Monthly Archives: January 2016

Coeliac Disease

Following from my post about food intolerance’s, I have received my blood test results. I have been diagnosed with coeliac disease which causes inflammation in the lining of the small intestine. My results will be confirmed at a follow-up appointment but from now on I cannot eat gluten or wheat food products. Although it has been distressing to find that I have limitations to my diet, I am relieved that I know the cause of my problem and hopefully my symptoms will calm down as I change my food intake.

Wheat and gluten excluded from my diet
Wheat and gluten have to be excluded from my diet

Interestingly, coeliac disease is not a food allergy or intolerance. It is in fact an autoimmune disease. Since my sister has type 1 diabetes, another autoimmune disease, it is not surprising that I have one too; if a close family member has such a disease there is a 1 in 10 chance of developing one. My diagnosis means that my body actually makes antibodies against gluten. Therefore, my small intestine identifies gluten as harmful; responding in the same way as it would to pathogens. It reacts with the gluten leading to the development of inflammation in the lining of the intestine. The villi that line the small intestine become flattened due to this inflammation. Villi normally help food and nutrients to be digested and so with coeliac disease you do not properly digest your food. This is why I have had limited weight gain, abdominal pains and tiredness; the main symptoms of the disease. The average time from the first symptoms to diagnosis of coeliac disease is 13 years in the UK; this means I could have been living with it for nearly my whole life.

The impact of coeliac disease on the lining of the small intestine
The impact of Coeliac disease on the lining of the small intestine

My blood test for coeliac disease was obviously positive as there was a high percentage of the antibody that occurs in the disease in my blood. My follow-up appointment may include a biopsy where a small sample of tissue is taken from the lining of the intestine in order to examine the typical changes that coeliac disease causes. This is carried out by using an endoscope which is a thin flexible tube that is passed down the oesophagus, through the stomach and then to the small intestine. In addition, I may have to have further tests to see how poor absorption of food has affected me, such as blood tests for iron or protein levels.

Endoscopy is used to confirm coeliac disease
Endoscopy is used to confirm Coeliac disease

The main treatment for the disease is a gluten free diet. The symptoms should then go within a few weeks. Wheat, barley and rye are the main foods that contain gluten. This means breads, pasta, cakes, pastries and most cereals are out of the question. Nevertheless, potatoes, rice, maize, corn, fruit, dairy products and vegetables are all allowed. The main disadvantage with Coeliac disease is eating out. Processed foods, fast foods and ready-meals almost always contain gluten. Care has to be taken with foods such as french fries in McDonald’s; although they do not contain gluten, they are likely to be contaminated with the various other foods containing gluten that the restaurant is cooking.

Image of the small intestine before and after coeliac disease
Image of the small intestine before and after Coeliac disease

To avoid all symptoms and complications I will have to avoid gluten for life as even small amounts can sensitize the gut. Furthermore, I may have to take vitamin supplements for the first 6 months to replace deficiencies while my gut is returning to normal.

Coeliac disease means I now have an increased risk of developing other conditions such as the thinning of the bones (osteoporosis). Commonly people think that consuming small amounts of gluten will not matter. In reality only a small amount can cause symptoms to return.

The disease affects 1 in 100 people in the UK, with anyone at any age being impacted. If you think you may be Coeliac you should see your doctor. A gluten free diet should not be attempted before diagnosis as if you go on this diet before the blood test then it may give negative results. Hopefully I will be able to live free from the symptoms of Coeliac disease if I avoid gluten! For more information visit: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/celiac-disease/Pages/facts.aspx

Temporomandibular Disorder (TMD)

My mother has lately been diagnosed with TMD also known as jaw joint dysfunction or myofascial pain disorder. This is a group of conditions that result in joint pain which can stop the correct movement of the jaw. 1 in 6 people are affected by the condition, and 30% of adults will experience TMD at some point in their lives.

