<<Disclaimer: Verify this information before applying it to your situation.>> Newsletter Roundup ------------------ Compiled by Jim Lyles This section contains excerpts from newsletters produced by other celiac groups. .......................................................... : : : Excerpts from _Gluten-Free Friends_ : : ----------------------------------- : : Summer 1998 (Vol. 4, No. 2) R. Jean Powell, editor : : Montana Celiac Society : : 1019 So. Bozeman Ave. #3 : : Bozeman, MT 59715 : :........................................................: Dental Defects and CD: The following are excerpts from an article written by Cleo Anderson of Helena, Montana. I became interested in the connection between celiac disease (CD) and dental defects shortly after being diagnosed with CD. I read an article which stated that not many dentists were aware of this connection, which surprised me since malabsorption causes problems throughout the body; why shouldn't teeth also be affected? Months later I read another article<5> about the effects of malabsorption of the necessary minerals and nutrients needed for the body to grow and develop properly. My own dentists over the years had not made any connection to the dental problems I had experienced since childhood. I had severe enamel problems in my baby teeth which doctors attributed to an allergic reaction I had to penicillin at age two. As it turns out, one of my four children has CD and also has problems with his teeth. Two of his children are believed to have CD and at the ages of three and four have severe dental problems with many fillings, root canals, and caps on molars. My family history spurred me on to further research on this subject. At the past two CSA national conferences I discussed dental problems with many celiacs. The consensus seems to be that many celiacs have had dental problems throughout their lives. Most were not aware of the connection to CD. Doctors who have studied and treated celiacs (mostly in other countries) ARE aware of the connection and often use dental records in helping to decide whether or not to biopsy a patient for celiac disease. For instance, I asked two pediatric gastroenterologists in Seattle to list the criteria they used to determine if a child should be biopsied. The list included: presence of intestinal irregularities (severe diarrhea or constipation), small stature (failure to thrive), thinning hair, distended abdomen, dental enamel and cavity problems, and (sometimes) irritability and mood swings. Unfortunately, many dentists do not appear to be aware of this connection with CD. In 1988 Dr. Lissa Aine and the Finnish Dental Society conducted a study in which it was discovered that enamel defects (hypoplasia) found in systemic patterns correlated significantly with gluten ingestion and severity of symptoms in celiac children. The upper two front teeth were affected in 95% of the celiac children studied who had their permanent teeth. Both initial gluten ingestion and subsequent gluten challenge prior to the age of three years could be clearly seen as enamel defects on the upper two front teeth. Both dental maturity and skeletal maturity were delayed in celiac children when compared to non-celiacs. "Catch-up" growth in dental tissues and bone occurred in celiac children when placed on a gluten-restricted diet. It is not known whether the malabsorption or the immune response is primarily responsible for enamel defects in celiacs. In the study, the enamel defects in the celiacs were symmetrical and time-related, whereas enamel defects in non-celiac children (which were less severe and frequent) were not symmetrical or systemic. The study also found a direct correlation between the severity of clinical celiac symptoms and the severity of the enamel defects of permanent teeth. The more severe the symptoms, the more severe was the damage to the teeth. -=-=- -=-=- Milk: Sensitivity or Intolerance? The following are excerpts from an article written by R. Jean Powell: Human infants and other mammals produce an enzyme called lactase, which is used in digestion to break down the complex milk sugar, lactose, into simpler sugars. In many cases, lactase production slows down dramatically as children approach adolescence. Without sufficient lactase, the lactose in milk cannot be digested. This condition is known as lactose intolerance. People of Northern European, Middle Eastern, and Central African descent typically have no difficulty with dairy foods. They are descended from societies that have domesticated goats and cattle for thousands of years. Natural selection gradually changed their genetics so that lactase production remains functional throughout life. How did this natural selection happen? If fresh cheeses and milk were among a society's main food sources, then lactose intolerant individuals in that society would not thrive and would be less likely to have children. Meanwhile, those who could digest lactose would be more likely to survive and would have more children. Each generation would have a higher percentage of people who could digest lactose, until lactose-intolerance was mostly bred out of the population. African Americans, Asians, Native Americans, and people who come from areas surrounding the Mediteranean have a different heritage and lose the ability to produce lactase soon after weaning. This implies that school-aged children can suffer from an inability to digest lactose as readily as adults. Actually, an intolerance to lactose occurs naturally in a large portion of the world's population. It's all in your genes. The lactase enzyme is produced by hair-like projections located in the brush border of the absorptive cells in the small intestine. A person with active celiac disease (CD) will have damage to these cells and lose the hair-like projections; this causes secondary lactase deficiency. For those who normally can tolerate milk, active CD causes a sort of temporary lactose intolerance. When the small intestine heals, the hair-like cells are restored and lactase production will return to its normal level. But if you are one of those who don't produce much lactase anyway, you will remain lactose intolerant for life for reasons that have nothing to do with celiac disease. Not all dairy products must be avoided. Microscopic allies reside in our intestines that, if properly cared for, can "gobble up" at least some of the lactose our enzymes can't digest. Too much lactose will overwhelm them, so moderation is crucial. In yogurt and aged, hard cheeses, some lactose is broken down prior to consumption. Also, yogurt encourages "good" bacteria to begin fermentation even while the yogurt sits on the store shelf. When eaten, these "good" bacteria release lactose-digesting enzymes into your