Sensitivity and intolerance to certain foods can cause health problems.
Information about Gluten Intolerance (Celiac Disease), Lactose Intolerance, Food Allergies.
Gluten Intolerance
History and incidence
Gluten intolerant people have celiac disease, which is an inability to digest gluten. This disease has been around a long time. It was named back in the first century A.D. by a Greek physician, who named it koiliakos after the Greek word koelia, meaning stomach. His description was that the stomach could not retain the food, it would pass through indigested and not be taken up by the body. In the 19th century Doctors Mathew Baillie and Samuel Gee recognized the disease, and the importance of treating it through diet. However it was still pretty much hit or miss since no one had figured out the etymological cause of celiac disease. In the 1920's the banana diet became very popular for treating both anorexics and celiacs. Part of the diet regimen was to eliminate all breads, crackers, cereals, etc from the diet, so no doubt its success was in eliminating gluten. Dr. Sidney Haas, who developed the diet, believed it was eliminating ALL carbohydrates that brought success, not just wheat.
It was a Dutch doctor in the Netherlands during WWII that noticed a connection between wheat and celiac disease. He noticed during bread shortages that celiac children improved, and when bread was dropped by the Allied planes these patients deteriorated. In the 1950's the first jejunal biopsy was done and doctors could finally see the actual changes in the small intestine that this disease caused. Throughout the next 40 years many studies were done on causes and symptoms of celiac disease, and the best means of diagnosis. In the 1990s it became accepted that celiac disease is an autoimmune condition, and that the trigger for this disease is gluten.
Celiac disease is found in people worldwide. In the United States about 1% of the population has celiac disease. Researchers have found that 1 in every 77 Swedish children has the disease and 1 in 230 school-age Italian children. It is believed to be rare in black Africans, Chinese and Japanese. See Guidelines for the Diagnosis and Treatment of Celiac Disease in Children. Celiac disease is also high incidence in people of Irish descent. Because adults often don't show gastrointestinal symptoms with this disease there are probably many undiagnosed cases.
In 2003 a Dutch doctor, Dr. Nieuwenhuizen, published a study in the Lancet linking celiac disease with candida yeast infections. According to his research, a candida infection can trigger celiac disease, and can also cause many of the same symptoms in a celiac, even if the person's diet is gluten free. Interesting that ground breaking research on this disease comes from the Netherlands once again.
Symptoms
Gluten is a set of proteins found in wheat, rye and barley. Oats also have a similar protein and may cause problems for some celiacs. Gluten is actually made up of two proteins, glutenin and gliaden. Gliaden is the substance that causes the problems with the small intestine. But for some reason we call it gluten intolerance instead of gliaden intolerance. I guess it just sounds better.
When a person with celiac disease eats gluten, the body responds by attacking the lining of the small intestine. Tiny, fingerlike protrusions called villi, which are supposed to absorb many nutrients, are flattened. As a result, many other nutritional diseases can arise from this condition.
A condition often found in celiacs is Dermatitis herpetiformis, an itchy, blistering rash that can appear on elbows, knees and buttocks, almost always on both sides of the body. Sometimes people with this rash don't have a positive blood test for celiac disease, but will exhibit the changes in the intestine that go along with the disease.
The most well known symptom of celiac disease is abdominal pain, bloating, diarrhea and/or vomiting, but it can also affect many other parts of the body. Other symptoms of celiac disease include joint pain, fatigue, anemia, infertility, osteoporosis, tingling numbness in legs, the rash mentioned earlier, peripheral neuropathy, anxiety and depression.
Diagnosis
Diagnosis can be done in three steps: genetic testing, a blood test for antibodies, and a biopsy of the small intestine. The last test is the only one that can definitely diagnose the disease.
Celiac disease is a genetic disease and if one family member is diagnosed, it's likely other members will have it as well. There are two genes identified which a person must have in order to develop the disease. You can test for these genes with a simple cheek swab. Therefore, this can be used as a test to eliminate family members that do not need to be watched or tested for this disease. You can also use the test to eliminate the disease as a possibility when you are being diagnosed in the first place. If the gene test is positive, it doesn't mean you have the disease, just that it is possible for you to have it.
A blood test can measure levels of antibodies that are present when a celiac eats gluten. There are several tests available, but one of the most sensitive is Anti-Tissue Transglutaminase. The next step after a positive blood test is to have a biopsy of the small intestine, in which a doctor passes a tube through your mouth and stomach into the small intestine and collects some tissue samples. This is the only test that can tell for sure if you have celiac disease.
