Basic Introduction To Gluten Related Health Issues


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A Very Basic Introduction to Gluten Related Health Problems, Celiac Disease, and Links to Various Resources

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Basic Introduction To Gluten Related Health Issues

  1. 1. Basic Introduction to Gluten-Related Health Issues and Celiac Disease By William T. Beverly, Ph.D., L.C.S.W. (November 2008) (copyright 2008, William T. Beverly, Ph.D.)
  2. 2. Note <ul><li>Many of the slides here contain citations noting the sources being used. </li></ul><ul><ul><li>If you are online and you click on the source (typically at the bottom of the quote) you should be taken to the original source itself. </li></ul></ul>
  3. 3. Background <ul><li>Of the Gluten-Related Illnesses Celiac Disease is the most common. </li></ul><ul><ul><li>Celiac disease affects at least 3 million Americans. </li></ul></ul><ul><ul><li>About 1% of Americans. </li></ul></ul><ul><ul><ul><ul><ul><li>( UChicago Celiac Disease Center, 2008 ) </li></ul></ul></ul></ul></ul>
  4. 4. Celiac Disease <ul><li>“ Celiac disease (CD) is a genetic disorder. </li></ul><ul><li>In people with CD, eating certain types of protein, called gluten, sets off an autoimmune response that causes damage to the small intestine. </li></ul><ul><li>This, in turn, causes the small intestine to lose its ability to absorb the nutrients found in food, leading to malnutrition and a variety of other complications.” </li></ul><ul><ul><ul><ul><ul><li>(, 2008 ). </li></ul></ul></ul></ul></ul>
  5. 5. Celiac Disease History <ul><li>“ Celiac sprue disease was first described in the second century, but it wasn't until the 20th century that rudimentary causative factors were identified. Terminology changed as research confirmed that celiac disease diagnosed in children was the same disease as non-tropical sprue diagnosed in adults. The term &quot;celiac disease&quot; is now most commonly used. Another term for the same condition includes &quot;gluten sensitive enteropathy&quot; (, 2008 ). </li></ul>
  6. 6. Symptoms of Celiac Disease <ul><li>Abdominal cramping/bloating </li></ul><ul><li>Feet (Reduced fat padding) </li></ul><ul><li>Abdominal distention </li></ul><ul><li>Flatus (Passing gas) </li></ul><ul><li>Acidosis </li></ul><ul><li>Gluten ataxia </li></ul><ul><li>Appetite (Increased to the point of craving) </li></ul><ul><li>Mouth sores or cracks in the corners </li></ul><ul><li>Back pain (Such as a result of collapsed lumbar vertebrae) </li></ul><ul><li>Muscle cramping (Especially in the hands and legs) </li></ul><ul><li>Constipation </li></ul><ul><li>Night blindness </li></ul><ul><li>Decreased ability to clot blood </li></ul><ul><ul><ul><ul><ul><li>Continued on next slide. </li></ul></ul></ul></ul></ul>
  7. 7. Symptoms of Celiac Disease cont. <ul><li>Skin (Very dry) </li></ul><ul><li>Dehydration Stools (Loose? Hard? Small? Large? Foul smelling? Floating? Clay, Light tan or Gray-colored? Highly rancid? Frothy?) </li></ul><ul><li>Diarrhea (See Stools below) </li></ul><ul><li>Tongue (Smooth or geographic - looks like different continents) </li></ul><ul><li>Edema </li></ul><ul><li>Tooth enamel defects </li></ul><ul><li>Electrolyte depletion </li></ul><ul><li>Weakness </li></ul><ul><li>Energy loss </li></ul><ul><li>Weight loss </li></ul><ul><li>Fatigue </li></ul>
  8. 8. Emotion-Specific Symptoms of Celiac Disease include: <ul><li>Depression </li></ul><ul><li>Disinterested in normal activities </li></ul><ul><li>Irritable </li></ul><ul><li>Mood changes </li></ul><ul><li>Unable to concentrate </li></ul><ul><li>Fatigue </li></ul>
