You are here: Home / Archives for Gluten

Gluten can impede growth – is your child short?

March 16, 2012 By
Lots of parents bring their children to see me because of short stature: that means they are shorter than expected.
 
Classically, short stature is seen in children with celiac disease. It is usually attributed to nutritional deficiency.  However, this cannot be the usual reason – because most of the children I see are not nutritional deficient – they are not loosing weight, and they have no bowel damge, although they have evidnce of gluten sensitivity.
 
So why are these children short?  Some of them come from short families – so they are genetically short.
 
But more likely, gluten and the immune response to gluten is adversely affecting the activity of growth hormone.
 
 
A recent paper comes to this conclusion: “short stature is one of the most common clinical manifestations of CD and should be considered in all children with short stature. Catch-up growth is observed on gluten-free diet (GFD), mostly in the first 6 months from diagnosis [if this is due to a nutritional deficiency]. The absence of catch-up growth requires the evaluation of compliance and endocrinological evaluation. Patients should be tested for GH reserve, particularly if the test for anti-pituitary antibodies (APA) is positive.”
 
Many research groups report a dysfunction of the endocrine growth axis in children with CD.  And likewise with gluten sensitivity.
 
Every child with suspected growth issues needs to be checked out for celiac disease and gluten sensitivity.  In these children a gluten-free diet might make a big difference.
 
We investigate children with short stature and poor growth at The Children’s Clinic | Allergy Centre.
 
Dr Rodney Ford
Filed Under: Gluten, Uncategorized

Who needs a gluten test?

December 13, 2011 By

“What a great video. This is so helpful and I will be going for a blood test shortly.” – says a grateful viewer.

This YouTube has over 18,000 views – so happily it must be helping a lot of people understand who needs testing and what test to get.
Gluten sensitivity and coeliac disease are such common problems, but often not tested for.
Filed Under: Gluten

Oats – can they be part of a gluten-free diet?

December 1, 2011 By

There has been controversy for years as to whether it is okay, or not okay, to eat oats if you are gluten-sensitive.

Clinical studies have now provided very good evidence that oats do not damage the gut mucosa in most people who have coeliac disease.  Following this, guidelines from some Coeliac Societies now accept that moderate amounts of oats can be consumed by most coeliacs without risk.

Many experts concerned with coeliac disease have now concluded that oats are safe for coeliacs, as long as they limit their consumption to amounts “found to be safe” in these research studies.  This quantity is up to one-half cup of dry whole-grain rolled oats per day.  Of course, any oats that are consumed need to be free of any contamination from other grains.
Half a cup of oats each day is usually okay
Here is some of the information that this opinion is based on:
A study in Finland looked at 52 coeliacs who were in remission and who had been on a gluten-free diet for more than a year.  They all had a duodenal-biopsy, then they ate about 50 grams of oats (half a cup) per day over the next six months. Finally, they had a second biopsy.   None of the people had any villus damage.
Your gut can heal whilst eating oats
Another group studied 40 newly diagnosed coeliacs in the same way.  As expected, their initial biopsy showed significant villus damage (this was of course because they were still on a gluten-containing diet until they began the study). These people started on their gluten-free diet as well as eating their 50 grams of oats each day for 12 months. At the end of the year, their biopsies showed no damage to their villi. The meaning of this study was that their damaged villi were able to heal while eating oats.
A few people get unwell eating oats
However, other studies have found that not all people with coeliac disease are able to tolerate oats. Especially, those who also have dermatitis herpetiformis.  Researchers report that although oats are well tolerated by most coeliacs, they did find a few exceptions.  Several people recounted initial abdominal discomfort and bloating.  A few patients have been found to eventually develop total villous atrophy during an oat challenge.
Yet another study has investigated 20 adult coeliacs who were in remission, to see if they could eat even larger amounts of oats in their daily gluten-free diet.  They consumed about 100 grams (one cup) of uncontaminated rolled oats in their daily diet for  over a year.  They were tested four times during the study period.  This included small bowel endoscopy and blood samples.  They experienced no gut symptoms.  Also, there were no adverse effects seen in small bowel histology or in their blood test results.   The conclusion was that the vast majority of adults with coeliac disease could include large amounts of rolled oats in their diet without problems.
   
Oats have also been studied in children.  A group of ten children with coeliac disease were investigated at the time of their diagnosis.  They were put on a gluten-free diet but they were also eating about 25 grams (quarter of a cup) of rolled oats each day.  After six months they were tested again.  There was improvement in both their small bowel histology and their tissue transglutaminase antibody results.
  
Children tolerate oats well
However, there is still a word of caution.  Oat proteins have been shown to trigger the immune response of cells taken from coeliac people.  Therefore, the long-term effects of oat cereal added to a gluten-free diet in children still need to be determined.
Oats are useful fibre
The ability to use oats in your diet gives an important source of fibre as well as other important nutrients.  This is very important in children who have other food allergies.  If you are also allergic to cow’s milk and eggs, then going gluten-free is a big task.  Therefore, if oats can be tolerated, this makes food planning just a little bit easier.
Each person will have to work out whether or not they can tolerate oats for themselves.  This needs to be determined both clinically and with follow-up blood tests.
Finally, some gluten experts have expressed some further concerns about oats.  These are:
  • Some food chemistry research studies suggest that avenin protein in oats does have toxic properties.
  • The purity of oat products in some countries is suspect.  Oats and oat products can inadvertently be contaminated with wheat.  This can occur during harvesting, milling and  processing.
  • There is a possibility that gut damage from oats takes longer than six to twelve months to show up.  Also, symptoms might not be readily apparent to the person.
  • The possibility that young children might have a higher cross-sensitivity to oats because of their relatively immature immune system.