So, you can have a positive genetic test meaning you have the potential to develop the disease, and you can have a positive antibody test, and still not have the intestinal changes showing you are a celiac. That is why the biopsy is the final diagnosis for this disease.
If you suspect you may have celiac disease and are tempted to just start the diet and see what happens, consider this. After your symptoms have gone and your small intestine is healed, any tests done for the disease will come back negative. In order to confirm your diagnosis medically, you will have to eat gluten again, and it can take up to 3 months for an adult to reach a point where he will test positive again for celiac disease. If your doctor is willing to test you, its much easier to do it before starting the diet. Also, people who have been confirmed by a biopsy tend to stick to the diet better and for a longer time than those who started it on conjecture.
Treatment: Living with Celiac Disease
The only treatment for celiac disease is to stop eating gluten completely. This can mean major changes to the diet, but most celiacs agree it is worth it to feel healthy. In adults it can take 6 months and as long as two years for the villi to heal itself so that you are feeling healthy again. There are many resources available for people who need to follow a gluten free diet, so even though it is a major change, you can still live a full life and eat a wide variety of foods. Here are some of the foods you must avoid on a gluten free diet:
- wheat bread
- pasta (unless gluten free), and semolina
- bulghur
- wheat germ, whole wheat flour, bran, groats and any other type of flour or grain with WHEAT in the name!
- hydrolyzed wheat protein
- foods with caramel coloring
- beer, ale and lager
- brewers yeast
- couscous
- farina, cream of wheat, and other wheat-based cereals
- most packaged cold cereals, unless they say they are gluten free
- graham flour
- barley, malted barley, malt syrup, malt vinegar and malted milk
- soy sauce
- matzo
- orzo
- rye products
- spelt products
- tabbouli
- textured vegetable protein
- sprouts made from wheat, rye, spelt or barley
- wheat noodles
- wheat nuts
- foods with breading
- croutons
- some processed lunch meats
- triticale
- stuffing or dressing
- dishes made with a roux-based thickener such as macaroni and cheese
- all baked goods containing wheat, rye, spelt or triticale, or any of the other things listed
- communion bread or wafers
- certain medications, vitamins and supplements may have gluten - look for a gluten free brand
This is already a daunting list, and there are many products left off. Also, you can't trust other grains such as corn or oats unless they are specifically milled in a gluten free environment. Particles of gluten can actually contaminate the mill and get into other grains. It does give you an idea of how many common foods and dishes contain gluten. Just skipping bread is not enough! The good thing is that many food manufacturers are now making gluten free versions of their products. Some grocery stores have large gluten free sections containing breads, cookies, crackers, cereals and more.
If you suspect you have celiac disease you may want to see a doctor who specializes in this area. He or she will be more likely to take your symptoms seriously, and know the appropriate path for testing. This is most likely a gastroenterologist, but could be a family doctor or pediatrician with an interest in this area. You could try asking your doctor for a referal to a specialist, or look over one of the lists online to find one in your area.
Resources for Gluten Intolerance
Celiac Disease Facts and Figures
Celiac Sprue Association provides lists of Celiac Centers in the US, Government links, information on Communion, and information on foods and recipes.
The mission of the Gluten Intolerance Group of North America is to provide support to persons with gluten intolerances in order for them to lead healthy lives.
Celiac Central is the web site for the National Foundation for Celiac Awareness. Here you can find a celiac symptoms checklist to take to your doctor, news feeds of recent studies being done in this area, programs and events for Celiac awareness, a list of Celiac clinics, and more food lists and resources.
The Celiac Disease Foundation provides support and increases awareness of celiac disease. Among other resources, they have a recommended reading list on the topic.
Among other resources, Clan Thompson's Celiac Site lists prescription and over the counter meds that are gluten free. Click on "resources" and then on "free lists". You can also find a list of doctors that specialize in celiac disease on this site.
The Glutenfreeda Online Cooking Magazine was created to help people with Celiac Sprue Disease learn to prepare all the foods they love, gluten-free.
Celiac.com has been providing celiac disease and gluten-free diet information since 1995. You can find a list of doctors on this page, as well as many other lists and resources.
Lactose Intolerance
History and incidence
Lactose is a sugar found in milk, and in order to process it your body uses an enzyme called lactase. Lactase is produced by the small intestine. It breaks down the lactose into glucose and galactose, both of which can be absorbed into the body. Lactose that is not broken down travels through your intestine producing the symptoms of lactose intolerance. This condition has been around since ancient times, and is mentioned in Greek and Roman literature. However it wasn't until the 1960's and 70's that doctors understood how the enzyme lactase was involved.
