Sunday, February 04, 2007
taking them. If you have good gut health, your immune system is humming and this will help. If you have poor health (gut or other systems), then you might want to read why this may help your immune system!
I typed this for a friend whose child has chronic constipation and a prolapsed rectum, not to mention chronic ear infections and repeated Rs's for antibiotics. I thought it would be useful info for ya'll, too. My gastroenterologist believes EVERYONE should be on them regardless of health status! The doctor who wrote this, concurs.
Here's what Dr. Sherry A. Rogers said in her NO MORE HEARTBURN book I've been reading (this is part of Ch. 3 about "Curing the Most Commonly Missed Caused of Gut Disease" - Candida - sweet cravers listen up!:
Are you obsessed with sweets? Of all the viruses, bacteria, and parasites I've treated in over a quarter of a century, none holds a candle to candida albicans and the secret damage this supposedly harmless yeast can do. Even though Candida can cause symptoms that mimic more diseases than the rest of the uninvited guests to the body, it is still presumed by the medical majority to be a normal part of our intestinal flora. Doctors may even argue that it is harmless unless you are in an extremely compromised state, such as end-stage cancer. But unsuspected Candida albicans is one of the biggest reasons why some people just never get better.
Although Candida albicans is one of the more common types of yeast and we normally house small amts of it in our intestines, if the delicate balance between Candida and the other bugs in the gut is tipped, Candida grows rampantly, which can produce over one hundred different symptoms, beginning in the gut.
The Many Causes of Candida Outbreak
Taking antibiotics that kill off hundreds of types of bacteria but not yeasts, is the most common way to cause a Candida outbreak. With no competition and with Candida leading the way, the yeasts grow wildly, taking control of the gut. Diets high in sugar will also enhance yeast outbreak as can medications like prednisone, birth control pills, and other synthetic estrogens.
Unfortunately, synthetic estrogens are not limited to medication, but can silently sneak into our bodies from toxic chemicals called estrogen mimics used in plastic bottles holding soda, baby formula, and bottled water, as well as from plastic wraps for candy bars and supermarket meats and vegetables. In addition, estrogen mimics can enter our bodies from pesticides that continue to contaminate our food, air, and water (Jobling).
Undiagnosed, It Mimics Any Symptom
Once Candida takes over the gut, it inflames the gut wall provoking much of the gas, bloating, indigestion, alternating diarrhea and constipation, or pain that you may suffer. If the yeast inflames the lower esophagus or stomach, you have burning and heartburn. If the lining of the small intestine is inflamed, carrier, or transport, proteins are damaged, making it more difficult for the gut to absorb vitamins and minerals - with mysterious fatigue and new infections the possible result. Now, with the gut inflamed, putrifactive toxins from the contents of the bowel leak into the bloodstream, prompting aches and pains all over (mysterious fibromyalgia), as well as damaging local nerves in the gut, which leads to constipation. (This is why you'll often see me refer to celiac and possibly candida together as they are so similar!)
Because the inflamed gut can leak large food particles that the immune system has never encountered before, an antibody attack is mounted against them. Suddenly the innocent host of Candida (you!) has food allergies to all sorts of foods that never bothered you before.
But food allergies are only the beginning. As Candida inflames the gut wall, where half the body's detoxification system lies, you may find yourself reacting to perfumes, smoke, cleansers, shopping malls, offices, and chemicals in the environment with runny nose, headache, brain fog, depression, fatigue, dizziness, or aching all over, with pains mysteriously migrating from one spot to another.
Begin with a Suspicion or Diagnosis
For those who are sick of being sick and who wish to determine if they suffer from an outbreak of Candida, forge ahead. Within one month of following the strict program below, you should sense a convincing difference in the way you feel and act. For those who want to play it safe and start with a medical diagnosis, have your doctor order a special stool test to determine if Candida is growing in your gut. (See Ch. 7). Merely get an Rx for the test, call the 800 number of the lab, have the kit sent to you, mail it back, and await your results.
... more great info ... trying to get to the probiotics info ...
