Erin Elberson, a fitness blogger from sunny Florida, USA, contacted me in January and inquired about my interest in this series. I was very excited about this venture with Erin since I have not covered the basic pathophysiology, an analysis of diagnosis, or my experiences with the gluten-free diet yet. Thanks to Erin, this series of podcasts gave me the perfect opportunity to accomplish that goal and to hopefully present it in a more interesting way through podcasting. Erin also has celiac disease and manages a wonderful blog called “Gluten Free Fitness”. She has her Master’s degree in Physical Therapy, a Bachelor’s in Health Science, and is an amateur Figure competitor. Through her blog, Erin advocates good nutrition and fitness habits to improve quality of life and health.

If you would like to listen to this podcast, please click http://www.glutenfreefitness.com/podcast-episode-3-shelly-stuart-celiac-nurse-interview-part-2/

For most of our lives, my mother and I only had one major symptom which was anemia (the rest of our symptoms were vague). My daughter only had stomach aches. Once I became more ill, then I had a variety of symptoms. I believe that everyone who requests a celiac screen should receive it and this belief has led to this post. The celiac home test provides a nice option for those people who believe they may have celiac disease due to their own symptoms or due to the presence of celiac disease in a relative.

Transglutaminase is an enzyme that has an affinity for undigested gluten and deamidates (alters) it into a form that is toxic for those with the genetic predisposition for celiac disease. The immune system reacts, antibodies are created, and these antibodies tag transglutaminase for destruction. This test measures the presence of IgA anti-tissue transglutaminase antibodies in your blood. For this test, you will need to obtain a fingertip blood sample with the small sterile lancet that is supplied in the package. The results are apparent within 10 minutes with a clear yes or no. Click here to view the video instructions supplied by 2G Pharma.

10% Celiac Home Test Discount

2G Pharma is offering a 10% discount for Canadian orders as long as you use my promo code (REF-SS) when you place your order. As well, 2G Pharma is generously paying me 10% with each order which will help sponsor this blog. Click here if you are interested in ordering this test.  For US inquiries, please call 1-866-838-1911.

What If The Test Result is Positive?

If your result is positive, continue eating your regular gluten containing diet, print out 2G Pharma’s Dear Doctor Letter for your doctor to help explain the test results, and see your doctor (I suggest taking the test with you as well). The doctor can do further testing and make appropriate referrals for bloodwork, other diagnostic tests, and to other professionals. As well, talk to your relatives about screening (since their risk has increased with your diagnosis) and request that your physician take steps to screen your children.

What If The Results Are Negative?

There are a number of reasons why this test may give a negative result. If an individual has an IgA deficiency, then a false negative test result could occur. In this situation, an IgG anti-tissue transglutaminase antibody test could be used (as long as you don’t have an IgG deficiency). Secondly, this home test (IgA anti-tissue transglutaminase) result tends to parallel the amount of intestinal damage present. If you have a gluten intolerance with very little or no bowel involvement, then the result could be negative. Some people with gluten intolerance have very atypical symptoms with no bowel involvement. Thirdly, some individuals have latent celiac disease and the test may show a negative result a few times before there is enough bowel damage (and antibodies) to show a positive result.  Fourthly, with very young children, this test might be negative since they may not have high enough antibody levels to show up on the test yet. Fifthly, for an accurate result, the person using the home test should be eating gluten regularly. The antibodies necessary for testing may not be present if gluten is not being consumed. Overall, I believe this home test can help rule you in (as having celiac disease), but it can’t entirely rule you out.

A complete panel of bloodwork is needed to help rule out Celiac Disease and gluten intolerance. The celiac panel includes:

1. IgA and IgG anti-tissue transglutaminase antibody test

2. Endomysial antibody test

3. Total serum IgA test

4. Total serum IgG test

5. Antibodies against deamidated gluten

6. IgA and IgG antigliadin antibodies

7. Skin biopsy for skin rashes

8. Small intestinal biopsies

9. Genetic testing

If the above tests are negative, then ask your doctor about a referral to receive testing for food allergies and intolerances or you can go to a naturopathic doctor for this. Other tests will likely be ordered to investigate your symptoms. As well, for a variety of reasons, false negatives can occur with the panel of celiac tests. Discuss (with your doctor) the possibility of trying a gluten free diet to see if it provides some relief.  If you choose to try a gluten-free diet, then ask your doctor for a referral to a registered dietician for advise and guidance. I hope this information helps and I wish you the best!

