- File Under liver health
Celiac hepatitis can go undetected until it's too late
By Doug Childress, M.D.
Emily had been seeing her regular physician for years and years for an annual checkup.
And every year he would say, “Emily, you have got to stop drinking.” “But I have never had a drink in my life, doctor,” she would reply. Emily's liver function enzymes were always slightly elevated, which can be a side effect of alcohol use. But in Emily's situation, this was not the cause.
By the time she was 85, she had only 4 percent of her liver function left and was diagnosed with cirrhosis.
If you have not heard of these conditions, don't fret – many physicians haven't, either.
What is celiac disease?
Although it has been described in the medical literature for centuries, the term “celiac disease” was not assigned to the disorder until the late 19th century. Classically, celiac disease is an intolerance to a protein called gluten that is found in wheat, rye and barley. In susceptible people, the body's immune system reacts against this protein and its subcomponents, causing damage to various parts of the body.
This specific fact accounts for an underappreciation of glutenrelated health effects with many clinicians who require intestinal findings to support the diagnosis of celiac disease. The current estimate of celiac disease in the U.S. and Europe is approximately 1 percent of the population. Celiac disease is defined by evidence of intestinal damage related to an immune reaction to gluten, and physicians often require an intestinal biopsy to make the diagnosis.
Once defined, the only effective treatment is to avoid gluten completely in the diet. Thomas O'Bryan, D.C., is a diplomate of both the National Board of Chiropractic Examiners and of the Clinical Nutrition Board of the American Chiropractic Association. He counsels patients on functional health and nutrition in his private practice in the Chicago area. As a certified clinical nutritionist and one of the world's most dedicated speakers on gluten-related health disorders, he has dedicated his current career to educating the public and clinicians on the effects of gluten on health.
The lack of distinction is causing a great deal of confusion and significant numbers of missed diagnoses among patients.
These patients have NCGS, and by O'Bryan's conservative estimates,
Based on O'Bryan's experience and research, he estimates that 4 percent of these patients have gluten sensitivity as a cause of their liver condition. Gluten damages the liver through two main mechanisms.
Once across, the immune system sees the larger molecules as foreign material and launches an attack against them. This immune response not only targets these molecules but also spills over into normal tissues. As normal liver tissue is attacked, liver enzymes are released into the bloodstream. If this inflammation goes on chronically, scarring and even cirrhosis can occur.
The other mechanism involves an increased toxic load on the liver. Gluten's irritation of the intestinal lining allows food toxins that would normally be eliminated as waste to escape into the body.
The liver is one of the major organs responsible for ridding the body of toxins, so overloading the liver with toxins can also result in elevated liver enzymes. In both instances, the primary event is an intolerance of gluten and the resultant inflammation of the intestinal lining.
If neither of these pathologies exists, then a diagnosis of celiac disease is not made. “Gluten sensitivity is a spectrum of ongoing pathology,” says O'Bryan. “At the severe end, you have villous atrophy and lymphocytes in the intestinal walls, but at the other, the degree of intestinal damage is not enough to cause these features. As a result, only the people on the severe end of the spectrum are labeled as celiac disease, and many others go undiagnosed.”
Based on their 20 years in private practice in Sunnyvale, Calif., they agree with O'Bryan's opinions about the number of people unaware of their intolerance to gluten. “From our clinical experience, of patients that have lab elevations in liver function enzymes, approximately 20 percent have gluten sensitivity,” says Rick Petersen.
The Petersens say they are amazed at the number of patients with gluten sensitivity they have diagnosed since making functional health a focus of their practice.
The symptoms are incredibly vast – headaches, memory loss, osteoporosis, thyroid dysfunction, sleep difficulty and abdominal discomfort are just a few of the common complaints. Later this year, the Petersens are releasing a comprehensive book on the health effects of gluten sensitivity. The book describes the varied effects of gluten on our bodies and gluten's history in our diets.
An entire chapter is dedicated to celiac hepatitis. Making the diagnosis One of the world's renowned researchers on celiac hepatitis is Joseph Murray, M.D., of Mayo Clinic Rochester.
In addition, other liver disorders including primary biliary cirrhosis, autoimmune hepatitis and primary sclerosing cholangitis are frequently associated with gluten sensitivity.
Given the limitations of intestinal biopsies in diagnosing gluten intolerance, the question arises as to how a diagnosis can actually be made. Fortunately, blood tests now enable accurate diagnosis in many people.
Blame your parents Gluten intolerance is primarily a genetic disorder. In people with celiac disease and NCGS, the HLA genes, which encode the development of immune system proteins, are aberrant. Specifically, people who have HLA DQ2 and HLA DQ8 genes are most susceptible to gluten intolerance.
However, while screening for these genes through blood work is possible, antibody tests are more effective in making the diagnosis.
These screenings should occur even if symptoms are absent. Identifying gluten-related antibodies and invoking treatment can prevent progressive health disorders later in life.
Early detection and elimination of gluten from the diet allows the liver to fully recover from the inflammatory damage, but the chance of permanent injury increases the longer gluten-induced immune reactions exist.
An explosion of gluten-free foods has now surfaced in the market, and these continue to grow every day. As we as a country move toward evidenced-based health care and preventive health, we are looking more closely at diet and lifestyle. Gluten is one of the most common dietary factors that contribute to poor health, and learning to detect gluten sensitivity and to change dietary habits will pave the way for other preventive health care measures.
Celiac hepatitis is an example where both prevention and early detection are important. If this had been available for Emily, her cirrhosis would have never developed.
There is indeed still much to learn about how our diet affects our health.
We are what we eat.
Doctors explore link between liver disease and gluten intolerance
According to a report on the website Liver Support, more and more physicians are finding a connection between liver disease and gluten intolerance. The article notes that although full blown Celiac Disease may be rare, many people suffer from a form of gluten intolerance. Gluten may harm individuals with liver disease by causing the intestinal lining to become inflamed and eventually weakening, allowing food particles to the bloodstream. When the body’s immune system attempts to attack these molecules, it may also attack the liver’s tissues, thereby causing inflammation and possible scarring. Furthermore, the food in the bloodstream may also lead to a higher instance of toxic substances further weakening the liver, which attempts to get rid of the waste. If it cannot discard these toxins, it is again subject to inflammation and further scarring. In fact, researchers in Finland found that individuals who suffered from Celiac Disease and liver damage prevented further damage to the liver by refraining from ingesting gluten.
It may be beneficial for you to experiment with a gluten free diet to see if your body responds well to consuming less of the particular protein. There are so many products on the market today that act as great substitutions for the food you are used to. After discussing it with your doctor, see if you can gradually introduce gluten free items into your diet and after a couple of months have some blood work done to see if your liver enzymes have improved. There is nothing harmful about gluten free products, and you may just be able to thwart the progression of your liver disease.