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Nutritional Repercussions of Celiac Disease

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April 3, 2015

!toastI had the pleasure to present “Nutritional Repercussions of Celiac Disease” to the Boulder County Celiac Association this past August. Celiac Disease and gluten intolerance are very important to me, as I was diagnosed gluten intolerant during a stressful period in Chiropractic College and my grandfather suffered from Parkinson’s disease brought on as a complication from Celiac Disease. Although gluten is becoming a household word, many people including doctors are not aware of the complexity and seriousness of being gluten intolerant or Celiac. It is my hope that you will gain insight into your condition and be empowered to make changes that will improve your quality of life.

Gluten intolerance is ranked as the most common genetic disorder in the United States making it one of the most common lifelong disorders a physician will encounter. Unfortunately, for every one patient diagnosed there are 8 others whose symptoms are not overt and therefore are misdiagnosed. This is because Celiac is thought of as a gut condition; however celiac and gluten sensitivity affects almost every system in the human body from skin and teeth to the liver and brain.

The consequences of intolerance have dramatic repercussions as described in a 2005 Alimentary article: “Children identified, but never put on a gluten-free diet, as adults have a significantly higher percentage of auto-immune disorders, osteoporosis, dental enamel defects, alcohol intake, cigarette smoking, sexual habits and lower neo-natal weight in their children with subsequent shorter breast-feeding time”. Furthermore, gluten “sensitivity” is nothing to shake a stick at according to a 2009 JAMA article: “looking at 30,000 patients, there was a 39% increased risk of death in those with Celiac Disease, a 35% increased risk of death in those with Gluten Sensitivity but no CD, and a 72% increased risk of death in those with gut inflammation related to gluten. It is shocking to think of the patients who have been told “it’s just a mild elevation in antibodies”, or “try eating smaller amounts and we’ll see how you do” after reading that article!

One of the most important take home messages I feel is that according to a 2001 Neurology article, Gluten sensitivity can be primarily and at times exclusively a neurologic disease. Specifically, the most common neurologic symptoms I encounter and this article indicates are: 1) Fatigue & Depression 2) Headaches (especially migraines) 3) Peripheral neuropathy (unusual symptoms in the extremities) 4) Behavioral disorders, and in my personal clinical opinion 5) Brain Fog or Fuzzy Headed. It is known that far fewer celiacs achieve university degrees or higher paying jobs.

Additionally, behavioral disorders in children and adults are common and have become a passion of mine. The standard treatment are schedule II narcotics which have potentially life altering side effects. ALL children diagnosed with ADD/ADHD showed a significant improvement in their behavior and functioning after 6 months on a gluten-free diet according to the Journal of Attention Disorders, 2006. Results like these are unheard of in medicine, making this finding very exciting! Although it can sound daunting to remove gluten from a child’s diet, knowing that they will perform better in school and live and longer, healthier and more prosperous is comforting.

The incidence of celiac disease increased by 400% in the past 50 years!

Why? To understand, we must know three things about all auto-immune diseases: There is an environmental trigger, genetic susceptibility and a gut abnormality (Surprises From Celiac Disease, Scientific American Aug 2009). Triggers can range from stress, gastro-intestinal infections, dysbiosis (poor gut bacteria ratio), trauma/child birth, inadequate vitamin D, lectins or early exposure to gluten, enzyme deficiencies, NSAIDS, steroids, anti-biotics, and excessive alcohol consumption. Our gut mucosal barrier called secretory IgA depends on a tightly regulated stress hormone called cortisol. If the body fails to adapt to stress, that barrier may be weakened until the stress is addressed and the hormone is balanced. Gut infections are very common in the United States. Helicobacter Pylori is estimated to reside in 80%+ of Americans. Additionally, viruses, bacteria, molds and fungi may cause inflammation and toxicity, which create a vicious cycle with gluten in the mix!

Genetics of course play a central role in celiac disease. Currently, there are two genes commonly connected to celiac disease: HLA-DQ2 & HLA-DQ8. Most genetic tests will address these two; however they are not 100% sensitive since all genes coding for celiac disease and sensitivity are not yet known. A diagnosis of Celiac can be frightening, but also a relief. It’s great to know what’s wrong, but it’s challenging to adhere to a strict diet.
Yet that diet is the glimmer of hope to improved quality of life. Unfortunately, the gut is often damaged from years of gluten consumption, causing wide spread vitamin deficiencies including: A,E,D,K,B6,B12 zinc, selenium, calcium, magnesium, carnitine and fatty acids. Signs are the body’s way of showing deficiencies. A larger forehead (vertical dimension) indicates long-term gluten intolerance.

Additional signs are white spots or lines on nails or teeth, rashes on the extremities, dry eyes, night blindness, bruising easily, and rough red spots on the back of arms. Even if you feel “fine” and do not notice these signs, the June 2003 New England Journal of Medicine indicated that patients with celiac disease should be treated, whether or not they have symptoms or associated conditions!

With a strict gluten free diet and the coaching to maintain this lifestyle plus a functional medicine workup anyone can turn their life around! Nutritional deficiencies can be a challenge for anyone’s health, but with modern diagnostics and a thorough history and examination your health can begin to turn around. A chain is only as strong as its weakest link and a celiac has a long road to making sure their health is strong and robust.

Thank you for letting me educate you a little more on celiac disease and gluten sensitivity and remember, everything we learned about is reversible or preventable – it only requires your determination and willingness to let your health soar.

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