Diagram showing the jaw joint
Diagram showing the jaw joint

Grinding her teeth was the main cause of my mother’s TMD; this happens normally when you’re asleep meaning the jaw muscles are overworked so there is unnecessary pressure on the jaw joint. Nevertheless the disorder can be caused by stress, uneven bite, specific diseases or wear and tear of the jaw joint. TMD is not usually serious and the symptoms typically last a few months before improving. However, this can have a significant impact on someone’s quality of life and it may develop into a more severe dysfunction.

My mother had been experiencing more severe symptoms of the condition for around a year before being diagnosed. She was suffering from painful migraines and serious neckache. However other symptoms include clicking or popping as you chew food, muscle pain around the jaw, earache, backache and difficulty opening the mouth.

Milder versions of TMD can be treated by making simple lifestyle changes such as eating soft food, holding a warm/cold flannel on the jaw several times a day, doing jaw-stretching exercises or massaging the jaw muscles. However my mother had previously tried such techniques and had no success. Hence, she has now been prescribed with a mouth guard. This fits over your teeth to stop grinding, especially at night. So far she has found her jaw to be less painful as clenching has been reduced.

My mother's mouth guard
My mother’s mouth guard

For very severe cases, surgery may be necessary to resolve TMD. One treatment is called arthrocentesis which involves inserting needles into the affected joint. The needle injects a sterile solution to wash out the joint- removing any extra scar tissue while increasing mobility. In rarer cases, open joint surgery is required to fix an abnormality within the joint. Very few people are recommended to have complete joint replacement as it can have significant side effects.

If you think you are suffering from TMD try making some simple life changes as suggested. If your symptoms do not improve consult your doctor or dentist.

Food Allergies and Intolerances

Food allergies cause a reaction in the body’s immune system causing various effects on different organs. Hence, a food allergy can be severe or life-threatening and so a certain type of food cannot be consumed at all. Whereas with food intolerance, the body can cope with small amounts of a type of food without a reaction and there are ways in which this intolerance can be prevented.

Milk, gluten, nuts and eggs are common foods that induce reactions, however effectively any food has the potential to cause an adverse effect. It is estimated that between 1 to 2% of people in the UK have a food allergy, although 30% “believe” that they are allergic or intolerant to certain types of food. Therefore, it is important that sufferers who “believe” they have intolerance seek advice from their doctor before changing their diet.

Food intolerance can be caused by: enzyme absence; meaning food cannot be digested, irritable bowel syndrome, food poisoning, food additive sensitivity, stress or celiac disease. Such symptoms that may develop include abdominal pains, bloating, constipation, diarrhoea, fatigue, headaches, stomach cramps and weight loss.

% of population with intolerance to certain food groups
% of population with intolerance to certain food groups

 

Over the past few months I have come to realise that I may be intolerant to certain types of food. Over a year ago I went to Ecuador on an aid-working expedition where I contracted gastroenteritis; an infection of the gut. Possible complications of the disease include lactose intolerance as the gut lining can be damaged leading to a lack of the chemical enzyme lactase which is required to digest lactose. Thus, recently I have been drinking soya milk instead of regular milk and my symptoms seemed to have calmed slightly. Nevertheless I have visited my doctor where I had a blood test to see if I have any allergies, and I will get the results back soon to see if my self-diagnosis is correct.

Map presenting lactose intolerance globally
Map presenting lactose intolerance globally

 

So why do not all people develop allergies? As a baby the body becomes tolerant to a multitude of proteins that it encounters in the first stages of its life. Such mechanisms it undergoes are still unknown, hence research would be able to reveal if the timing of introducing foods is important in order for normal tolerance to function. Most childhood allergies disappear after 12-24 months, however why this is, is unclear. There is limited knowledge as well with why allergic diseases develop, though existing diseases such as asthma may influence them.

In conclusion, if after eating a particular food you have a reaction ensure you visit your doctor as soon as possible to see if you have an intolerance or allergy. Keeping a food diary can also help if you have unexplained constipation or stomach cramps in order to identify a trigger food. If you wish to know more about this aspect of nutrition visit: https://www.nutrition.org.uk/nutritionscience.html.