intestine. However, freezing kills these bacteria so you won't find them in frozen yogurt or in acidophilus milk (which is often made with frozen starter cultures). Also, these microbes can digest buttermilk lactose only when phosphorus is added. Fortunately, there are gluten-free (GF) enzyme replacements on the market. Some hard cheeses, ices, ice creams, butters, and margarines are low in lactose. Consuming milk with meals slows its progress through the digestive tract, giving the bacteria a greater opportunity to break down the milk sugars. Analyze your own symptoms carefully and you can occasionally enjoy dairy products in moderate amounts. Just don't overload! Gas, cramps, and diarrhea set in when more lactose is consumed than can be processed by the bacteria. A few techniques: * Avoid dairy products for two weeks, carefully scanning labels for hidden sources of lactose, such as anything creamed. * If your symptoms lessen dramatically in two weeks, then gradually reintroduce a dairy food. There may be no indication for two or three days, so be patient. * Bacterial infections, viruses, antibiotics, and parasites can interfere with the lactose-digesting bacteria in your intestine. Once that problem is solved, the "good" bacteria will return. * For newly-diagnosed celiacs, as the intestine heals the hair-like projections on the villi may return and begin to produce lactase again, perhaps not abundantly, but enough to allow you to enjoy dairy products several times a week. Just gauge from your symptoms. Foods other than dairy products which contain calcium include: eggs fish fruit green vegetables sardines & salmon w/bones tofu broccoli kale figs & dates celery turnip greens sesame seeds Also, there are many GF juices fortified with calcium and many GF calcium supplements. [Dorothy Vaughn, our dietitian advisor, notes that none of these products are as calcium-rich as most dairy products. Some would have to be eaten in large quantities to match the calcium in a glass of milk.] [Editor's note: For celiacs, the symptoms of accidental gluten ingestion and lactose intolerance can be very similar. Both can cause bloating, cramps, and diarrhea. However, there is a big difference in what goes on inside your gut. When a celiac eats gluten, it causes damage to the small intestine along with these more immediate symptoms, which can lead to serious long-term complications if it occurs repeatedly. When you are lactose intolerant and consume too many dairy products, the immediate symptoms are the only real concern. Lactose does not cause damage to the small intestine. So for celiacs that are lactose intolerant, the policy should be: "dairy in moderation, gluten not at all".] Lactaid and Dairy Ease no longer guarantee that their products are GF. Lactrase (800-558-5114) gave the following statement: Ingredients include maltodextrin (corn-based), aspergillus oryzea (a fungus) and magnesium stearate (a beef or porcine fat). Red and orange dyes color the capsule. No gluten sources are used, so the product is believed to be GF, but the product itself has not been tested. Some people can digest lactose, but have a sensitivity to milk protein [casein]. This can cause symptoms almost immediately, whereas lactose intolerance symptoms are usually delayed. Symptoms include lip swelling, tingling in the mouth and throat, vomiting, abdominal distention, diarrhea, bad breath, sudden fatigue, and irritability. [Note from Dr. Alexander: This is typically a condition that occurs in children.] The only treatment for milk protein sensitivity is to avoid all milk products. -=-=- -=-=- Celiac Disease: A Recent Event? The following are excerpts from an anthropology paper by Joe Barr, Montana State University, published in April 1998: Celiac Disease (CD) manifests itself in many ways due to its negative effects on an individual's gastrointestinal tract, affecting the ability to absorb nutrients. Celiacs who inadvertently consume gluten find themselves at a disadvantage in evolutionary terms. Faced with sickness and death at an earlier age, often without mating, it follows that such individuals carrying the genetic tendency towards CD would eventually die out, effectively terminating their lineage and eradicating CD. So how then, did the genes consistent with CD remain in existence and at such a high frequency in many populations today? Perhaps CD is a relatively recent mutation in the human genotype. The grain that is most noxious to celiacs is wheat. Wheat was first domesticated in around 8400 BC, and wild wheat was being gathered as early as 9400 BC by certain neolithic peoples in the Near East [such as Palestine, Lebanon, and Syria]. The center of early wheat cultivation implicated in the onset of CD is found in the Near East in countries such as Greece, Turkey, Israel, and Northern Africa. Researchers have concentrated on establishing some sort of correlation between the frequency of CD and the presence of wheat in the diet of these populations. Surprisingly, they've found that the highest concentration of CD is found, not near the center of wheat cultivation, but rather, on the periphery of the regions with the greatest wheat consumption. On a map displaying the frequency of CD, a pattern appears: The incidence of CD, from lowest to highest, shifts with the spread of grain cultivation from the Near East to Northern Europe and the British Isles as if the celiac genotype were fleeing the specter of a mysterious, daunting predator. Other similar patterns can be observed between smaller populations, such as between the English and the Irish. This daunting predator, of course, is natural selection, the mechanism behind Darwin's theory of evolution. An article addressing the geographic distribution of CD suggests that the onset of the disease generally occurs before the reproductive years and leaves stricken individuals with a much decreased reproductive capacity, thereby diminishing the number of viable offspring in subsequent generations. One simply has to note the systematic elimination of individuals less fit to survive in an age when survival meant the consumption of a food source that would ultimately lead to their demise. The author of this article claims that the genetic mutation leading to CD must have been relatively recent in human evolution. Natural selection simply has not had the time necessary to effect a complete eradication of the celiac genotype. [Had the celiac genetic mutation or the cultivation of wheat occurred a few thousand generations earlier, there might not be any CD today. Of course, many of the readers of this article would also not be here today, as their ancestors would have been wiped out by natural selection. With modern medicine and a gluten-free diet, we celiacs can outfox evolution.-ed.]