References

1. Dr. Stephen Wangen. Healthier Without Wheat. Innate Health Publishing, 2009.

2. Cleo J. Libonati, RN. Recognizing Celiac Disease. Gluten Free Works Publishing, 2007.

3. Dr. Peter Green and Rory Jones. Celiac Disease A Hidden Epidemic. Collins, 2006.

4. M Hadjivassiliou, RA Grünwald, GAB Davies-Jones. Gluten Sensitivity As A Neurological Illness. J Neurol Neurosurg Psychiatry 2002:72:560-563.

5. Marios Hadjivassiliou, Richard Grünwald. The Neurology Of Gluten Sensitivity: Science vs Conviction. Pract Neurol 2004,4:124-127.

6. Canadian Celiac Association.  http://www.celiac.ca

7. Wm K. Warren Medical Research Center For Celiac Disease. http://celiaccenter.ucsd.edu/

8. Dr. Peter Green. The Celiac Disease Centre’s Channel. Videos

Part 1:  http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/0/r8LwNCGcBKY

Part 2: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/1/qxLF4BAU_Vo

Part 3: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/1/qxLF4BAU_Vo

9. Dr, Suzanne Lewis. The Celiac Disease Centre’s Channel. Videos

Part 1: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/3/_4yX7×0ddec

Part2: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/4/wkdcIrImCDM

Part3: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/5/DPNuu3d6GJo

10. Dr. Christina Tennyson. The Celiac Disease Centre’s Channel. Videos

Part 1: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/9/bL9RJhZjuyg

Part 2: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/10/cQmYYwMpeNc

Part 3: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/11/bhkzesfqh_k

11. Carina Lagerqvist, Ingrid Dahlbom, Tony Hansson, Erik Jidell, Per Juto, Per Olcen, Hans Stenlund, Olle Hernell, Anneli Ivarsson. Antigliadin Immunoglobulin A Best In Finding Celiac Disease In Children Younger Than 18 Months. J Pediatr Gastroenterol Nutr. 2008 Oct;47 (5):428-435.

12. Prause, Christian; Ritter, Maria; Probst, Christian; Daehnrich, Cornelia; Schlumberger, Wolfgang; Komorowski, Lars; Lieske, Ruediger; Richter, Thomas; Hauer, Almuthe C; Stern, Martin; Uhlig, Holm H; Laass, Martin W; Zimmer, Klaus-Peter; Mothes, Thomas. Antibodies Against Deamidated Gliadin as New and Accurate Biomarkers of Childhood Coeliac Disease. Journal Of Pediatric Gastroenterology And Nutrition. July 2009-Volume 49-Issue 1-p 52-58.

13. GR Corazza And V Villanacci. Coeliac Disease. J Clin Pathol. 2005 June; 58(6): 573-574.

14. Jill Stein. Marsh Grading System Not A Good Gauge Of Coeliac Disease Severity: Presented At UEGW. www.docguide.com

Erin Elberson, a fitness blogger from sunny Florida, USA, contacted me in January and inquired about my interest in this series. I was very excited about this venture with Erin since I have not covered the basic pathophysiology, an analysis of diagnosis, or my experiences with the gluten-free diet yet. Thanks to Erin, this series of podcasts gave me the perfect opportunity to accomplish that goal and to hopefully present it in a more interesting way through podcasting. Erin also has celiac disease and manages a wonderful blog called “Gluten Free Fitness”. She has her Master’s degree in Physical Therapy, a Bachelor’s in Health Science, and is an amateur Figure competitor. Through her blog, Erin advocates good nutrition and fitness habits to improve quality of life and health.

If you would like to listen to this podcast, follow this link, http://www.glutenfreefitness.com/gluten-fitness-and-wellness-podcast-interview-with-shelly-stuart/

References For The Podcast

1. Sompayrac Lauren. How The Immune System Works. Blackwell Publishing, 2nd edition, 2003.

2. Anna-Liisa Prangli, Meeme Utt, Ija Talja, Epp Sepp, Marika Mikelsaar, Tarvo Rajasalu, Oivi Uibo, Vallo Tillmann, Raivo Uibo. Antigenic Proteins Of Lactobacillus Acidophilus That Are Recognised By Serum IgG antibodies In Children With Type 1 Diabetes And Celiac Disease. Pediatr Allergy Immunol. 2009 Jul 2. http://www.ncbi.nlm.nih.gov/pubmed/19573144

