Tuesday, April 12, 2011

Gluten Free...Why?

You have probably seen the labels in the grocery store “Gluten Free”, but why? If you have heard the word gluten or wheat insensitivity, you are on the track of celiac disease. Celiac disease, like Vitamin D deficiency is coming into its own on the medical front lately. This disease indeed is not new at all but spans all the way back to the second century! It used to be thought of only as a bowel mal-absorption issue and not all that common but now has been linked to numerous other diseases.

During World War II during periods of food shortages, the symptoms of patients improved once bread was replaced by non-cereal containing foods. There was less diarrhea and abdominal cramping. A doctor by the name of Dicke found that wheat, barely, and rye all could trigger the abdominal pain and foul stool.

Later it was found that the primary problem occurred in the small intestine with inflammation and flattened villie (the fingers of the bowel that are responsible for absorption). There was found to be a genetic factor as well. Celiac disease is genetic disorder (Hla-DQ20) that is triggered by an environmental agent (gluten) in a predisposed individual. There is a strong association between the genetics of celiac disease and type I diabetes.

What are the symptoms? Some common symptoms of the disease include: bulky, foul smelling floating stools, a lot of gas, weight loss, anemia, deficiencies of vitamins such as vitamin D, osteoporosis. These are classic findings. Many, however, are without symptoms at diagnosis.

How do you know if you have it? The best way to make the diagnosis is a biopsy of your small bowel. There are blood tests also that are available. Ask your doctor for an endomyseal antibody test. There is an antibody called IgA that is especially associated with Celiacs.

This disease as noted is much more common than once thought. It was originally thought to be only related to mal-absorption of the bowels. It may be as high as one person in 250 affected. The question arises should everyone be tested even if no symptoms? Possibly.

So, should you be tested? There are four reasons to consider it: 1) the danger of cancer—the risk of cancer associated with Celiacs is not fully known but there is some association 2) the presence of unsuspected nutritional deficiencies (i.e. body not able to absorb nutrients) 3) to association with low-birth weight babies 4) the occurrence of autoimmune diseases such as diabetes and thyroid diseases.

As well, there is a ton data coming in now for associations with this disease with other things such as: arthritis (osteo), iron deficiency (high association), osteopenia/osteoporosis( due to vitamin D and calcium deficiency), kidney disease, risk of cancer-this is under active study, rash:, liver disease including hepatitis, menstrual issues, and perhaps even heart disease.

It is amazing to see the possible links of this disease with all the above! What is just as amazing is to think that all or most of it is treated or even avoided by simply a strict adherence to a gluten-free diet! Even the rash goes away with this diet! That is why I think you should ask your doctor if it makes sense for you to be screened for this disease.


Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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