Celiac disease is the most common food intolerance in the United States. It also seems to be a common source of confusion for many who may be affected.

The Basics

Gluten is a protein found in wheat, barley and rye. In people with celiac disease, gluten damages the small intestine and interferes with absorption of nutrients from food. It is a problem of both malnutrition as well as an abnormal immune response.

An estimated 1% of the U.S. population has celiac disease, and for unclear reasons it seems to be on the rise.

Who is at Risk for Celiac Disease?

If a person has a parent, sibling or child with celiac disease, they have a 1 in 22 chance of developing celiac disease.  People with a related autoimmune disorder or other genetic conditions are at increased risk as well: these include: Type 1 diabetes, Autoimmune thyroid or liver conditions, Rheumatoid arthritis, Addison’s disease, Sjogren’s syndrome, Down syndrome and Turner syndrome.

The majority of those diagnosed with celiac disease are not considered at “increased risk,” but were diagnosed because they were having symptoms.

What are the Symptoms?

The symptoms of celiac disease vary widely. Scientists are studying the reasons for this, but some factors may be a person’s age or the degree of damage to the intestine.

A person may have “typical” symptoms such as:

• Chronic diarrhea
• Weight loss
• Pale, fatty, foul-smelling stools
• Abdominal bloating and pain
• Dermatitis Herpetiformis: an itchy, blistering skin rash

Or, more commonly, a person may have more non-specific symptoms such as:

• Iron-Deficiency Anemia
• Fatigue
• Joint/Bone pains
• Osteoporosis
• Depression or Anxiety
• Tingling or numbness in the hands and feet
• Seizures
• Missed menstrual periods
• Infertility or recurrent miscarriage
• Canker sores inside the mouth

How Do We Diagnose Celiac Diseae?

If your doctor suspects celiac disease, she may order some Blood Tests and obtain tissue biopsies.

Blood Tests:

• tTg/EMA: People with celiac disease have elevated levels of certain antibodies, tissue transglutaminase (tTG) or anti-endomesial antibody (EMA.)  As long as gluten is being ingested, these antibodies can be detected at elevated levels in the blood.

• HLA DQ2/DQ8: If the tTG or EMA is normal, but your doctor still highly suspects celiac disease, then certain blood tests to check for genetic markers may be useful.

Tissue Biopsy:

• If blood tests indicate celiac disease, tiny biopsies of the small intestine are obtained using an endoscope to confirm the diagnosis.

Why Do We Treat Celiac Disease?

Naturally, one reason that we treat celiac disease is to relieve a person’s symptoms. However, the other reason to treat is to avoid long term complications. These may include:

• Malnutrition
• Anemia
• Osteoporosis
• Miscarriage
• Liver Problems
• Rarely: Cancer of the Intestine

How Do We Treat Celiac Disease?

The only proven treatment is lifelong avoidance of gluten. Because even a small amount of gluten can damage the intestines, it is important not to eat foods, such as pasta, grains, cereals and many processed foods or other products, such as medications, which contain this protein.

Despite the restrictions in a gluten-free diet, people can eat a wide array of plain meat, fish, rice, fruits and vegetables. There are many “gluten-free” versions of their favorite foods available as well. A nutritionist may help guide them as they learn to make the right food choices.

If you have further questions or are concerned that you may be affected by celiac disease, call your gastroenterologist (that’s us) at 301-251-9555

So, if you have this condition, increase your dietary fiber, ideally to 25 grams daily, and if you experience pain in the lower left abdomen that persists with or without a fever or bleeding (less common complication), contact your gastroenterologist (that’s us)!  (301) 251-9555

Clostridium difficile is an intestinal infection typically occurring after antibiotic exposure and hospitalization. Word of it has spread due to its association with drugs commonly used to treat heartburn such as, for example, Prilosec. Sometimes it can be hard to cure. Recently I read an article in the May 2010 “Clinical Gastroenterology and Hepatology” journal (Dr. Michael Silverman et.al.) that mentioned the treatment of 7 patients with FECAL TRANSPLANTATION! These patients were given one fecal enema (created in a home blender using normal saline and fecal matter (poo) donated by their near and dear and VOILA! cured. Granted these patients (and families) were described as highly motivated and the donors were cleared as it regards their medical histories, blood and stool studies (in other words, don’t undertake this by yourself at home). All patients were cured after having failed prior courses of antibiotic therapy.

