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Gluten Problems
and Solutions
by Stephen Gislason MD
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book, Gluten Problems and Solutions
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Stephen Gislason's Preface
What is
Gluten?
What is Celiac Disease?
Gluten & Food
Digestive
Tract Permeability
Diseases Related
to Celiac Disease
Allergy
Digestive
Tract Permeability
Diseases Related
to Celiac Disease
Gluten-Free Diet Revision
Celiac Diagnosis
Gluten Psychiatry
Dermatitis Herpetiformis
Celiac Disease & Cancer
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The Alpha Nutrition Program is Gluten
free
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Celiac Disease Study Guide
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Increased Intestinal Permeability
Patients with celiac disease have circulating antibodies to food
proteins; they also have circulating immune complexes, revealing increased
permeability of the digestive tract to macromolecules, especially gluten
and other food proteins. The reduction or absence of an intestinal
IgA barrier that increases absorption of antigenic material from the
gut. Antibodies to some of the food antigens can cross react with the
host's self components and can produce autoimmune disease. Measurements
of GIT permeability are important tools of research and clinical assessment.
Elemental Formulas Solve Permeability
Problems
Elemental nutrient formulas are designed to solve the problem of
increased GIT permeability. By excluding potential antigens from Alpha
Nutrition formulas, nutrients are provided in a safe context. All proteins
and peptides are excluded. Hydrolyzed proteins are not used so that
there is no risk of peptide effects. Instead of proteins or hydrolyzed
proteins, free l-form amino acids are provided. The individual
amino acids fall into two groups: the essential AA's, which must be
ingested, and the non-essential AA's, which can be synthesized in the
body and need not appear in the food. Nine amino acids are considered
essential nutrients, while another eleven or so can be synthesized from
the essential amino acids. All 19 nutrient amino acids are included
in the Alpha Nutrition Formulas as individual amino acids rated at 100%
purity, with the highest solubility attainable.
Abstracts
GIT Permeability Abstracts
Lymphocytic gastritis
and gastric permeability in patients with celiac disease.
- Author
Vogelsang H; Oberhuber G; Wyatt
J
- Address
Department of Gastroenterology and
Hepatology, University Clinic of Internal Medicine IV, Vienna,
Austria.
- Source
Gastroenterology, 1996 Jul, 111:1,
73-7
-
Abstract
Lymphocytic gastritis is associated
with celiac disease. Gastric permeability can now be assessed
by a sucrose test, and intestinal permeability measured by a
lactulose/mannitol test is increased in untreated celiac patients.
The aim of this study was to prospectively compare gastric and
intestinal permeability with histological changes of the stomach
and small bowel in patients with celiac disease. METHODS: Gastric
and intestinal permeability were measured by oral or duodenal
(during endoscopy) administration of a triple sugar solution
containing 20 g sucrose, 10 g lactulose, and 5 g mannitol in
100 mL water in 43 adult patients with celiac disease (28 without
diet) and in 30 healthy controls. Endoscopical biopsy specimens
were taken from the antrum and distal duodenum and investigated
for intraepithelial lymphocyte counts. RESULTS: Urinary sucrose
excretion decreased after duodenal administration (n = 8) as
opposed to oral administration and thus measured gastric permeability
in celiac disease. Gastric permeability was elevated in 60%
of the celiac patients and correlated with antral intraepithelial
lymphocyte counts. Intestinal permeability (measured by a lactulose/mannitol
test) was also elevated in 69% of the celiac patients and correlated
with duodenal intraepithelial counts. CONCLUSIONS: There is
a high prevalence of lymphocytic gastritis in untreated celiac
disease associated with elevated gastric permeability. Celiac
disease seems to be a general disorder of the gastrointestinal
tract associated with disturbed permeability.
Gut permeability to human alpha-lactalbumin, beta-lactoglobulin,
mannitol, and lactulose in celiac disease.
- Author Kuitunen M; Savilahti E
- Address Children's Hospital, University of Helsinki,
Finland.