3. Dr. Stephen Wangen. Healthier Without Wheat. Innate Health Publishing, 2009.

4. Cleo J. Libonati, RN. Recognizing Celiac Disease. Gluten Free Works Publishing, 2007.

5. Dr. Peter Green and Rory Jones. Celiac Disease A Hidden Epidemic. Collins, 2006.

6. Dr. Christina Tennyson. The Celiac Disease Centre’s Channel. Videos

Part 1: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/9/bL9RJhZjuyg

Part 2: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/10/cQmYYwMpeNc

Part 3: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/11/bhkzesfqh_k

7. Peter Parham. The Immune System. Garland Science; 3 edition (January 19, 2009)

8. Dr. Peter Green. The Celiac Disease Centre’s Channel. Videos

Part 1:  http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/0/r8LwNCGcBKY

Part 2: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/1/qxLF4BAU_Vo

Part 3: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/1/qxLF4BAU_Vo

I love the cinnamon and maple flavour of this custard. It can be served warm fresh from the oven or later, after it has cooled in the fridge.

To begin, get a ceramic or stoneware pie pan, a larger pan with 1 inch of water in it, and a large mixing bowl.

Large Bowl

6 eggs, lightly beaten

1/2 cup of white sugar

The seeds from 1 vanilla bean

1/2 tsp of grain-free ground cloves

1 and 1/2 tsp of ground cinnamon

2 cups grain-free, dairy-free almond milk

Whisk all of the ingredients together, until combined.

Ceramic Pie Pan

Put 2 tbsp of pure maple syrup into the bottom of the pie pan, then spread it around. Then add the mixed ingredients from the large bowl into the pie pan. Place the pie pan into a larger pan that is already filled with 1 inch of water (the water should come half way up the side of the pie pan). Bake at 350 degrees Fahrenheit  for 35-40 minutes or until the custard has set. Enjoy!

Note: My husband is in the picture above. He is holding our eldest child, she was only a few hours old. They are both sound asleep in my hospital bed.

Many suffer with food allergies, intolerances, or sensitivities. If an individual has an anaphylactic response, the effects can be devastating, if not promptly treated. Others can suffer with a wide range of multisystem symptoms that can be debilitating emotionally and physically. Could preventative screening of all children for Celiac Disease and gluten intolerance decrease the prevalence of other reactions to food? If so, I believe the costs related to this preventative screening would be well spent. Many might benefit if this truly prevented allergy development. Decreased permeability of the bowel associated with eating a strict gluten-free diet may be a preventative treatment. Healthcare dollars related to treating allergic conditions and undiagnosed CD would be saved, lives may be saved (some loose their life due to anaphylactic allergies), and many could live an increased quality of life without the stress associated with allergies and undiagnosed CD. What do you think? Do you believe there could be a connection? If you have food allergies or sensitivities, have you been tested for CD or gluten intolerance?

Extra Information: In individuals that are genetically predisposed to Celiac Disease or gluten intolerance, gluten consumption can lead to increased expression of zonulin (a human protein that is a haptoglobin 2 precursor) in the intestinal tissues. This increases intestinal permeability allowing macromolecules (ex. food antigens, bacterial, and viral particles) exposure to the immune system. The immune systems exposure to gluten and the subsequent autoimmune reaction is thought to be responsible for the intestinal and other systemic damage seen in Celiac Disease. Unfortunately, the increased bowel permeability can also increase the risk of developing food allergies/intolerances/sensitivities.

References:

1. Fasano A, Not T, Wang W, Uzzau S, Berti I, Tommasini A, Goldblum SE. Zonulin, a newly discovered modulator of intestinal permeability, and it’s expression in coeliac disease. Lancet, 2000 Apr 29;355(9214):1518-9

2. Drago S, El Asmar R, Di Pierro M, Grazia Clemente M, Tripathi A, Sapone A, Thakar M, Iacono G, Carroccio A, D’Agate C, Not T, Zampini L, Catassi C, Fasano A. Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scand J Gastroenterol. 2006 Apr;41(4):408-19.

3. University of Maryland Medical Center. Dr. Alessio Fasano MD. Researchers Find Increased Zonulin levels Among Celiac Disease Patients, Public Release 28-Apr 2000.

4.Alessio Fasano, M.D. Physiological, Pathological, and Therapeutic Implications of Zonulin-Mediated Intestinal Barrier Modulation. American Journal of Pathology, 2008;173:1243-1252.

5. Alberto Rubio-Tapia, Robert A. Kyle, Edward L. Kaplan, Dwight R. Johnson, William Page, Fredrick Erdtmann, Tricia L. Brantner, W. Ray Kim, Tara K. Phelps, Brian D. Lahr, Alan R. Zinsmeister, L. Joseph Melton, Joseph A. Murray. Increased Prevalence and Mortality in Undiagnosed Celiac Disease. Gastroenterology. Volume 137, Issue1, Pages 88-93 (July 2009).

