Is Celiac Disease A Threat For Blacks?

assorted loaves of breadFor more than twenty years, while there may be nothing new about this Celiac disease, there are still a lot of questions, and confusion. Specifically about what it is, and who is at the highest risk.

What is Celiac Disease?

Celiac disease is a hereditary autoimmune disorder in which the small intestines are damaged and the absorption of essential nutrients is disrupted. Those individuals who live with celiac disease experience a severe inability to tolerate gluten, which is a common protein found in wheat, rye and barley.

When an individual with celiac disease ingests foods containing gluten, a response is triggered wherein their immune system immediately begins to attack the internal lining of the small intestine. This lining is made up of fingerlike protrusions known as “villi”, protrusions that vastly increase the surface area of the small intestine and facilitate the absorption of nutrients from foods that have been eaten and processed by the stomach.

In celiac disease (also known as “celiac sprue”), not only does the immune system attack and damage the sensitive and important lining of the small intestine in the presence of gluten, but the disease itself also causes a general malabsorption of nutrients from all foods ingested, thus the individual with celiac disease runs a constant risk of malnourishment, nutritional deficiencies, and the effects of those deficiencies.

What Are The Symptoms of Celiac Disease?

The digestive symptoms of celiac disease usually occur more frequently in children, and may include chronic diarrhea, vomiting, constipation, abdominal pain and bloating, foul-smelling stool that is pale and frequently fatty, as well as weight loss. Irritability, delays in growth, defects of the tooth enamel, and delayed puberty are also common.

In adults, common symptoms include but are not limited to anemia, fatigue, joint pain, arthritis, osteoporosis, depression, miscarriage, infertility, seizures, mouth sores, and a itchy rash known as dermatitis herpetiformis. However, many adults with celiac disease can be asymptomatic for years prior to the acute manifestation of the disease.

Since celiac disease involves poor absorption of nutrients, deficiencies can lead to anemia, bone loss and other significant problems, and some evidence exists that a predisposition to cancer is also possible.

Who Has Celiac Disease?

It is estimated that approximately 2 million Americans have celiac disease. It is more common in individuals with Down Syndrome and Turner Syndrome (a genetic disease affecting females), and it is also common in those living with Type 1 diabetes and autoimmune disorders related to the thyroid and liver.

Most sources state that celiac disease is rare in African Americans and those of Asian and Caribbean background, however data also demonstrates that African Americans susceptible to the disease can frequently be misdiagnosed. Based on information from several reputable sources, some African Americans with Type 1 diabetes have more potential of developing the illness than others, but many African American Type 1 diabetics test negative for the gene predisposing them to celiac disease. These findings notwithstanding, a general under-diagnosis of celiac disease in African Americans is reported in the literature.

Testing and Diagnosis

Celiac disease is generally diagnosed through blood tests and biopsies of the small intestine. For those individuals with close relatives with celiac disease, testing is generally recommended.

Treatment

The only effective treatment for celiac disease is maintaining a gluten-free diet, a restriction that many individuals find difficult to manage, especially in a society where thousands of products contain gluten. In many cases, adherence to a strict gluten-free diet can prevent symptoms, help to heal previous intestinal damage, and prevent subsequent attacks. However, this type of diet is especially difficult for children and adolescents, and some individuals with celiac disease show no improvement, even with strict dietary practices.

What Foods Contain Gluten?

Many foods contain gluten, and gluten can unfortunately often be hidden in ingredients such as food starch, stabilizers and other additives.

Generally, most grains, cereals and processed foods contain some form of gluten, although specialty gluten-free foods are becoming more widely available, just as special foods for diabetics have gained ground in the marketplace over the last few decades.

Individuals with celiac disease can eat potato, rice, soy, amaranth, quinoa and buckwheat, and various forms of bean flour can be substituted for wheat flour. Oats are generally acceptable as well, but care must be taken to eat oats that have not been contaminated with gluten during processing. Unfortunately, some medicines also contain gluten, so those individuals with celiac disease should inform their doctor when being prescribed a new medication.

Celiac Disease: Education Is Key

Celiac disease, although rare in African Americans, can often be misdiagnosed, even in African Americans with Type 1 diabetes.

This disease can only be positively diagnosed through blood tests and biopsies, and untreated celiac disease can lead to serious illness. If you have a history of celiac disease in your family, testing is generally recommended.