Your Anti-Candida Program to Beat the Yeast
Conquering yeast and all the symptoms they cause is a multistage pyramid. You can take all the time you feel you need between stages, from one to several weeks. The steps are:
1. Empty the gut.
2. Start the yeast-free, mold-free, sugar-free diet.
3. Start the probiotics (the good bugs like acidophilus, etc).
4. Start other non-Rx yeast fighters (like garlic, etc).
If this is not sufficient, you will need to enlist the help of your physician:
5. Start Rx Nystatin
6. Start Rx Nizoral, Diflucan, or others (as indicated by culture).
7. Do repeat culture to determine if yeast has been eradicated.
8. See your doctor to determine causes and course for getting rid of any remaining symptoms.
Yeasts Can Make You Drunk Without Drinking
There is one other aspect to Candida that most are unfamiliar with. As a living organism, Candida must rid itself of toxins. I refer more specifically to acetaldehyde, a Candida toxin that some folks may have problems with. In those who do not metabolize and exrete toxins as quickly and efficiently as they should, acetaldehyde is the same chemical that backs up in us if we have too much alcohol to drink. In this regard, one doesn't have to drink any alcohol at all to get the auto-brewery syndrome. With acetaldehyde, the gut bugs will make their own alcohol-like compounds.
In addition to having gas, bloating and indigestion, such folks can appear drunk and disoriented. Or they can have severe mood swings, depression, or even mania. In addition to gut and brain symptoms, acetaldehyde stimulates the chemistry behind cravings, making the very folks who need them the LEAST crave sugars, alcohol, and ferments.
Another paragraph here.
No yeast (incl breads, rolls, pastries, bagels, buns, bisquits, cake, etc)
No mold or fungi (mushrooms)
No fermented foods (pickles, aged, malted, risen or leftovers with mold)
No fermented drinks (apple cider, root beer, soft drinks)
No coffee or teas (incl herbal) - except for green tea
No condiments or commercial salad dressings (mustard, ketchup, Worcestershire sauce, soy sauce, pickles, pickle relish, green and black olives, sauerkraut, horseradish, all vinegars and vinegar-containing foods such as mayo and salad dressings).
No sugar or sugar-containing foods (no sucrose, fructose, maltose, lactose, glycogen, glucose, mannitol, sorbitol, galactose, monosaccharides, polysaccharides, saccharin, asparatame. Safe sugar substitute: stevia. (leaf of shrub).
No cheese. All cheeses contain mold. Almost all dairy products, except for pure unsalted butter and ghee, contain high levels of yeast.
No processed foods. No malt products.
No fruits, including dried and candied fruits, and fruit juices.
Avoid the many drugs that encourage yeast. If your doctor wishes to treat you with antibiotics, be sure there is very good evidence for him/her to do so. If the problem is really allergic or viral, antibiotics do not help. If you must take an antibiotic, stay on the diet and keep taking probiotics like Lactobacillus acidophilus, but stop taking Nystatin and Nizoral to avoid fostering the growth of fungi that could become resistant to them. If possibe, try to avoid all cortison-type drugs as well as oral contraceptives and synthetic estrogens.
FOODS TO EAT!
Meat: beef, veal, lamb, pork, venison, buffalo, and any game animal.
Poultry: chicken, Cornish hen, duck, good, turkey, and eggs (preferably free-range, preferably organic).
Fish and seafood: not breaded, and try to avoid farmed fish.
Vegetables: artichokes, asparagus, beets, broccoli, Brussel sprouts, cabbage, carrots, cauliflower, celery, cucumber, eggplant, garlic, all lettuces and greens, jicama, kohlrabi, okra, all onions, parsley root, parsnips, pea pods, peppers (sweet and hot), radishes, rutabaga, string beans, summer squashes, tomatoes (fresh only), turnips, and zucchini.
Limited veggies: sweet corn, sweet potato, yam, winter squash (acorn, butternut, etc), white potato.
Dried beans and peas (cooked): aduki, black, garbonzo, lentils, kidney, navy, pinto, soy, green peas, lima beans.
and I could go on, but I'm trying to get to the probiotic section after giving the previous perspective! Then she has menus and recipes.
You must put some healthy "good" bugs back in the intestine so that when your yeast program is done, the yeasts do not just regrow, returning you to the ill health you've recovered from. Probiotics, the best way to get healthful competing bugs, also have other beneficial effects contributing to a healthy gut and immune system, and they lower cholesterol, improve your resistance to infections, and make gut cells less prone to cancer.
You can measure ifyou have sufficient levels of the two most common probiotics, or beneficial bacteria, Lactobacillus acidophilus and Bifidus, in the intestines, when you culture the stoold (comprehensive digestive stool assay (CDSA) - as described in Ch. 6).