  9. 9. Gluten, Adults & Mental Illness <ul><li>“ Paulley wrote in 1959: many (adult celiacs): </li></ul><ul><ul><li>showed extreme obsessional neuroses, </li></ul></ul><ul><ul><li>suffering delusions, </li></ul></ul><ul><ul><li>frequently believing they had cancer. </li></ul></ul><ul><ul><li>Paranoid ideas were also frequent and </li></ul></ul><ul><ul><li>many were considered psychotic or near psychotic.” </li></ul></ul><ul><ul><ul><ul><ul><li>(from Professor F. C. Dohan of the University of Pennsylvania was the first researcher to use this concept, beginning in the late 1960’s. He quoted from earlier researchers in his article published in The Biological Basis of Schizophrenia (Hemmings, ed; MTP Press; London, 1980)). </li></ul></ul></ul></ul></ul>
  10. 10. Emotional Impact of Celiac Disease in Adulthood <ul><li>“ Psychic alterations have been reported in celiac disease. </li></ul><ul><li>Our aim was to evaluate: </li></ul><ul><ul><li>the emotional impact of celiac disease diagnosis in adulthood, </li></ul></ul><ul><ul><li>the patient/doctor relationship, and </li></ul></ul><ul><ul><li>the patients’ cooperation with disease treatment and diet. </li></ul></ul><ul><li>The patients were 114 adult celiac patients on a gluten-free diet, there were 25 untreated celiac patients. </li></ul><ul><li>Self-administered questionnaires aimed to evaluate: </li></ul><ul><ul><li>the patients’ level of knowledge of disease, </li></ul></ul><ul><ul><li>the emotional impact at diagnosis, and </li></ul></ul><ul><ul><li>feelings during follow-up.” </li></ul></ul><ul><ul><ul><li>Continued on next slide: </li></ul></ul></ul><ul><ul><ul><ul><ul><li>( Igenta Connect, 2008 ) </li></ul></ul></ul></ul></ul>
  11. 11. Emotional Impact on Adults cont. <ul><li>“ Celiac patients showed good knowledge of the disease, directly correlated to their socioeconomic level (P = 0.011). </li></ul><ul><li>At diagnosis, relief was most intense feeling (Mean ± SD, 10.82 ± 7.63), demographics, time latency of diagnosis, and the duration of the disease had no effect on the intensity of all feelings. </li></ul><ul><li>The scores of the self-rated emotions were entered into a principal component analysis that generated three factors: </li></ul><ul><ul><li>1 (fear, anger, anxiety and sadness), </li></ul></ul><ul><ul><li>2 (reassurance and resignation), and </li></ul></ul><ul><ul><li>3 (relief); patients judged the clinicians presenting the disease “in the right way” (F = 33.279; P < 0.0001). The right way correlated with relief and reassurance (P = 0.0009; P = 0.0008 respectively).“ </li></ul></ul><ul><ul><ul><ul><ul><li>Continued on next slide. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>( Igenta Connect, 2008 ) </li></ul></ul></ul></ul></ul>
  12. 12. Emotional Impact on Adults cont. <ul><li>“ At follow-up, anger was the predominant emotion that induced patients to transgress. </li></ul><ul><li>A positive correlation was observed between feeling different and the sadness, anger, fear (P < 0.0001 for all). Anger was inversely correlated with actual compliance to diet (P = 0.0005). </li></ul><ul><li>In conclusion, in adult patients, adaptive and psychological aspects must be taken into account to understand the celiac patient and for better clinical management.” </li></ul><ul><ul><ul><ul><ul><li>( Igenta Connect, 2008 ) </li></ul></ul></ul></ul></ul>
  13. 13. Children, Gluten and Mental Illness <ul><li>“ Celiac disease may present with psychiatric symptoms, which, in association with other symptoms, may be of diagnostic help... </li></ul><ul><li>Kaser (1961) described celiac children as showing definite symptoms in all cases. The children are: </li></ul><ul><ul><li>conspicuously quiet, </li></ul></ul><ul><ul><li>turned, </li></ul></ul><ul><ul><li>inward, </li></ul></ul><ul><ul><li>often weepy, </li></ul></ul><ul><ul><li>often discontented or surly and </li></ul></ul><ul><ul><li>apparently lack all joy in living. </li></ul></ul><ul><li>They can take on negativistic and schizoid characteristics and may execute ceaseless stereotyped movements.” </li></ul><ul><ul><ul><ul><ul><li>(from Professor F. C. Dohan of the University of Pennsylvania was the first researcher to use this concept, beginning in the late 1960’s. He quoted from earlier researchers in his article published in The Biological Basis of Schizophrenia (Hemmings, ed; MTP Press; London, 1980)). </li></ul></ul></ul></ul></ul>
