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Obesity

KONICA MINOLTA DIGITAL CAMERAWhat Is Obesity?

[dropcap]O[/dropcap]besity is an inflammatory metabolic disorder that is characterized by body mass index greater than 30% resulting from excessive body fat stored in adipose tissue.

Q: What is body fat?

A: Body fat is part of the body that functions as a reserve of stored energy. It is composed of fat cells, called adipocytes, having thin membranes between these cells. Adipocytes expand to store fat and shrink as fat is released as needed into the bloodstream for other body cells to use for metabolizing energy.

Each adipocyte contains a drop of triglyceride which is a type of lipid (fat). Triglycerides are a normal component in the bloodstream and, as such, are transported wherever needed as a form of energy. Excess triglycerides are the form of fat that is stored.

Initially, fat that is eaten in the diet is changed by digestive enzymes into the triglyceride form which is a molecule composed of three fatty acids and glycerol. Triglycerides are then absorbed through the small intestinal wall to be delivered to the liver. Of note, the liver can make triglycerides from excess protein and carbohydrates eaten in a meal, especially sugar and alcohol. The liver on the other hand makes cholesterol from triglycerides.

Triglyceride levels in the blood generally increase as weight increases. It is thought that an elevated blood triglyceride level hampers the body’s ability to feel full or satisfied with food that is eaten. Elevated triglyceride levels also increase the risk of clot formation because they cause the blood to become thicker. A normal triglyceride blood level is 150 mg/dL.

The causes of obesity are complex and varied. Those related to gluten sensitivity are discussed below.

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

Anemia, Iron Deficiency

Red Blood Cell Comparison. Courtesy medindia.com
Red Blood Cell Comparison. Courtesy medindia.com

What Is Iron Deficiency Anemia?

[dropcap]I[/dropcap]ron deficiency anemia is a blood cell disorder that is characterized by formation of small, pale red blood cells, causing tissue hypoxia. Hypoxia is the inability to meet the demands of the body for oxygen.

Q: Why do small, pale red blood cells cause tissue hypoxia?

A: Small, pale red blood cells (erythrocytes) cause tissue hypoxia because they are not able, as do normal erythrocytes, to pick up adequate oxygen from the lungs and carry it to cells that use oxygen.

Red blood cell production and function are dependent on a sufficient level of iron in the body and also the ability to use available iron to make hemoglobin in red blood cells.

Hemoglobin is a protein that binds oxygen in red blood cells to be carried by the bloodstream to cells throughout the body. In iron deficiency anemia,  hemoglobin in females is below 12.5g/dl (normal range is 12.5 to 16g/dl) and in males it is below 13.5g/dl (normal range is 13.5 to 17.5g/dl).

Iron must be obtained from the diet, since the body cannot make it, but there are various factors that can interfere with absorption and use in the body, causing anemia. Iron absorption from the gut first requires ionization, or gaining a positive electrical charge, in the strongly acidic environment of stomach juice. Ionized iron, only, can be absorbed in the duodenum, which receives the acidic contents of the stomach before it is neutralized further along.

Dietary iron can be heme or non-heme depending on the food source. Heme iron obtained only from animal food sources is absorbed into the bloodstream by active transport across the brush border (microvilli) which cover the multitudinous villi of the small intestinal lining.

Non-heme iron obtained from plants must bind with apoprotein after entering the enterocyte (surface cell of small intestinal lining) to be ferried to the underlying basolateral membrane and exited by active transport into the bloodstream.

Frequently, chronic anemia due to iron deficiency is accompanied by increased platelets, and this thrombocytosis resolves with iron repletion (normal iron level). Conversely, in severe iron deficiency anemia, patients may have thrombocytopenia (low platelets), which also resolves with iron therapy.1

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

Sources:
  1. Koury M and Rhodes M. How to approach chronic anemia. Hematology Am Soc Hematol Educ Program. 2012;2012:183-90. doi: 10.1182/asheducation-2012.1.183. [↩]

Tuberculosis – Increased Susceptibility 

Bacteria that causes tuberculosis. Courtesy Wikimedia.
Bacteria that causes tuberculosis. Courtesy Wikimedia.

What Is Increased Susceptibility To Tuberculosis?