You can start building your probiotic levels with powder or capsule form. Klaire Laboratory's VitalPlex, one tsp. in water twice a day, or among many to choose from; one to two capsules or one-half to one tsp. should be taken twice a day. Most forms will work best before or between meals, so that the gastric juices do not kill them.
Always test your probiotics by taking a double or triple dose once. If it causes tremendous gas for a few hours, the organisms are alive and growing well in the gut. Then cut back to a dose that does not cause gas. If your probiotic is dead, or your stomach acid is killing them before they get to the small intestine where they live, you are wasting money and should change brands. Although I discuss probiotics in more detail in Ch. 4, the brief review here will get you started.
When you are better, remember that the probiotics are the last thing to stop in the program, outside of the diet. That is because many of the yeast-fighters also kill some of the good bugs. So you need to be sure to continue the probiotics about a month beyond your last yeast-fighter. High levels of the good bugs discourage yeasts from ever showing up again. Also, even though all the reports say that fructo-oligosaccharides (FOS) are safe for folks fighting Candida, I have found a significant number of folks who tell me that FOS definitely makes their Candida symptoms worse. So watch out for this rare event.
Then she talks about yeast-fighters.
Ch. 4 Bugs: The Good, the Bad, and the Deadly
info info ...and then we'll get to:
Not all bugs are bad. Remember, not everyone gets the flu, and not everyone who kisses you when you have a cold catches it. It is not so much the virulence of the bug as it is the faulty resistance of the host. There is another factor besides the strength of your immune system that determines whether or not a bug sets up housekeeping in your gut: competition.
Nature is wonderfully orchestrated with more ingenenious mechanisms than we have yet to fathom. The balance of intestinal organisms that we cannot live without is but one example I don't need to tell you how nasty some of the more than 500 bugs in your stool there are. Just smell it. But they serve to break down your food into smaller, more absorbable particles. There is a beautiful balance here, because such bugs do not cause us to rot until we die. Bacteria and fungi are what turn ashes to ashes, dust to dust.
Pro = for promoting; biotic = life. And that's what probiotics do, promote healthy life in the gut and the whole body. They serve as competition for the bad bugs and keep them under control. Probiotics, or good bugs, also improve the integrity of the gut's immune system, fight cancer, strengthen the detox system, make the gut acidic through the production of lactic acid to promote digestion, produce lactase to promote the digestion of dairy products, lower cholesterol, control the overgrowth of bad bugs like Candida and invading bacteria, and even make B vitamins.
What are the Good Bugs?
Lactobacillus acidophilus is the leader, a normal inhabitant of the large and sm. intestine, mouth, and vagina. Bifidobacterium bifidum, another good bug, accounts for 99 percent of the microflora of the lg. intestine of breast-fed infants, and declines in humans with age. More beneficial bugs are continually discovered, and some are what we call transient residents of the gut, but they still have multiple health benefits, like Lactobacillus bulgaricus and Streptococcus thermophilus, the two bacteria in yogurt.
So what difference do these bugs make for you? In some folks, probiotics can heal the gut, for others they can enhance their resistance to the diarrhea that travelers many times suffer, or they can improve the digestion of foods so much as to reduce food allergies. Remember as well that good bugs compete with and kill bad bugs. It's a simple as that. But every time you take antibiotics, eat a lot of junk food, have vaccinations, go through a period of severe stress, or even use herbs to kill intestinal bugs, you can distort the balance of flora in the gut. Fortunately, like so much else, you have direct control over it.
Next paragraph: take probiotics weeks before going abroad to help prevent diarrhea.
How to Select the Best Probiotics for You:
Make sure they're refrigerated so the live cultures stay alive. Avoid tablets, as the heat generated by pressing a tablet has a greater change of killing the good bugs. Capsules are handy and provide protestion for the probiotics from the harsh acid of the stomach. It is along way to the sm. intestine. For others, a powdered form is better for folks who cannot swallow pills. It would be best to take these between or just before meals, when the stmoach acidity is less stimulated.
Is your probiotic still alive? Is it any good? To find out, take a triple or quadriple dose as you normally would. If you get gas and bloating within a day, the organisms are growing. It will pass.
Then she lists her favorite brands and for what reasons they are good.