  14. 14. Illnesses Commonly Associated with Gluten-Sensitivity <ul><li>Celiac Disease </li></ul><ul><li>Crohn’s Disease </li></ul><ul><li>Dermatitis Herpetiformis </li></ul><ul><li>Autism </li></ul><ul><li>Gluten Sensitive Enteropathy </li></ul><ul><li>Chronic Fatigue Syndrome </li></ul><ul><li>Schizophrenia </li></ul><ul><li>Rheumatoid Arthritis </li></ul><ul><li>Depression </li></ul><ul><li>Thyroid Disease </li></ul><ul><li>Migraines </li></ul><ul><li>ADD </li></ul>
  15. 15. Celiac Disease and Wheat <ul><li>“ Dr. Willem Karel Dicke, a Dutch pediatrician, recognized in 1952 that the disease is caused by the ingestion of wheat proteins. He wrote his doctoral thesis on the subject for the University of Utrecht in 1950. By 1954, Dicke, Charlotte Anderson and a number of their colleagues, working in Birmingham, England confirmed the treatment and described the histologic damage to the intestinal mucosa as being directly related to celiac disease.” (, 2008 ). </li></ul>
  16. 16. Good Old Wheat <ul><li>“The offending protein, gluten, is found in wheat, barley, rye, and to a lesser extent, oats (WBRO). Related proteins are found in triticale, spelt, kamut.” </li></ul><ul><ul><ul><ul><ul><li>(, 2008 ). </li></ul></ul></ul></ul></ul><ul><li>With the historical prevalence of wheat in Western foods and other products, avoiding hidden sources of Gluten is very difficult. </li></ul>
  17. 17. Primary Treatment for Celiac Disease <ul><li>Gluten-Free Diet, includes: </li></ul><ul><ul><li>No Wheat </li></ul></ul><ul><ul><li>No Barley </li></ul></ul><ul><ul><li>No Oats </li></ul></ul><ul><ul><li>No Rye </li></ul></ul><ul><ul><li>No products that have been cross-contaminated with the above. This can include: </li></ul></ul><ul><ul><ul><li>Mayonnaise, Salad Dressings, Vinegar, Sauces, Soups </li></ul></ul></ul><ul><ul><ul><li>Beer, Liquors, Cakes, Cookies, Crackers </li></ul></ul></ul><ul><ul><ul><li>Vinegar, Soy Sauce, Steak Sauces </li></ul></ul></ul><ul><ul><ul><li>Make ups </li></ul></ul></ul><ul><ul><ul><li>Some medicines </li></ul></ul></ul>
  18. 18. Prevalence of Celiac Disease <ul><li>“ In average healthy people: 1 in 133 </li></ul><ul><li>In people with related symptoms: 1 in 56 </li></ul><ul><li>In people with first-degree relatives (parent, child, sibling) who are celiac: 1 in 22 </li></ul><ul><li>In people with second-degree relatives (aunt, uncle, cousin) who are celiac: 1 in 39 </li></ul><ul><li>Estimated prevalence for African-, Hispanic- and Asian-Americans: 1 in 236 </li></ul><ul><li>In the landmark prevalence study on celiac disease, investigators determined that 60% of children and 41% of adults diagnosed during the study were asymptomatic (without any symptoms).” </li></ul><ul><ul><ul><ul><ul><li>Source: A multi-center study on the sero-prevalence of celiac disease in the United States among both at risk and not at risk groups. Fasano et. al., Archives of Internal Medicine. February 2003. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>( UChicago Celiac Disease Center, 2008 ) </li></ul></ul></ul></ul></ul>
  19. 19. How Common is Celiac Disease? <ul><li>“Nearly one out of every 133 Americans suffer from Celiac Disease, according to a new study by the University of Maryland Center for Celiac Research in Baltimore. The research indicates that celiac is twice as common as Crohn's disease, ulceric colitis and cystic fibrosis combined.” </li></ul><ul><ul><ul><ul><ul><li>(UM, Celiac, 2008) . </li></ul></ul></ul></ul></ul>
  20. 20. Celiac Disease and Culture <ul><li>“Celiac (see-lee-ack) disease appears to be most common among those of us with Scandinavian-Celtic roots.” </li></ul><ul><li>“In Finland they have Gluten-Free burgers at their McDonald's” </li></ul><ul><ul><ul><ul><ul><li>(, 2007). </li></ul></ul></ul></ul></ul>