[dropcap]T[/dropcap]uberculosis (TB), is an infectious disease caused by a bacteria called mycobacterium tuberculosis. It is characterized by chronic bacterial infection most commonly affecting lungs that develops in stages.

Increased susceptibility to tuberculosis menas the person’s defense mechanisms against developing infection are inadequate. Tuberculosis may be dormant or active.

Q: What happens in active tuberculosis?

A: Active tuberculosis  produces inflammation and formation of tubercles, necrosis (death of tissues), abcess, fibrosis, and calcification. Calcification is the body’s action to encapsulate the bacterial invasion. Active tuberculosis is life-threatening and may result in death.

About one third of the world’s population is infected with tuberculosis bacteria. In 2012 the number reached a staggering 8.6 million people. Of these, 1.3 million people died from tuberulosis.  About 95% of tuberulosis deaths occur in low- and middle-income countries and it is among the top three causes of death among women aged 15 to 44.1

People with weakened immune systems have a much greater risk of falling ill from tuberculosis. For example, a person living with HIV is about 20 to 30 times more likely to develop active tuberculosis.2 The combination of tuberculosis, HIV coinfection, and malnutrition has been commonly termed as “triple trouble.”3

What Is Increased Susceptibility To Tuberculosis In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. http://www.who.int/features/factfiles/tb_facts/en/index.html [↩]
  2. http://www.who.int/features/factfiles/tuberculosis/en/ [↩]
  3. Steinbrenner H, Al-Quraishy S, Dkhil MA, Wunderlich F, Sies H. Dietary selenium in adjuvant therapy of viral and bacterial infections. Adv Nutr. 2015 Jan 15;6(1):73-82. doi: 10.3945/an.114.007575. Print 2015 Jan. [↩]

Iron Deficiency

ferritinWhat Is Iron?

[dropcap]I[/dropcap]ron is an essential mineral that is required for normal body function.

Almost two-thirds of iron in the body is found in hemoglobin, the protein in red blood cells that carries oxygen to tissues. Smaller amounts of iron are found in myoglobin, a protein that helps supply oxygen to muscle, and in enzymes that assist biochemical reactions.

Iron is also found in proteins that store iron for future needs and that transport iron in blood.

Q: How are iron stores regulated?

A:Iron stores are regulated by intestinal iron absorption.1That is, whenever iron is needed, more iron is absorbed than when iron is sufficient. This mechanism prevents excess iron in the body which is harmful.

In the brain, iron is necessary to ensure oxygenation and to produce energy in the cerebral parenchyma (via cytochrome oxid. ase), and for the synthesis of neurotransmitters and myelin.

Iron concentrations in the umbilical artery are critical during the development of the fetus, and in relation with the IQ in the child.2

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

Sources:
  1. http://ods.od.nih.gov/factsheets/Iron-HealthProfessional accessed 12/11/12 [↩]
  2. Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients. J Nutr Health Aging. 2006 Sep-Oct; 10(5):377-85. [↩]

Cataracts

Slit lamp view of cataract in human eye. Courttesy Wikimedia
Slit lamp view of cataract in human eye. Courtesy Wikimedia

What Are Cataracts?

[dropcap]C[/dropcap]ataract is a clouding of the normally clear lens in an affected eye characterized by blurred vision and progressive blindness due to loss of the len’s ability to focus light rays on the retina. Cataracts can occur in either or both eyes.

Q: How does a cataract form?

A: The lens is a transparent, colorless, oval-like structure of the eye made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light coming through the pupil to pass through it to reach the retina where it is recorded. Once an image reaches the retina, it is changed into nerve signals that are sent to the brain.1

In each eye, the lens is enclosed in a capsule that is held in place directly behind the pupil by the ciliary body and the suspensory ligaments. The lens consists primarily of lens fibers that at the periphery are soft, forming the cortis lentis, and in the center are of a harder consistency, forming the nucleus lentis. Beneath the capsule on the front surface is a layer of cells, the lens epithelium. The shape of the lens is changed by the ciliary muscle to focus light rays onto the retina.2

A cataract begins to form when some of the protein clumps together and starts to cloud a small area of the lens. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.3

A cataract is diagnosed by an ophthalmologist, who is a medical doctor specializing in the treatment of eye conditions. The eye examination involves viewing the anterior (front) of the eye by means of a slit lamp microscope. This instrument allows detailed observation of the lens and its supporting structures.

