Sunday, May 27, 2007

Help for food allergies and food sensitivity: The Food Doc website update and possible link of gluten to herniated discs.

For those of you suffering from various forms of food allergies, sensitivity, food intolerance, celiac disease, gluten sensitivity, IBS, colitis, Crohn's disease or other food related or digestive conditions, I want update you on what is going on with “the Food Doc”. I also want to explain why there have been fewer blog posts recently. Some of you reach this blog via my website www.thefooddoc.com. That is only a brief taste of what is to come on the food doc website. As I promised earlier I also want to comment briefly on a possible link of celiac disease and herniated discs.

The target date the premier food doc website is mid-June. My medical assistant, Christine, and I have been working furiously to add content and work with the web development team to finish the interactive on-line applications we are featuring on the site.

In the meantime, I continue to maintain an active GI practice that includes after hours and weekend hospital coverage. My wife is also now three weeks out from having spine surgery for a recurrent herniated lumbar disc in the context of celiac disease. I took some time off from work and from writing to help her. I still believe there may be a link between celiac disease and premature or recurrent herniated discs. I am still researching the limited research and published articles. I have also had some of her herniated disc material to a laboratory to be processed in hope that we look for markers of celiac disease involvement.

I have found articles describing an autoimmune link including the presence of autoimmune antibody markers in herniated disc tissue. The disc is a nutritionally active tissue made up of proteins. The presence of inflammatory reactions is well documented including the presence of various mediators. Anti-inflammatory treatments like anti-tumor necrosis factor agents (Remicade) used to treat Crohn's disease and rheumatoid arthritis have been reported beneficial in disc disease. However, I have been unable to find specific research linking celiac disease and herniated discs. However, based on may professional experience and wife's history as well as numerous posts on celiac forums suggests there is a link. I would be interested in hearing from any of you who have celiac disease or gluten sensitivity that have had herniated discs including what age it occurred.

When www.thefooddoc.com re-launches it will have it’s own “virtual office” with secure messaging service and on-line consult capability. It will also have an on-line diet symptom diary, interactive info wizard and symptom assessment tools, a regular newsletter, blog, e-store and much more.

The www.thefooddoc.com is taking on an amazing appearance and capabilities. It will be much more than I had envisioned. It is exciting and I wish I could share with you how it looks so far. However, according to my web development team, I cannot while it is still under development and vulnerable to security breaches and crashing. When it launches, I am convinced there will not be another site like it anywhere on the web. It will be capable of offering interactive tools and resources for people with digestive and food related conditions or illness that will astound you.

I will be adding some new posts over the next few days as some interesting new articles have been published I want to share with you. I am finishing up a booklet titled “Diagnosing Celiac Disease and Gluten Sensitivity” that will be published in print form as well as available as an e-book for purchase on www.thefooddoc.com. I am working on four others to be published over the next 3-6 months.

The second booklet will cover food allergy, sensitivity and intolerance, including various testing options. It is already undergoing editing now and will be published shortly after the first. The third will cover irritable bowel syndrome, Crohn’s disease, colitis and leaky gut syndrome. Though it is also in progress some additional writing is needed. But isn’t too far from being done. A fourth will cover nutrition, supplements, probiotics, prebiotics and antibiotics in treatment and prevention of digestive and food related conditions. Marie Pizzolatto, a leader of the local celiac support group in Colorado Springs is also an experienced editor/publisher who is helping me with these projects.

Dr. Ron Hoggan (co-author of Dangerous Grains and editor of celiac.com newsletter ScottFree) has volunteered to lead a group of us in a project on multi-doctor authored book on gluten sensitivity. Dr. Rodney Ford (author, pediatric gastroenterologist and the other food doctor from New Zealand www.doctorgluten.com www.thefooddoctor.net) and I have committed to this project. Our writing for that project has already begun. Dr. Ken Fine founder of Enterolab www.enterolab.com and Dr. Mario Hadjivassilou, a neurologist from England who is considered the world expert on gluten and the brain, have indicated interest to join us as co-authors.

As I indicated in an earlier post, I am going to be offering Dr. Rodney Ford's helpful books on gluten through my website. I will also be adding videos that will be available by streaming on-line downloads like my first video “What is the difference between food allergies and food intolerance?” Our future videos will be a little shorter and better in quality. We are also looking at other products to offer that we believe are helpful. These include some gluten free cooking videos, restaurant guides and dining cards, gluten free recipes and cookbooks, and medical testing resources.

