Weight Gain and Unsuspected Gluten Sensitivity, Sub-Clinical Gluten Enteropathy

The ‘Classical Presentation’ is the Exception, not the Rule

by David S. Klein, M.D. FACA, FACPM

Introduction: Obesity is now endemic.  More than a national disgrace, the fattening of America may well be one of our greatest threats to our national security. In North America, the general public spends huge sums of money in futile effort to lose weight, when simultaneously, we are wasting huge sums of money ignoring what may be the treatable cause of weight gain in a large percentage of the population. Gluten Enteropathy is a common cause of weight issues in populations that consume grain as a diet staple.

Celiac Disease (CD) is a digestive disease that damages the small intestine and interferes with nutritional absorption, and it can result in unexplained weight gain.  Sufferers of CD cannot tolerate gluten, a binding protein found in wheat, rye, and barley. Most commonly, gluten is found in food products, but Gluten may also be found in everyday products such as medicines, vitamins, and cosmetic products. It’s best to avoid gluten altogether if you have sensitivity of any sort, but fortunately, there are digestive enzymes devoted to helping people digest gluten and therefore, suffer fewer consequences from ingestion.  I have spent many years studying this subject and I have formulated a wonderful product to help you digest gluten. It’s called “Gluten Digest” and there is more about this incredible supplement later on.

Sensitivity to Gluten is very common.  Affecting as many as 30% of the general population, sensitivity to gluten is a ‘spectrum disorder.’  That is, it varies from Subclinical-mild in severity to overwhelming-devastating. In its’ severest form, it is known as Celiac Sprue, Celiac Disease (CD), non-tropical Sprue, and less commonly as Gee-Herter Disease, Gee-Thaysen Disease or Heubner-Herter Disease.

Celiac disease is both a disease of malabsorption, and an immunological condition. There may be a familial or genetic predisposition to CD, and it may be triggered after trauma, surgery, pregnancy, childbirth, infection, or emotional stress.

Autoimmune in nature, CD sufferers will experience periods of time where symptoms are minimal, stable and flair.  Triggers are usually dietary, as the protein family known generally as  ‘Gluten’ will trigger complaints in most patients, that’s why avoidance, or minimizing absorption (through supplementation) helps control the misery.  Equally confusing is that hormonal shifts, co-morbid disease states, infection and stress can trigger symptoms, as well.

Clinical Presentation: Misdiagnosed as ‘irritable bowel disease,’ CD is a life-long complaint.  Rare is the patient that presents to the office complaining of the ‘classical presentation’ of dramatic weight loss, diarrhea and cramping precipitated by pizza, spaghetti and bread.  More typically, patients present with peculiar, episodic cramping, bloating and weight gain.  Self-diagnosed with ‘leaky gut,’ they often go through an embarrassing series of self-treatment protocols, GI detoxifications and fad diets. A minority of patients present with skin rash known as Dermatitis Herpetiformis, as the principal symptom.

Other Signs and Symptoms Include:

unexplained iron-deficiency anemia

fatigue, depression, anhedonia, anxiety

arthritic bone or joint pain

bone loss, osteopenia, or osteoporosis

tingling numbness in the extremities

seizures, depression, bipolar disorder

dysmenorrhea

canker sores in the mouth

dermatitis Herpetiformis

The most common complaints are dyspepsia, bloating and abdominal uneasiness.

Associated disorders include:

Diabetes

Autoimmune thyroid disease, e.g. Hashimoto’s Thyroiditis, Grave’s Disease

Autoimmune liver disease

Rheumatoid arthritis

Autoimmune adrenal dysfunction; Addison’s Disease

Sjögren’s syndrome

Bipolar Disorder.

Lupus

Diagnosis: To most medical practitioners, blood work is the preferred approach to diagnosis, elimination diet is often the most practical way to infer diagnosis. Elimination of gluten from the diet for a 2 week period is often all that is necessary to infer diagnosis.

The ‘gold standard’ in confirming diagnosis is the endoscopic biopsy.  When positive, diagnosis is firmly established.  Unfortunately, biopsy for CD is fraught with false negatives.

Easiest of all is testing, serum anti-body determinations for IgG, IgA, IgE and tTG IgA and tTG IgE are useful, but the derived information is sometimes confusing.  Best drawn early in the morning, these anti-body titers may demonstrate patterns that suggest gluten sensitivity or frank Celiac Disease.

Nutraceutical Treatment of Celiac Disease

The mainstay of treatment is as simple and as complicated as avoiding Gluten in the diet.  This means avoidance of most processed foods, and nearly all grains.

Gluten is widely used as a binder in medicines, supplements and in many cosmetic products.

It takes a good bit of research to identify sources of Gluten in the ingestible environment, and it takes but a single slip to cause a patient to go into a gastrointestinal crisis.