Vital-Dophilus (Klaire Labs) contains over 10 billion live Lactobacillus acidophilus (DDS-1) per qtr. tsp. Use one quarter to one tsp, one to 4x/day, just below the point of gas. You don't want to provoke symptoms, but you do want to build up the competeing good flora quickly. For example, if you get extra gas with just half a tsp./day, cut it back to one-qtr. tsp/day. Within time you may be able to tolerate more. It takes several months to develop SUBSTANTIAL flora. The amount of the beneficial flora can be measured at any time with a special stool study, the CDSA. You can mix it in water, and take before or between meals. For folks with too much stomach acid, which kills the organisms, capsule form - with 2.5 billion organisms per capsule -is preferred. The dose again would depend on gas: one to four caps taken 1 to 4x/day. This form can be taken with meals, since the acid will start to dissolve the capsule.
Vital-Plex (Klaire Labs), also in powder or caps, goes a step further, providing 3.3 billion live organisms each of: Lactobacillus acidophilus, Bifido bacterium bifidum (important in colonizing the lg. intestine as well), and Streptococcus faecium (useful in diarrheal diseases) per 1/4 tsp.
Vital-Immune Biotic (Klaire) contains L. acidophilus, Lactobacillus casei, Bifido longum, as well as Lactobacillus rhamnosus. This one is particularly resistant to destruction from bile, has eliminated lactose intolerance for some as well as some food allergies, is strongly adherent to the gut wall, and quickly invades the large intestine as well. All three of this lab's products are hypoallergenic as I have seen in terms of not containing other ingredients that folks with food allergies might react to.
and she continues.
P.S. You can find a yogurt drink which has more live culture than say yogurt itself (which I see is being marketed as such) and it's called Kefir. Google kefir recipes - you can make it yourself if you feel like the extra work - it's better for you of course. But I take my probiotic with Kefir in the morning.
Sunday, February 04, 2007
Arthritis and Celiac Disease
Copyright © 1995-2006
Scott Adams, celiac.com
Arthritis may be an allergic response to materials in the food supply. Diet revision may be helpful in reducing the activity of inflammatory arthritis and in some instances may halt the progression of the disease. There are many patterns of arthritis. A group of related joint and connective disorders have been called rheumatic diseases. All these diseases are immune-mediated, and all are expressions of inflammation in connective tissues. Inflammation damages joints and surrounding tissues resulting in loss of function and deformities. Variations in the patterns of these diseases reflect the many possibilities for immune damage to disturb and distort structure and function. Severity ranges from mildly painful, chronic activity to drastic, disabling disease. Rheumatoid arthritis, often severe and disabling, is the dominant rheumatic disease that can attack all joints in the body.
Rheumatoid arthritis is often considered to be an autoimmune disease. Our idea is that no disease is just internally generated and must involve outside contributions. Arthritis is often associated with inflammatory bowel disease. The mechanisms of food allergy link abnormal Gastrointestinal Tract (GIT) function with immune attacks on connective tissue. In all arthritic patients, normal GIT function should be rigorously sought by adaptive dietary adjustments.
Simple allergic arthritis is a definite entity that is often not recognized as a food allergy. Typically, a dramatic, acute, and painful swelling develops in one or more joints asymmetrically. Eating a food, either an unusual food eaten for the first time or sometimes a regular food eaten in excess usually brings on the joint inflammation. This presentation is similar to and often confused with gout. Any food can cause allergic arthritis. Staple foods such as milk, eggs, and wheat (rye, oats, barley), coffee, beef, pork, and food additives are the most common food triggers. Carinini and Brostroff reviewed the concepts of and evidence for food-induced arthritis. They stated:
"Despite an increasing interest in food allergy and the conviction of innumerable patients with joint disease that certain foods exacerbate their symptoms, relatively little scientific attention has been paid to this relationship. Abnormalities of the gastrointestinal tract are commonly found in rheumatic disease...Support for an intestinal origin of antigens comes from studies of patients whose joint symptoms have improved on the avoidance of certain foods antigens, and become worse on consuming them. These have included patients with both intermittent symptoms, palindromic rheumatism and more chronic disease."
In another study, 33 of 45 patients with rheumatoid arthritis improved significantly on a hypoallergenic diet. The authors concluded: "Increasing numbers of scientific studies suggest that dietary manipulation may help at least some rheumatoid patients and perhaps the greatest need now is for more careful and well-designed research so that preconceptions may be put aside and role of diet, as a specific or even a nonspecific adjunctive therapy, may be determined."