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

Sources:
  1. Tabers Cyclopedic Medical Dictionary. 19th ed. FA Davis Company, Philadelphia, PA. [↩]
  2. Tabers Cyclopedic Medical Dictionary.C 19th ed. FA Davis Company, Philadelphia, PA. [↩]
  3. http://www.nei.nih.gov/health/cataract/cataract_facts [↩]

Nails, Splinter Hemorrhages In

The tiny brown streak is a splinter hemorrhage.
The tiny brown streak is a splinter hemorrhage.

What Are Splinter Hemorrhages In Nails?

[dropcap]S[/dropcap]ubungual (under the nail) splinter hemorrhage is characterized by fragility of the underlying capillaries resulting in bleeding under the nail . Bleeding that results looks like a brown streak or splinter.1

Because the streak of blood is not in the nail but under the nail, it does not grow out with the nail. It can be a feature of vitamin C deficiency which resolves with adequate nutrition.

Nail Anatomy. Nail Anatomy. A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin. Courtesy Wikipedia.org.

A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin. Courtesy Wikipedia.

Splinter hemorrhage can be seen in a diet poor in vitamin C, disorders of food absorption, systemic disease such as psoriasis, nail lichen planus, an aggressive disease that may destroy the nail plate, and endocarditis. Some drugs, such as oral contraceptives, cause vitamin C deficiency.

Who is Affected in the General Population? Both sexes are commonly affected, though it occurs significantly more frequently in males. Where present in females, they were confined to a single digit.2

What Are Splinter Hemorrhages In Nails In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Krause’s Food, Nutrition, & Diet Therapy. 10th Edition. Kathleen Mahan, Sylvia Escott-Stump. 2000. W.B. Saunders Company. [↩]
  2. Monk BE. The prevalence of splinter haemorrhages. Br J Dermatol. 1980 Aug;103(2):183-5. [↩]

Bronchiectasis

Bronchiectasis Image. Courtesy Quizlet.com
Bronchiectasis Image. Courtesy Quizlet.com

What Is Bronchiectasis?

[dropcap]B[/dropcap]ronchiectasis is a pulmonary disorder characterized by chronic dilation of bronchi (main airways) and bronchioles (small airways) with chronic inflammation and swelling, increasing the risk of infection.

In bronchiectasis, mucus produced to trap foreign substances, such as dust and bacteria, builds-up because the ability of airways to move it out is impaired. Normally, hair-like cilia that line airways beat mucus out of the lungs. Loss of this action increases mucus in the airways which increases risk of pneumonia.

The anatomy of airways is likened to a branching tree. The trachea, or windpipe, like the trunk of a tree, branches into two primary bronchi that connect it to the lungs. One bronchus connects to the left lung and the other to the right lung. Each bronchus further divides into smaller bronchi that connect to the lobes. Lobes are large subdivisions of lung tissue: two of the left lung and three of the right lung.

Lobe bronchi divide into smaller bronchial tubes ending in small bronchioles. The ends of bronchioles are surrounded with and attached to tiny alveoli which are air sacs that look like clusters of grapes.

Q: What effect does inflammation have on the lungs?

A: Alveoli are only one cell thick, where oxygen is obtained by the bloodsteam from air breathed into them and carbon dioxide is released from the bloodstream to air that is breathed out of air sacs through the pulmonary tree. Two things happen:

  1. Inflammation  impairs exchange of gases in alveoli, resulting in lack of sufficient oxygen (O2) for body cell functions, called hypoxia, and build-up of carbon dioxide (CO2) in blood, called CO2 retention.
  2. Inflammation narrows passageways, which reduces the movement of air to and from the alveoli, and this puts stress on the right side of the heart.

Bronchiectasis can affect one or both lungs or one segment or multiple segments of a lung. Treatment is with antibiotics, chest physiotherapy and good nutrition.

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

Nosebleeds, Unexplained (Epistaxis)

Epistaxis1[1]What Is Epistaxis?

[dropcap]E[/dropcap]pistaxis, or nosebleed, is a feature of secondary hemostasis (blood clotting) characterized by fragility of a plexus of blood vessels in the antero-inferior septum (just inside nostril) and/or abnormal blood coagulation.

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