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[IPp] Re: [IP] constipation/Celiac

In a message dated 10/27/2003 7:36:38 PM Eastern Standard Time, 
email @ redacted writes:
I'd also suggest that you ask your doc to run blood tests for celiac
disease next time you have other blood work done.  CD is another autoimmune 
 disease that can present as either diarrea or constipation, or without symptoms
at all, for that matter.
I'm glad to see someone bring this up....the following is excerpted from my 
monthly Diabetes Updates:
    I have long advised families to "DO YOUR HOMEWORK" when advocating for 
your children's health. Somehow, I never knew that my own "ignorance" about 
celiac disease was NOT "bliss". Classically, celiac disease "presented" with 
diarrhea, failure to thrive (delayed growth), and abnormal stools. It was 
 considered to be a rarity, affecting 1 in nearly 4000 people. In the past few
however those beliefs are being shattered as a rapidly growing population of 
undiagnosed "silent celiacs" is being discovered in the USA. Some researchers 
 believe that as many as 1 in 133 people may have it, only 1/3 of whom "present"
with diarrhea & 40% of whom have NO symptoms. When I started hearing about 
 several children with diabetes whose blood testing had shown positive
 associated with celiac, despite the absence of "classic symptoms", I wondered
Melissa should be tested. None of her previous 4 endocrinologists had ever 
mentioned it nor had anyone even asked about the frequency of stomach aches, 
 despite the fact that so many parents comment anecdotally about that complaint.
Finally, 9 months after I first asked for the blood work, Melissa's current 
endo called me with the test results done in New York this summer: all 3 
"markers" had come back very positive. 
     Celiac disease is an inherited autoimmune disorder that affects the 
 digestive process of the small intestine. When someone with celiac consumes
- the protein found in wheat, rye, & barley, his or her immune system 
 responds by causing an inflammation of the lining of the small intestine that
in malabsorption of important nutrients into the body. Undiagnosed and 
 untreated, celiac disease can lead to other autoimmune disorders, osteoporosis,
infertility, neurological conditions and years of misdiagnosis by doctors 
unfamiliar with this growing problem.     
      On October 9th, an endoscopy was done at Columbia-Presbyterian Hospital 
in New York City by Dr. Peter Green, one of the few celiac specialists in the 
country. Even without the pathology report, Dr Green could SEE the damage in 
her small intestine, consistent with celiac. Furthermore, he believes that it 
possibly PRECEDED her onset of diabetes, which correlates with recently 
released studies (October 2003 issue of the Journal of the American Medical 
 association: JAMA -- Norris et al. 290 (13): 1713) theorizing that the
introduction of
gluten (the proteins that comprise grains) triggers a reaction in an 
 under-developed immune system of a baby that can result in heightened
 sensitivity in those children predisposed genetically. Had I KNOWN all that I
know, I might have "connected the dots" sooner. Instead we treated each of 
 Melissa's symptoms: her constant fatigue ( had her do an overnight hospital
study), depression ( therapy & medication), constipation ( fiber pills), 
 anemia ( iron pills), stomach pains ( Gas-X and nexium)..OR...simply attributed
 them to yet another side effects of diabetes and/or high blood sugars. Now I
that these may be documented symptoms of celiac disease. The body's inability 
to tolerate gluten damages the proximal ( upper) portion of the intestine, 
 depriving the body of essential nutrients. Even something as seemingly
as emotionally needy/ clingy children ( which describes Melissa perfectly as 
a child) is believed to be related, since these children may never feel quite 
"right".  More interesting still are other listed symptoms of infertility, low 
birth weight babies, hypothyroidism, irritable bowel, osteoporosis- all of 
which I have or had, so Dr. Green also did blood work on me yesterday. The 
 absence of acute intestinal distress is no guarantee that one doesn't have
if another family member has been diagnosed, or if there are already 
 autoimmune conditions diagnosed. Given Melissa's diagnosis & my hypothyroidism,
I have
a 1 in 4 chance of being positive too. (note: my results turned out to be 
    The "good news" is that almost magically, by totally removing gluten ( 
 bagels, pizza, cookies, cereal, pretzels, etc) from one's diet, the body
itself so well that Melissa should no longer be saying "Mom - why am I always 
tired..it's not normal for a 20 yr old to always feel like this?" within a 
matter of days, weeks or months.
    The bad news is that this is a lifelong dietary change. Even tiny amounts 
of unseen gluten in caramel coloring, in malt, in modified food starch, in 
soy sauce ( usually contains wheat), etc can perpetuate the autoimmune "storm" 
that was raging in her intestines.   But as I told Melissa, if all that we've 
done to date to keep her healthy enough to take advantage of a diabetes cure s
omeday is thwarted by NOT KNOWING that something else is occuring, then we're 
sabotaging our efforts. She may be swimming in the "wrong gene pool", but by 
 knowing that her kidneys were leaking protein, we were able to intercede with
ACE inhibitor & decrease those levels 95%. Many parents STILL tell me their 
 doctors disregard the need to check microalbumin levels, yet in the 6 1/2 years
that Melissa has been on this medication, I have seen nothing but 
 increasingly optimistic reviews of the benefits of this medication in those at
risk of
microvascular complications. Once again, this does NOT mean that everyone with 
diabetes NEEDS this intervention, but wouldn't you want to do so, if you 
 KNEW..With today's nutritional labeling, insulin pumps, increased availability
gluten-free products, etc, living with this dual diagnosis is "do-able" and 
certainly preferable to the alternatives of a lifetime of suffering & unseen 
 damage. The blood can be drawn anywhere, but the lab which will assess the
is critical in order for accurate interpretation. The complete celiac antibody 
screening should include:
    anti-gliadin (AGA) IgA
    anti-Gliadin (AGA) IgG
    IgA anti-tissue transglutaminase (tTG)*** This is the more recent test & 
has proven to be very predictive. High antibody levels are usually indicative 
of celiac disease, but should be confirmed by an intestinal biopsy.  
     Believe me, after all the advocacy I have done, and continue to do, for 
those affected by breast cancer and diabetes, NO WAY I needed another 
 "cause".....but since this has been handed to us, NO WAY will I sit silently
by. As a
breast cancer survivor, I know all too well how critical early diagnosis can 
be, which is probably why I'm having so much trouble "accepting" not having 
KNOWN more about this disease sooner.
Renee (pump mom to Melissa- dx'd 9/16/92/ dx'd with celiac 10/9/03)
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