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Celiac Disease Can Have Serious Consequences

Kate Brophy — Mon, 18 May 2020 14:49:42 +0000

Celiac disease, an autoimmune disorder that interferes with the body’s absorption of certain nutrients, is often believed to affect only younger people. However, it can develop for the first time in seniors—in fact, some studies indicate that a substantial number of people with celiac disease are diagnosed after age 50, and about one-third after age 65. The condition can have serious health consequences, including anemia, weaker bones, colon cancer, and lymphoma, a cancer that affects immune-system cells called lymphocytes. It also is linked to a greater risk of death due to cardiovascular disease.

What is Celiac Disease? In order for the body to fully utilize the nutrients in food, they have to be absorbed from the small intestine into the bloodstream. “Absorption takes place through villi: tiny protrusions on the lining of the small intestine,” explains Mount Sinai gastroenterologist Brijen J. Shah, MD. “If the villi are damaged, nutrients may not be absorbed.”

In celiac disease, villi are damaged by gluten, a protein found in wheat, rye, and barley. “The immune system mistakenly treats gluten as an invader and attacks it,” Dr. Shah says. “This triggers inflammation in the small intestine, and the inflammation irritates the villi, impairing their ability to do their job.”

Celiac Disease Symptoms In most people, celiac disease causes gastrointestinal (GI) symptoms, such as excessive wind, abdominal bloating and discomfort, diarrhea, and pale, foul-smelling stools. It also is associated with bone and joint pain, muscle cramps, tingling and/or numbness in the legs, fatigue, pale sores inside the mouth, and an itchy rash.

When GI symptoms occur in seniors with celiac disease, they tend to take the form of gas and abdominal bloating that might be blamed on another health condition, such as irritable bowel syndrome, or on a medication. But one symptom that can help doctors diagnose celiac disease in seniors is the presence of pale, foul-smelling stools that may be difficult to flush away when passed. “This signals that there is excess fat in the stools: a phenomenon known as steatorrhea,” Dr. Shah explains. “Celiac disease is one of the most common causes of steatorrhea in older adults.”

Anemia is another red flag for celiac disease, occuring in up to 80 percent of seniors with the condition. “Deficiencies of calcium and vitamin D—manifesting as osteoporosis—also may signal celiac disease in an older adult, as can abnormal liver function tests,” Dr. Shah adds.

Diagnosing Celiac Disease If your doctor suspects that you have celiac disease, he or she will likely order a blood test to determine whether your immune system is producing antibodies against gluten. If the blood test shows the presence of antibodies, a biopsy (a small sample of tissue for examination under a microscope) of the small intestine may be taken using a procedure called endoscopy. This involves having an endoscope (a long, thin, flexible tube with a light and a tiny camera lens on the end) inserted down your throat and esophagus. In order to take a biopsy, the doctor will pass a thin wire with forceps through the endoscope.

“Examination of the biopsy under a microscope will reveal characteristic changes in the villi that indicate celiac disease,” Dr. Shah says. “Confirmation of celiac disease is important, since strict adherence to a gluten-free diet can eliminate symptoms and prevent complications.”

Treating Celiac Disease The treatment for celiac disease is to avoid all gluten, since this is the only way to stop your immune system from reacting to the protein. “Once this reaction stops and the inflammation resolves, the villi will begin to heal and your absorption of nutrients will return to normal,” Dr. Shah says. “However, in seniors it may take up to two years for the intestine to completely heal.”

Dietary Challenge Living a gluten-free life requires that you avoid wheat, rye, and barley. This means no more pasta, cereal, or bread made with these grains—instead, you’ll need to substitute them with gluten-free options, which include oats, corn, quinoa, amaranth, brown rice, buckwheat, and millet. If you like to bake, consider using flours made from potato, soy, or beans. “You may benefit from consulting a dietitian who can help you devise an eating plan that completely eliminates gluten from your diet while ensuring that you get the nutrients you need,” Dr. Shah says.

Many stores carry gluten-free products, but if it isn’t easy to obtain these locally, check all food labels carefully to avoid hidden sources of gluten (these include additives like modified food starch, preservatives, and stabilizers). Eating out can be risky, since gluten is found in many products, and when a gluten-free restaurant meal is prepared in the vicinity of other foods or ingredients that contain gluten, cross-contamination can occur. In one 2019 study, 32 percent of “gluten-free” meals randomly taken from restaurants nationwide had detectable levels of gluten. “When eating out, order dishes without breading, gravies, or sauces,” Dr. Shah advises. “Also check if precautions were taken to prevent cross-contamination.”

On the Horizon Pharmaceutical companies are currently trying to develop drugs that enable people with celiac disease to tolerate gluten-containing foods. One such drug, larazotide acetate, is now in phase-3 clinical trials, the last stage before approval by the Food and Drug Administration. The drug works by preventing gluten from crossing the lining of the small intestine.

The post Celiac Disease Can Have Serious Consequences appeared first on University Health News.

8. Diseases and Disorders of the Small Intestine

Lynne Christensen — Tue, 27 Aug 2019 14:41:26 +0000

The small intestine isn’t small in terms of size or significance. Stretched out, it covers about 20 feet—about the same height as an adult male giraffe. It also is where much of your digestion takes place. Along its winding, track, nutrients from foods are broken down before they enter the bloodstream.

Because of its larger-than-life role, many conditions can affect the small intestine’s health and function. Here is a look at the major ones.

Lactose Intolerance

During normal digestion, the small intestine breaks down lactose (a sugar found in milk) into glucose, a form that can be absorbed into the bloodstream and used by the body. An enzyme called lactase, which is produced in the lining of the small intestine, is responsible for digesting lactose. People with lactose intolerance have a shortage of lactase, and this impairs their ability to digest lactose.

Lactose intolerance is not a dangerous condition—however, it can be uncomfortable. It also can be hard to avoid the effects, since lactose is found in milk and other dairy products, including cheese, and ice cream. It also is found in yogurt, but yogurt containing active cultures can break down lactose.

Sometimes, lactose intolerance has a distinct cause, such as a disease or injury to the small intestine. However, in most people, it is genetic and develops slowly over time. An estimated 40 percent of the world’s population is lactose intolerant, with Asian Americans, African Americans, and Native Americans at particularly high risk.

Lactose Intolerance Symptoms

Undigested lactose ferments in the small intestine or colon, causing nausea, cramps, bloating, gas, and diarrhea. These symptoms usually occur about 30 minutes to two hours after eating or drinking foods containing lactose. Since people have varying degrees of lactose intolerance, the severity of symptoms will depend on how much lactose an individual can tolerate. Some people may be able to consume small amounts of dairy products, while others may need to avoid them altogether.

Diagnosing Lactose Intolerance

In people with symptoms of lactose intolerance, the diagnosis can be made with tests that measure the absorption of lactose in the small intestine. Testing options include a lactose tolerance blood test, hydrogen breath test, and stool acidity test, with the latter typically used for young children. See Chapter 2 for more on these tests.

Treating Lactose Intolerance

Lactose intolerance cannot be cured, but avoiding or limiting dairy products can help manage it. Young children with lactase deficiency should not eat any foods containing lactose. For older children and adults, total avoidance is usually unnecessary.

People with lactose intolerance also should be aware of other sources of lactose aside from dairy products. Small amounts may be found in bread and other baked goods, processed breakfast cereals, instant potatoes, soups, breakfast drinks, margarine, lunch meats, salad dressings, candies and other snacks, pancake mixes, biscuits, cookies, and powdered meal-replacement supplements. You should carefully check the labels of these products for milk by-products, whey, curds, dry milk solids, and non-fat dry milk powder. The amount of milk that is tolerable varies from person to person. Some people can handle a little bit—others may tolerate ice cream and aged cheeses, but not other dairy products.

Today, most supermarkets carry reduced-lactose milk and non-dairy alternatives. Lactase enzymes also are available for people who react to even small amounts of lactose, or who wish to consume dairy foods. These come in tablet and liquid form and are available without a prescription.

Dairy products are a major source of nutrients, particularly calcium. Calcium is essential for keeping bones strong and preventing osteoporosis. Therefore, people with lactose intolerance need to be mindful about getting enough calcium from other food sources if they must limit milk or eliminate it from their diet. Non-dairy sources of calcium include fortified cereals and fruit juices, dark green leafy vegetables, canned fish (eat the soft bones), and calcium-set tofu. Discuss with your doctor whether you also should take a calcium supplement.

Celiac Disease

For the food we eat to be useful to the body, all of the processes involved in digestion must work correctly. One essential process is the absorption of nutrients from the small intestine into the bloodstream. Disorders that interfere with nutrient absorption are called malabsorption disorders. One of the most common of these disorders is celiac disease (also called celiac sprue), a condition in which damage to the small intestine prevents nutrients from being absorbed properly.

The process of absorption takes place through villi, which are tiny, finger-like protrusions on the lining of the small intestine. If the villi are damaged, nutrients may not be absorbed, and the person becomes malnourished. Damage to the villi occurs because a person with celiac disease cannot tolerate gluten, a protein found in wheat, rye, and barley. The body mistakenly treats gluten as a dangerous invader and attacks it. This triggers inflammation in the small intestine, and the inflammation irritates and damages the villi, impairing their ability to do their job.

The exact cause of celiac disease is not understood, although there is a genetic component (it occurs in 5 to 15 percent of the offspring and siblings of a person with celiac disease). It can develop at any time in life.

Celiac Disease Symptoms

The severity of celiac disease varies from no symptoms at all to very troublesome symptoms. Some, like excessive wind, diarrhea, and pale, foul-smelling stools, relate directly to the digestive system. But because celiac disease can lead to malnourishment, it can affect other systems of the body as well. For example, anemia (iron deficiency) is common in people with the condition, as are abnormal liver function, and the bone-thinning disease osteoporosis.