1. CLA- Conjugated Linoleic Acid.  When taken 1,000 mg two or three times daily, CLA will act as a topical anti-inflammatory for the GI tract.  Taking a week or two, symptomatic relief can be dramatic

2. Castor Oil- This old standby is useful to settle an inflamed GI tract.  Taken ½ Tsp to ½ Tbs in apple sauce, once daily, the irritable bowel symptoms often abate within a few days.  It should be taken for several weeks, consistently, then periodically as symptoms dictate.

3.  “Gluten Digest” Formula- This contains DPP IV (a gluten digestive enzyme)- One or two capsules taken immediately before meals will provide some protection from modest amounts of Gluten.  Taking these digestive enzymes mitigates (but does not completely eliminate) the damage from dietary gluten, but social circumstances sometimes dictate the need for this intervention. Sometimes, well-meaning restaurants do not realize they are putting gluten in their dishes, such as using soy sauce, spelt flour or by cooking their grilled chicken on pans that share space with breaded chicken/meats. You get into gluten more often than you realize! Taking “Gluten Digest” supplements can be one of the most inexpensive ways to control the symptoms associated with accidental gluten ingestion.

Dietary Supplementation

Celiac Disease results in an unpredictable but inevitable malabsorption of essential vitamins, minerals, amino acids, oils and essential fatty acids. Many nutritional deficiency syndromes are easily detectable through available nutritional test panels. Most practitioners are unfamiliar with these panels making specific intervention impossible. General supplementation should include:

Mineral chelate (organic mineral salts)

Essential Fatty Acids & Oils

Amino Acid/protein supplementation

Vitamin B Complex, Vitamin C, Vitamin E

Vitamin D-3 (dosage dictated by age and condition)

These supplements are sold in health food stores, and being a physician, I also offer some very high-quality formulas (www.suffernomore.com). I routinely combine the use of medications with supplements for all of my patients because I feel that addressing underlying vitamin/mineral imbalances is also important to getting well, and feeling healthy and vibrant.

My patients tell me they feel a difference in their health within days to weeks of taking high-quality, pure supplements. It’s important to consider the quality of your nutraceuticals, as well as the foods you eat. As we age, we become less and less efficient in absorbing nutrients from the foods we eat, and from dietary supplements through the gastrointestinal tract.  With CD, this efficiency deteriorates even more dramatically.  In short, it takes a great deal more than the ‘recommended daily allowance (RDA),’ to ensure adequate levels of these important and inexpensive nutrients.

NOTE WELL:  The commonly available OTC multivitamin/mineral complexes are entirely inadequate.

Individuals with CD tend to have elevations in CRP, suggesting increased risk of cardio-vascular disease.  Omega-3 fatty acid (fish oil) administration is an interesting, new intervention for the treatment and prevention of coronary artery disease (CAD). Certain omega-3 fatty acids have biochemical properties that promote atherosclerotic plaque stability and thereby decrease the incidence of cardiac ischemia and  ischemic cardiac arrhythmias. An ever-increasing body of evidence supports the role for omega-3 fatty acids, i.e. fish oil, in  through a role as anti-arrhythmic agents, through anti-thrombotic effect, and through atherosclerotic plaque stabilization, probably as a result of topical anti-inflammatory action.

Dosage requirement is between 2 and 3 grams per day, in divided doses.  Generally, the preferred cardiac ratio of 3:2 EPA/DHA, but in inflammatory conditions such as CD, the EPA/DHA ratio does a bit better at 6:1.

Patient should begin with 1 mg per day, increase over a week or two to the desired daily dosage.

I have done my best to outline suggestions for you to better care for yourself, and of course, these are just “suggestions” so please ask your own physician what is appropriate for your individual needs.

David S. Klein, MD has practiced pain medicine for the past 27 years and is the author of over 50 published articles and textbook chapters and has lectured extensively. He is a member of the American Board of Anesthesiology, American Board of Pain Medicine, American Academy of Pain Management, American Board of Minimally Invasive Medicine & Surgery, and has Sub-Specialty Certification in Pain by the American Board of Anesthesiologists. Dr. Klein is presently the Medical Director of the Pain Center of Orlando, located at 225 W. SR 434, Suite #205, Longwood, Florida 32750.

Telephone 407-679-3337.

FAX:  407-678-7246.

www.suffernomore.com

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Dear Readers,

After I presented last year’s dumbest healthcare ‘awards,” I received your emails and chuckles for months afterwards.  Sometimes, ridiculous things happen in the medical industry, so at this time, I’d like to present my second annual ‘Dumb Awards’ in Medicine:

Dumb Award: The first ones goes to (drum roll please)… the Federal Communications Commission for allowing both pharmaceutical and fast-food commercials to blast our airwaves. Just chill out, squeeze some Cheez Whiz on your foot-long sub, and watch “The Simpsons.” During commercial breaks, all of the disorders that afflict your friends and relatives (not you) will become apparent. Watch TV with new eyes okay? You will first notice lots of junk food commercials -which promote disease- followed by drug commercials and attorneys offering their services to people injured by drugs.  Eventually, the news comes on so you can learn about the newest approved drug. Hysterical!