The ability to produce lactase seems to be a genetic mutation present in only some races For example, for American Indians and some Asian races 100% of the people are lactose intolerant. Other races have varying degrees of tolerance. Scandinavia and northwest Europe are the best milk drinkers, with less than 5% of people being lactose intolerant. As you go further south and east in Europe, the number grows, and in southern Italy and Turkey about 70% of the people are lactose intolerant. In South America, Africa and Asia the prevalence is 50%, with some Asian countries being up to 100%. In North America, caucasians have a lactose intolerance rate of about 15%, but African Americans and Mexican Americans can be as high as 50%. There doesn't seem to be a difference in gender - the rate stays the same for men and women. However lactose intolerance does increase with age as our bodies produce less lactose the older we get. You can find this detailed information and related studies at Foodreactions.org.
Symptoms
As mentioned above, lactose that hasn't been broken down by enzymes cannot be absorbed by the small intestine, so it travels into the large intestine. Here it becomes a feast for bacteria living in the intestine, and they create the conditions that give you gas, bloating and diarrhea. Nausea and abdominal cramps may also be present, and all these wonderful things can happen anywhere from 30 minutes to 2 hours after you eat.
Diagnosis
There are two tests that can be done in a doctors office to test for lactose intolerance. They are a blood glucose test and a hydrogen breath test. These are generally not safe for infants and children, so they are given a stool sample test instead.
For the blood glucose test, you must fast for a time period before. At the doctors office you are given a drink with high levels of lactose. If you are producing lactase this should be broken down to glucose and absorbed, causing your blood glucose levels to rise. Blood samples are drawn, and if your glucose levels don't rise during a prescribed time period it means you are not breaking down the lactose.
For the hydrogen breath test you are given a similar lactose laced drink. After a period of time the doctor will measure the amount of hydrogen in your breath. For a person with normal digestion this should be low. If you aren't digesting the lactose and it is fermenting in your intestines, a lot of hydrogen is produced. This is absorbed through the intestines, carried in the bloodstream to the lungs, and then removed and exhaled through your breath.
Infants and children are not given these tests because the amount of lactose in the drink can be dangerous for them. Usually a stool sample is checked for the presence of lactic acid, which would indicate that lactose is not being digested.
Living with Lactose Intolerance
There is no cure for lactose intolerance, but it can easily be managed by diet. You can approach it in two ways: avoid eating any foods with lactose, or supplement your diet with lactase in order to digest the lactose that you eat. Milk is the most obvious source of lactose, but foods made with milk will also need to be restricted, and often lactose is added to prepared foods.
Some foods that contain lactose are:
- milk
- cheese, especially soft cheeses
- puddings, cream sauces, milk shakes, cream soups or other dishes made with milk
- cottage cheese (has lower levels, and some people may be able to eat it)
- buttermilk
- cheese dips and spreads
- evaporated and condensed milk
- hot chocolate made with milk, including mixes
- sour cream, cream cheese
- products containing whey, milk solids, malted milk or milk powder
- ice cream
- cruelest of all, milk chocolate
If you must eliminate all lactose from your diet, you will need to make sure you are getting calcium, vitamins A and D, riboflavin and phosphorus from other sources. Some good non-milk sources of these nutrients are:
- leafy green vegetables
- broccoli
- canned salmon
- sardines (with bones)
- tofu
- soy milk and soy yogurt
- rice milk
- products fortified with calcium such as orange juice or cereals (without milk, of course)
- almonds
You can also take vitamin and calcium supplements to make sure you are getting your daily needs. Some people just have reduced levels of lactase, and don't need to be as vigilant with the diet. If you eat lactose in small amounts throughout the day, and try to combine it with other foods (ie: don't drink a huge glass of milk on an empty stomach), it will be easier for your body to process. For an adult, this is not a life threatening condition, but a question of comfort level. You can experiment with foods that work for you.
If you can't stand the thought of giving up milk, or are in situations where you don't have a choice, you can take lactase enzymes along with your food, to help your body digest the lactose. One of the brands available is called Lactaid. You can get these quite easily without a prescription, as a tablet, or a liquid which you can stir into your food. Lactaid also makes milk with lactase added.
Resources for Lactose Intolerance
A page about lactose for kids.A guide for teens from Center for Young Women's Health.