Unfortunately, dairy products, wheat and its close relatives, oats, barley, and rye, have proved to be a major problem in the diets of our patients. There are many possible reasons for cereal grains to become pathogenic. Hypersensitivity mechanisms triggered by grain proteins, collectively called "Gluten", are the likely cause of the illnesses related to intake of cereal grains. Gluten is a mixture of individual proteins classified in two groups, the Prolamines and the Glutelins. The prolamine fraction of gluten concerns us the most when grain intolerance is suspected. The prolamine, Gliadin, seems to be a problem in celiac disease; gliadin antibodies are commonly found in the immune complexes associated with this disease. Recently marketed grains, spelt and kamut, are wheat variants (despite claims to the contrary) and are likely to cause problems similar to other wheat varieties.
A wheat gluten mechanism has been studied in rheumatoid arthritis patients. The clinical observation is that wheat ingestion is followed within hours by increased joint swelling and pain. Little and his colleagues studied the mechanism, as it developed sequentially following gluten ingestion. Dr. Parke and colleagues concurred with this explanation of the gut-arthritis link in their report of three patients with celiac disease and rheumatoid arthritis. The mechanism involves several stages:
GIT must be permeable to antigenic proteins or peptide fragments, derived from digested gluten.
The food antigens appear in the blood stream and are bound by a specific antibody (probably of IgA or IgG, not IgE class), forming an antigen-antibody complex, a circulating immune complex (CIC).
The antigen-antibody complex then activates the rest of the immune response, beginning with the release of mediators - serotonin is released from the blood platelets.
Serotonin release causes "symptoms" as it circulates in the blood stream and enhances the deposition of CICs in joint tissues.
Once in the joint, the immune complexes activate complement, which in turn damages cells and activates inflammation. More inflammation results in more pain, swelling, stiffness, and loss of mobility.
Arthritis is usually treated with salicylates or related anti-inflammatory drugs generally referred to as NSAIDs. These drugs alleviate the terrible pain of active arthritis but do not favorably affect the outcome of the disease. All anti-arthritic medication can produce asthma or chronic rhinitis and a variety of allergic skin rashes. Gastrointestinal surface irritation, bleeding, and ulceration are routine problems of anti-arthritic medication.
The first attack of joint swelling and pain should be treated as an urgent problem to be solved. Inflammation may damage joints. Often NSAIDs and physiotherapy are the only treatments prescribed and inflammation is given every opportunity to ravage tissues. We have seen countless patients, just treated with NSAIDs, who progressed rapidly to a severe disabling disease, often with poor pain control. In unlucky patients, severe deformities of joints accumulate in the first few months of a severe attack. There is a trend to recommend more aggressive treatments, using drugs that impair the immune response. The best drug is prednisone, but it is seldom used because it has long-term side effects which scare both physicians and patients. Prednisone is often a magic drug that relieves terrible pain and suffering often in the first 48 hours of therapy. Beyond prednisone, there is a grab bag of immune suppressant drugs to treat arthritis-chloroquine, penicillamine, gold and methotrexate have emerged as the favored drug therapies. All these drugs have impressive side effects and great potential for toxicity.
Our preference is to try to stop the inflammatory activity as soon as possible with diet revision. All inflammation is likened to a fire. You get out the fire-extinguishers and go to work. No matter what pattern the immune attack assumes, our standard defense can be tried first. The Core Program method of diet revision is used. Food is replaced with an elemental nutrient formula, ENFood, for a clearing period of 10 to 20 days. Prednisone and/or NSAIDs are drug options during the clearing period and then the dosage is reduced after pain and swelling have subsided. Improvement is followed by slow food reintroduction (see Core Program). Each returning food is carefully screened for arthritis- triggering effects. You hope that food allergy caused the problem and that food control can be successful controlling the disease in the long- term. Nothing is lost by taking this approach and complete control of the disease can sometimes be obtained. If strict food control proves to be inadequate, then other drug treatments can be instituted.
Carinini C, Brostroff J. Gut and joint disease. Annals of Allergy 1985;55:624-625.
Darlington et al. Lancet Feb 1 1986;236-238.
Keiffer M et al. Wheat gliadin fractions and other cereal antigens reactive with antibodies in the sera of of celiac patients. Clin Exp Immunol 1982;50:651-60.
Little C, Stewart AG, Fennesy MR. Platelet serotonin release in rheumatoid arthritis: a study in food intolerant patients. Lancet 1983;297-9.
