Archive for the ‘diagnostic’ Category

This is an excerpt from my book (see links for editions in print and Kindle, in English and Spanish). Studying the search-terms that bring traffic to the blog, I thought it might be a good idea to post this information to the general public.

The Coeliac Connection

Coeliac Disease (spelled Celiac in the USA) is an autoimmune disorder caused by a reaction to gliadin, a gluten protein found in wheat. The reaction causes inflammation of the small intestine, which leads to atrophy of the vilii (surface cells), which then causes malabsorption of nutrients. Coeliac Disease is not a symptom of gall bladder dysfunction, but it can definitely be a cause. If you are suffering from gall bladder problems you should definitely be screened for Coeliac Disease. It affects about 1% of the population in the USA.

Coeliac Disease gets in the way of proper gall bladder function by dampening or canceling out the Cholecystokinin (CCK) signal sent from the duodenum. If the duodenum can’t sense fat content because its lining is inflamed or atrophied, it doesn’t know to send the CCK and call the gall bladder to action.

The gall bladder, not getting the proper signal, either sits idle waiting or does an inadequate job and doesn’t give 100% effort. Therefore bile doesn’t circulate properly, it has a greater opportunity to settle and crystallize, and the chance of gallstone formation is greatly increased.

Not only does Coeliac Disease cause malabsorption of nutrients in general due to its inflammatory nature, but its problems are further compounded by a double dose of malabsorption caused by reduced bile output from a lazy or unresponsive gall bladder. As the atrophy of the intestinal lining worsens over time, more symptoms and digestive disorders can result (such as lactose intolerance).

Symptoms of Coeliac Disease:

  • Diarrhea: often pale and foul-smelling

  • Abdominal pain and cramping

  • Bloating

  • Often misdiagnosed as IBS (Irritable Bowel Syndrome)

  • Vitamin A, D, E, and K deficiencies

  • Calcium malabsorption/deficiency

  • Bacterial overgrowth in the bowels

  • Dermatitis Herpetiformis (DH), an itchy skin rash

  • Mouth ulcers

  • Hypothyroidism

  • Iron deficiency

  • Chronic fatigue

  • Osteoporosis

  • Intestinal cancer

  • Sterility

Getting tested for Coeliac Disease:

Blood tests are the fastest way to screen for Coeliac Disease. The tests you should get are as follows:

  • IgA or tTG antibodies: Sensitivity 90%, Specificity 99%. IgA means anti-transglutamase antibodies. These antibodies are very specific, occurring 100% in people with Coeliac Disease, and 80% in people with DH (Dermatitis Herpetiformis). IgA is also called tTG (tissue trans-glutamase). If your test comes back IgA positive, there is a 97% chance that you have Coeliac Disease. This test does give occasional false-negatives; if you test negative, there is only a 71% chance that the negative result is accurate.

  • IgG anti-gliadin antibodies: Sensitivity 87%, Specificity 91%. This test shows positive results more readily but does not have as strong a correlation to proving Coeliac Disease. For ecample, IgG-positive results show up in 21% of people suffering from non-Coeliac digestive disorders. This test may not provide as good a test-positive result as the IgA/tTG but it provides less false-negatives, and therefore should be done at the same time.

Other testing methods:

  • Endoscopy with biopsy of duodenum or jejunum. Most Coeliac sufferers have a bowel that appears normal through the endoscope but inspection of a tissue sample viewed through a microscope reveals proof of the disease.

What to do if you have Coeliac Disease:

Presently, the only cure is to go on a gluten-free diet for the rest of your life. There are no miracle medications. Fortunately the solution requires only willpower, and costs nothing extra. In time, the intestinal walls will heal and the symptoms will abate or disappear completely.

Unfortunately, this means that you will have to stop ingesting anything containing gluten. The list of forbidden ingredients containing gluten is as follows:

  • Wheat

  • Spelt

  • Kamut

  • Rye

  • Barley

  • Triticale

  • Oats (if your oats are pure, you may not need to exclude them; normally they do not contain gluten but the machines that process oats are also used to process the other grains and may be cross-contaminated. There are also studies that show oats contain peptide sequences very similar to gluten which can cause problems in 10% of Coeliac patients)

The list does not stop there; all things derived from the above products must be avoided as well:

  • Bread and flour products of all kinds, with exception to pure corn bread.