  21. 21. Complications <ul><li>Early diagnosis of celiac disease is important, as it might prevent complications. </li></ul><ul><li>“Untreated Celiac Disease has also been linked an increased risk of certain types of cancer, especially intestinal lymphoma.” </li></ul><ul><ul><ul><ul><ul><li>(UM, Celiac, 2008) . </li></ul></ul></ul></ul></ul>
  22. 22. Long-Term Effects of Celiac Disease <ul><li>“ Untreated Celiac Disease can be life threatening. </li></ul><ul><li>Celiacs are more likely to be afflicted with problems relating to malabsorption, including: </li></ul><ul><ul><li>osteoporosis, </li></ul></ul><ul><ul><li>tooth enamel defects, </li></ul></ul><ul><ul><li>central and peripheral nervous system disease, </li></ul></ul><ul><ul><li>pancreatic disease, </li></ul></ul><ul><ul><li>internal hemorrhaging, </li></ul></ul><ul><ul><li>organ disorders (gall bladder, liver, and spleen), and </li></ul></ul><ul><ul><li>gynecological disorders.” </li></ul></ul><ul><ul><ul><ul><ul><li>(UM, Celiac, 2008) . </li></ul></ul></ul></ul></ul>
  23. 23. Delay in Diagnosis <ul><li>“ The average length of time it takes for a symptomatic person to be diagnosed with celiac disease in the US is four years; this type of delay dramatically increases an individual’s risk of developing autoimmune disorders, neurological problems, osteoporosis and even cancer.” </li></ul><ul><ul><ul><ul><ul><li>Source: Characteristics of adult celiac disease in the USA: results of a national survey. Green, P.H. American Journal of Gastroenterology, 2001, 2006. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>( UChicago Celiac Disease Center, 2008 ) </li></ul></ul></ul></ul></ul>
  24. 24. Awareness is Key <ul><li>“ A recent study in North America shows that an active case-finding strategy in the primary care setting is an effective means to improve the diagnostic rate of Celiac Disease: by screening with the blood test all subjects belonging to known “at-risk” groups such as those listed above, the diagnosis rates increased more than 40-folds.” </li></ul><ul><ul><ul><ul><ul><li>Source: Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Ventura A, Gastroenterology 1999 Aug;117(2):297-303. Rampertab SD et al. Trends in the Presentation of Celiac Disease Am J Medicine 2006 </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Catassi C et al. Detection of Celiac disease in primary care: a multicenter case-finding study in North America. Am J Gastroenterol 2007 </li></ul></ul></ul></ul></ul>
  25. 25. Blood Tests for Celiac Disease <ul><li>“ A number of tests, sometimes collectively referred to as the Celiac Blood Panel , will aid the physician in diagnosis. The tests may include, but are not limited to: </li></ul><ul><ul><li>Serologic Tests </li></ul></ul><ul><ul><ul><li>EMA (Immunoglobulin A anti-endomysium antibodies) </li></ul></ul></ul><ul><ul><ul><li>AGA (IgA anti-gliadin antibodies) </li></ul></ul></ul><ul><ul><ul><li>AGG (IgG anti-gliadin antibodies) </li></ul></ul></ul><ul><ul><ul><li>tTGA (IgA anti-tissue transglutaminase) </li></ul></ul></ul><ul><ul><ul><li>Tolerance or Measure of Digestion/Absorption Tests </li></ul></ul></ul><ul><ul><ul><li>Lactose tolerance test. </li></ul></ul></ul><ul><ul><ul><li>D-Xylose test.” </li></ul></ul></ul>
  26. 26. Before and After results from an informal survey of about 20 people with gluten related sensitivity <ul><li>After going gluten-free, more than 90% reported improvement from the gluten-free diet. </li></ul><ul><li>All Participants spoke of delayed learning prior to a gluten-free diet either in themselves or their children. </li></ul><ul><ul><ul><ul><ul><li>Please Go to then next slide. </li></ul></ul></ul></ul></ul>