Parke AI et al. Celiac disease and rheumatoid arthritis.
Annals of Rheum Dis 1984;43:378-380.
Voorneveld CR, Rubin LA Disease-modifying antirheumatic drugs: early use is better. Medicine North Amer. Oct 1991 3177-3184.
Thursday, February 01, 2007
From Clan Thompson's newsletter:
1. CELIAC DISEASE: Just the Tip of the Iceberg
A Report on Dr. Kenneth Fine's Conference in Dallas - March 4, 2006
by Lani K. Thompson
Twenty percent of all Americans have some auto-immune problem - and "it's almost certainly related to gluten sensitivity", Dr. Kenneth Fine told a group of doctors, nurses, nutritionists, celiac patients and other interested people who attended his "Intestinal Health...and Beyond" Conference in Dallas, TX between March 3-5. That's because there's an increased risk of other auto-immune diseases developing in a person with celiac disease when the diagnosis is made later in life, as it often is in America.
Dr. Fine's lecture was called "Early Diagnosis of Gluten Sensitivity Using Fecal Testing: Report of an 8-Year Study" and it was the focal point of the weekend. In it, he discussed the spectrum of gluten sensitivity vs. celiac disease, the shortcomings of blood tests and biopsies for gluten sensitivity, and how stool testing has overcome these shortcomings and revealed the problem to be more extensive than previously known.
Celiac Disease, also known as celiac sprue, is an autoimmune disorder. In order to develop celiac disease, a person needs to have the celiac gene, some kind of "trigger" or activation of the gene, and be eating gluten. People with celiac disease can't eat gluten, a grain-based protein found in wheat, rye, barley, and oats. When they do, the protein sets off an immune response that causes damage to their small intestine. Symptoms of celiac disease vary widely, as do their severity. Some people don't have any symptoms at all. Others may experience diarrhea, bloating, abdominal cramping, anemia, fatigue, muscle cramping, pain in the bones or joints, unexplained weight loss, weakness, decreased ability to clot blood, osteoporosis, depression, mood changes, and more. There is no cure, but the disease can be treated with a gluten free diet. However, not everyone who gets better on the gluten free diet has celiac disease, said Dr. Fine. "Celiac sprue is just the tip of the iceberg of gluten induced disease".
"We now know, not only is there this spectrum of change in the intestine and in the symptoms, but that we can actually identify people who seem to be gluten sensitive but never have the villous atrophy" that is seen in full blown celiac disease, he told his audience. Reports of gluten sensitivity with no villous atrophy - or intestinal damage - have been around since the early 1980's, but when the antitissue transglutaminase Ab test was developed in the 1990's, doctors thought it could rule in and rule out all disease. "Blood tests allowed us to pick up more disease, and in more people," Dr. Fine said.
However, he continued, Celiac Sprue is really the end disease and it is only in the end stages of this disease that doctors have 100% reliability of the tests currently used to diagnose it. A positive biopsy or blood test result means you have the disease, but a negative result does not mean you are fine. In fact, each of the two blood tests that are commonly used to make a diagnosis are only accurate 59% of the time and, in celiacs with only partial villous atrophy, the antigliadin and anti-endomysial antibodies tests were only able to detect the disease 31% of the time.
Celiac disease was first written about by Aretaeus the Cappadocian in 100 AD. However, not much was known about the disease until the past few decades. Now some doctors think that undiagnosed celiac disease may be as common as 1 in 130 people. Before he founded the Intestinal Health Institute and EnteroLab.com, Dr. Fine studied microscopic colitis, an inflammatory disease of the colon in which the body's immune system starts to attack the bacteria living in the colon. Colitis can cause the body's immune system to react to gluten.
Dr. Fine used slides to show how the pathology of microscopic colitis is virtually identical to celiac sprue. When the pathology occurs in the small bowel, it's celiac disease. When it occurs in the large bowel, it's microscopic colitis. However, because the patient doesn't usually have fully developed celiac disease, diagnostic tests, like blood tests, are usually negative. The first study Dr. Fine ever did, as a young researcher, was to try to figure out why there seemed to be an overlap between the different syndromes of microscopic colitis and celiac sprue.
What he discovered was that 64% of people with microscopic colitis have the celiac-like genes of the HLA which is DQ2 and most of the others had another set of genes that had never before been reported in an inflammatory condition associated with gluten sensitivity.