Celiac disease also is associated with bone and joint pain, muscle cramps, tingling and/or numbness in the legs, fatigue, pale sores inside the mouth, an itchy skin rash (dermatitis herpetiformis), tooth discoloration or loss of enamel, seizures, and behavior changes. Infants with celiac disease may fail to thrive, and it can result in delayed growth in older children.

Diagnosing Celiac Disease

When celiac disease is suspected, the physician will order a blood test to determine whether the body’s immune system is making antibodies against gluten or any other enzyme involved in the disease process (assuming the person has not been abstaining from gluten). Antibodies are substances produced by the body to attack “foreign invaders,” such as bacteria and allergens. Gene testing to help identify a genetic predisposition to the disease also is available.

If the blood test shows the presence of antibodies, a biopsy of the small intestine will be taken during an endoscopy (see Chapter 2). Examination of the tissue under a microscope will reveal characteristic changes in the villi that indicate celiac disease. Confirmation of celiac disease is important, since strict adherence to a gluten-free diet can eliminate symptoms and prevent complications.

Treating Celiac Disease

The treatment for celiac disease is to avoid all gluten. Once gluten is removed from the diet, the body’s immune reaction to gluten stops, and inflammation resolves. The small intestine begins to heal, and the absorption of nutrients returns to normal. The small intestine should be completely healed after following a gluten-free diet for three to six months in children and younger adults, and two years in older adults.

Keep in mind that a gluten-free diet is a medically necessary diet—despite ambitious marketing efforts, it does not offer specific health benefits for people without celiac disease or gluten sensitivity. Living a gluten-free life can be challenging because it requires avoiding all wheat, rye, and barley. This means no more pasta, cereal, or bread made with these grains. Instead, people with celiac disease need to find substitute products. Grains that are naturally gluten free include oats, corn, quinoa, amaranth, brown rice, buckwheat, and millet. You also may be able to obtain flour made from potato, soy, or beans. Because a gluten-free diet requires a substantial change in dietary habits for most people, guidance from a dietitian can be helpful.

Many stores carry gluten-free products, but if it is not easy to obtain these locally, check all food labels carefully to avoid hidden sources of gluten (including additives like modified food starch, preservatives, and stabilizers). Eating out in a restaurant can be risky, since gluten is found in many unsuspected products. Even meals labeled as gluten-free are not always safe (see “Gluten-Free Meals on Restaurant Menus May Still Contain Some Gluten”). When eating out, it is best to order dishes without breading, gravies, or sauces. You also can ask the waiter or chef about ingredients in a particular dish, but if in doubt, order something else.

Since cross-contamination between foods is possible, people with celiac disease can unknowingly consume gluten, and even the smallest amount can trigger symptoms. In view of this, pharmaceutical companies are trying to devise drugs that would allow people with celiac disease to tolerate consumption of gluten-containing foods. One such drug, larazotide acetate, is now in phase-3 clinical trials, the last stage before approval by the Food and Drug Administration. The drug works by preventing gluten from crossing the lining of the small intestine.

Diarrhea

Diarrhea is a common digestive disorder that happens to just about everyone at some time. The loose, watery stools that require frequent trips to the bathroom can have numerous possible causes, ranging from minor to more serious. Most cases are caused by mild food poisoning or a viral infection, and the problem goes away on its own after a day or two. Diarrhea that lasts longer than this may be a symptom of disease, and should be checked out by a physician. Prolonged diarrhea can lead to dehydration, which itself can be serious.

Common causes of diarrhea include:

Bacterial infections. The most common cause of hospitalization for diarrhea worldwide is infection with the bacterium Clostridium difficile (C. diff). There are several strains of C. diff, one of which causes serious illness and even death (this strain accounts for about one-third of C diff cases). The most common cause of C. diff infection is antibiotic use—one study found that 78 percent of community-acquired C. diff infections arose from antibiotic use within the prior 90 days. Diarrhea also may be caused by food or water contaminated with Campylobacter, Salmonella, Shigella, Yersinia, or Escherichia coli.
Noroviruses. These are the leading cause of foodborne disease outbreaks in the United States, and result in symptoms that include diarrhea, vomiting, and stomach pain. Noroviruses are highly contagious, but the infection is usually not serious, and most people recover fully in one to two days. In those who are susceptible to more severe illness, including young children and older adults, excessive diarrhea may occur. This can cause dehydration, and may require hospitalization to replace fluids. Noroviruses are transmitted by consuming food or water contaminated with the virus, or by direct person-to-person contact. Effective transmission makes noroviruses a common cause of outbreaks of illness where people are closely confined and sharing resources, such as cruise ships, nursing homes, and daycare centers. An infected person is contagious for at least three days after starting to feel ill, and possibly as long as two weeks after recovering.
Food intolerances, including lactose intolerance and other conditions that impair a person’s ability to digest some component of food.
Parasites, such as Giardia lamblia, Entamoeba histolytica, and Cryptosporidium, which enter the body in food or water and settle in the gastrointestinal (GI) tract. Traveling to undeveloped countries raises the risk of contamination with a parasite.
Medications, including antibiotics, blood pressure medications, and antacids containing magnesium. Stopping the drug or lowering the dose may eliminate the problem, but don’t try this without your doctor’s permission.
Intestinal diseases, including inflammatory bowel disease, celiac disease, and irritable bowel syndrome with diarrhea-predominant symptoms.

Diarrhea Symptoms

As well as cramping and loose, watery bowel movements, people with diarrhea may sometimes experience fecal incontinence (loss of bowel control). If this occurs regularly, report it to your doctor.

Although short bouts of diarrhea can be harmless, a doctor should be consulted if it lasts more than three days or is accompanied by severe pain in the abdomen or rectum, a fever of 102 degrees Fahrenheit or higher, bloody stools, or signs of dehydration. Dehydration can be serious, because along with water the body loses electrolytes (potassium and sodium), which are necessary for proper organ function. Dehydration is particularly dangerous for children, who can die from it within a matter of days.

Diagnosing Diarrhea

It may not be possible to determine the exact cause of mild cases of diarrhea, but as long as the problem does not last long, diagnostic tests and treatments are not necessary. To determine the underlying cause of long-lasting diarrhea, one or more diagnostic tests may be needed. These may include a stool culture to look for bacteria, viruses or parasites, blood tests, fasting tests to identify food intolerances, sigmoidoscopy, and colonoscopy.

Treating Diarrhea

The appropriate treatment for diarrhea will depend on what is causing the condition. Treatment for digestive disorders such as celiac disease, inflammatory bowel disease, and irritable bowel syndrome are discussed in those sections of this report.

If the culprit is bacterial, antibiotics may be prescribed—for example, diarrhea caused by C. diff is treated with the medication fidaxomicin (Dificid), metronidazole (Flagyl), or vancomycin (Vancocin). Fecal microbiota transplantation (FMT), a newer treatment, also can be highly effective. In FMT, a small sample of stool from a healthy donor is purified, and then placed in the colon of the person with diarrhea. The healthy bacteria in the normal stool quickly populate the intestine, resolving diarrhea in as little as a couple of hours.

Drugs that stop diarrhea may be used in some cases of diarrhea. However, if the cause is a bacterium or a parasite, these drugs will trap the organism in the GI tract. Although it may be unpleasant to continue having diarrhea, it is better to allow the body to naturally eliminate the invaders.

Some food and drinks can aggravate diarrhea. These include milk products and foods that are greasy, high in fiber, or have high sugar or artificial sugar content, so it’s best to avoid these until the diarrhea subsides.

Anyone who is experiencing diarrhea should take steps to avoid dehydration. Drink plenty of water, along with fluids that contain sodium and potassium. Good options for rehydration include chicken or beef broth, fruit or vegetable drinks, ginger ale, Gatorade, and Pedialyte.

In some people, probiotics may lessen the risk of C. diff. In healthy people, probiotics occur naturally in the gut, but antibiotics can eradicate them. The two most common probiotics—lactobacillus and bifidobacterium—are found in yogurt and other dairy products. They also can be purchased in supplement form (typically capsules) at pharmacies and health-food stores.

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Blurred Vision Is Often a Sign of a Serious Condition

Chandra Johnson-Greene — Thu, 06 Dec 2018 07:00:20 +0000

If you’re blessed with the gift of perfect or near-perfect eyesight, it can be quite jarring when you first experience a significant period of blurred vision. You’re not sure whether it’s a temporary occurrence or a sign that you might be losing your eyesight.

Blurred vision refers to a lack of sharpness in your sight, leading to an inability to see things in fine detail. It could last just a few seconds, or it could occur long-term and progressively worsen. Blurred vision can occur in one or both eyes, and while it can be caused by eye disease or injury, it can also be a symptom of a condition that doesn’t involve your eyes at all.

Causes of Blurred Vision

Blurred vision can result from many conditions—both minor and major—and most of them are preventable as well as treatable. The conditions below are some of the most common causes of blurred vision; all should be evaluated by a medical professional:

Astigmatism. A relatively common eye condition, astigmatism occurs when your cornea is irregularly shaped, thus preventing light from focusing on the retina in the back of the eye and making it difficult to focus on what’s in front of you. For more information, check out What Is Astigmatism and Why Does it Make Your Vision Blurry?
Headaches. Blurred vision is a common symptom of a migraine headache. Migraines can also make your eyes sensitive to light and cause an “aura” or visual disturbance right before the symptoms begin. For more information, check out Migraine Symptoms: Treatment (and Prevention) Tips.
Head injury. If you experience blurred vision after hitting your head, that’s often a sign of a concussion. Concussion symptoms can also include light and noise sensitivity, dizziness, and slurred speech. For more on concussions, check out “Concussion Symptoms: Here’s How to Identify Them.”

