Linking a malabsorptive gastrointestinal
illness with the number one health problem facing the US seems
rather odd at best. These two illnesses may however play a strange
duet. The diagnosis of Celiac Disease may often be not even
considered as part of the differential diagnosis in an obese
patient with abdominal pain and diarrhea because the patient’s
corpulent appearance may belie the lurking nutritional deficiencies.
Further, if good nutritional and behavioral modification does
not accompany the treatment of celiac disease, once the patient’s
gut is no longer affected by the presence of the wheat antigen,
they will often gain even more weight.
To review, celiac disease is an acquired
or inherited inflammatory disease of the small intestine, characterized
by malabsorption, and precipitated by the ingestion of gluten-containing
foods such as wheat, rye, and barley in genetically predisposed
individuals. The prototypical lesion on biopsy shows the absence
of absorptive villi, hyperplasia of enteric crypts, and increased
presence of lymphocytes. Three fourths of patients respond very
quickly (generally within several weeks) with complete abstinence
of gluten-containing foods.
Patients with celiac disease may present
with loose stools to frank diarrhea, flatulence, fatigue, abdominal
distention, dermatitis herpetiformis, angular cheilitis, and
apthous ulcers. Patients may also demonstrate nutritional deficiencies,
particularly b12, vitamin E, folate and iron, hypokalemia, vitamin
D deficiency, elevated aminotransferase and alanine aminotransferase.
Fortunately for many, restriction of all
gluten leads to dramatic improvement in symptoms. Improvement
of the intestinal mucosal lining leads to improved intestinal
nutritional absorption and intestinal defense function. Unfortunately
for some, this resolution of intestinal leakiness leads to weight
gain. This may occur because of improved absorption of calories
but may also occur because patients may take the dietary restriction
to mean that portion control for the “okay” foods
is not necessary. In other words, they believe there is no reason
to measure the portions of corn, rice or meat that they eat.
Patients with celiac disease can
learn to manage both their malasorbtive disease and their weight.
As patients learn to read labels to look for gluten additives,
encourage them to increase their use of natural and whole foods,
particularly fruits and vegetables, and they will already be
on their way to journaling their food intake and understanding
calorie consumption.
About Dr. Margaret MacKrell
Gaglione
Dr. Margaret MacKrell Gaglione is the Medical Director of Tidewater
Bariatrics in Chesapeake, a practice dedicated to the care of
overweight and obese patients. She is a board-certified internal
medicine physician and bariatric specialist. She can be reached
at (757) 644-6819 or www.tidewaterbariatrics.comnecessary for
lifelong success.
Margaret M. Gaglione, MD, FACP
757-644-6819
Email: doctor@twb4u.com
Always
Consult Your Physician before beginning any Diet or Exercise Program.