6. Gibney MJ, Marinos E, Olle L, Dowsett J. Clinical Nutrition. Blackwell Publishing 2005.

10 Facts

1. Small intestinal villi are finger-like projections that are each approximately 1mm in length. Millions of villi cover the circular folds of the small intestine. These small intestinal folds are valuable because the folds increase the intestinal surface area that is available to interact with and absorb nutrients. As well, smooth muscle within each villus help it to lengthen and shorten which allows the villi to inter mix with the nutrients in the intestinal lumen for optimum absorption. Enzymes on the villi’s surface assist with digestion (1,17,18). 

2. The outer layer of each villus consist of columnar shaped epithelial cells that have absorptive abilities. Nutrients are absorbed through these epithelial cells into the core of each villi and enter into the bloodstream through the blood capillaries within each villus. As well the lacteal, a lymphatic capillary within the villus, absorbs nutrients (dietary fats) for distribution to the body (1,2,5,16-18).

3. Microvilli are are tiny projections located on the outer absorptive epithelial cells of the villi and are often referred to as the brush border. The microvilli assist with absorption and the microvillis plasma membranes excrete digestive enzymes (mainly for protein and carbohydrate digestion) (1,2,5,16-18). 

4. Dispersed intermittently among the absorptive epithelial cells are are another type of epithelial cell called goblet cells. These cells secrete a lubricating mucous. Also interspersed in among the absorptive epithelial cells of the villi are enteroendocrine cells (another type of epithelial cell) that belong to the enteric endocrine system and these cells produce enterogastrones (hormones) in response to the current food particles in the intestinal lumenal environment. The villus epithelium, including absorptive columnar, goblet, and enteroendocrine cells renews itself every 3-6 days. The villi cells are shed at the tip of each villus (2,5,16-18).

5. Autoimmune damage makes the intestinal villi become dysfunctional. The absorptive cells of the damaged villi become cuboidal, sometimes squamoid, when the absorptive cells should be columnar. The cytoplasm in the absorptive cells becomes more basophillic and the nuclei’s  basal polarity is absent. The villi become flat and dysfunctional. The crypt (area at base of each villi) become elongated resulting in crypt hyperplasia. The affected small intestine’s  lamina propria cellularity is increased resulting in an infiltration of lymphocytes. Cytologically abnormal surface cells are present. This is a problem since the intestinal villi are responsible for absorbing the nutrients required to maintain a functional body (2,5,13,14,16).

6. Autoimmune damage to the villi (villus flattening), in CD, can lead to malabsorption of nutrients. Once diagnosed, accidental ingestion of gluten or related prolamines can lead to ongoing villi damage and malabsorption of nutrients. The extent of malabsorption is dependent on the total length of the small intestine affected. Typically, proximal small bowel damage is more severe and it tends to diminish distally. Nutrient deficiencies can result in a variety of multisystem symptoms that are described in my 12 part series about celiac and gluten intolerance symptoms (1,5,14,16).

7. Adverse reactions to various food antigens in the small intestine can also lead to villus flattening. In CD, gluten intolerance or sensitivity, reactions to other food antigens (in addition to gluten) is a risk. Increased expression of zonulin (a human protein) in the intestinal tissues increases permeability allowing macromolecules (ex. food antigens, bacterial, and viral particles) exposure to the immune system. The immune systems exposure to gluten and the subsequent autoimmune reaction is thought to be responsible for the intestinal and other systemic damage seen in Celiac Disease. Unfortunately, the increased bowel permeability can also increase the risk of developing food allergies, intolerances, or sensitivities. Identification of food allergies is important to help preserve the integrity of the intestinal villi. Reactions to food antigens may be responsible for continuing gastrointestinal symptoms even when you are maintaining a strict gluten-free diet (3,15,25,27,19-22).

8. There are bacteria, viruses, and parasites that may affect intestinal villi health, possibly leading to villous flattening. As well, intestinal lymphoma, certain medications, and immunodeficiency syndromes may affect villi health. Individuals with undiagnosed CD are at a higher risk for intestinal infections, lymphoma, and the use of medications  which may be ordered to treat the many multisystem symptoms of undiagnosed CD (23,28).