"We had an apparent celiac-like gene genetic predisposition and, perhaps, a new set of genes making their first appearance," Dr. Fine said. When they looked at the small bowel biopsies, they found they were abnormal in 70% of the patients...but it was not celiac disease. There was no villous atrophy and, when they looked at the blood, there were no more antigliadin antibodies than there are in the general population.
"So, here I was scratching my head. What were all of these celiac genes doing in these microscopic colitis people? Why does the biopsy look like celiac disease?" He found a study comparing the presence of antigliadin antibodies inside the intestine to antigliadin antibodies in the blood.
Patients with celiac disease showed these antibodies in both the blood and the small intestine. Normal people had no antibodies in their blood or in their small intestine. Celiacs who followed a gluten free diet for one year tested negative for antibodies in the blood but positive for antibodies in the intestine. So, when there is mild intestinal damage, there are antigliadin antibodies in the intestine.
This was such an important finding that researchers developed a technique to try to detect the antibodies without having to insert a long tube into the small intestine. They had the patient swallow a short tube that went into the stomach, pumped twenty gallons of fluid through to clean everything out, then looked for the antigliadin antibodies. This was considered a relatively non-invasive screening test for celiac sprue and was used for many years!
"You have to get inside the intestine to see what's going on immunologically," Dr. Fine said. A less invasive way to do this is through fecal analysis. Fecal analysis is superior to blood testing because it is more sensitive to the presence of the offending proteins.
Comparison of Test Results for the Presence of Antigliadin Antibodies
Patient Group Blood Test Fecal Analysis
Untreated Celiacs 76% 100%
Microscopic Colitis 9% 75%
Sympomatic People 12% 57%
Asymptomatic People 11% 29%
"That was an extremely important finding in my career. What this meant was that...at a minimum, 29-30% of the general population and 50-75% of people with irritable bowel syndrome, microscopic colitis, perhaps other forms of inflammatory bowel disease and autoimmune disease" have these antigliadin antibodies in their stool.
In a follow-up study, Dr. Fine looked at 7336 patients. 99.4% of them were sick and/or symptomatic and 60% of his patients tested positive for gluten sensitivity.
42% had autoimmune disease
21% had irritable bowel syndrome
20% had a family history of celiac disease or gluten sensitivity
6% had microscopic colitis
2% had chronic fatigue
8% had weight loss, headaches, autism, ADD, or other disorders.
Of the patients in this study, 57% of them had the celiac gene and only 0.07% had no predisposing gene at all. In the general US population, 42% of people have the celiac gene and only 0.4% have no predisposing gene at all.
"Who should be screened?" asked Dr. Fine. There are certain people at greater risk of developing gluten sensitivity. They include: people with microscopic colitis, Crohn's Disease, Ulcerative colitis, Irritable Bowel Syndrome, relatives of those with gluten sensitivity, those with hepatitis C, Down's Syndrome, Gastroesophageal reflux disease, seizure disorders, short stature in children, autoimmune liver disease, dermatitis herpetiformis, Type I diabetes, Rheumatoid arthritis, Sjogren's syndrome, Lupus, Autoimmune thyroid disease, Aids, Peripheral neuropathy, and autism.
Unlike other tests for gluten intolerance, Dr. Fine's new stool test is not invasive and his own research shows that it's more sensitive than other tests, too. It can help identify gluten sensitivity before significant intestinal damage is done, before other complications and autoimmune diseases can develop, and before gluten intolerance becomes full-fledged celiac sprue.
(Note: Slides from Dr. Fine's keynote address from the conference have been posted at www.EnteroLab.com. Click on the "Research and Education" link for the slides and a related essay. To obtain a DVD of the conference, you may email requests for them to email@example.com. Include your name, mailing address (U.S. mail) phone number (to contact you when they are completed), and email address. The Intestinal Health Institute will contact you when they are ready. The cost is $49.95 + S/H.)
About Dr. Kenneth Fine: Dr. Fine is the Medical Director and Director of Operations for EnteroLab.com Reference Laboratory, the Director of Operations and Director of Medical Research for Intestinal Health Institute and Director of Operations and Chief Consultant for FinerHealth and Nutrition. You can visit him online at www.EnteroLab.com, www.finerhealth.com or www.intestinalhealth.org.
Monday, January 22, 2007
"Let us not become weary in doing good, for at the proper time we will reap a harvest if we do not give up."
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