VISION HEALTH BY THE NUMBERS

According to the Centers for Disease Control and Prevention:

• Approximately 14 million Americans aged 12 years and older have self-reported visual impairment defined as distance visual acuity of 20/50 or worse.
• 1.6 million Americans aged 50 years and older have age related macular degeneration.
• 0.5 million (or 16 percent of) Americans aged 40 and older have cataracts.
• 2.2 million (or 2 percent of) Americans aged 40 and older have glaucoma.

Eye infection. In addition to itching, pain, and swelling, an eye infection can also affect your vision. Conjunctivitis, also known as pinkeye, is common type of eye infection. For more information, check out Are Eye Infections Clouding Your Vision?
Dry eyes. More than 25 million Americans are affected by dry eyes, which is cause by poor tear production or poor-quality tears. For more information, check out 4 Strategies for Natural Dry Eye Treatment.
Glaucoma. This disease causes irreparable damage due to excess pressure in the eyes. There are no warnings signs for glaucoma, so getting a yearly eye exam is very important. For more information, check out Glaucoma: Symptoms, Treatment, and Prevention of a Serious Eye Disease.
Cataracts. This eye condition can cause cloudy spots consisting of protein and water to form on the eyes’ lenses and impair vision. For more about cataracts, check out Cataract Symptoms: Correcting the Clouded Vision Caused by Cataracts.
Macular degeneration. Age-related macular degeneration affects the center of the retina and causes blind spots in central vision. For more information, check out What is Age-Related Macular Degeneration?
Medication. Certain drugs prescribed to treat osteoporosis, erectile dysfunction, high blood pressure, and enlarged prostate can cause blurred vision in some people, according to ConsumerReports.org. Blurred vision is also commonly associated with tricyclic antidepressants, such as Elavil, Pemelor, and Norpramin, according to VeryWellMind.com. With these medications, however, blurred vision usually subsides after a few weeks.
Celiac disease. Celiac disease comes with numerous symptoms and blurred vision happens to be one of them. To learn about the other 200+ ailments associated with the condition, check out “Celiac Disease Symptoms: List of 281 Ailments.”

There are many more conditions associated with blurred vision, including:

Blurred Vision Testing

Your eye doctor may perform one or more of the following tests to determine the cause of your blurred vision:

Ophthalmoscopy. This test allows your eye doctor to examine the back of your eye, including your retina, optic disc, and blood vessels. Glaucoma, macular degeneration, and optic nerve damage can be identified using this exam.
Refraction test. It checks your vision for refractive errors, such as astigmatism and myopia, and helps your eye doctor prescribe glasses or contact lenses if necessary.
Slit lamp examination. This procedure allows your doctor to view the back of your eye with greater magnification than a basic ophthalmoscopy by using a bright light from a stilt lamp.
Tonometry. This test detects changes in eye pressure by temporarily flattening or blowing a brief puff of air at your cornea. Some eye doctors alternatively use a handheld device called a Tono-Pen, which provides a digital measurement of eye pressure.
Blood tests. They can reveal hypoglycemia, or low blood sugar, which is common in people with diabetes, as well as your white blood cell count if infection is suspected.

Treatments

Depending on the underlying cause of your blurred vision, your doctor may one or more of the following treatments:

Medication. Your doctor may prescribe eye drops to treat injuries or infection or other medications for underlying conditions that contribute to your blurred vision.
Laser surgery. These procedures are often used by eye doctors to treat refraction errors, glaucoma, cataracts, and floaters.
Food. If your blurred vision is caused by low blood sugar, foods containing fast-acting sugars are recommended to increase your blood sugar quickly.

How to Protect Your Eyes from Blurred Vision

To maintain optimal eye health, you should do the following, according to Healthline.com:

Protect your eyes from the sun. When in the sun, always wear sunglasses that include 99 to 100 percent protection from UVA and UVB rays, which can protect you from long-term eye damage.
Eat a diet that’s healthy for your eyes. Foods that are rich in three particular carotenoids—lutein, zeaxanthin, and astaxanthin—can protect your eyes from damage, fatigue, and vision loss. Fish, eggs, and avocado are just a few of the foods that are a good source of these carotenoids. For more information, check out Eating for Eyesight: Which Foods Protect Your Eyes?
Avoid (or quit) smoking. Smoking increases your risk of developing age-related macular degeneration.
Get a yearly eye exam. Your eye doctor will be able to identify any issues that could potentially cause blurred vision early and recommend proper treatment. Report any noticeable changes to your doctor as soon as possible in between your exams.
Keep your blood pressure and cholesterol levels under control. Research suggests there is a link between cardiovascular disease and age-related macular degeneration.
Wash your hands before touching your eyes. This is particularly important if you wear contact lenses. Washing your eyes before putting them in or taking them out can reduce risk of infection.
Properly protect your head and eyes when working in dangerous situations. It’s important to guard yourself against concussions or severe eye injuries when operating heavy machinery or doing home repairs.

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8. Diseases and Disorders of the Small Intestine

Lynne Christensen — Tue, 09 Oct 2018 13:51:33 +0000

The small intestine—which is about 22 feet long—is where much of the digestion process takes place as nutrients are broken down into sugar, amino acids, and fatty acids before they enter the bloodstream. Here is a look at some of the conditions that can affect the health of the small intestine.

Lactose Intolerance

During normal digestion, the small intestine breaks down lactose (the predominant sugar found in milk) into glucose, a form that can be absorbed into the bloodstream and used by the body. An enzyme called lactase, which is produced in the lining of the small intestine, is responsible for digesting lactose. People with lactose intolerance have a shortage of lactase, and this impairs their ability to digest lactose. Lactose intolerance is not a dangerous condition, but it can be uncomfortable. It also can be hard to avoid the effects, since lactose is found in milk and other dairy products, including cheese, ice cream, and cottage cheese. It is also found in yogurt, but yogurt containing active cultures can break down lactose.

Sometimes, lactose intolerance has a distinct cause, such as a disease or injury to the small intestine. However, in most people, it is genetic and develops slowly over time. An estimated 40 percent of the world’s population is lactose intolerant, with Asian Americans, African-Americans, and Native Americans at particularly high risk.

Lactose Intolerance Symptoms

Diagnosing Lactose Intolerance

In people with symptoms of lactose intolerance, the diagnosis can be made with tests that measure the absorption of lactose in the small intestine. The tests include:

Lactose tolerance test. This involves drinking a liquid that contains lactose. Blood samples are then taken to measure levels of blood glucose. This shows how well the lactose breaks down into glucose.
Hydrogen breath test. This measures the amount of hydrogen in the breath. As undigested lactose ferments, hydrogen is produced. Hydrogen gets absorbed in the bloodstream and excreted in the breath—higher-than-normal amounts of hydrogen in the breath indicate that the body is not properly digesting lactose.
Stool acidity test. The most common way of diagnosing lactose intolerance in young children, this test measures the amount of lactic acid (a byproduct of lactose digestion) in the feces.

Treating Lactose Intolerance

People with lactose intolerance also should be aware of other sources of lactose aside from dairy products. Small amounts may be found in bread and other baked goods, processed breakfast cereals, instant potatoes, soups, breakfast drinks, margarine, lunch meats, salad dressings, candies and other snacks, pancake mixes, biscuits, cookies, and powdered meal-replacement supplements. Carefully check the labels of these products for milk by-products, whey, curds, dry milk solids, and non-fat dry milk powder. The amount of milk that is tolerable varies from person to person. Some people can handle a little bit—others may tolerate ice cream and aged cheeses, but not other dairy products. Today, most supermarkets carry reduced-lactose milk and nondairy alternatives.

Lactase enzymes also are available for people who react to even small amounts of lactose, or who wish to consume dairy foods. These come in tablet and liquid form and are available without a prescription.

Celiac Disease

Celiac Disease Symptoms

The severity of celiac disease varies from no symptoms at all to very troublesome symptoms. Some symptoms, like diarrhea, relate directly to the digestive system. But because celiac disease can lead to malnourishment, the disease can affect other systems of the body as well. Celiac disease can cause:

Chronic diarrhea
Recurring abdominal bloating, gas, and pain
Anemia (iron deficiency)
Abnormal results on tests of liver function
Weight loss
Bone and joint pain
Osteoporosis
Muscle cramps
Pale, foul-smelling stool
Behavior changes
Tingling and/or numbness in the legs
Fatigue
Pale sores inside the mouth
Itchy skin rash (dermatitis herpetiformis)
Tooth discoloration or loss of enamel
Seizures.
Failure to thrive in infants
Delayed growth in children

Diagnosing Celiac Disease

When celiac disease is suspected, the physician will order a blood test to determine whether the body’s immune system is making antibodies against gluten or any other enzyme involved in the disease process. Antibodies are substances produced by the body to attack “foreign invaders” such as bacteria and allergens. Gene testing to help identify a genetic predisposition to the disease is also available.

Treating Celiac Disease

The treatment for celiac disease is to avoid all gluten. Consultation with a dietitian with experience in celiac disease management is a valuable part of the treatment plan. Once gluten is removed from the diet, the body’s immune reaction to gluten stops, and inflammation resolves. The small intestine begins to heal, and the absorption of nutrients returns to normal. The small intestine should be completely healed after following a gluten-free diet for three to six months in children and younger adults, and two years in older adults.