A little bit of chemistry
More chemistry of lactose
The Premier Australian website for Lactose Intolerant People
Lactose-free recipes
The Really BIG List of Lactose Percentages
Milk Free Pantry
Food Allergies
History and incidence
Even though about 30% of people claim to have a food allergy, the actual incidence is only 3% of children, and that drops to 1% for adults, in the United States. This number is a bit higher in some European countries, although I've found lots of contradictory numbers out there. There is a difference between a food intolerance, such as the lactose and gluten intolerances mentioned on this page, and a food allergy. However experts agree that the incidence is rising, especially in developed countries. The CDC (Centers for Disease Control and Prevention) found incidence of food allergy in US children rose 18% in the ten year period from 1997 to 2007. This may be just because parents are aware of the need to have their children diagnosed, whereas before kids would just be "sickly" and no one knew exactly why. Or it may be due to changes in our food supply such as many additives and preservatives, genetically modified foods, or just the vast increase in types of food available in different regions.
Causes and Symptoms
Food allergies are a reaction to the protein in a particular food, and like other allergies your immune system mistakenly attacks that protein, causing symptoms like hives, skin rash, itching in mouth, swelling, wheezing, dizziness and fainting, and gastrointestinal problems. A severe reaction in some people can cause anaphylactic shock, which includes swelling in the throat and difficulty breathing, shock, drop in blood pressure, rapid pulse, and eventually coma and death if not treated.
When your immune system identifies something in your food that it thinks is an enemy, it releases Y-shaped antibodies known as immunoglobulin E, or IgE. IgE attach to the bodies of mast cells, which contain histamine. Then every time you eat that food, even in a tiny amount, the allergen hooks into IgE on the mast cells, giving them the signal to release histamine. You can see an great illustration at Alegent Health. Histamine is responsible for most of the symptoms of allergies.
The most common foods that cause allergic reactions in grownups are shellfish, eggs, peanuts, tree nuts and fish. Children frequently have allergies to milk, soy, eggs, peanuts and tree nuts. You'll be happy to know that chocolate rarely causes an allergic reaction. There is also a phenomenon known as cross-reactivity, where the antibodies that were created to respond to one allergen react to another allergen. Some common examples are people who are allergic to ragweed might have a reaction if they eat melon, and people allergic to birch might react to apples. If you are allergic to one type of shellfish it is very common to have cross-reactivity to all shellfish, so you should avoid them all.
Diagnosis
If you go to the doctor to be diagnosed with a food allergy, you will most likely start out by giving a history of when you ate the offending food,and what reaction occurred, when it occurred, etc. The doctor might ask you to keep a food diary showing when you eat the food and what happens. You may be put on an elimination diet, where the food is removed from your diet to see if the symptoms go away. Then the food is added back, and if the symptoms return its a good bet that your are allergic to that food. Obviously if these symptoms are life threatening you wouldn't be able to add it back to the diet.
Once you narrow down the offending foods this way, there are some lab tests that can confirm your body is reacting to those substances. In the skin test, a small amount of the food is placed just below the skin by pricking it with a needle. If you are allergic you would develop a rash or itchy bumps. There are also several blood tests which can measure the amount of IgE in your blood. You may have some or all of these tests done in order to confirm a food allergy.
Living with Food Allergies
There is no cure for food allergies, and the best way to manage is to stay away from the allergen. This is easier said than done, as so many processed foods may contain ingredients that you don't recognize right away as being that particular food. Also food processing plants may have traces of nuts or eggs that can contaminate other foods. With the number of food allergies on the rise many manufacturers are providing this information on food labels. Here are some resources that can provide information about specific food allergies:
- peanutallergy.com
- FAAN has resources for several food allergies
- a page for kids and teens
- Mayoclinic.com has information on egg allergy
- The Food Allergy Initiative
- Best Allergy Sites lists them for you!
There are always going to be times when you eat a food on purpose or by accident that sets off an allergic reaction. If your symptoms are not life-threatening you can handle this by taking antihistamines, either an over-the-counter version or something prescribed by your doctor. People with a life-threatening allergy should carry a device called an autoinjector to administer epinephrine. This may be called a EpiPen, EpiPen Jr or Twinject, and is a small syringe that you press against your thigh to inject the medicine. Many people carry an extra one of these, and it doesn't hurt if someone you are with is trained to use it as well. You may also need to get to the emergency room quickly.
People who are allergic to things in the environment like pollen and pets can get a series of shots that can gradually alleviate their symptoms, but unfortunately these aren't effective with food allergies.
Whole Food Resources
Many illnesses are a result of food processing. Buy natural whole foods.© Elizabeth Quinn 2008 - All contents of these pages.