Importance of ingesting adequate daily levels of fiber

Insufficient understanding of the importance of ingesting adequate daily levels of fiber and persisting negative perceptions about the taste of high-fiber foods continue to be significant obstacles for marketers of fiber-rich/fiber-enriched foods, according to Mintel’s consumer survey findings.

Nearly one-third (30%) of survey respondents report that they make it a point to eat naturally fiber-rich foods, and 37% say that they can get enough fiber from regular foods, so supplements and foods with added fiber are unnecessary, reports the market research firm. Yet, studies show that most Americans are failing to meet recommended daily fiber intake levels.

Consumers more likely to limit sugar

“Consumers are more likely to report limiting sugar, fat, sodium and calorie intake than they are to report eating naturally fiber-rich foods,” says Mintel senior health and wellness analyst Molly Heyl-Rushmer.

Some of the reasons: 27% still think food with added fiber usually has an unpleasant taste, 22% don’t fully understand that fiber is important to health (that lack of fiber is associated with cancers, heart disease and diabetes, for instance); and 25% think that fiber is only necessary for those who suffer from irregularity or other digestive problems.

Men view fiber differently than women

Men are more likely to express the last belief, and 30% of men (compared to 23% of women) also believe that supplements are just as effective as fiber-enriched foods.

“The way men view fiber is a considerable obstacle for marketers to overcome,” sums up Heyl-Rushmer.

The answer? She believes that employing “macho” spokesmen in advertising to “gently poke fun” at these false beliefs could help fiber-rich food marketers convince men that they’re in error about fiber.

Heyl-Rushmer also believes that marketers should implement money-back guarantees (aimed in part at getting consumers to try high-fiber foods despite taste concerns) and educational initiatives to address the various negative perceptions and inform consumers about the importance of dietary fiber to good health.
http://www.mediapost.com/publications/?fa=Articles.showArticle&art_aid=128862

Interesting Reading from The Miami Herald

Dave Barry: A journey into my colon — and yours

Document | Get your Dave Barry colonoscopy certificate!

(This Dave Barry column was originally published Feb. 22, 2008.)

OK. You turned 50. You know you’re supposed to get a colonoscopy. But you haven’t. Here are your reasons:
1. You’ve been busy.
2. You don’t have a history of cancer in your family.
3. You haven’t noticed any problems.
4. You don’t want a doctor to stick a tube 17,000 feet up your butt.
Let’s examine these reasons one at a time. No, wait, let’s not. Because you and I both know that the only real reason is No. 4. This is natural. The idea of having another human, even a medical human, becoming deeply involved in what is technically known as your ”behindular zone” gives you the creeping willies.
I know this because I am like you, except worse. I yield to nobody in the field of being a pathetic weenie medical coward. I become faint and nauseous during even very minor medical procedures, such as making an appointment by phone. It’s much worse when I come into physical contact with the medical profession. More than one doctor’s office has a dent in the floor caused by my forehead striking it seconds after I got a shot.
In 1997, when I turned 50, everybody told me I should get a colonoscopy. I agreed that I definitely should, but not right away. By following this policy, I reached age 55 without having had a colonoscopy. Then I did something so pathetic and embarrassing that I am frankly ashamed to tell you about it.
What happened was, a giant 40-foot replica of a human colon came to Miami Beach. Really. It’s an educational exhibit called the Colossal Colon, and it was on a nationwide tour to promote awareness of colo-rectal cancer. The idea is, you crawl through the Colossal Colon, and you encounter various educational items in there, such as polyps, cancer and hemorrhoids the size of regulation volleyballs, and you go, ”Whoa, I better find out if I contain any of these things,” and you get a colonoscopy.
If you are as a professional humor writer, and there is a giant colon within a 200-mile radius, you are legally obligated to go see it. So I went to Miami Beach and crawled through the Colossal Colon. I wrote a column about it, making tasteless colon jokes. But I also urged everyone to get a colonoscopy. I even, when I emerged from the Colossal Colon, signed a pledge stating that I would get one.
But I didn’t get one. I was a fraud, a hypocrite, a liar. I was practically a member of Congress.
Five more years passed. I turned 60, and I still hadn’t gotten a colonoscopy. Then, a couple of weeks ago, I got an e-mail from my brother Sam, who is 10 years younger than I am, but more mature. The email was addressed to me and my middle brother, Phil. It said:
“Dear Brothers,
“I went in for a routine colonoscopy and got the dreaded diagnosis: cancer. We’re told it’s early and that there is a good prognosis that they can get it all out, so, fingers crossed, knock on wood, and all that. And of course they told me to tell my siblings to get screened. I imagine you both have.”
Um. Well.
First I called Sam. He was hopeful, but scared. We talked for a while, and when we hung up, I called my friend Andy Sable, a gastroenterologist, to make an appointment for a colonoscopy. A few days later, in his office, Andy showed me a color diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Minneapolis. Then Andy explained the colonoscopy procedure to me in a thorough, reassuring and patient manner. I nodded thoughtfully, but I didn’t really hear anything he said, because my brain was shrieking, quote, “HE’S GOING TO STICK A TUBE 17,000 FEET UP YOUR BUTT!”