- Source J Pediatr Gastroenterol Nutr, 1996 Feb, 22:2,
197-204
-
- Abstract Our objective was to examine the permeability
of the gut to protein macromolecules and sugar probes and their
possible association in celiac disease patients. We studied
the permeability to human alpha-lactalbumin, beta-lactoglobulin,
mannitol, and lactulose on 46 occasions in 33 celiac disease
patients in various phases of the disease; in addition, mannitol
and lactulose permeability was studied in 18 healthy controls.
Lactalbumin absorption was detected in 19 of 42 patients tested,
more often in celiac disease patients with villous atrophy than
in those with normal jejunal biopsy (p = 0.01). Higher absorption
of lactalbumin was found in patients with subtotal villous atrophy
than in those with normal biopsy (p = 0.02). beta-lactoglobulin
was found in four of 42 patients tested. Less mannitol was absorbed
by patients with either subtotal or partial villous atrophy
than by those with normal histology (p = 0.001 and 0.006, respectively).
Lactulose recovery was higher in newly diagnosed patients and
patients with subtotal villous atrophy than in controls (p =
0.007 and 0.03, respectively). The lactulose/mannitol ratio
was higher in newly diagnosed patients and patients with villous
atrophy than in controls (p = 0.002 and 0.002, respectively).
The correlation between permeability to lactalbumin and mannitol
and lactulose was poor. We conclude that permeability to proteins
and sugar molecules is abnormal in celiac disease patients with
mucosal damage and that they probably reflect different mechanisms
of penetration.
Follow-up of celiac disease with D-xylose breath test.
- Author Casellas F; De Torres I; Malagelada JR
- Address Digestive System Research Unit, Hospital General
Vall d'Hebron, Barcelona, Spain.
- Source Dig Dis Sci, 1996 Oct, 41:10, 2106-11
-
- Abstract Hydrogen breath tests (H2-BT) are commonly
used to diagnose carbohydrate malabsorption. Specifically, the
H2-BT with D-xylose has been shown to be as valid as the traditional
urinary test for the recognition of intestinal malabsorption.
We have now investigated the H2-BT with D-xylose in the follow-up
of patients with celiac disease. Seventeen patients with celiac
disease established clinically and confirmed by jejunal biopsy
were studied. H2-BT was performed before and after treatment
with a gluten-free diet for at least five months. Alveolar breath
samples were obtained before administering orally 25 g of D-xylose
and thereafter at 30 min intervals for 5 hr. Samples were analyzed
for H2 by chromatography. Simultaneously, the 5-hr urinary excretion
of D-xylose was determined by colorimetry. Gluten removal significantly
decreased the H2 delta change (from 56.5 +/- 5.9 ppm to 32.2
+/- 8.8, P < 0.05). A similar decrease was observed in the area
under the curve (P < 0.05). Conversely, urinary D-xylose excretion
increased significantly (P < 0.05). Eleven of the 17 celiacs
clinically improved after treatment. The H2-BT normalized in
every patient who entered remission on the gluten-free diet,
whereas the urinary D-xylose excretion remained abnormal in
six of them. In the six nonresponder patients the H2-BT remained
high in five, whereas urinary D-xylose excretion paradoxically
normalized in 2. We conclude that H2-BT with D-xylose is a useful
and practical test for the follow-up of celiac disease and is
simpler and more reliable than the urinary D-xylose test.
Screening for celiac disease in first-degree relatives
of patients with celiac disease by lactulose/mannitol test.
- Author Vogelsang H; Wyatt J; Penner E; Lochs H
- Address Department of Gastroenterology, University of
Vienna, Austria.
- Source Am J Gastroenterol, 1995 Oct, 90:10, 1838-42
-
- Abstract OBJECTIVES: In first-degree relatives of celiac
patients, the risk of oligosymptomatic celiac disease is elevated.