Although gluten-free diets are restrictive and difficult to follow, many individuals with celiac disease successfully adhere to a gluten-free lifestyle and remain symptom-free for decades.

There are many support networks and a great deal of online information available about celiac disease. Also, speak with your health care provider if you or a member of your family have concerns about your risk for celiac disease.

What's Your Gut Pain Really Mean?

african doctor examining female patient(BlackDoctor.org) — Your stomach is cramping, you’re in pain, and you’re afraid to venture too far from your bathroom. What’s going on?

You may have a clostridium difficile infection, often referred to as C. diff.

What Is C. Diff?

C. diff is a bacterium that causes a wide range of symptoms, the most common being diarrhea. While C. diff most frequently impacts older individuals in hospitals or long term care facilities, it can also affect the general public.

How Common Is C. Diff?

Infections with C. diff have become more common, more frequent, and more difficult to treat over the last few decades. Thousands of Americans are infected with this particular bacterium each year, and those who have recently taken antibiotics are often at great risk of infection.

How Is C. Diff Spread?

C. diff is generally passed through the fecal-oral route, wherein people handle food, food preparation surfaces and utensils without properly washing their hands. Some people naturally carry the bacterium in their large intestine, and C. diff is known to live for weeks (or even months) on contaminated surfaces.

C. diff can be spread via door handles, faucets, telephones, remote controls, stethoscopes, toilets, sinks, bedside tables, and any “high touch” surfaces where contaminated hands can leave a trace of bacteria.

What Are The Symptoms?

Watery diarrhea more than three times per day for at least two days is the main symptom of a C. diff infection. Abdominal cramping and tenderness is also common. In severe cases, a grossly enlarged colon (large intestine) can result in bleeding, severe abdominal pain, bloody stool, dehydration, loss of appetite, weight loss, and severe and protracted diarrhea, as well as bowel perforation.

Am I At Risk?

Again, while most cases of C. diff occur in hospitals and nursing homes, infections also occur outside of health care facilities and institutions. Other risk factors include:

• Taking antibiotics, especially “broad spectrum” antibiotics that are used to kill a wide range of various bacteria
• Being 65 or over
• Having been recently hospitalized
• Living in nursing home
• Having inflammatory bowel disease or intestinal or rectal cancer
• Having a history of previous C. diff infection
• Having a weakened immune system
• Undergoing chemotherapy or other treatment that weakens the immune response

Complications Of C. Diff Infection

Individuals with C. diff infection are at great risk of dehydration, which can lead to kidney failure if not properly treated.

If C. diff infection becomes out of control, enlargement and perforation of the large intestine can result, which causes fecal matter to leak into the abdominal cavity and may lead to a potentially deadly case of peritonitis (an inflammation of the membrane which lines the inside of the abdomen and all of the internal organs).

If left untreated or improperly treated, the ultimate complication of C. diff. is death.

Treatment

There are several different steps you can take to help control a C. diff infection:

• Antibiotics. C. diff is, oddly enough, treated with antibiotics that can kill off the bacterium and allow the system to return to normal.

• Probiotics. It is now widely accepted as prudent to take probiotics (especially if you are also on an antibiotic regimen). Probiotics are naturally occurring “friendly” bacteria that need to propagate inside your large intestine for optimal health. Antibiotics cannot tell the between good and bad bacteria, so replacing your good bacteria with probiotic capsules (or yogurt or kefir) is an important step to take in assuring that your normal intestinal “flora” is healthy.

• Home Care. Handwashing, drinking plenty of fluids, and eating foods that will not exacerbate your diarrhea are all important if you have an active C. diff infection. Diarrhea can cause massive fluid loss, so replacing that lost fluid is essential.

• Brat Diet. For active diarrhea, a “BRAT” diet is often recommended, which consists of bananas, rice, applesauce and dry toast. Crackers, soup and boiled vegetables can also be used, while dairy products should be avoided. Once the diarrhea is over, you can reintroduce other foods, including yogurt or kefir.

Conclusion

All of us have a plethora of bacteria living in our large intestines, and many of those bacteria are essential to good health and help to fight off the growth of detrimental bacteria like C. diff. Unfortunately, taking antibiotics can kill off your supply of healthy bacteria, and with wider antibiotic use, resistant strains of C. diff are developing. This unfortunate reality makes handwashing, avoiding unnecessary antibiotic use, and the thorough cleaning of surfaces in health care facilities ever more important ways to prevent the spread of this troublesome and potentially life-threatening bacterium.

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