Following a gluten-free diet can be challenging because it requires avoiding all wheat, rye, and barley. This means no more pasta, cereal, or bread made with these grains. Instead, people with celiac disease need to find substitute products. Grains that are naturally gluten free include oats, corn, quinoa, amaranth, brown rice, buckwheat, and millet. You also may be able to obtain flour made from potato, soy, or beans. Many stores carry gluten-free products, and you should check labels carefully to avoid hidden sources of gluten in some products, including additives like modified food starch, preservatives, and stabilizers. Eating out in a restaurant can be challenging, since gluten is found in many unsuspected products, such as soy sauce. It is best to order dish-es without breading, gravies, or sauces. You also can ask the waiter or chef about ingredients in a particular dish, but if in doubt, order something else. Because a gluten-free diet requires a substantial change in dietary habits for most people, a dietitian can be helpful.

Since cross-contamination is possible, people with celiac disease can unknowingly consume gluten. Even the smallest amount can trigger symptoms; however, a new drug is being developed to help people who accidentally ingest gluten (see, “New Drug Eases Effects From Low Amounts of Gluten”).

Keep in mind that a gluten-free diet is a medically necessary diet—despite ambitious marketing efforts, it does not offer spe-cific health benefits for people without celiac disease or gluten sensitivity (see “Gluten-Free Diets Won’t Help Reduce Heart Dis-ease Risk in People Without Celiac Disease”).

More than one company is trying to devise a drug that would allow people with celiac disease to tolerate consumption of gluten-containing foods. One such drug, larazotide acetate, is now in phase-3 clinical trials, the last stage before approval by the Food and Drug Administration. The drug works by preventing gluten from crossing the lining of the small intestine.

Diarrhea

Diarrhea is a common digestive disorder that happens to just about everyone at some time. The loose, watery stools that require frequent trips to the bathroom can have numerous possible causes ranging from minor to more serious. Most cases are caused by mild food poisoning or a viral infection, and the problem goes away on its own after a day or two. Diarrhea that lasts longer than that may be a symptom of disease, and should be checked out by a physician. Prolonged diarrhea can lead to dehydration, which itself can be serious.

Common causes of diarrhea include:

Bacterial infections. The most common cause of hospitalization for diarrhea worldwide is infection with the bacterium Clostridium difficile (C. diff). The most common cause of C. diff infection is antibiotic use—one study found that 78 percent of community-acquired C. diff infections arose from antibiotic use within the prior 90 days.There are several strains of C. diff, one of which causes serious illness and even death (this strain accounts for about one-third of C diff cases). Diarrhea also may be caused by food or water contaminated with Campylobacter, Salmonella, Shigella, Yersinia or Escherichia coli.
Noroviruses. These are the leading causes of food-borne disease outbreaks in the United States, and result in symptoms that in-clude diarrhea, vomiting, and stomach pain. Noroviruses are highly contagious, but the infection is usually not serious, and most people recover fully in one to two days. In those who are susceptible to more severe illness, including young children and old-er adults, excessive diarrhea may occur. This can cause dehydration, and may require hospitalization to replace fluids. No-roviruses are transmitted by consuming food or water contaminated with the virus, or by direct person-to-person contact. Effective transmission makes noroviruses a common cause of outbreaks of illness where people are closely confined and sharing resources, such as cruise ships, nursing homes, and daycare centers. An infected person is contagious for at least three days after starting to feel ill, and possibly as long as two weeks after recovering.
Food intolerances, including lactose intolerance and other conditions that impair a person’s ability to digest some component of food.
Parasites, such as Giardia lamblia, Entamoeba histolytica, and Cryptosporidium, which enter the body in food or water and settle in the digestive tract. Traveling to undeveloped countries raises the risk of contamination with a parasite.
Medications, including antibiotics, blood pressure medications, and antacids containing magnesium. (Stopping the drug or lowering the dose may eliminate the problem, but never try this without your doctor’s permission.)
Intestinal diseases, including inflammatory bowel disease, celiac disease, and irritable bowel syndrome with diarrhea-predominant symptoms.

Diarrhea Symptoms

As well as cramping and loose, watery bowel movements, patients with diarrhea may sometimes experience fecal incontinence (loss of bowel control). If this occurs regularly, report it to your doctor.

Signs of dehydration include:

Thirst
Dry or sticky mouth
Fatigue
Dry skin
Less frequent urination
Light-headedness.

Diagnosing Diarrhea

Treating Diarrhea

The appropriate treatment will depend on what is causing the diarrhea. Treatment for digestive disorders such as celiac disease, inflammatory bowel disease, and irritable bowel syndrome are discussed in those sections of this report.

If the culprit is bacterial, antibiotics may be prescribed—for example, diarrhea caused by C. diff is treated with the medication fidaxomicin (Dificid). Fecal microbiota transplantation, a newer alternative, also can be highly effective. In this procedure, a tiny amount of stool from a healthy individual is inserted in the colon of a person with diarrhea. The healthy bacteria found in the normal stool quickly populate the intestines, resolving diarrhea in as little as a couple of hours.

Drugs that stop diarrhea may be used in some cases of diarrhea. However, if the cause is a bacterium or a parasite, these drugs will trap the organism in the digestive tract. Although it may be unpleasant to continue having diarrhea, it is better to allow the body to naturally eliminate the invaders.

Some food and drinks can aggravate diarrhea. These include milk products and foods that are greasy, high in fiber, or have high sugar or artificial sugar content, and it’s best to avoid these until the diarrhea subsides.

Anyone experiencing diarrhea should take steps to avoid dehydration. Drink plenty of water, along with fluids that contain so-dium and potassium. Good options for rehydration include chicken or beef broth, fruit or vegetable drinks, ginger ale, Gatorade, and Pedialyte.

In some people, using probiotics may lessen the risk of C. diff. In healthy people, probiotics occur naturally in the gut, but anti-biotics can eradicate them. The two most common probiotics—lactobacillus and bifidobacterium—are found in yogurt and other dairy products. They also can be purchased in supplement form (typically capsules) at health food stores.

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Celiac Disease Symptoms: Get Ready For Related Conditions

Timothy Cole — Mon, 21 May 2018 05:00:11 +0000

You’re experiencing celiac disease symptoms and your doctor suspects you may have celiac disease. That’s hard enough. But you also need to be aware that celiac disease symptoms can tee you up for a host of related disorders. Autoimmune disorders lead this list.

A 1999 Italian study published in the journal Gastroenterology showed that the prevalence of other autoimmune disorders in patients with celiac disease is related to the duration of exposure to gluten. The older patients were when diagnosed with celiac disease, the greater their chances of developing other autoimmune disorders like hypothyroidism, but also—less commonly—hyperthyroidism, Addison’s disease, vitamin B12 deficiency, vitiligo (spotty loss of skin pigment), and alopecia (hair loss), among others.

Autoimmune Risks

Type 1 diabetes: Celiac disease and type 1 diabetes are both chronic, lifelong autoimmune diseases. The two conditions have a genetic link, sharing some genes and environmental factors that may cause the immune system to attack the villi in the small intestine (in celiac disease) and beta cells in the pancreas (in type 1 diabetes). Researchers believe that celiac disease and diabetes have at least seven genes in common and there may be more.
Other autoimmune diseases: Autoimmune disorders result when the body’s leukocytes (white blood cells), which normally fight infection, attack and destroy healthy body tissue. Celiac disease is associated with an increased prevalence of other autoimmune conditions, including multiple sclerosis, Hashimoto’s thyroiditis (which results in hypothyroidism), Graves disease (which leads to hyperthyroidism), Addison’s disease, and autoimmune hepatitis.

Associated Complications

Infertility: When researchers at the Celiac Disease Center at Columbia University screened 188 women with unexplained infertility, almost 6 percent had celiac disease—a rate nearly six times higher than expected, making celiac disease an important association of unexplained infertility, according to a study published in The Journal of Reproductive Medicine in 2011.Untreated celiac disease can rob a woman’s body of nutrients, but malnourishment isn’t the only mechanism behind infertility. Antibodies to tissue transglutaminase (tTG)—one of the key markers of celiac—can have an effect on the placenta’s development.
Osteoporosis: When celiac disease goes untreated, the small intestine is injured and can’t properly absorb nutrients, including calcium. Calcium is so critical for nerve and muscle functions—like heartbeat—that if it’s not absorbed from food, survival mechanisms take over and the body taps the bones for calcium. Over time, this leads to bone loss associated with osteoporosis. Gluten can also increase the systemic level of inflammation in the body. Inflammation causes proteins, called cytokines, and other inflammatory mediators to circulate in the blood and interfere with bone growth.
Chromosomal disorders: Individuals with chromosomal abnormalities, such as Down syndrome, Turner syndrome and Williams syndrome, have a predisposition toward autoimmune diseases (including celiac disease), endocrine disorders, and cancers.
Celiac disease symptoms without the celiac disease: For years, many people reported having celiac-like symptoms—abdominal pain, fatigue, foggy mind, joint pain, tingling of the extremities, even depression—but they repeatedly tested negative for celiac disease and responded positively to the gluten-free diet. Now specialists recognize that these patients may have non-celiac gluten sensitivity, a condition that is distinct from celiac disease.

How Common is Non-Celiac Gluten Sensitivity?

Studies have now demonstrated that non-celiac gluten sensitivity is a distinct medical condition that differs from celiac disease. Celiac disease is considered a subset of gluten sensitivity. Anyone with celiac disease, by definition, is gluten sensitive. However, not all gluten-sensitive people are celiacs.

Unlike celiac disease, non-celiac gluten sensitivity causes no measurable intestinal damage. Classic symptoms are gastrointestinal, such as diarrhea, bloating, or constipation. Some people report symptoms ranging from clumsiness, brain fog, and depression to ADHD or autistic-like behaviors.