9. Preservation of the villi epithelial cell’s function and integrity is dependent on the availability of luminal and bloodstream sources of nutrients. The villi require nutrients to remain viable and functional. A diet that is deficient in nutrients or the presence of dysfunctional villi leading to malabsorption (due to autoimmune damage) can decrease the availability of nutrients for villi health. This may lead to abnormal growth, division, and differentiation of villi cells possibly adding to the dysfunctional flattened villi (12-14,6-9,12,24).

For example, in animal studies, prolonged vitamin A deficiency in rats lead to decreased height of the intestinal villi (10), decreased cell division and differentiation were noted, and reduced goblet cells were found in the villus (10,11). Another animal study described how vitamin A deficiency in mice combined with a rotavirus infection caused more inflammation and damage to the villus tips (12). 

A few human studies have shown that vitamin A supplementation can help to lesson diarrhea episodes with intestinal illnesses in impoverished countries where vitamin A intake is often inadequate (6-9). You can imagine how a vitamin A deficiency, often present in undiagnosed CD, could add to the autoimmune damage, increase malabsorption due to the negative effect on the villi, and increase the risk of intestinal infections which may further hinder the villi. Vitamin A deficiency is just one example, multiple nutrient deficiencies, often present in CD, could further decrease intestinal health.

10. Dysfunctional villi can lead to a variety of gastrointestinal symptoms. Some of the symptoms occur as a result of malabsorbed nutrients remaining in the intestine and increasing the osmotic load. Others are a result of a nutrient deficiency. Some symptoms can include diarrhea, flatulence, abdominal cramping, constipation, occult blood, steatorrhea, bloating burping, vomiting, and infections. See my Gastrointestinal symptoms post for more detail.  As mentioned above, the resulting nutrient deficiencies can cause many other multisystem symptoms that are discussed in the 12 part series about symptoms.

Steps To Improve Villi Health

You can see how intestinal autoimmune damage to villi in CD/gluten intolerance, combined with the dysfunctional effects of nutrient deficiencies, certain medications, infections, and food intolerance or allergic reactions can collectively or individually decrease the function and integrity of small intestinal villi. There are many steps I believe can help improve intestinal villi health.

1. Consume a nutrient rich diet. This will help supply all the required nutrients for intestinal villi health. Consult a Registered Dietician to ensure your diet is complete.

2. Ask your MD and your dietician about a nutrient supplement.

3. Consume a strict gluten-free diet. Re-check ingredient lists on the foods/vitamins/supplements/medications you consume to ensure that all are gluten-free. Products that were once gluten-free may not be now due to a change in the ingredients. It’s worth viewing the label each time you buy a product. Also, check with companies to ensure that there is no cross contamination at their company due to packaging gluten and non-gluten foods on the same machine. It can be time consuming, but well worth the effort. Ask your MD/Gastroenterologist to do a Celiac Screen to see if you still have circulating antibodies. This can help you to see if you are still exposed to gluten.

4. If symptomatic, talk to your doctor about stool tests for parasites, fungal and bacterial infections. An overstressed intestinal immune system, maladaptive intestinal environment, and damaged mucosa may predispose individuals to develop bacterial or fungal bowel infections or provide an environment for parasites to thrive. 

5. Upper endoscopy with biopsies can be used to assess villi health when diagnosed with CD and for follow-up.

6. Ensure adequate hydration is maintained. All human cells, including intestinal villi cells, require water for hydration. Usually, 8-10 glasses of fluids should be consumed every day. However, the recommended fluid intake can depend on your current hydration status and your health history. For example, an individual with a cardiac or kidney medical history may have fluid restrictions. Check with your MD.

7. Take precautions to avoid infections. Wash your hands, keep healthy, and avoid contact with others who have infections.

8. Check for other food intolerances/sensitivities or allergies. Ask about a referral to an allergist for blood tests and other allergy tests.

9. Consult your doctor about an effective probiotic. I take probiotics bi-annually (and after antibiotics) to help improve my intestinal health. Two interesting articles about probiotics, “Probiotic Modulation of Immune Response in Gluten Sensitivity” and “Probiotics and Their Benefit to Your Health” can outline the benefits.

With probiotics, there are a few possible concerns to consider. Christina Tennyson (MD), from the Celiac Disease Center in Chicago, mentioned that she is not sure about recommending probiotics yet. Probiotics might help to inhibit pathogens and modulate the immune system. However, there are many unanswered questions. With Celiac disease, what are the best and safest strains to use? Is there a possibility that a Celiac’s immune system may respond to probiotics differently? A 2008 study, “Antigenic Proteins Of Lactobacillus Acidophilus That Are Recognised By Serum IgG Antibodies In Children With Type 1 Diabetes And Coeliac Disease”, highlights this possibility. As with any food, gluten contamination leading to an immune reaction is also a concern? Overall, is there enough research to know how probiotics will affect those with celiac disease? I do take probiotics and I have not had a reaction that I’m aware of. However, as we know with silent Celiac Disease, pathological changes can be occurring within the body without any obvious symptoms (29,30). If you are interested in consuming probiotics, I recommend that you talk to your medical doctor to discuss the pros and cons before making any changes.