Dumber Award:   We have a tie between anti-depressant drugs and the doctors who prescribe them for every woman who is tired or tearful.  Of the various ‘happy’ chemicals naturally produced in our body, serotonin is the one most likely to be raised by anti-depressant drugs.  But research shows that depression may be caused by elevated stress hormones, low vitamin D levels, diabetes or insulin-resistance (diagnosed or not), low progesterone hormone, niacin or folate deficiency or exposure to plastics.  So what’s up with all the drugs? Their side effects are depressing if you think about it -problems achieving orgasm, low sex drive, insomnia, suicidal thoughts and heart palpitations.  Anti-depressant drugs don’t fix the underlying cause for neurotransmitter deficiencies and doctors should be conducting lab tests to determine the cause for emotional instability before prescribing pills and dismissing you.

Dumberest Award: Yes I spelled “dumberest” that way on purpose, and please throw confetti here… The Centers for Disease Control, who in September 2009, recommended that “All people with suspected or confirmed influenza who require hospitalization be treated with Tamiflu or Relenza.”  By December 2009, based on a number of scientific studies, scientists concluded that the benefits of this anti-viral treatment were grossly over-estimated, because it could only shorten the length of illness by approximately one day.  Whoop-dee-doo! Potential side effects include: Vomiting, diarrhea, abdominal cramps, arrhythmias, nightmares, dizziness, headache, fatigue, delusions, hallucinations, altered level of consciousness, and seizures. Spare me.

Honorable Mention: To Kellogg’s for making packaging claims last May to the effect that Cocoa Krispies can boost your child’s immune system. They timed their campaign around the swine flu  outbreak so parents would know what to feed their kids (wink). I agree with Kellogg’s that increasing the amounts of vitamins in food can promote health, but even the FDA viewed the Kellogg’s claim as ridiculous and made them stop. What’s next, soda pop posed as healthier because it’s made with cane sugar instead of high fructose corn syrup? Hurry, hurry, for a limited time you can now buy Pepsi-Cola Throwback.   Puhleeze!

If there is a super star in Big Pharma’s list of money making drugs, it may well be the group of medications known as statins. The New York Times reported last year that statins are, in fact, the biggest selling drugs in the world. Their names, like Lipitor and Crestor, are familiar from countless television and magazine ads and almost everyone knows someone taking a statin. Promoted widely as safe, they are actually known to cause a litany of potential side effects. For example, the National Institutes of Health (NIH) web site notes that about one in 1,000 of those taking statins suffer from muscle pain. Usually, these aches go away. But not always. And now new research shows that in some people statins cause serious structural damage to muscles.

The study, just published in CMAJ (the Canadian Medical Association Journal) suggests that patients who are taking statins and who complain to their doctors about muscle tenderness or pain could well be describing severe muscle problems due to the drugs. Although muscle damage is usually associated with elevated levels of an enzyme called creatine phosphokinase, the CMAJ research shows that’s not always the case. And it may take muscle biopsies to show that underlying structural injury has occurred.

The study was conducted by scientists from the University of Bern, Switzerland and the Tufts-New England Medical Center in Boston, Massachusetts. The research team investigated muscle biopsies from 83 patients. Twenty of these had never taken statins. The results showed significant muscle injury only in people who had taken statin drugs. Perhaps what was most surprising is that several people who were no longer taking statins were found to still have significant structural muscle damage.

“Although in clinical practice, the majority of patients with muscle symptoms improve rapidly after cessation of therapy, our findings support that a subgroup of patients appears to be more susceptible to statin-associated myotoxicity, suffering persistent structural injury,” Dr. Annette Draeger from the University of Bern and her coauthors wrote in the CMAJ article.

The study did not address whether statins might cause other significant body-wide damage. However, it is interesting to note that the very organ statins are supposed to protect, the heart, is a muscle. And that raises troublesome questions about possible long term, not-yet-known side effects statin drugs may have on the heart itself.

The researchers did note in a statement to the media that there is “a need to evaluate alternative treatment strategies for patients with significant muscle symptoms.” As Natural News readers are well aware, there are already well-known natural health strategies that lower cholesterol levels safely, without any possibility of muscle damage. For example, previous research has shown certain foods, including tofu, almonds, cereal fiber and plant sterols, can lower total cholesterol and LDL, the “bad” cholesterol, better than statins (http://www.naturalnews.com/008310.html). Weight loss, increased intake of Omega-3 fatty acids and exercise are also drug-free strategies that lower cholesterol safely (http://www.naturalnews.com/025715.html)/

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