Patients with non-celiac gluten sensitivity might have various reactions to gluten. In a study of 347 gluten-sensitive patients conducted by the University of Maryland, 68 percent experienced abdominal pain, 40 percent had eczema or a rash, and approximately a third reported headache, diarrhea, fatigue, or “foggy mind.” Depression, anemia, numbness in the legs, arms or fingers, and joint pain were also frequently reported.

How Is Gluten Sensitivity Diagnosed?

Currently, non-celiac gluten sensitivity is a diagnosis of exclusion; it’s diagnosed only after other conditions are ruled out. Non-celiac gluten sensitivity is not an allergic condition, is not an autoimmune reaction to gluten, does not cause any significant damage to the small intestine, and is not associated with HLA genes (as is celiac disease).

There are no genes that are currently known to be associated with non-celiac gluten sensitivity and no diagnostic markers—such as anti-gliadin antibodies, stool tests, saliva tests, or biopsy—for conclusively diagnosing the condition. (See our post “Celiac Disease: How Do You Know If You Have It?“) Non-celiac gluten sensitivity is typically determined by a positive response to the gluten-free diet. The defining element of non-celiac gluten sensitivity is feeling better when you don’t eat gluten.

For further reading, see these University Health News posts:

“What Does ‘Gluten-Free’ Mean?“
“Gluten Intolerance Symptoms: Is It Celiac Disease That’s Making You Ill?“
“Celiac Disease Diet: Your Gluten-Free Planning Guide“

Originally published in 2016, this post is regularly updated.

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Celiac Disease Diet: Your Gluten-Free Planning Guide

Timothy Cole — Thu, 11 Jan 2018 07:00:12 +0000

Keeping a strict celiac disease diet—avoiding all foods that contain wheat, rye, or barley—is essential for those with celiac disease or non-celiac gluten sensitivity. People on a gluten-free diet can eat a well-balanced menu with a wide variety of foods. Unprocessed meat, fish, rice, fruits, and vegetables do not contain gluten, plus there are plenty of gluten-free breads, pasta, and cookies that use rice flour and alternative grains. The key is to focus on what you can eat, not what you cannot.

On the other hand, the gluten-free diet requires a completely new approach to eating. People on a celiac disease diet have to be extremely careful about what they buy for lunch at school or work and what they eat at cocktail parties or order from restaurants.

Cheating (eating food containing gluten) or cross-contamination (even as small as one-eighth of a teaspoon) can cause intestinal damage. A dietitian who specializes in celiac disease can help patients learn about their new diet.

Gluten-Free Basics

A strict gluten-free diet—one free of all forms of wheat, barley, and rye—is necessary to help prevent both short-term and long-term consequences of celiac disease. Miniscule amounts of gluten—a crumb on a shared stick of butter—can be enough to cause problems for those with celiac disease.

Don’t eat a food if you are unable to verify the ingredients or if the ingredient list is unavailable. Regardless of the amount eaten, if you have celiac disease, damage to the small intestine occurs every time gluten is consumed, whether symptoms are present or not.

Understanding these dietary requirements will enable the newly diagnosed to read labels of food products and determine whether a product is gluten-free—critical knowledge for anyone on a celiac disease diet.

Grains Allowed

Sticking to a celiac disease diet starts with watching for gluten content in the food you buy. Understand which foods are absent of gluten and keep them around.

Amaranth
Arrowroot
Beans
Buckwheat
Corn (maize)
Flax
Garfava
Millet
Montina
Nut flours
Potato
Quinoa
Rice
Sorghum
Soy
Tapioca
Teff

Grains Not Allowed in Any Form

Wheat (einkorn, durum, faro, graham, kamut, semolina, spelt)
Rye
Barley
Triticale

Foods/Products That May Contain Gluten

Beers, ales, lager
Breading and coating mixes
Brown rice syrup
Communion wafers
Croutons
Dressings
Drugs and over-the-counter medications
Energy bars
Flour and cereal products
Herbal supplements
Imitation bacon
Imitation seafood
Marinades
Nutritional supplements
Oats
Pastas
Processed luncheon meats
Sauces, gravies
Self-basting poultry
Soup bases
Soy sauce or soy sauce solids
Stuffings, dressings
Supplements
Thickeners (roux)
Vitamins & minerals

Pantry Preparation

Those who eat a celiac disease diet know it’s essential to prevent gluten cross-contamination. Clean or replace the items in your kitchen where gluten contamination can occur: scratched pans, the toaster, colanders, cutting boards, your food mill. Do the homework to truly understand cross-contamination, gluten-containing ingredients, and food labeling so that your kitchen becomes a safe haven.

If your kitchen is not fully gluten-free, take steps to make sure there is no cross contact with gluten before baking. Scrub your counters and put utensils, pans, bowls, cutting boards and sponges in the dishwasher before baking gluten-free. Be aware that particles of wheat flour can linger in the air for 24 to 36 hours.

If someone in your household plans to continue to eat gluten, organize your pantry and cabinets so that no gluten-containing foods, pots, or pans are mistakenly used. Use clear plastic bins in your pantry to segregate items so there are no mix-ups when unpacking the groceries or when reaching for cereals or snacks. Color-code pots, pans, utensils, and the like with fun-colored duct tape so that it’s easy to tell which are dedicated for gluten-free use.

Take out everything in the pantry, refrigerator, and freezer and check labels. Keep a permanent marker in the kitchen and write “GF” (gluten-free) on all safe foods and condiments. Use separate jars of mustard, peanut butter, and jelly and separate sticks of butter to avoid cross-contamination from wheat crumbs. Or buy squeeze bottles for condiments, which reduces the chance of cross-contamination. Don’t buy foods from bulk bins that are prone to contamination from other grains.

Buy some prepared gluten-free foods, like frozen pizza, pasta, soup, pretzels, and other favorite snacks—whatever you enjoyed eating before going gluten-free. Having these on hand will keep you from feeling deprived and help you avoid the temptation to eat gluten. Try a few different brands to figure out which you like best. The best ways to find tasty alternatives are to get connected with others by joining a support group and to attend gluten-free fairs and expos, where you can sample different items before buying.

You’ll also want to stock some gluten-free baking mixes and a reliable all-purpose gluten-free flour blend. Find an all-purpose flour blend that can be used for almost everything, from fish sticks and tempura to birthday cake and sandwich bread. Once you’ve gained confidence, you can experiment with the growing variety of alternative gluten-free flours made from whole grains and seeds. The best ones offer rich flavor, nutrients, and fiber that will enhance your culinary repertoire.

Even if you’ve never baked from scratch, consider doing it now. Despite all the new gluten-free products available, many just don’t taste like the foods you remember. That’s where you and your oven come in. Any item you enjoyed prior to your diagnosis, you’ll be able to enjoy once again, gluten-free. Bread, cookies, cake, muffins, pizza—you’re limited only by your imagination.

Labeling Lingo

The sweeping legislation known as FALCPA, the Food Allergen Labeling and Consumer Protection Act of 2004, requires clear labeling of the top eight allergens (milk, eggs, tree nuts, peanuts, fish, shellfish, soy, and wheat, frequently referred to as “the great eight”). Thus, all food containing wheat must declare it on the label.

The term “gluten-free” took shape in the United States in 2013. Updating an earlier proposal, the Food & Drug Administration issued a rule on Aug. 5, 2013 defining the term “gluten-free” for voluntary use in the labeling of foods. The compliance date for manufacturers was Aug. 5, 2014. Food products bearing a “gluten-free” label on or after that date are to meet the rule’s requirements: gluten content has to be less than 20 ppm (parts per million).

“In general,” the FDA ruling stated, “foods may be labeled ‘gluten-free’ if they meet the definition and otherwise comply with the final rule’s requirements. More specifically, the final rule defines ‘gluten-free’ as meaning that the food either is inherently gluten free; or does not contain an ingredient that is: 1) a gluten-containing grain (e.g., spelt wheat); 2) derived from a gluten-containing grain that has not been processed to remove gluten (e.g., wheat flour); or 3) derived from a gluten-containing grain that has been processed to remove gluten (e.g., wheat starch), if the use of that ingredient results in the presence of 20 parts per million (ppm) or more gluten in the food. Also, any unavoidable presence of gluten in the food must be less than 20 ppm.”

Permissible synonyms for “gluten free” include “free of gluten,” “without gluten” and “no gluten.”

For further reading, see these University Health News posts:

This article was riginally published in 2016 and is regularly updated.

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8. Diseases and Disorders of the Small Intestine

Kate Brophy — Mon, 09 Oct 2017 17:19:27 +0000

The small intestine—which is about 22 feet long—is where nutrients are broken down into sugar, amino acids, and fatty acids before they enter the bloodstream.

Lactose Intolerance

During normal digestion, the small intestine breaks down lactose (the predominant sugar found in milk) into glucose, a form that can be absorbed into the bloodstream and used by the body. An enzyme called lactase, which is produced in the lining of the small intestine, is responsible for digesting lactose. People with lactose intolerance have a shortage of lactase, which impairs their ability to digest lactose. Lactose intolerance is not a dangerous condition, but it can be uncomfortable. It also can be hard to avoid the effects, since lactose is found in milk and other dairy products, including cheese, ice cream, and cottage cheese. It’s also found in yogurt, but yogurt containing active cultures can break down lactose.

Sometimes, lactose intolerance has a distinct cause, such as a disease or injury to the small intestine. However, in most people, it’s genetic and develops slowly over time. An estimated 40 percent of the world’s population is lactose intolerant, with Asian Americans, African Americans, and Native Americans at particularly high risk.