10. Review all medications with your MD and a Pharmacist. Ask if any affect the intestinal villi.

I eat a nutrient rich diet, take cod liver oil (contains vitamin A, D, & omega#3) daily, frequently eat hemp seed (nutrient rich), and take probiotics to help improve my intestinal health. I believe that these steps, along with the 10 listed above have helped me to increase my intestinal villi health.

Links To Pictures Of Intestinal Villi And A Video

Pictures of villi- http://cellpics.cimr.cam.ac.uk/villi.html

Stages of intestinal damage in CD http://en.wikipedia.org/wiki/File:Coeliac_Disease.png

Simplified intestinal villi picture http://medical-dictionary.thefreedictionary.com/villus

Small Intestinal villi http://en.wikipedia.org/wiki/File:Gray1061.png

Transverse section of a villus to show inner lacteal http://en.wikipedia.org/wiki/File:Gray1060.png

Diagram showing villus, crypt, and microvillus http://en.wikipedia.org/wiki/File:Normal_Villus_Illustration.png

Microvilli in the duodenum http://en.wikipedia.org/wiki/File:Microvilli-Duodenum.JPG

Short video that includes small intestinal villi http://www.encyclopedia.com/video/yOL7eOkBgXc-microscopic-anatomy-of-intestinal-villi.aspx

Note: USE CAUTION WITH SUPPLEMENTS. Toxicities can occur with over supplementation and this can lead to permanent damage. Consult your MD, Registered Dietician, or other medical specialists involved in your care to determine which nutrients should be supplemented and to identify appropriate dosages for you. Review your symptoms and everything in this post with a Medical Doctor and your specialists before you make any changes. Your MD knows your medical history and the treatments that are appropriate for you.

References

1. Green PHR, Jones, R. Celiac Disease A Hidden Epidemic. Collins, Harper Collins Publishers, 2006 http://tinyurl.com/ljeqjc

2. Marieb Elaine. Human Anatomy And Physiology.The Benjamin/Cummings Publishing Company, Inc.,1992.

3. Fasano A, Not T, Wang W, Uzzau S, Berti I, Tommasini A, Goldblum SE. Zonulin, a newly discovered modulator of intestinal permeability, and it’s expression in coeliac disease. Lancet, 2000 Apr 29;355(9214):1518-9

4. Marsh, Michael N.; Miller, Victor. Studies of Intestinal Lymphoid Tissue. VIII. Use of Epithelial Lymphocyte Mitotic Indices in Differentiating Untreated Celiac Sprue Mucosa from Other Childhood Enteropathies. Journal of Pediatric Gastroenterology and Nutrition:

5. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders

6. Ghana VAST Study Team. Vitamin A Supplementaion in Northern Ghana: Effects on Clinic Attendances, hospital admissions, and child mortality. Lancet 1993;342:7-12.

7. Hossain S, Biswas R, Kabir I, et el. Single Dose Vitamin A Treatment In Acute Shigellosis In Bangladesh Children: Randomized Double Blind Controlled Trial. BMJ 1998;316:422-6.

8. Barreto M, Santos L,Assis A, et el. Effect of Vitamin A Supplementaion On Diarrhea and Acute Lower Respiratory Tract Infections In Young Children In Brazil. Lancet 1994;344:228-31.

9. Bhandari N, Bhan M, Sazawal S. Impact of Massive Dose of Vitamin A Given to Preschool Children With Acute Diarrhea On Subsequent Respiratory and Diarrhoeal  Morbidity. BMJ 1994;309:1404-7.

10. Warden RA, Strazzari MJ, Dunkley PR, O’Loughlin EV. Vitamin A Deficient Rats Have Only Mild Changes In Jejunal structure and Function. J Nutr 1996;126:1817-26.

11. Rojanapo W, Lamb AJ, Olsen JA. The Prevalence, Metabolism And Migration of Goblet Cells in Rat Intestine Following The Induction of Rapid, Synchronous Vitamin A Deficiency. J Nutr 1980;110:178-88.