So, there are a lot of exciting developments and projects in the works. It is a privilege to share these with you as you join me in our journey searching for more answers and links to how food and the gut interact so we may all achieve a “healthy gut, healthy life”

Best regards,

Dr. Scot Lewey
The Food Doc
www.theFoodDoc.com
www.gacsonline.com
1699 Medical Center Point
Colorado Springs CO 80907
719 632 7101

The Food Doc, LLC
PO Box 51460
Colorado Springs CO 80949

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com

Monday, May 14, 2007

Modern day Twinkie legend, wheat gluten, leaky gut and two food doctors' thoughts

Is the non-decaying Twinkie story an urban legend? Well, this Twinkie is officially two months old today. Apart from being very hard, it looks the same to me as it did when I removed it and it’s sibling from the package on March 14, 2007. The twin suffered a fatal drop from my six year-old son’s hands a couple of weeks ago. It was soggy from being placed in a zip lock bag and had been in the dark loset, only being brought out for photos. My son picked it up to look for mold (he found none) when the accident occurred. We continued with the surviving Twinkie dry and in the light. No mold or signs of decay on this Twinkie now at two months prompts me to ask if anyone really believes that a food that shows no sign of deterioration after this long is really safe to eat. The makers of Twinkies already concede they aren’t healthy but they taste good. One of my friends in medical residency, Dr. Bruce Caldwell, affectionately called fast food “garbage food”. He or someone else in my past commonly referred to various junk foods as “food-like substances”. I doubt they knew how right they were over twenty years ago.

Now, though I would like to blame gluten on the failure of the Twinkie to mold, I cannot honestly attribute this attribute to that amazing but frightening property. I guess other ingredients contribute to the legendary long shelf life of the Twinkie. It is like the cockroach of foods, destined to survive any environmental assault or disaster.

My concern is that processed food capable of surviving uncovered in the air exposed to mold causing bacteria and yeasts, can’t be completely benign in our human digestive tract. Nearly one hundred year old research proved wheat or wheat gluten alone is toxic to cattle and dogs. Flour in the U.S. is required to be supplemented with vitamins due the the nutritional deficiencies in wheat. Scientific studies have also shown gluten can injure normal human and rat intestinal cells causing increased gut permeability or "leaky gut".

Considering most of the food proteins we now eat come from organisms that have been genetically modified or enhanced and are mixed with other chemicals or food proteins in the digestive tract, the possibility of toxic effects is not far fetched.

Knowing our gut has altered bacteria levels from chemicals used to treat foods and water, antibiotics given to animals under the guise of protecting us and we are often over prescribed antibiotics, our intestinal lining cells are more prone to be injured. Intestinal damage is known to occur from infections, chronic stress, and medications like aspirin, ibuprofen and others. The resulting leaky gut is vulnerable to these genetically modified food proteins and industrial chemicals.

The hygiene theory suggests we may be too clean and not getting enough good soil bacteria in our food supply. Instead the bad bacteria are overgrowing empowered by the overuse of antibiotics. The dysbiosis, or altered gut flora state is believed to be triggering increased gut permeability that allows bacteria, yeast and food proteins direct contact with our immune system. Ongoing self-perpetuating immune stimulation reactions, especially in the genetically predisposed, results in various autoimmune diseases.

Altered gut bacteria levels have recently been suggested as a cause of the obesity epidemic. Food proteins, known as like gluten and others known as lectins have been been suggested to be linked along with gut bacteria, in the epidemic of autoimmune diseases.

As a gastroenterologist I see an increased incidence of Celiac disease, Crohn’s disease, ulcerative colitis, microscopic colitis, and eosinophilic gastrointestinal disorders. The neurologists and rheumatologists are observing greater numbers of patients with MS like conditions, ataxia, migraines, brain fog or attention difficulties, autistic spectrum disorder, rheumatoid arthritis, lupus, and fibromyalgia. It is no wonder that if toxic chemicals such as melamine have been routinely added to food to falsely raise the protein content, improve the color or appearance or lengthen the shelf life, that despite great health advances our gut seems to be more upset and at risk for injury. It is as if our bodies are slowly being poisoned.

Instead of feeling safe by the FDA’s new reassurances every several days to weeks in regard to the wheat gluten-melamine issue, the public seems to be wondering about the safety of our food. It doesn’t help when we find out that contaminated wheat gluten containing melamine has been fed to chickens, hogs and farm raised fish even if various “experts” claim there is no danger from the chemical in foods made from those animals.