Lactose Intolerance Symptoms

Undigested lactose ferments in the small intestine or colon, causing nausea, cramps, bloating, gas, and diarrhea. These symptoms usually occur about 30 minutes to two hours after eating or drinking foods containing lactose. Since people have varying degrees of lactose intolerance., the severity of symptoms will depend on how much lactose an individual can tolerate. Some people may be able to consume small amounts of dairy products, while others may need to avoid them altogether.

Diagnosing Lactose Intolerance

In people with symptoms of lactose intolerance, the diagnosis can be made with tests that measure the absorption of lactose in the small intestine. The tests include:

Lactose tolerance test. This involves drinking a liquid that contains lactose. Blood samples are then taken to measure levels of blood glucose. This shows how well the lactose breaks down into glucose.
Hydrogen breath test. This measures the amount of hydrogen in the breath. As undigested lactose ferments, hydrogen is produced, hydrogen gets absorbed in the bloodstream and excreted in the breath. Higher-than-normal amounts of hydrogen in the breath indicate that the body is not properly digesting lactose.
Stool acidity test. The most common way of diagnosing lactose intolerance in young children, this test measures the amount of lactic acid—a byproduct of lactose digestion—in the feces.

Treating Lactose Intolerance

Lactose intolerance can’t be cured, but it can be managed by avoiding or limiting dairy products. Young children with lactase deficiency should not eat any foods containing lactose. For older children and adults, total avoidance is usually unnecessary.

People with lactose intolerance should also be aware of other sources of lactose aside from dairy products. Small amounts may be found in bread and other baked goods, processed breakfast cereals, instant potatoes, soups, breakfast drinks, margarine, lunch meats, salad dressings, candies and other snacks, pancake mixes, biscuits, cookies, and powdered meal-replacement supplements. Carefully check the labels of these products for milk by-products, whey, curds, dry milk solids, and non-fat dry milk powder. The amount of milk that is tolerable varies from person to person. Some people can handle a little bit—others may tolerate ice cream and aged cheeses, but not other dairy products. Today, most supermarkets carry reduced-lactose milk and nondairy alternatives.

Lactase enzymes are also available for people who react to even small amounts of lactose, or who wish to consume dairy foods. These come in tablet and liquid form and are available without a prescription.

Celiac Disease

In order for the food we eat to be useful to the body, all of the processes involved in digestion must work correctly. One essential process is the absorption of nutrients from the small intestine into the bloodstream. Disorders that interfere with nutrient absorption are called malabsorption disorders. One of the most common of these disorders is celiac disease (also called celiac sprue), a condition in which damage to the small intestine prevents nutrients from being absorbed properly.

The process of absorption takes place through villi, which are tiny, finger-like protrusions on the lining of the small intestine (see Box 8-2, “Villi of the Small Intestine”). If the villi are damaged, nutrients may not be absorbed, and the person becomes malnourished. Damage to the villi occurs because a person with celiac disease cannot tolerate gluten, a protein found in wheat, rye, barley, and possibly oats. The body mistakenly treats gluten as a dangerous invader and attacks it. This triggers inflammation in the small intestine, and the inflammation irritates and damages the villi, impairing their ability to do their job (see Box 8-3, “Celiac Disease,” on page 63).

The exact cause of celiac disease is not understood, although there is a genetic component—it occurs in 5 to 15 percent of the offspring and siblings of a person with celiac disease. It can occur at any time in life, and may be triggered by emotional stress.

Celiac Disease Symptoms

Chronic diarrhea
Anemia (iron deficiency)
Recurring abdominal bloating, gas, and pain
Abnormal results on tests of liver function
Weight loss
Bone and joint pain
Osteoporosis
Muscle cramps
Pale, foul-smelling stool
Behavior changes
Tingling and/or numbness in the legs
Fatigue
Failure to thrive in infants
Pale sores inside
the mouth
Delayed growth in children
Itchy skin rash (dermatitis herpetiformis)
Tooth discoloration or loss of enamel
Seizures

Diagnosing Celiac Disease

When celiac disease is suspected, the physician will order a blood test to determine whether the body’s immune system is making antibodies against gluten or any other enzyme involved in the disease process. Antibodies are substances produced by the body to attack “foreign invaders” such as bacteria and allergens. Gene testing to help identify a genetic predisposition to the disease is also available.

Treating Celiac Disease

Following a gluten-free diet can be challenging because it requires avoiding all wheat, rye, barley, and, possibly, oats. This means no more pasta, cereal, or bread made with these grains. Instead, people with celiac disease need to find substitute products made from potato, rice, soy, or bean flour. Many stores carry gluten-free products, and you should check labels carefully to avoid hidden sources of gluten in some products, including additives like modified food starch, preservatives, and stabilizers. Eating out in a restaurant can be challenging, since gluten is found in many unsuspected products, such as soy sauce. It’s best to order dishes without breading, gravies, or sauces. You can also ask the waiter or chef about ingredients in a particular dish, but if in doubt, order something else. Because a gluten-free diet requires a substantial change in dietary habits for most people, a dietitian can be helpful.

More than one company is trying to devise a drug that would allow people with celiac disease to tolerate consumption of gluten-containing foods. One such drug, larazotide acetate, is now in phase 3 clinical trials, the last stage before approval by the Food and Drug Administration. The drug works by preventing gluten from crossing the lining of the small intestine.

Diarrhea

Diarrhea is a common digestive disorder that happens to just about everyone at some time. The loose, watery stools that require frequent trips to the bathroom can have numerous possible causes ranging from minor to more serious. Most cases are caused by mild food poisoning or a viral infection, and the problem goes away on its own after a day or two. Diarrhea that lasts longer than that may be a symptom of disease, and should be checked out by a physician. Prolonged diarrhea can lead to dehydration, which itself can be serious.

Common causes of diarrhea include:

Bacterial infections. The most common cause of hospitalization for diarrhea worldwide is infection with the bacterium Clostridium difficile (C diff). The most common cause of C diff infection is antibiotic use—one study found that 78 percent of community-acquired C diff infections arose from antibiotic use within the prior 90 days.

There are several strains of C diff, one of which causes serious illness and even death. This strain accounts for about one-third of C diff cases. Diarrhea also may be caused by food or water contaminated with Campylobacter, Salmonella, Shigella, Yersinia or Escherichia coli.

Viruses. Viruses that can cause diarrhea include rotavirus, norovirus, and cytomegalovirus. Noroviruses are the leading cause of foodborne disease outbreaks in the United States. They cause symptoms that include diarrhea, vomiting, and stomach pain. Noroviruses are highly contagious, but the infection is usually not serious, and most people recover fully in one to two days. In those who are susceptible to more severe illness, including young children and older adults, excessive diarrhea may occur. This can cause dehydration, and may require hospitalization to replace fluids.

Noroviruses are transmitted by consuming food or water contaminated with the virus, or by direct person-to-person contact (see Box 8-4, “Tips for Preventing Norovirus”). Effective transmission makes the norovirus a common cause of outbreaks of illness where people are closely confined and sharing resources, such as cruise ships, nursing homes, and daycare centers. An infected person is contagious for at least three days after starting to feel ill, and possibly as long as two weeks after recovering.

Food intolerances, including lactose intolerance and other conditions that impair a person’s ability to digest some component of food.
Parasites, such as Giardia lamblia, Entamoeba histolytica, and Cryptosporidium, which enter the body in food or water and settle in the digestive tract. Traveling to undeveloped countries raises the risk of contamination with a parasite (see Box 8-5, “Tips for Preventing Traveler’s Diarrhea”).
Medications, including antibiotics, blood pressure medications, and antacids containing magnesium. (Stopping the drug or lowering the dose may eliminate the problem, but never try this without your doctor’s permission.)
Intestinal diseases, including inflammatory bowel disease, celiac disease, and irritable bowel syndrome.

Diarrhea Symptoms

As well as cramping and loose, watery bowel movements, patients with diarrhea may sometimes experience loss of bowel control, a condition called fecal incontinence. If this occurs regularly, it should be reported to your doctor (see Box 8-6, “Don’t Let Fecal Incontinence Disrupt Your Life”).

Although short bouts of diarrhea can be harmless, a doctor should be consulted if it lasts more than three days or is accompanied by severe pain in the abdomen or rectum, a fever of 102 degrees or higher, bloody stools, or signs of dehydration. Dehydration can be serious, because along with water the body loses electrolytes (potassium and sodium), which are necessary for proper organ function. Dehydration is particularly dangerous for children, who can die from it within a matter of days. Signs of dehydration include:

Thirst
Dry or sticky mouth
Fatigue
Dry skin
Less frequent urination
Light-headedness

Diagnosing Diarrhea

It may not be possible to determine the exact cause of mild cases of diarrhea, but as long as the problem does not last long, diagnostic tests and treatments are not necessary. To determine the underlying cause of long-lasting diarrhea, one or more diagnostic tests may be needed. These may include a stool culture to look for bacteria, viruses, or parasites, blood tests, fasting tests to identify food intolerances, sigmoidoscopy, or colonoscopy.

Treating Diarrhea

If the culprit is bacterial, antibiotics may be prescribed—for example, diarrhea caused by C diff is treated with the medication fidaxomicin (Dificid). Fecal microbiota transplantation, a newer alternative, can also be highly effective. In this procedure, a tiny amount of stool from a healthy individual is inserted in the colon of a person with diarrhea. The healthy bacteria found in the normal stool quickly populate the intestines, resolving diarrhea in as little as a couple of hours.

