Q. I read with interest your column of a few weeks ago about gas and bloating. And I realize that many gastrointestinal problems cause the same symptoms. I also realize that your column has space constraints. But as a person with celiac disease and a member of the Canadian Celiac Association, I would like you to provide more information to people about this disease.
A. You're right that space constraints often limit the amount I can write on a subject. So I tend to write about more common causes of problems. A small percentage of people with diarrhea and bloating have celiac disease, but when you add it up the disease affects many people.
One in 2,000 Canadians have this disease, according to the Canadian Celiac Association. Because it occurs primarily in people of Northern European ancestry, this percentage is considerably higher than it is in the United States.
With these figures, it could mean that more than 100,000 people in North America might have this disease, especially if you include many people with mild symptoms.
In celiac disease, the lining of the small intestine is inflamed so foods are poorly absorbed and pass along to the large intestine. The poor absorption can cause nutritional deficiency and weight loss. The extra food in the large intestine also can cause bloating, flatulence and diarrhea.
It is an immune system problem that is inherited to some degree. The risk of getting it increases if a family member has it. More severe cases are usually diagnosed in childhood, but many people are not diagnosed until they're in their 40s.
The inflammation of the intestinal lining is caused by contact with gluten. Gluten is the protein component of grains such as barley, oats, rye and wheat, and it is used as a food additive in many prepared foods.
A blood test for antibodies against gluten helps determine whether someone has celiac disease. But this test is positive in other disorders. A biopsy of the lining of the small intestine will confirm the diagnosis.
In addition to the intestinal problems, about 10 percent of these people have a burning, itchy rash called dermatitis herpetiformis. Although everyone with this rash also has celiac disease, their intestinal symptoms are often mild.
Treatment is straightforward--eliminate gluten from the diet. However, this may require the advice of a dietitian or other nutritional expert because gluten is found in many foods. In addition, the rash also may benefit from using medications called sulphones.
I hope your disease is under control. And I thank you for asking me to tell more about this condition. The Canadian Celiac Association can be reached at 905-507-6208 and the U.S. Celiac Sprue Association at 402-558-0600.
Update on caregiving: Taking care of someone is one of the most rewarding things we will do. And the benefits are obvious as well. Or are they?
The caregiver of a person who is ill has many roles. They are often nurse, delivery person, cook and maid. But they also may be doctor, lawyer and pharmacist.
But most of all, the caregiver is a consoling friend. A recent medical study strongly reinforces that this may be the most important part of caregiving.
People hospitalized for a variety of illnesses involving the heart, lungs, intestines and blood were observed for two years to see how well they did. An important finding is that for all illnesses, people were twice as likely to die if they also had depression.
Although depression is strongly influenced by biochemical changes in the brain, having a loving caregiver is critical for its prevention and treatment. Not only is the psychological support important, the caregiver often recognizes and encourages the adequate treatment of depression.
Write to Dr. Douma in care of the Chicago Tribune, Room 400, 435 N. Michigan Ave., Chicago, IL 60611.