12. Ahmed F, Jones DB, Jackson AA. The Interaction of Vitamin A Deficiency and Rotavirus infection In the Mouse. Br J Nutr 1990;63:363-73.

13. Gibney MJ, Vorster HH, Kok FJ. Introduction to Human Nutrition. Blackwell Publishing 2002.

14. Gibney MJ, Marinos E, Olle L, Dowsett J. Clinical Nutrition. Blackwell Publishing 2005.

15. Drago S, El Asmar R, Di Pierro M, Grazia Clemente M, Tripathi A, Sapone A, Thakar M, Iacono G, Carroccio A, D’Agate C, Not T, Zampini L, Catassi C, Fasano A. Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scand J Gastroenterol. 2006 Apr;41(4):408-19.

16. Friedman SL, McQuaid KR,Grendall JH. Current Diagnosis and Treatment in Gastroenterology. Lange Medical Books/McGraw-Hill. 2nd Edition 2003.

17. Radivoj V. Krstic. Human Microscopic Anatomy: An Atlas For Students Of Mediicine And Biology. Springer; 1st ed. 1991. Corr. 3rd printing edition (Mar 18 2004).

18. Helga Fritsch and Wolfgang Kuehnel. Color Atlas of Human Anatomy: internal organs v. 2 Thieme Publishing Group; 5th Revised edition edition (Nov 21 2007).

19. Arnaldo Cantani. Pediatric Allergy, Asthma and Immunology. Springer; 1 edition (Feb 6 2008).

20. SCOTT H. SICHERER, M.D. Manifestations Of Food Allergies: Evaluation And management. American Family Physician, 1999.

21. Author: Professor Cassim Motala, South Africa Web Editor: Professor Richard Lockey, USA. Food Allergy, 2004. http://www.worldallergy.org/professional/allergic_diseases_center/foodallergy/

22. D. D. Metcalfe, Hugh Sampson, and Ronald Simon. Food Allergy: Adverse reactions to food and food additives. Wiley-Blackwell; 3 edition (Jun 16 2003)

23. Yezid Gutierrez. Diagnostic Pathology of Parasitic Infections With Clinical Correlations. Oxford University Press; Second Edition edition (Dec 15 1999).

24. Barrett KE. Gastrointestinal Physiology. Lange Medical Books/McGraw-Hill 2006.

25. University of Maryland Medical Center. Dr. Alessio Fasano MD. Researchers Find Increased Zonulin levels Among Celiac Disease Patients, Public Release 28-Apr 2000.

26. Tursi A,Brandimarte G, Giorgetti G. High Prevalence of Small Intestinal Bacterial Overgrowth in Celiac Patients With Persistance of Gastrointestinal Symptoms After Gluten Withdrawl. Am J Gastroenterol 98(4):839-43

27. Alessio Fasano, M.D. Physiological, Pathological, and Therapeutic Implications of Zonulin-Mediated Intestinal Barrier Modulation. American Journal of Pathology, 2008;173:1243-1252.

28. Dr. Scott Lewey. Celiac Disease Biopsy Explained: Part I Villous Atrophy. http://ezinearticles.com/?Celiac-Disease-Biopsy-Explained:-Part-I-Villous-Atrophy&id=315570

29. Anna-Liisa Prangli, Meeme Utt, Ija Talja, Epp Sepp, Marika
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30. Dr. Christina Tennyson. The Celiac Disease Centre’s Channel. Videos
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Part 2: http://www.youtube.com/user/CeliacDiseaseCenter#p/c/E4747F2C9D008E6D/10/cQmYYwMpeNc
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This cake divides into 2 layers as it bakes. The upper layer becomes a light cake that covers a rich lemon pudding layer underneath. It is relatively easy to make, but does require a second pan with 1 and 1/2 inches of water for the the baking dish or pan to sit in while it bakes. I use a large stoneware pan so I have purchased a large foil roasting pan that is large enough for it to sit in.

The finished cake can be enjoyed warm from the oven or later after it has cooled in the fridge.

 

To begin, get one large bowl, and a medium sized bowl.

Large Bowl

1 and 1/2 cups of white sugar

4 tbsp of potato starch

1/2 tsp of salt

Mix these 3 ingredients together, then add,

2 and 1/2 tsp of finely grated lemon rind

1/2 cup of freshly squeezed lemon juice

2 tbsp melted coconut oil

5 egg yolks

2 cups of grain free almond milk

Mix together with a mixer

Small Bowl

5 eggs whites (preferably at or near room temperature)

Beat egg whites with a mixer until stiff peaks form, then fold egg whites into the mixture in the large bowl.