Drugs that stop diarrhea may be used in some cases of diarrhea. However, if the cause is a bacteria or a parasite, these drugs will trap the organism in the digestive tract. Although it may be unpleasant to continue having diarrhea, it is better to allow the body to naturally eliminate the invaders.

Some food and drinks can aggravate diarrhea. These include milk products and foods that are greasy, high in fiber, or very sweet, and it’s best to avoid them until the diarrhea subsides.

Anyone experiencing diarrhea should take steps to avoid dehydration. Drink plenty of water, along with fluids that contain sodium and potassium. Good options for rehydration include chicken or beef broth, fruit or vegetable drinks, ginger ale, Gatorade, and Pedialyte.

In some people, the risk of C diff may be lessened by using probiotics (see Box 8-7, “Probiotics May Prevent C diff Infection”). In healthy people, probiotics occur naturally in the gut. Antibiotics can eradicate them. The two most common probiotics—lactobacillus and bifidobacterium—are found in yogurt and other dairy products. They can also be purchased in in supplement form (typically capsules) at health food stores.

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Q&A: Celiac Disease; Shortness of Breath; Coping with Stress

Diane Muhlfeld — Fri, 21 Jul 2017 17:36:20 +0000

Q. What’s the difference between gluten intolerance and celiac disease?

A. Gluten, a protein found in some grains, such as wheat, barley, rye, and triticale, can cause gastrointestinal symptoms in people with gluten intolerance similar to those of celiac disease. Symptoms include diarrhea, cramps, nausea, bloating, and constipation. Until now, gluten intolerance has been viewed as a less serious disorder than celiac disease; however, that view is changing: A recent study shows that in people with gluten sensitivity, but who do not have celiac disease, gluten can trigger an immune reaction that can damage cells in the small intestine. Celiac disease is an autoimmune disease in which gluten triggers an attack against the lining of the small intestine. This impairs the intestine’s ability to absorb nutrients, which can raise the risk of osteoporosis, and other autoimmune disorders, such as Type 1 diabetes and multiple sclerosis, and other debilitating symptoms, such as anemia, fatigue, bone and joint pain, skin rash and depression. The only treatment for celiac disease or gluten intolerance is to follow a strict gluten-free diet, for life. The Celiac Disease Foundation estimates that 2.5 million Americans are undiagnosed with celiac disease, putting them at risk for long-term health complications, including infertility, epilepsy, migraines, and intestinal cancers. If you suspect you have celiac disease, ask your healthcare giver for a blood test that checks for certain antibody proteins that can help diagnose celiac disease.

Q. My husband complains of shortness of breath and fatigue, and seems to have low energy. Is it possible he has heart failure? And if so, what treatments are available?

A. Heart failure comes on gradually, due to a weakening or injury to the heart resulting from many underlying causes, such as heart attack, high blood pressure, diabetes, abnormal heart rhythms and other conditions. In addition to shortness of breath and fatigue, symptoms include diminished exercise capacity, high blood pressure, and increased weight brought on by fluid retention. Have your husband see his health care provider as soon as possible; if he is diagnosed with heart failure, he can start treatment immediately to prevent any worsening of his condition.

Treatment options include medications, lifestyle adjustments, and surgery. Heart failure drugs lower blood pressure, stabilize the heart rate and improve the heart’s pumping ability. Your husband may be treated with an angiotensin converting enzyme (ACE) inhibitor, such as Vasotec, or an angiotensin receptor blocker (ARB), such as Atacand, both of which also improve exercise capacity. They also may help prevent “remodeling,” a side effect of heart failure in which the left ventricle enlarges, increasing the heart’s demand for oxygen, and stretching the walls of the heart muscle so they no longer contract effectively. Other drugs include diuretics, which lower blood pressure by eliminating excess fluid and sodium from the body, and beta blockers, which may reverse remodeling and slow the heart rate. Your husband’s doctor also may prescribe statins and anti-arrhythmia drugs to improve functional capacity and quality of life. Lifestyle changes include a heart-healthy diet such as the Dietary Approaches to Stop Hypertension (DASH) or the Mediterranean diet, both of which emphasize fruits, vegetables, whole grains and healthy fats; limiting fluid intake to reduce swelling; and limiting alcohol intake to one drink a day. Continue to exercise, a combination of aerobics, strength training and flexibility, or just walk 30 minutes a day. Surgical procedures include valve repair, angioplasty, or cardiac resynchronization therapy (CRT), a device implanted under the skin that stimulates the heart to beat in a synchronized way.

Q. I’m going through a fairly rough patch in my life—job and relationship stress. Any coping tips for getting through this period?

A. Here are six strategies that may help keep stress from overwhelming you. 1. Avoid distressing thoughts and toxic people—walk away. 2. Focus on optimism—be more grateful. 3. Take action you can control—achievable small steps. 4. Take care of yourself: get plenty of sleep, eat a healthy diet, exercise, and take time to relax. 5. Stay socially active with trusted friends and family members. 6. Practice daily relaxation techniques.

The post Q&A: Celiac Disease; Shortness of Breath; Coping with Stress appeared first on University Health News.

Ask Dr. Etingin: Celiac Disease vs. Wheat Sensitivity; Fitness Bands

UHN Staff — Mon, 22 May 2017 17:23:46 +0000

Q. Is there a difference between celiac disease and wheat sensitivity? I’ve noticed that I get a little bloated after eating bread, but that’s my only symptom. Could it be celiac disease?

A. It could be celiac disease, but only about one-third of adults with this condition have digestive issues such as bloating, diarrhea, stomach cramps, and constipation. These signs are much more common in children with celiac disease. Adults are more likely to have symptoms such as fatigue, depression, bone and joint pain, headaches, and any of dozens of other possible reactions, while some people experience no symptoms at all. Celiac disease can be a difficult condition to diagnose because it affects people differently. People who think they may have celiac disease are advised to ask their doctors to order a blood test that screens for this condition; testing is the only way to ensure an accurate diagnosis of celiac disease.

Non-celiac wheat sensitivity can produce bloating as well as other traditional celiac disease symptoms. People with this problem do not test positive for celiac disease, however. There are several related conditions, including gluten sensitivity and wheat allergy, that all fall under the umbrella term “wheat intolerance syndrome.”

If you suspect that you have one of these conditions, try avoiding foods that contain gluten, the protein found in wheat, barley, and rye. If the post-meal bloating goes away, you have a solution. Of course, other foods, such as beans, lentils, and certain cruciferous vegetables, can also cause bloating. High-fat foods are common culprits, too. In addition to limiting or avoiding foods that cause bloating, you may also want to drink more water and consume more probiotics, the “good” bacteria found in yogurt and other fermented foods, or in supplement form.

Q. I’ve been told that I can use a fitness band for strength training instead of weights. Are these elastic bands really a good alternative?

A. Using fitness bands—or resistance bands, as they’re sometimes called—has some advantages over free weights and weight machines. Fitness bands are inexpensive, and also very portable, so you can take one with you to the office or when you travel. And because the bands rely on tension and resistance instead of actual weight, there is less chance of injury while you work out.

Fitness bands come in a variety of sizes and resistance levels, and some have handles. If you buy a set of bands, it will probably come with a booklet of exercises—you can also find dozens of different exercises online. To improve your strength, do fitness band exercises twice a week. Warm up first, with simple stretches that will increase the blood flow to your muscles, and help you avoid injury. Then do 10 to 12 repetitions of an exercise, building up gradually to two or three sets of reps. You can also challenge yourself by moving to a band with greater resistance.

If you’re unsure how to use fitness bands safely and effectively, book an appointment with a personal trainer who is familiar with these handy exercise tools. Your local YMCA also can advise you.

–Orli R. Etingin, M.D., Editor-in-Chief

The post Ask Dr. Etingin: Celiac Disease vs. Wheat Sensitivity; Fitness Bands appeared first on University Health News.

Celiac Disease Symptoms Checklist

Timothy Cole — Mon, 13 Mar 2017 05:00:18 +0000

Over a lifespan, celiac disease symptoms tend to shift from primarily gastrointestinal ones in children (diarrhea, bloating, pain) to “non-classical” or “subclinical” ones in adults (fatigue, anemia, arthritis, and numbness/tingling in the fingers and toes). Non-classical symptoms can make celiac disease harder to spot, particularly if a patient has other medical conditions with similar symptoms.

Jump to the full list of celiac disease symptoms

As our celiac disease symptoms list illustrates, those with the condition are more likely to be afflicted by problems relating to inflammation, malabsorption, and malnutrition, including osteoporosis, tooth enamel defects, central and peripheral nervous system disease, pancreatic disease, internal hemorrhaging, organ disorders (gall bladder, liver, and spleen) and gynecological disorders, including infertility.

Dr. Salvatore Alesci, Chief Scientist at Beyond Celiac, says that untreated celiac disease can affect people neurologically, as well. “Fatigue, brain fog, anxiety, and depression are common symptoms that may persist if left untreated,” says Dr. Alesci. “Other non-classical symptoms include anemia, osteoporosis, thyroid disease, other autoimmune diseases, a specific skin manifestation called dermatitis herpetiformis, canker sores, dental defects and many more.”

Untreated celiac disease has also been linked to an increased risk of certain types of cancer, particularly intestinal lymphoma and bowel cancer. Some people with celiac disease have no symptoms but they still can develop complications of the disease over time. Later complications can include liver disease, peripheral neuropathy, type 1 diabetes, and subsequent autoimmune disorders, according to Dr. Ellie Heintze, Naturopathic Doctor at Starting Point Acupuncture. “There is a high correlation between Hashimoto’s disease [autoimmune thyroid disease] and celiac disease,” says Dr. Heintze.

