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With apologies
to the Bard, "what is sprue"? Sprue is a generic medical term meaning
intestinal malfunction resulting in poor absorption of nutrients. However, it
has come to connote celiac sprue, or an inherited sensitivity to grain
proteins.
If you
are among the one in 64 people who carry the genes that react aggressively to
grain proteins, it could have a lot to do with your health. Maybe you have
fatigue, or even depression that cannot be explained. Perhaps vague intestinal
complaints like bloating, irregularity, or discomfort are troubling you. Do you
have a recurring skin rash, or difficulty with recent memory? Does your child
have a learning disorder, or unexplained seizures? Do you suffer from
autoimmune diseases like lupus, scleroderma, or mixed connective tissue
disease? Is there a mysterious anemia or abnormal liver tests that your doctor
found on your annual physical? Do you have thyroid problems or adrenal
insufficiency, or is there sexual impotence?
By now, you're getting the picture: sprue can
masquerade as many diseases, and is frequently overlooked by physicians. Most
doctors think you could have celiac sprue only if you were losing weight,
having diarrhea, and not absorbing your food. But that is "the tip of the
iceberg". All of the problems mentioned above, plus many others, such as the
"enviable" ability to eat like a horse and not gain weight lie below the
surface, and go undiagnosed.
Who gets celiac sprue? The disease was first
described in the Netherlands in the late 1890's. During WWII, the Nazis
confiscated all the wheat, barley and hops, leaving only oats for the Dutch
people. Doctors began to notice that children, who experienced growth
retardation before the war, began to achieve normal growth and development,
only to resume their pre-war problems when wheat again became available after
the war. Doctors discovered that the protein fraction of wheat, or gluten, was
the offending agent. From this, interest in celiac sprue spread rapidly
throughout northern Europe and the British Isles. This led to the impression
that this was primarily a disease of northern European
Caucasians.
However, I have diagnosed this disease in people of Nigerian,
Tamil, Thai and Chinese ancestry. Thus, celiac sprue can be found among any
group of people who have inherited certain genes that make intestinal and
immune cells process proteins from grains such as wheat, rye, barley and many
others abnormally.
How does one find out if they have celiac sprue? There are
screening blood tests that are designed to see if antibodies against grain
protein (anti-gliadin antibodies) and against your own intestinal tissue
(anti-endomysial and anti-tissue transglutaminase antibodies) are present.
Since these antibodies belong to a certain class of antibodies called IgA
antibodies, a total IgA level must also be measured, as IgA deficiency is
common, and low levels of IgA will make the other antibody tests falsely
normal. If these tests show a strong suspicion that you could have celiac
disease, then you should see a gastroenterologist, and have an endoscopy to
obtain an intestinal biopsy to secure the diagnosis.
"What is the treatment to tame the
sprue"? You have to avoid the offending grain proteins, and that's not easy.
With the help of your gastroenterologist and a trained dietician, you must
avoid the injurious grain proteins by carefully following a gluten-free diet.
Gluten is hidden in many foods, especially in those in which texture and
consistency are important. It is used as a binder in medications, and even in
cosmetics. The important thing is that almost every aspect of this disease can
be treated if you avoid gluten. The food and cosmetic industries can help
significantly if they clearly label their products to indicate the presence of
the offending grains. As an example, I recently saw a patient who became ill
after eating a presumably safe rice cereal. It was only after considerable
detective work by contacting the cereal company; she discovered that the rice
puffs were coated with a thin layer of barley syrup to make them
crispy!
The
broader development and availability of gluten-free products is a major step in
helping all those who must battle celiac sprue daily. It is also incumbent upon
the clinical laboratory industry to expand the development and affordability of
the blood tests for celiac sprue.
The mysteries of this disease have become revealed as the
result of basic research from many seemingly unrelated disciplines. Research
into the pathogenesis of HIV disease unlocked many of the intricacies of the
immune system that allowed scientists to explore its role in celiac sprue and
hundreds of other diseases. With continued support of research by government
and industry all of us will benefit.
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