Put combined mixtures into stoneware pan (or ceramic). Then place the baking pan into the large foil pan and add 1 and 1/2 inches of water to the large foil pan (not the baking pan). Bake at 350 Fahrenheit for 45-60 minutes. Test with a spoon, make a small hole at the edge to see if pudding has firmed up. It will firm up more as it cools. With my oven mitts, I lift the stoneware pan out of the pan with hot water and place it on the stove to cool. I leave the other pan with water in the stove until it cools, then empty. Enjoy!

Note: Any grain-free, dairy-free milk can be substituted for the almond milk. If no milk is available, take 2 peeled apples and remove the core. Put the 2 apples with 2 cups of water in a blender. Blend until smooth and use this mixture to replace the milk.

The sweet coconut flavour of this crust complements the smooth, rich lemon flavour of the filling, combined with the light fluffy melt in your mouth meringue. For me, this dessert provides a nice light ending to a Christmas meal. If this sounds good to you, get your oven mitts, a large and small mixing bowl, and a sauce pan, then proceed with this recipe and experience some lemon goodness!

Pie Crust

1/2 cup of coconut flour

1/8 cup of fine coconut

1/8 cup flax meal (may substitute with fine coconut)

1 and 1/2 tbsp virgin coconut oil melted

3 tbsp maple syrup

1/2 cup of brown Demerara sugar

1/4 tsp grain-free baking powder

1/4 tsp sea salt

Mix ingredients together in bowl, then press into bottom of a stoneware or ceramic pie pan. This crust tends to burn in a metal pie pan.

Lemon Filling

1 and 1/4 cups white sugar

2 cups of water

1/2 tsp sea salt

6 tbsp potato starch

3 egg yolks (lightly beaten)

1 tbsp coconut oil (melted)

1/2 cup freshly squeezed lemon juice

1 tbsp grated lemon rind

1 and 1/2 tsp of Knox gelatine

Mix the sugar, salt, gelatine, and potato starch in the bottom of the sauce pan. Gradually, stir in water while whisking with a whisk. Bring to a boil over a medium high heat while stirring constantly.Once boiling, reduce to medium low and continue stirring for about 3-4 minutes. It will start to thicken. Then add oil and whisk until blended. Then add a couple of tsp of hot mixture into egg yolks, stir well, then add to hot mixture and whisk it. Continue stirring on heat for 2-3 minutes (to cook egg in mixture, then add lemon juice and rind. Stir well for 1-2 minutes. Remove pot from heat and gently pour into the pie pan with the prepared crust. Place in the fridge to cool while you prepare the meringue.

Meringue

3 egg whites (at room temperature)

1/4 tsp grain-free, diary-free cream of tartar

6 and 1/2 tbsp white sugar

Beat egg white with cream of tarter until stiff peaks form when beater is taken out. Then continue beating while slowly adding sugar. Eventually, peaks will become shiny and peaks will form again when beater is removed. Pour onto filling and bake at 350 Fahrenheit for 10 –12 minutes until meringue is golden. Sometimes, I finished it under the broiler for a minute, if necessary. Sit at stove and supervise until the peaks are a golden brown (it can burn easily). Let cool, then serve, or refrigerate. Enjoy!

Ingredients

3 large russet potatoes chopped

1 large yam chopped

1 large sweet potato chopped

2 leeks sliced (push on middle of each slice to separate into rings)

1/4 cup extra virgin olive oil

Sea salt and pepper to taste

2 tbsp of fresh rosemary chopped fine

3 tbsp of fresh sage chopped fine

2 cloves of garlic pressed through the garlic press

Add the rosemary, garlic, and sage to the olive oil and stir. Put the chopped yams, sweet potato, and potato in the roasting pan with the sliced leek. Pour the olive oil and herb mixture over the vegetables and stir the vegetables around until are well coated with olive oil and herbs. Apply sea salt and pepper to taste. Cook at 350 Fahrenheit for 60 minutes (or longer) until vegetables are soft.

To begin, get a medium saucepan, a strainer with a bowl under it, and a measuring cup

In the saucepan, add:

3 cups of fresh cranberries

1 cup of white sugar

1 cup of water

Boil this mixture for 15-20 minutes, then pour mixture through the strainer with a bowl underneath (it should look a bit thicker now). Take a large spoon and press the mixture against the strainer to ensure all flavour and most of the pulp is pushed through. The residue left is mostly cranberry skin. Remove bowl with strained mixture and place it in the fridge to cool and thicken. Enjoy!