Read more:

©2008 Dave Barry This column is protected by intellectual property laws, including U.S. copyright laws. Electronic or print reproduction, adaptation, or distribution without permission is prohibited. Ordinary links to this column at www.miamiherald.com may be posted or distributed without written permission.

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It’s probably safe to say all of us have had a bout of heartburn at least once in our lives. If acute heartburn goes untreated or unchecked it could lead to something far more serious and even deadly.

Studies have shown that approximately 4 out of 10 people experience occasional heartburn which experts say is considered fairly normal if it is indeed occasional. Often triggered by fatty foods, chocolate, peppermint, tomato sauces, alcohol and caffeine, it feels like food is trapped behind the breastbone leaving a burning sensation. Hence the name heartburn, but the medical term for it is acid reflux.
Here’s how it happens:
The food travels down through the esophagus, often called the food pipe and into the stomach where it is digested by acid secretions present in gastric juices. Both openings of the stomach have sphincters. At the opening of the stomach is what’s called the lower esophageal sphincter that prevents acid backflow into the esophagus, but when that muscle doesn’t work normally that’s exactly what happens. Acid goes back up into the esophagus and gives us that burning pain in the chest.
Avera Gastroenterologist Dr. Dany Shamoun at Avera Gastroenterology Clinic says that acid reflux could develop into Gastroesophageal Reflux Disease or GERD.
Dr. Shamoun says, “That sphincter relaxes at certain times to allow food to go in to the stomach. Now given most people have it, they think its normal and to some degree acid reflux is normal.”
If you find yourself eating antacids after every meal there may be more of a serious problem.
Dr. Shamoun says, “The most significant risk that we worry about is cancer of the esophagus and if GERD happens for a long time in certain predisposed patients it can result in changes in the normal lining in the esophagus. The esophagus is not supposed to encounter or handle a lot of acid. If it does, the lining can change over time. It could become a condition known as Barrett’s Esophagus and that is a risk factor for esophageal cancer.”
Dr. Shamoun says once you have Barrett’s Esophagus your risk for cancer increases 40 fold and that’s why seeing a specialist is important. Don’t pass off chronic acid reflux as just a simple case of ongoing indigestion, left untreated you could end up with a cancer diagnosis which is a lot tougher to swallow in the long run.
Dr. Shamoun says there are multiple levels of treatment if you suffer from heartburn and nothing else.

1. Diet and lifestyle modifications. Changing what you eat and how much, eliminating the foods that trigger the acid reflux.
2. Elevating the head of the bed at night, especially if your heartburn occurs at night.
3. There are over-the-counter antacid medications for those with GERD like Zantac. Or if you need something stronger there is Prilosec or Nexium (by prescription).

If a gastroenterologist thinks your esophagus need to be checked. They will do an endoscopy to check the lining of the esophagus, if they see questionable area they will do a biopsy. The earlier you catch the cancer, the better the outcome.