to the foot by tendons must contract to shorten or relax to return to their resting length. Calf muscles contract to point the foot down (flexion) while the shin muscles relax (extension).  For the foot to point up, calf muscles relax while the opposing shin muscles contract.

Each muscle is made up of individual muscle fibers. A muscle fiber is a long cylindrical cell that contains many nuclei, mitochondria, and sarcomeres. Each muscle fiber is surrounded by a thin layer of connective tissue called the endomysium.

Approximately 20–80 of these muscle fibers are grouped together in a parallel arrangement called a muscle fascicle or fiber bundle that is encapsulated by a perimysium. A distinct muscle is formed by enveloping a large number of muscle fascicles in a thick collagenous external sheath extending from the tendons called the epimysium.1

Muscles fall into three types:

  • Voluntary muscles.  These muscles, also called skeletal, we can control by will. Voluntary muscles function by contracting their fibers to draw one part of the body toward another in flexion while opposing muscles that extend or pull a body part away from another. They move our bones to perform activities such as walking to get somewhere, chewing to eat food, lifting to do work, and moving the eyeball to look at something.
  • Involuntary muscles. These muscles work independently of our conscious control. They are needed for internal organs, sphincters, and other parts to do their work, such as peristalsis in the gut that must function at all times to digest and move food, the squirting of bile juice into the duodenum by the Sphincter of Odi in the presence of fat eaten, and action of the pupil to see.
  • Cardiac muscles. These muscles are specialized to keep the heart functioning at all times.

  Muscle weakness can involve all types of muscles.

What Is Muscle Weakness In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. http://www.ncbi.nlm.nih.gov/books/NBK57140/ [↩]

Peripheral Neuropathy 

What Is Peripheral Neuropathy? [dropcap]P[/dropcap]eripheral neuropathy is a syndrome involving damage to one or more peripheral nerves characterized by impaired nerve transmission. Peripheral nerves are nerves of the body outside the brain and spinal cord. Q:… 

Apathy

Apathy celiac disease symptomWhat Is Apathy?

[dropcap]A[/dropcap]pathy is an abnormal emotional state that is characterized by indifference to things which others find interesting, moving or exciting, and diminished motivation to perform regular daily activities.

The neural mechanisms of apathy are postulated to involve the brainstem and forebrain circuits that regulate goal-directed behavior.1

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

Sources:
  1. Marin RS. Apathy: Concept, Syndrome, Neural Mechanisms, and Treatment. Semin Clin Neuropsychiatry. 1996 Oct; 1(4):304-314. [↩]

Inability to Concentrate 

2007_Pioppi064What Is Inability To Concentrate?

[dropcap]I[/dropcap]nability to concentrate is a mental dysfunction characterized by trouble fixing the mind on one subject to the exclusion of all other thoughts.

What Is Inability To Concentrate In Celiac Disease and/or Gluten Sensitivity?

Anxiety, Chronic

AnxietyWhat Is Anxiety?

[dropcap]A[/dropcap]nxiety or worry is a distressing emotional state of mind or mood that is characterized by a vague uneasiness, unpleasant feelings of apprehension or anticipation of danger and by interference with normal functioning, ranging from mild qualms and easy startling to occasional panic.

Q: What causes anxiety?

A: Anxiety can be a normal response to stress such as making an important decision, illness, divorce, problems at work or preparing for an exam.

In a dangerous situation, profound physiological changes rapidly prepare us for a “fight or flight” response by release of adrenalin hormone. Adrenalin speeds up metabolism to make available quick energy, tightens muscles in readiness, and speeds up the heartbeat and breathing so that more oxygen is made available to the brain and muscles.

Anxiety becomes a maladaptive disorder when it is excessive, unrealistic, or not provoked and impairs the ability to lead a normal life.

Anxiety that is part of a person’s personality is called “trait anxiety.” Anxiety that comes and goes is “state anxiety,” as in state of mind, and is usually due to unresolved stress or an underlying health problem.

What Is Chronic Anxiety in Celiac Disease?