Sunday, August 9, 2009

crohn's and coeliac

Sunday morning: 6mp, levisin, peppermint pill, ginger tea, probiotic and oatmeal.
Sunday afternoon: split pea soup.
Sunday evening: levisin, promethazine, peppermint pill, ginger tea... baked potato and spinach.

Now then. Way the hell back in 1984, the two most prevalent instigators of Crohn's were dairy and wheat (Workman et al). However, most Crohnies are told that wheat is the lesser of the two evils and end up embarking on a primarily bread-packed diet, especially when ill. A decade later, there is a notably high prevalence of Coeliac disease in Crohn's patients (Tursi et al 2005). Huh... I wonder how in the world this might have happened.

[note: I reserve the right to use the scientific spelling of coeliac disease, since celiac is meant to be called the disease of the coelem...]

I have two working theories.

1) Crohnies seek out the most mild diet possible, including wheat breads to try to give some kind of nutritional value to the meager gustatory regimen and subsequently develop Coeliac or gluten-sensitivity due to the overload of gliadin and transglutaminases that are the trademarks of gluten/wheat intolerance.

2) Coeliac and Crohn's are actually cohorts.

I like the Tursi study because, unlike many medical case studies, it actually has a pretty thorough methods protocol (yes, I am particularly scrupulous about scientific protocol). When they conclude that all patients should begin a gluten-free diet upon CD diagnosis, this recommendation is sound. Namely, all of their case study patients were diagnosed with CD for the first time immediately prior to being subject to this correlative Coeliac study.

What I would have liked to see is the prevalence of actual villous damage in CD patients with antibody markers of Coeliac. This study, however, looked only at biomarkers of Coeliac, and not at histological damage. If most CD patients with Coeliac disease do not have villous atrophy, it suggests that Coeliac evolved after the onset of Crohn's inflammation, is in early or benign stages, and is the result of an elevated wheat intake (likely inadvertent) in the quest for a "Crohn's friendly" diet.

I would also like to see a study in veterans of CD to see what symptoms of Coeliac they exhibit, which would confirm or reject my working theories. A girl can dream, eh?


The point of this post is that I'm now trying to modulate (but not eliminate) my gluten intake... just for the hell of it. Coeliac disease has been discarded from my list of contributing ailments by several blood tests, so I'm not really concerned, but it is interesting.

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