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Dear friends:

I asked this questions:

1)How could I properly absorb or digest the polysaccharides of GF diet with
one severe atrophy of the intestinal villi ?

2) why the all doctors give us only a GF diet if we only
can absorb monosaccharides for a long time?

Adding for Summary I these are three more answers:


1)
De: Richard Lovegrove 
I had severe damage and I was able to quicky absorn polysaccharides and
protein. Everybody is different.

2)
De: Donald Baisch 
Carlos,
good questions.
First we need to eliminate the 
sub-proteins that activate the killer T-cells.
Depending on how long the patient has been
exhibiting symptoms will determine how
long it will take to start growing villi and
microvilli.
Anytime he/she eats gluten- during that period
will set back how long it will be to get some
healthy villi and start getting the blood chemistry
closer to normal and getting a normal
balance of the digestive enzymes needed in the blood
to start processing absorption of nutrients.
On some people it take 6-8 weeks
others like me, it took 8 years to get a normal
blood chemistry and normal absorption.

don in Carlsbad, Calif

it was nice to hear from you again

3)
De: Ron Hoggan 
Hi Carlos, 
I want to suggest two things: 
1. The intestinal wall is not flat for its entire length, and;  
2. The perception of celiac disease as one of malabsorption is a very
limited view that is less than accurate. 

One of the great diagnostic challenges has been to get endoscopists to
take several biopsies, because the celiac lesion is usually patchy, and
does not consistently damage the intestinal wall. The distribution and
severity of the lesion is, in fact, quite variable. 

Historically, celiac disease was characterized as a disease of fat
malabsorption because of the elevated levels of fecal fat, and because
of the many symptoms of fat deficiency. Our fat absorption is
compromised by several factors, including dramatic reductions in CCK
production. This is the hormone that intestine produces in response to
fats to signal the gall bladder to contract and expel bile toward the
intestine to facilitate fat absorption. Gall bladder dysfunction is very
common in untreated celiac disease. Other factors in fat malabsorption,
in the context of untreated celiac disease, include damage to intestinal
microvilli, altered lymph circulation, and altered liver function.   

The general shift to limited perception of celiac disease as one of
general malabsorption has its roots in the early days of the intestinal
biopsies that showed dramatic flattening of the villi. Further, because
of the wide range of nutrient deficiency diseases that untreated celiacs
suffer, there was a common belief that this was the result of a failure
to absorb these nutrients. While there is considerable truth in this
understanding, it ignores the many other dynamics at work in our very
complex ailment. For instance, our propensity to bone mineral loss is
not usually the result of calcium malabsorption. Rather, it is often the
result of excessive calcium excretion. Vitamin B12 deficiency, also a
common condition in our disease, may be the result of damage to the
stomach lining which has compromised our ability to produce intrinsic
factor, a necessary element in B12 metabolism.      

The digestion of poly saccarides does require the presence of some
enzymes for digestion, but your severe atrophy of intestinal villi is
unlikely to involve the entire small intestine. Supplemental digestive
enzymes will likely reduce the negative impact of the damage you do
have, but it is likely that you have at least some brush border enzymes
still at work in your gut.

If you are not responding rapidly to a gluten-free diet, you may benefit
from looking for additional food allergies. We are inclined to such
allergies because of the years of intestinal damage and gut leakage
prior to diagnosis. 

Best Wishes, 
Ron Hoggan 
co-author of Dangerous Grains

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Many, many thanks for all the answers.

Carlos Mangione
Celiac
Buenos Aires
Argentina

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