Gluten, Celiac Disease, Non Celiac Gluten Sensitivity and Neurological Illness

Gluten FreeEverywhere I turn in the supermarket or in restaurants I am offered Gluten free products. Gluten is a protein found in wheat and grain products and until recently individuals with problems digesting the substance were screened for celiac disease. Celiac Disease is an autoimmune disease that occurs when sensitive individuals eat gluten and develop bloating, cramping, gas, diarrhea, tiredness, headaches, joint pains, paresthesia’s in the extremities and neurologic issues. To diagnose Celiac Disease patients must possess certain antibodies that can be detected with a simple blood test and have a biopsy of the small intestine which reveals damage done to small intestinal cells. If gluten is removed from these individuals diet the symptoms resolve and the small intestine appearance returns to normal.

Celiac Disease is relatively rare. Many patients with irritable bowel syndrome and other functional bowel diseases that are difficult to categorize improve significantly when they follow a gluten free diet for at least 8 weeks. These individuals do not possess the diagnostic antibodies detected in the blood tests of patients with celiac disease. These patients additionally do not have any abnormalities of the small intestinal cells when they are biopsied and looked at under a microscope. The NY Times is currently publishing a series of 4 review articles on gluten and illness.

Dr. Peter Gibson, an Australian gastroenterologist, believes that a syndrome exists called Non Celiac Gluten Sensitivity (NCGS) caused by foods called “FODMAPS.” Fodmaps is an acronym for fructose, lactose, fructans, galactans and polyols (sugar alcohol sweeteners.) Patients with irritable bowel syndrome who eliminate FODMAPS find their symptoms disappear or improve after 8 weeks of avoidance of these food groups. Dr. Joseph Murray, a gastroenterologist at the Mayo Clinic, suggests that patients first be tested for celiac disease while still consuming gluten. If the blood tests and small bowel biopsy are negative then a gluten free diet low in FODMAPS should be tried for 8 weeks. If symptoms resolve then reintroduce FODMAPS one at a time and see if the symptoms recur.

The evaluation for Celiac Disease and Non Celiac Gluten Sensitivity should be performed by a doctor. When switching to a gluten free diet I strongly recommend meeting with a certified and registered dietitian so that your intake of fiber and other essential nutrients is assured. Lists of foods containing FODMAPS are available at the website www. Stanfordhealthcare.org. A more detailed discussion of NCGS is available in a book called “Mayo Clinic Going Gluten Free.”

From a common sense point it seems that most adults should recognize which foods and food groups result in them feeling poorly and avoid those foods. When it comes to a more complex approach than that one needs to see their physician and receive professional nutritional counseling. The jury is still out on the extent of disease caused by gluten but the research needs to be done!

Irritable Bowel Syndrome Responds To Rifaximin

StomachIn a study presented at the annual meeting of The American College of Gastroenterology, Anthony Lembo, MD, of the Harvard Medical School and Beth Israel Deaconess Medical Center presented data that showed that the non-absorbable antibiotic Rifaximin helps control cramping and diarrhea related Irritable Bowel Syndrome (IBS). Irritable bowel cripples individuals by causing abdominal cramping and multiple loose or watery stools per day. These patients have been screened by colonoscopy and imaging studies for more serious diseases such as Crohn’s Disease and ulcerative colitis with testing ruling these entities out. They are left with severe symptoms but no objective findings on available tests.

Over 2,500 patients participated in this study and received either Rifaximin or placebo three times per week. The decision to try an antibiotic was based on the theory that some IBS patients have excessive bacteria in the gut causing the problem. The treatment was successful in a significant number of participants compared to placebo based on a reduction of pain and frequency and number of stools. The patients were then observed for four (4) weeks during which time some patients relapsed. If these patients were treated for another two (2) weeks they showed significant improvement.

Irritable bowel incapacitates millions of individuals. While this data is extremely preliminary, it gives us hope of another treatment regimen, becoming available soon, that is effective and safe.