Looking for Clues

Your search for celiac disease symptoms information will bring you to any number of lists prepared by various sources. Among them is a 300-symptom list published by The University of Chicago Celiac Disease Center (CDC).

The CDC adapted its list from C.J. Libonati’s book Recognizing Celiac Disease (Fort Washington, PA: Gluten Free Works Publishing; 2007). It notes that some symptoms tend to show up more than others. Besides those mentioned above, these are some of the more frequent telltale celiac symptoms:

Digestive issues (recurring abdominal bloating and pain, chronic diarrhea or constipation;
Vomiting
Liver and biliary tract disorders
Fatigue
Joint pain
Tingling numbness in the legs
Tooth discoloration
A skin rash called dermatitis herpetiformis (DH)
Unexplained infertility
Psychiatric disorders such as anxiety and depression.

The full list goes well beyond. We’ll post it here (see below) along with the Celiac Disease Center’s disclaimer that “the list is not intended to be used as the sole basis for diagnosis.”

A-Z List of Celiac Disease SymptomsS

Symptoms of celiac disease may include one or more of the following:

A

Abdominal Distention
Abdominal Pain
Abnormal Blood Studies
Adenocarcinoma of the Small Intestine
Addison’s Disease
Allergic Rhinitis
Alopecia Areata
Alopecia, Diffuse
Amenorrhea
Anemia, Folic Acid
Anemia, Iron Deficiency
Anemia, Vitamin B12
Angina Pectoris
Anxiety
Anorexia
Anti-Endomysium Antibodies (EMA)
Anti-Gliadin Antibodies (AGA)
Antiphospholipid Syndrome
Anti-Tissue Transglutaminase Antibodies (tTG)
Aortic Vasculitis
Apathy
Aphthous Ulcers
Appetite, Increased
Associated Autoimmune Antibodies
Asthma
Ataxia Gait Disturbance
Ataxia, Gluten
Ataxia, Progressive Myoclonic
Atherosclerosis
Attention Deficit Hyperactive Disorder
Autism and Learning Disorders
Autoimmune Cholangitis
Autoimmune Disorders in Celiac Disease
Autoimmune Disorders in Dermatitis Herpetiformis
Autoimmune Hepatitis
Autoimmune Polyglandular Syndromes
Autoimmune Thyroiditis (Hypothyroidism)

B

B-cell non-Hodgkin’s Lymphoma
Beta Casein Enteropathy
Bitot’s Spots
Bleeding, Unexplained
Blepharitis
Bloodshot Eyes
Blurred Vision
Bone Alkaline Phosphatase Enzyme, Elevated
Bone Fracture
Bone Pain
Brain atrophy
Bronchial Pneumonia
Bronchiectasis

C

Cachexia
Calcium, Low
Cancer of the Esophagus
Cancer of the Pharynx
Cancer Predisposition in Children
Candida Infections
Carbohydrate Malabsorption
Cardiomegaly
Cataracts
Cerebral Perfusion Abnormalities
Cheilosis
Cholesterol, Low
Chorea
Chronic Bullous Dermatosis
Chronic Fatigue Syndrome
Coagulation Factors, Low
Colitis, Collagenous
Colitis, Lymphocytic
Colitis, Ulcerative
Colonic Volvulus
Common Variable Immunodeficiency
Complications After Childbirth
Complications During Pregnancy, Labor and Delivery
Congenital Anomalies
Constipation
Constipation Alternating with Diarrhea
Copper, Low
Coronary Artery Disease
Cortical Calcyfying Angiomatosis
Crohn’s Disease
Cryptic Intestinal T-cell Lymphoma (Refractory Sprue)
Cutaneous Vasculitis
Cutis Laxa
Cystic Fibrosis

D

Defective Tooth Enamel
Delayed Gastric Emptying
Delayed Puberty
Dementia
Depression
Dermatitis Herpetiformis
Dermatomyositis
Developmental Delay
Diabetes Mellitus Type I
Diabetic Instability
Diarrhea, Acute (also called Celiac Crisis)
Diarrhea, Chronic
Down Syndrome
Duodenal Erosions in the Second Part of Duodenum
Dysmenorrhea
Dyspareunia
Dysphagia

E–F

Easy Bruising (Ecchymosis)
Early Menopause
Eczema
Edema
Edema of Small Intestinal Lining
Enteropathic Arthritis
Enteropathy Associated T-cell Lymphoma (EATL)
Epilepsy
Erythema Elevatum Diutinum
Erythema Nodosum
Esophageal Small Cell Cancer
Esophageal Motor Abnormalities
Extraintestinal Lymphomas
Failure to Thrive
Fatigue/Lassitude
Fecal Occult Blood
Follicular Hyperkeratosis
Food Allergies, IgE and non-IgE Immune Responses

G–H

Gas
Gastric Ulcer
Gastric Ulcerations
Gastritis, Collagenous
Gastritis, Lymphocytic
Gastro-Esophageal Reflux Disease (GERD)
Gastrointestinal Complications of Type 1 Diabetes
Gastrointestinal Occult Bleeding
Glucose, Low or Elevated
Gluten Sensitive Enteritis
Glycogenic Acanthosis
Graves’ Disease
Growth Retardation
Gums Bleeding/Swollen (purplish in adults/red in children)
Hangnail
Headache
Heartburn
Hemochromatosis
Hepatic Granulomatous Disease
Homocysteine, Elevated
H. Pylori Bacteremia
Hyperprolactinemia
Hypertension
Hypocalcuria
Hypogonadism
Hypokalemic Rhabdomyolysis
Hypoprothrombinemia
Hyposplenism
Hypotonia

I

Ichthyosis, Acquired
Idiopathic Dilated Cardiomyopathy
Idiopathic Pulmonary Hemosiderosis •Idiopathic Pulmonary Permeability
Idiopathic Hypoparathyroidism
Idiopathic Thrombocytopenic Purpura • IgA Deficiency
IgA Nephropathy
Impaired Gallbladder Motility
Impotence
Inability to Concentrate
Infertility
Insomnia
Intraepithelial Lymphocytosis in Small Bowel Samples
Intrauterine Growth Retardation
Irritability
Irritable Bowel Syndrome
Itchy Skin Rash

J–K

Jejunitis, Chronic
Juvenile Autoimmune Thyroid Disease
Juvenile Idiopathic Arthritis
Keratoconjunctivitis Sicca
Keratomalacia
Kidney Stones
Koilonychia

L–M

Lactose Intolerance
Laryngospasm
Late Menarche
Latent Anemia in Enzymopathies of Small Intestine
Leaky Gut Syndrome
Liver Enzymes, Elevated
Loss of Vitality
Lung Cavities or Abscess
Lymphadenopathy
Lymphoma
Macroamylasemia
Macrocytosis
Macrolipasemia
Magnesium, Low
Malabsorption of Nutrients
Maltose Intolerance
Melanoma
Mesenteric Lymph Node Cavitation
Migraine
Miscarriage
Monoarthritis, Recurrent
Multiple Sclerosis
Muscle Pain and Tenderness
Muscle Spasm and Cramps
Muscle Wasting
Muscle Weakness

N–O

Nails, Dry and Brittle That Chip, Peel, Crack, or Break Easily
Nails with Horizontal and Vertical Ridges/Fragile
Nail with Rounded and Curved Down Ends, Dark, Dry
Nails with White Spots
Nails with Splinter Hemorrhages
Nausea
Nervous System Disorders
Neutropenia
Nightblindness
Nonalcoholic Fatty Liver Disease
Nonresponse to Tuberculosis Treatment
Nosebleeds, Unexplained
Obesity
Ocular Myopathy
Oral Mucosal Lesions
Osteitis Fibrosa
Ostiomalacia
Osteomalactic Myopathy
Osteonecrosis
Osteopenia
Osteoporosis

P

Pancreatic Insufficiency
Parathyroid Carcinoma
Penicillin V Impaired Absorption
Peripheral Neuropathy
Phosphorus, Low
Pityriasis Rubra Pilaris
Plasma Proteins, Low
Plummer-Vinson Syndrome
Pneumococcal Septicemia
Polymyositis
Post-cricoid Cancer
Potassium, Low
Premenstrual Syndrome
Primary Biliary Cirrhosis
Primary Hyperparathyroidism
Primary Sclerosing Cholangitis
Progressive Multifocal Leukoencepha Iopathy
Prolonged Prothrombin Time
Prurigo Nodularis (Hyde’s Prurigo)
Psoriasis
Psoriatic Arthritis

R–S

Refractory Anemia
Rickets
Sarcoidosis
Schizophrenic Spectrum Disorders
Scleroderma
Seborrhea
Secondary Hypoparathyroidism
Severe Iron Deficiency Anemia in Pregnancy
Short Duration of Breast Feeding
Short Stature
Sjögrens Syndrome
Small Bowel Intussusception
Small Intestinal Bacterial Overgrowth
Smell, Loss of
Sperm Abnormalities
Spina Bifida
Steatorrhea
Stroke in Childhood
Sucrose Intolerance
Systemic Lupus Erythematosus

T

Taste, Loss of
Tetany
Thin hair
Tongue (beefy, red, smooth, burning)
Tongue (fiery red, smooth, swollen, sore)
Tongue (magenta, swollen)
Tongue (pale, smooth, burning)
Transient Erythroblastopenia
Tremors
Tuberculosis, Increased Susceptibility to
Turner Syndrome

U–Z

Urinary Tract Infection
Urticaria, Chronic
Uveitis, Bilateral
Vaginitis
Vasculitis of the Central Nervous System
Vitiligo
Vomiting
Weight Gain, Unexplained
Weight Loss, Unexplained
Xerophthalmia
Zinc, Low

Originally posted in March 2016 and updated.

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