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Newsletter Roundup
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Compiled by Jim Lyles
This section contains excerpts from newsletters produced by other
celiac groups.
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: :
: 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.]
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