  27. 27. Before going gluten-free, Participants had the following difficulties/complaints: <ul><li>Daydreaming in school </li></ul><ul><li>Difficulty in finishing sentences and finding words </li></ul><ul><li>Speech delay </li></ul><ul><li>In and out of Special Education classes </li></ul><ul><li>Delays in walking and talking </li></ul><ul><li>Delayed puberty including menarche </li></ul><ul><li>Vitamin deficiencies </li></ul><ul><li>Non-epileptic seizures </li></ul><ul><li>Arthritis and osteopenia </li></ul><ul><li>Short term and long term memory was not good </li></ul><ul><li>Many reports of struggles with school but score high in intelligence </li></ul><ul><li>Misdiagnosis of fibromyalgia </li></ul><ul><li>Visual and auditory delusions </li></ul><ul><li>Anxiety problems, tummy aches </li></ul><ul><li>Temporary dyslexia </li></ul><ul><ul><ul><ul><ul><li>( Gluten-Brain Connection, 2008 ) </li></ul></ul></ul></ul></ul>
  28. 28. Some of the physiological, cognitive, and emotional symptoms they reported with dietary avoidance of gluten included: <ul><li>Improved ability to learn </li></ul><ul><li>Improved interest in school </li></ul><ul><li>Improved concentration </li></ul><ul><li>No more meds for depression problems </li></ul><ul><li>No more avoidance of meeting people </li></ul><ul><li>Expected full recovery of ataxia problems (inability to coordinate muscle movements) </li></ul><ul><li>Improved gross motor skills (was delayed in some cases) </li></ul><ul><li>Improved physical growth (was smaller than expected) </li></ul><ul><li>Went from bottom of class to the top of his class after 3 months on diet </li></ul><ul><li>Found a &quot;hunger&quot; for learning after avoiding gluten </li></ul><ul><li>Improved mood with less “crossness” and “crankiness” </li></ul><ul><li>Improved development to catch up with peers </li></ul><ul><li>Improved intellect with definite increases in intelligence </li></ul><ul><li>Grade point average went from 2.5 to 3.9 </li></ul><ul><li>Many have acquired college degrees with high gpa after going gluten-free </li></ul><ul><li>Came alive academically </li></ul><ul><li>Improved ability to meet daily challenges </li></ul><ul><li>Improved speed of learning (&quot;quicker&quot; in her studies) </li></ul><ul><li>Absenteeism no longer a problem </li></ul><ul><li>Lots of stories about coming out of withdrawn state socially to an outgoing one -- running for student council, more motivated in doing well and meeting people </li></ul><ul><li>Increased well-being and better brain chemistry </li></ul><ul><li>No more &quot;brain fog&quot; </li></ul><ul><li>Improved in reading (“noticeable”) </li></ul><ul><li>Improved temperaments in children </li></ul><ul><ul><ul><ul><ul><li>( Gluten-Brain Connection, 2008 ) </li></ul></ul></ul></ul></ul>
  29. 29. Basically <ul><li>Many experts are agreed that: </li></ul><ul><ul><li>Gluten-Related problems are genetic and/or hereditary. </li></ul></ul><ul><ul><li>Gluten-Related illnesses such as Celiac Disease are both common and appear to be under -diagnosed at this time. </li></ul></ul><ul><ul><li>Gluten appears to significantly impact many people on physical, psychological, intellectual, social and economic levels. </li></ul></ul><ul><ul><li>Avoidance of, and/or a reduction in Gluten intake can have positive effects on several very serious and common human diseases/disorders, most clearly Celiac Disease. </li></ul></ul><ul><ul><li>Gluten-Avoidance can be very difficult today in the U.S.A. </li></ul></ul><ul><ul><li>There is Much More to Learn about Gluten-Related problems. </li></ul></ul>(copyright 2008, William T. Beverly, Ph.D.)
  30. 30. The End <ul><li>Contact: </li></ul><ul><ul><li>Dr. William T. Beverly, L.C.S.W. </li></ul></ul><ul><ul><ul><li>[email_address] </li></ul></ul></ul><ul><ul><li>Dr. Beverly is also available for related consultations, menu development, workshops, and presentations. </li></ul></ul><ul><ul><ul><li> </li></ul></ul></ul><ul><ul><ul><li>[email_address] </li></ul></ul></ul><ul><ul><ul><ul><ul><li>(C.2008, William T. Beverly) </li></ul></ul></ul></ul></ul>