<<Disclaimer: Verify this information before applying it to your situation.>>
Lactose Intolerance
-------------------
Dr. Murray revisited the topic of lactose intolerance. About 50% of
celiac patients are lactose intolerant at the time of diagnosis. Here
is why:
Lactose is a double sugar. The small intestine has an enzyme called
lactase which breaks that double sugar down into single sugars which
your body can then absorb. Lactase is produced right at the tips of
the villi. If the villi are damaged then you can't produce that
enzyme to split that double sugar. So the lactose stays intact in the
intestine, passes through it, and then acts as a laxative. You will
get diarrhea, bloating, or gas, depending on the severity of the
symptoms.
After you go on a GF diet and get healing in your intestine, usually
those villi will regenerate and begin producing lactase again,
allowing your body to break down the lactose and absorb it. Dr.
Murray looks for improvement in lactose tolerance as a measure of
healing. If you do not recover the ability to digest lactose, then
either the intestine has not yet healed or you are one of the few
celiacs that are also genetically-predetermined to never be able to
break down lactose, as was discussed earlier. So continued lactose
intolerance is not necessarily a sign of villi damage (though highly
suggestive); but improvement in lactose tolerance is a sign of
healing.
Dr. Murray tells patients who have a lot of problems with milk to
wait about six months after starting a GF diet before trying it again.
After about six months they should start testing themselves with a
little skim milk first thing in the morning, to see if they get any
symptoms. If they get symptoms (bloating, gas, or diarrhea) then they
probably are still lactose intolerant. If that continues then they
need to revisit their doctor to find out if there is still evidence of
damage in the intestine.
The important point is that in most (90%+) newly-diagnosed celiacs
with lactose intolerance, it should get better.
Dermatitis Herpetiformis
------------------------
Next Dr. Murray discussed dermatitis herpetiformis (DH). DH is an
extremely itchy skin rash. There is nothing that is as itchy as DH;
even poison ivy may not come close according to those who have had
both. It effects the elbows, knees, buttocks, back of the head, and
scalp. Dr. Murray even had one lady who got it in her outer ear
canal. It comes on in waves. Crops of little bumps appear and soon
turn into blisters that are extremely itchy.
DH is often thought of as a skin disease, but that is not strictly
true. DH is a manifestation of intestinal intolerance to gluten.
Research has been done in which gluten has been injected under the
skin of DH patients, and it does not produce a blister. So DH is NOT
a skin allergy to gluten.
However, if a DH patient takes gluten by the mouth, then it can come
out as DH on the skin. In fact, Dr. Marsh in Manchester (England)
has put gluten in the rectum and in a couple of cases he had DH
patients claim that they got an attack of DH afterwards.
What happens when a DH patient ingests gluten? In the intestine the
body's immune system mounts a response to the gluten. Part of that
response is the production of antibodies, which are like little
chemical messengers the body produces to attack things and help defend
itself. In DH patients those antibodies often get dumped under the
lining of the skin, where they just sit like little land mines for
days, months, or years. Then one day something triggers them
(sunlight, iodine in a cleanser, etc.) and you get this little
bursting forth as the skin's immune system begins attacking these
deposits thus forming the blisters. But the deposits occur originally
due to the intestine being exposed to gluten.
So DH is the skin manifestation of intestinal gluten sensitivity which
is indistinguishable from CD. Most, if not all, DH patients will have
some degree of damage in their small intestines. They may have no GI
symptoms but they have some degree of damage.
|