These are real concerns.  It is important that gluten-sensitive people know about the oats story.  Whether or not they choose to eat oats, they should be under some sort of regular medical evaluation and supervision. However, the common opinion is that the long-time consumption of oats as part of the gluten-free diet is well tolerated among the vast majority of those with coeliac disease.

Dr Rodney Ford
Food allergy and Gluten expert

Filed Under: Gluten

Gluten test: not always accurate

November 4, 2011 By

Should everybody go gluten-free? 
Should everybody with undiagnosed symptoms go gluten-free? 

Emma can help you answer this question.

Emma is a 3-year-old and turns out to have gluten sensitivity.  She came to our clinic with severe recurrent abdominal pain. She had lots of investigations,  including x-rays and ultrasound which were normal.  Her celiac and gliadin antibodies blood tests were also normal.  She does not carry the celiac gene, she does not have celiac disease. Gastric reflux and constipation medications were of no benefit.

Most paediatricians would diagnose her as having “functional abdominal pain” and fit her into the “Rome criteria” (http://www.romecriteria.org), a system that has been developed to classify the functional gastrointestinal disorders (FGIDs) of the digestive system when: “symptoms cannot be explained by the presence of structural or tissue abnormality, based on clinical symptoms.”

However, it is my experience that many of these children do in fact have gluten sensitivity.  A gluten-free trial is not part of the “Rome” diagnostic work up to exclude disease! So, Emma went on a gluten-free diet for a 3-month trial. Success! Mum said:

“A great result. Emma has no more sore tummies, except when she has gluten.  She is now sleeping through the night, except when she has gluten.  Toilet training is at last going well (with normal poos), and she is generally happier, and she is eating a wide range of fruit and vegetables (before she was a much more picky eater).  Also we have noticed a huge benefit for her behavior, with her not being as grumpy or frustrated.”

“And she is so good about being on this gluten-free diet. She is always asking if a food might have gluten in it.  But if we make a mistake she says ‘my tummy hurts’ she feels sick and gets cranky again.”

For Emma’s sake I’m very pleased that we have now found the cause for her recurrent abdominal pain.  It is NOT a functional pain – she has a real disease.  All her tests were normal, including her gluten/celiac tests.  She has gluten syndrome.

I expect that Emma will remain gluten-free for the long-term, for a life-time.

Should everybody with undiagnosed symptoms go gluten-free? I say yes. So many people experience a dramatic response.

At the Childrens Clinic | Allergy Centre, Christchurch, we will test you for, and help you with, celiac, gluten sensitivity and gluten syndrome.

Filed Under: Gluten

Gluten: how much is okay?

November 4, 2011 By

My position is: gluten-free means ZERO gluten.

Yes, I’ve changed my mind.  When I wrote my first gluten book (“Are you gluten-sensitive? Your questions answered”) I thought that people who were gluten sensitive could eat gluten to as much as they can tolerate.  This is wrong.  Over the last 10 years I have done a lot more research – I realise that even a tiny amount of gluten is bad. Now I say “zero gluten for everyone”.

Let me tell you about Amelia.  She is 7-years-old, and came to our clinic when she was just 3. We diagnosed her as gluten sensitive, and she has been gluten-free for 4 years.

Bright red cheeks from gluten
She had bright red cheeks – it looked like they had been painted bright scarlet-red.  This worried her parents. She also had some eczema, and often got distressed at night with painful leg cramps.  Her blood tests showed high gluten antibodies, but no evidence of celiac disease.

My explanation of her bright-red-cheeks was that the gluten reaction was interfering with her autoimmune system that controls how your skin looks (pale, pasty, washed-out, blushed).  So she went on a 3-montdh trial of a gluten-free diet.  She responded very well!  Over the last 4 years gluten-free diet she has been usually been compliant. However, she says, “I get a sore tummy if I have too much.” She says that she gets a tummy pain the next morning.

How strict should she be?
She is tempted to sneak lollies now and then, which can be loaded with gluten.  She loves gluten-cookies and cakes. But she knows these make her tummy hurt.

Mum notices that she immediately gets “hyperactive, and extremely wound up and excitable” when she has even tiny amounts of gluten.  This in turn can upset her school work.  So mum is very strict with the gluten-free diet.

But dad is more relaxed about giving Amelia gluten.  Dad has the notion that he should keep on feeding her gluten, so that she will eventually develop tolerance.  In my experience this does not happen.  He is only making her unwell and putting her at risk for other gluten disease and maybe triggering auto-immune disease.

In my view Amelia should continue to have ZERO gluten.

 

At the Childrens Clinic | Allergy Centre, Christchurch, we can help you manage gluten problems and your gluten-free diet.

Filed Under: Gluten

5 tests for celiac /gluten /wheat

October 28, 2011 By

Wendy says: “My daughter has had 2 negative results for coeliac but still has a major problem with wheat!  Are there other tests for wheat intolerance?”

My reply:
When she says “2 negative results for celiac” I do not understand the problem …  because there are at least 5 different tests for celiac/gluten/wheat problems. And, none can completely rule out a gluten problem: the only way to see if gluten is truly affecting you is to go on a gluten-free diet for a year and see if you get better.  But get your blood tests first.

The 5 tests:

  1. Gluten blood tests: IgG-gliadin
  2. Tissue damage blood tests: tTG, EMA, DGP
  3. Gene test: HLA DQ2/DQ8
  4. Endoscopy: a small bowel biopsy whilst still eating gluten
  5. Skin tests, EAST/RAST: specific IgE tests for wheat allergy.

Each of these tests needs interpretation in the context of your current diet and symptoms.  
We will help you through your gluten/coeliac/wheat testing at the Childrens Clinic | Allergy Centre, Christchurch.

Filed Under: Gluten