  • Beer (Rest In Peace!)

  • Most types of Whiskey

  • Malts

A general list of things that are gluten-free:

  • Corn

  • Potatoes

  • Rice

  • Cassava

  • Yams

  • Chickpeas/garbanzo

  • Meats (be careful of sausages, as some use ingredients containing gluten as filler or flavor enhancers)

  • Wine, rum, brandy, sake, vodka, and other spirits derived from fruit, honey, sugar, rice, potatoes, or corn.

The particulars of following a gluten-free diet could easily fill their own book. There are a wealth of gluten-free diet books on the market. It is such a common problem that there is even a “Celiac Disease for Dummies” book in addition to a “Living Gluten-free for Dummies” and a “Gluten-free Cooking for Dummies.” All three are quite informative, and rated 4 stars or higher on that online bookstore everyone knows. Fortunately, many product manufacturers are more aware of dietary gluten problems, and label their ingredient list clearly as either containing gluten or being gluten-free.

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To make a long story short, Hashimoto’s Syndrome is an autoimmune/thyroid disorder which can have similar results (and causes) to Celiac Disease. Basically unwanted protein infiltration through a leaky or compromised gut. Supposedly there are some 30 million undiagnosed cases of Hashimoto’s Syndrome in the USA. You can read all the specific details here on Wikipedia.

How does it relate to gall bladder problems? Well, the same problems from Hashimoto’s and Celiac Disease can also incapacitate your gall badder. If you are a gall bladder patient, you may want to test yourself for Hashimoto’s Syndrome.

The wife of my friend Bill (who is writing a book on the subject) has Hashimoto’s and has found successful treatment through dietary changes:

My wife has found that by partioning her meals – eating protein first and giving the stomach at least 30 minutes to break the protein down into assimilable fragments that can be digested by the upper gut enzymes before the fragments have a chance to leak through the gut wall, and then eating the vegetable portion of her meal, almost completely eliminated the auto-immune response.

Bill goes on further to say:

Second let me URGE any reader who has been diagnosed with any kind of gut issue – celiac, IBS, crohns, SIBO, etc – and ESPECIALLY gluten intolerance! – get yourself tested for Hashimoto’s. In most cases, Hashi’s is confirmed by two antibodies labs: anti-TPO and TgAb. The first antibody, anti-TPO, attacks an enzyme normally found in your thyroid gland, called the Thyroid Peroxidase, which is important in the production of thyroid hormones. The second antibody, TgAb, attacks the key protein in the thyroid gland, the thyroglobulin, which is essential in the production of the T4 and T3 thyroid hormones. If you have insurance you may find that your doc resists ordering the tests – though for the life of me I don’t know why. We have no insurance and the damn things only cost @ $60 – and they are absolutely diagnostic. SO – do not let your Doc tell you that since your T4 tests are normal there’s no need for the anti-body tests. MAKE them order the damn tests ( voice of frustrated experience here).Then, if it turns out that you do have Hashi’s, there are several well-established pathways back to health.

Last, let me say that after years of working on this together with my wife and having to do almost all our own research since docs just don’t seem to know or care ( gastroenterologists are the worst IMO) we are convinced that whole-body inflammation is the bottom-line, underlying issue not just in Hashi’s but in a huge range of disease – and most gut disease in particular. Get control of the inflammation and you get control of the disease. A quick story to illustrate this. Within a month of eliminating grain, dairy and eggs from her diet my wife, who had weighed 110 pounds all her life before all this began and then for years she see-sawed between 125-140 but the amount of food she was taking in did not vary and she never ate junk food, sweets etc – the stuff that “makes you fat” – within a month she was back down to 110. But here’s the kicker – she had zero loose skin, the way you do when you lose weight, especially in places like the back of your arms. That’s because her extra weight wasn’t fat – it was inflamed tissue. Once the inflammation was under control, the tissues returned to normal state, and there was no extra loose skin. None. So in my mind that is pretty good evidence that an awful lot of the obesity that’s around these days probably isn’t fat, but inflamation. Just an opinion.