<<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.