Wednesday, May 18, 2011

DON’T BE A GLUTTON FOR GLUTEN

There is yet no cure for Celiac Disease which is vastly under diagnosed and takes an average of 11 years between the first appearances of bowel symptoms until it is identified. Adding insult to injury, it often remains silent in the intestine while extra intestinal problems (headaches, arthralgias, thyroid problems and liver abnormalities) are occurring. To date there is no help for this malady other than completely avoiding this protein found in wheat and other grains, (the acronym B.R.O.W.S.: B for Barley, R for Rye, O for Oats, W for Wheat and S for Spelt). In the future, several medicines will be available to denature some of this protein that incidentally slips in with other foodstuffs. Still there is no long lasting for those who consume gluten. Much controversy exists in the literature with gluten allergy, sensitivity and true Celiac Disease. The three criteria for the disease by most knowledgeable physicians are a genetic predisposition, consumption of gluten and a triggering event of a physical or emotional nature.

To document the diagnosis, blood anti-transaminase, anti-myelysin and anti-gliadin studies are preformed. But they are only positive if the patient has significant bowel disease when the blood is drawn and he/she has been consuming gluten on a regular basis. The markers of HLA-DQ2 or HLA-DQ8 haplotype, which show the genetic predisposition can also be tested, but are more expensive and do not guarantee that the patient really does have the disease. According to Ken Fine, et al. (The prevalence and causes of chronic diarrhea in treated celiac sprue. Gastroenterology 1997; 112:1830-1837) the most cost effective test to diagnose celiac disease is an anti-gliadin stool test while the suspect is consuming gluten. This is the test we used to diagnose and follow the treatment results .

BRALY'S SIGN: A visible trait of Hashimotos Thyroid Disease which is common in Celiacs was first noted in Poland in 1953 and presented to the Western Europe by the English Gastroenterologist, James Braly, MD. The majority of Celiacs have a foreshortened 5th finger now designated as Braly’s Sign. (J Pediatric Gastroenterology and Nutrition 2000; volume 31 (Suppl.3): S29. New England Journal of Medicine, August 18, 1999). A positive sign is that the end of the fifth finger is shorter than the last joint of the ring finger. We used this external marker as a hallmark of the disease also in our study. In the combined experienced of the two of us and another colleague, Susan Solomon, a clinician in Raleigh N.C. we have found this marker positive in almost 85% of Celiacs that were either biopsied proven or had the positive genetic marker of the disease.

HYDROGEN BREATH TEST: This is an inexpensive, paid by insurance study that is a presumptive assessment for intestinal disease such as gluten intolerance. Actually, it detects bacterial overgrowth in the small intestine. This is common in intestinal diseases in which the mucosa of the intestine is compromised like celiac, but also small intestinal diverticulosis, abnormal flora, parasites and previous surgery where the usual anatomy of the intestine has been changed. An example of this is bypass surgery for weight loss. Also if the intestine cannot make the enzymes to break down food stuff it also causes abnormal gases due to the fermentation from normal bacteria. Lactose intolerance is an illustration.

Normally there should be NO hydrogen in the breath since the bacteria and the enzymes and the anatomy is doing its job. But if something is awry then hydrogen which is normally produced in minute amounts goes up. Gastroenterologist picked the cut point of 10 parts per million or more to be abnormal. The test is done by holding one's breath for 30 seconds then exhaling through a carboard tube into a special handheld device. In 20 seconds, the results are apparent.

9 comments:

  1. Oats do not contain gluten, unless they've been contaminated by wheat equipment. But great to know!

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  2. This has sparked debate amongst my family. Can you please advise which knuckle is considered the last knuckle? The one closest to the fingernail or furthest from the fingernail? thanks!

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  3. See this link: https://drchadedwards.com/1439/what-your-hands-can-tell-you-about-your-food/

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  4. but the 85% number means nothing unless you compare it to the general population. If it is 35% then WOW, but if it is 83% do we really see an indicator of celiac disease. I need all the numbers. I like data.

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  5. I can't find either of the articles you reference for braly's sign - can you provide a direct link?

    (J Pediatric Gastroenterology and Nutrition 2000; volume 31 (Suppl.3):S29. NEJM, August 18, 1999).

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