These individuals therefore also have a higher potential for
malignancy or nutritional deficiencies. Lactulose/mannitol permeability
is increased in untreated celiac patients and has been recommended
to screen for celiac disease. We investigated the usefulness
of a lactulose/mannitol home test kit for screening first-degree
relatives home test kit for screening first-degree relatives
of celiac patients. METHODS: The lactulose/mannitol test was
performed at home by 111 first-degree relatives. These subjects
received the test kit from celiac index patients, were instructed
by an information sheet how to carry out the test, and were
asked about their symptoms by questionnaire. When lactulose/mannitol
permeability was abnormal, endomysial antibodies were tested
by immunofluorescence. Any relatives with positive endomysial
antibodies were then biopsied. To investigate the specificity
of the lactulose/mannitol test for celiac disease, 40 patients
with nonspecific gastrointestinal symptoms were tested. RESULTS:
Lactulose/mannitol permeability was elevated in 34 (31%) relatives,
but only nine (8%) of those relatives showed positive endomysial
antibodies. Flat mucosa was found in all nine relatives after
biopsy. The prevalence of celiac disease was much higher (42%)
among 12 relatives who contacted the outpatient clinic themselves
because of symptoms. Seventy-one percent of the remaining 21
relatives with elevated permeability demonstrated normal intestinal
permeability at a control test within 1 yr. CONCLUSION: By combining
the lactulose/mannitol test with endomysial antibody testing,
we have developed a good strategy for use in screening for celiac
disease among first-degree relatives.
Assessing the site of increased intestinal permeability
in coeliac and inflammatory bowel disease.
- Author Teahon K; Somasundaram S; Smith T; Menzies I;
Bjarnason I
- Address Department of Clinical Pharmacology, University
of Newcastle upon Tyne.
- Source Gut, 1996 Jun, 38:6, 864-9
-
- Abstract The precise site of intestinal permeability
changes in patients with coeliac and inflammatory bowel disease
is unknown. AIMS: To design a non-invasive technique for the
localisation of altered gastrointestinal permeability to 51chromium
labelled EDTA (51CrEDTA). The method depends on comparing and
defining concentration/time profiles in serum of a series of
simultaneously ingested indicators with a well defined absorption
site (3-0-methyl-D-glucose (jejunal indicator), 57cobalt labelled
vitamin B12 (ileal indicator), and sulphasalazine (caecal-colonic
indicator)) in relation to simultaneously ingested 51CrEDTA.
SUBJECTS: Five normal controls, six patients with untreated
coeliac disease, five with Crohn's ileitis, and five with pan-ulcerative
colitis underwent study, which entailed the simultaneous ingestion
of the above four test substances followed, during the next
24 hours, by timed serial collection of urine and serum for
marker analysis. RESULTS: Urinary excretion of 51CrEDTA was
significantly increased in all patient groups. Analysis of serum
appearances and profiles of the markers suggested that the increased
intestinal permeation of 51CrEDTA took place in the diseased
jejunum in patients with coeliac disease, predominantly in the
ileum in Crohn's disease and in the colon in the patients with
pan-ulcerative colitis. CONCLUSION: A new non-invasive technique
has been assessed that permits the localisation of the site
of permeability changes with the gastrointestinal tract.
Measurement of sugar probes in serum: an alternative
to urine measurement in intestinal permeability testing.
- Author Fleming SC; Duncan A; Russell RI; Laker MF
- Address Department of Clinical Biochemistry, University
of Newcastle upon Tyne, UK.
- Source Clin Chem, 1996 Mar, 42:3, 445-8
-
- Abstract The percentage dose of lactulose and mannitol
excreted in urine after oral ingestion is used as a noninvasive
method of assessing small intestinal permeability. The collection
of incomplete or inaccurately timed urine samples can lead to
errors in estimation of sugar probe molecules. We describe an
HPLC method for the simultaneous determination of lactulose
and mannitol in serum after oral ingestion of test sugars. We
applied the test to healthy volunteers and to subjects undergoing
jejunal biopsy for suspected gluten-sensitive enteropathy. The
ratio of concentrations of lactulose and mannitol in serum discriminated
well between subjects with a normal biopsy and those with villous
atrophy, discrimination being best at 90 min postdose. The results
agree well with lactulose:mannitol ratios determined in urine
(r= 0.88), and the two methods can be used interchangeably.
The determination of mannitol and lactulose in serum provides
an acceptable alternative to urine collection and may be particularly
useful in young children. It also reduces the time spent on
the investigation from 5 h to 90 min.
Recommendations Alpha Nutrition
is gluten-free and is recommended as the diet revision strategy
for anyone with diagnosed celiac disease, or any person with symptoms
suggestive of gluten allergy.
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