Dear Readers:

In the March issue (see www.massagetoday.com/archives/2006/03/16.html), I introduced the basic concepts behind celiac disease (also known as celiac sprue), a disorder involving an inflammatory reaction to gluten. When people with celiac disease eat gluten-containing products (which is hard to avoid in processed foods), the body launches an immune response that damages or even destroys the intestinal villi. This makes it impossible to absorb nutrients, not just from gluten-rich foods, but from everything else as well.

One point that came up in reader responses to part 1 of the article was a need to clarify the difference between wheat allergy and gluten sensitivity. A wheat allergy is an immune response to anything with wheat in it; this is typically rare, and is detected in infants and young children who experience inflammatory reactions when they include wheat products in their diet. Gluten sensitivity, by contrast, is a reaction to incompletely broken-down gluten in the GI tract. The symptoms are not immediate, and they are not limited to wheat products, because gluten is found in many other grains as well.

Symptoms and Complications of Celiac Disease

Celiac disease can be mild or severe, depending on the severity of the inflammation and the extent of damage to the villi. Very severe cases are diagnosed in young children as "failure to thrive," since the affected child can derive little value from food. More often, it occurs as a subtler problem that is easily misdiagnosed as irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, hypothyroidism, lactose intolerance, candida, depression, or other chronic, multi-system conditions. Some people don't develop symptoms until adulthood, often after a stressful trigger such as an infection, surgery or childbirth.

Signs and symptoms of celiac sprue usually are arranged around malabsorption and malnutrition. Pain, gas, bloating and diarrhea are common. Stools tend to be high in volume, oily and very foul smelling. Anemia, irritability, depression, osteoporosis and muscle cramps are other frequent signs or complications of celiac disease; any one of these can be traced to poor absorption of nutrients, including iron, B₁₂ and vitamin D. Poor absorption of folic acid can lead to neural tube defects (i.e., spina bifida) in infants of pregnant women with celiac disease.

Other dangerous complications of celiac disease are associated with chronic inflammation in the GI tract: Adenocarcinoma or lymphadenoma are cancers of the small intestine linked to celiac disease. Non-Hodgkins lymphoma is another type of cancer with a statistical connection to this disease.

Treatment Options

Research is underway that would create a drug to limit intestinal T-cell hyperactivity in the presence of incompletely broken-down gluten. This might eventually open the door to a less limited diet for celiac disease patients. In the meantime, the best treatment option is to avoid gluten in any form, which is a considerable challenge. Flour made from corn, potatoes, beans or soy can be used as a wheat flour substitute. Fruits, vegetables, fish, and meats (that are neither marinated nor breaded) also are gluten-free. It's possible to have a varied and well-balanced, gluten-free diet, but eating processed foods or at restaurants might be problematic.

The good news is that the majority of celiac disease patients who can avoid all sources of gluten for months or years heal completely, and achieve the complete rebuilding of their intestinal villi. However, a person with celiac disease must commit to a lifelong dietary adjustment to accomplish this.

Massage

Massage has some specific cautions in the context of gastrointestinal tract problems. Because many symptoms of GI problems (gas, bloating, indigestion, constipation) can be related to stress, many people find that massage, even if not administered directly to the belly, has a positive effect. Most of the time, this is wonderful, but not always. GI symptoms are notoriously vague. The complaints of a person with irritable bowel syndrome (a functional problem that, although painful and inconvenient, is not life-threatening) can be similar to the symptoms of a potentially dangerous problem, such as ulcerative colitis or diverticulitis. Therefore, if a person finds that massage relieves symptoms, even temporarily, an accurate diagnosis might be delayed. Massage therapists should encourage clients who report new or persistent GI problems to seek medical advice, regardless of whether massage temporarily relieves symptoms.

In relation to celiac disease specifically, massage has no direct impact on the health of intestinal villi. Consequently, massage can neither improve nor exacerbate celiac disease. However, its ameliorating effects can make the transition to a gluten-free diet easier to take - if you can't have chocolate cake anymore, at least you can have a wonderful massage!

For Next Time

I've been receiving inquiries lately about MRSA: methicillin-resistant staphylococcus aureus, the causative agent behind some difficult and stubborn skin injuries. Massage therapists exposed to this pathogen are at particular risk for spreading it to others. If you have experience with this condition, write to me and let me know: What's on your table? Until then, many thanks and many blessings.

Resources

1. Celiac Disease May Be Underrecognized in America. © 2003 Clinicians Group, LLC. www.medscape.com/viewarticle/452468.
2. Celiac Disease. http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/index.htm.
3. Celiac Sprue Association: Celiac Disease Defined. www.csaceliacs.org/celiac_defined.php.
4. Celiac Sprue Association: Celiac Disease - How Is Celiac Disease Diagnosed? www.csaceliacs.org/celiac_diagnosis.php.
5. Celiac Disease. © 1998-2006 Mayo Foundation for Medical Education and Research (MFMER). www.mayoclinic.com/invoke.cfm?id=DS00319.
6. Dennis Lee, MD. "Celiac Sprue (Gluten Enteropathy)." © 1996-2006 MedicineNet, Inc. www.medicinenet.com/celiac_disease/article.htm.
7. Jason S. R. Jennings, MRCP; Peter D. Howdle, MD, FRCP. New developments in celiac disease. Curr Opin Gastroenterol 2003;19(2):118-129. www.medscape.com/viewarticle/450313.