My surprise was not the fact that our food supply is not safe from contamination. That I know personally and professionally. Personally, my wife has Celiac disease and I am gluten sensitive, though she is many times more sensitive to gluten than I am. I also have many patients who struggle continually to avoid being exposed by hidden sources of gluten or foods that are cross-contaminated with gluten during processing. However, the sobering reality that hit me was that in fact, all these other food sources were being fed wheat gluten.

Does wheat gluten get through in meat, fish, eggs, and milk? I don’t know the definite answer. However, I was talking by phone with my good friend and fellow gluten crusader, Dr. Rodney Ford, the real “Food Doctor” from New Zealand www.doctorgluten.com or www.thefooddoctor.org) about this issue this weekend. As a pediatric gastroenterologist in New Zealand, he has been treating and publishing about food allergy and intolerance for over thirty years. We both agreed that since we know gluten survives high heat baking and gets through human breast milk, it is not inconceivable nor is it illogical to believe that foods produced from animals fed a lot of wheat gluten may contain enough gluten to cause some patients ill effects. We also agreed, this latest news should cause anyone on a gluten free diet to consider not eating any meat, fish, eggs or dairy that has been grain fed.

Rodney and I share a common concern about the dangers of gluten, though this conviction has costs us both some credibility with our colleagues. We both however are collecting data on our patients who fail to meet strict criteria for Celiac disease yet respond to a gluten free diet. Despite most of our colleagues and peers criticizing or questioning our “imposing” such a burdensome and restrictive diet on our patients without Celiac disease, it seems, most not only don’t mind but they continually thank us for helping them feel better. A few on other hand, would rather feel bad and still be able to eat that Twinkie, because it tastes so good, even if it’s not natural, healthy or is possibly toxic. Join Dr. Rodney Ford, the New Zealand Food Doctor, and me, Dr. Scot Lewey, the Food Doc, as we continue our journey for a “healthy gut, healthy life”. Once my site, relaunches in it's premier form, hopefully in mid June, Rodney has graciously offered to allow me to resell his very helpful books on my site.

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com

Monday, May 07, 2007

Food sensitivity and intolerance testing options include new mediator release testing (MRT)

As a gastroenterologist, I diagnose and treat many people with food allergies and intolerance, colitis, Crohn’s disease, reflux and irritable bowel syndrome or IBS. As a food allergy and food intolerance specialist – the Food Doc, I find food allergies are relatively easy to diagnose, as is Celiac disease, the worst form of a spectrum of gluten sensitivity. Crohn’s and colitis are also usually easily diagnosed though this requires an endoscopic examination of the colon, colonoscopy, with biopsies of abnormal appearing intestinal lining. Sometimes specific blood tests for colitis and Crohn's disease may screen for or help confirm ulcerative colitis and Crohn’s disease. More recently, biopsies of normal appearing intestine lining, has been found to reveal previously unsuspected microscopic forms of inflammation that may be due to food allergies or intolerance. These various forms of microscopic colitis, often misdiagnosed as IBS include lymphocytic, collagenous and mastocytic enterocolitis may be due to foods. However, food intolerance or sensitivity are often the cause of a myriad of symptoms but can be quite difficult to confirm. I am now using new testing from Signet Diagnostic Corporation that may end some of the frustration experienced by people who have symptoms suspected to be due to food sensitivities. You may take a take a symptom survey and register for secure communication on my on-line consultation site. On that site I also review MRT testing for those interested.


Frequently, the testing available and covered by insurance is very incomplete for determining the possible link between foods and symptoms of ill health. After excluding Celiac disease, non-celiac gluten sensitivity can often be diagnosed based on blood or stool tests for gliadin antibodies and response to a gluten free diet. Other food sensitivities may be suspected based on IgG antibody blood tests or IgA stool tests. Genetic testing for high-risk genes for Celiac disease and gluten sensitivity can also be of some help.

IgG antibody testing has proved to be of some help in linking symptoms to foods in patients with IBS but is not available in most labs or is not covered by many insurances in the U.S. At least two laboratories offer IgG tests for foods. The tests offered by US Biotech IgG food panel testing and the Optimum Health Resources Laboratories IgG ELISA Food Intolerance Test are not necessarily covered by insurance. They do provide testing for a large number of foods but only IgG antibodies and the relevance to symptoms continue to meet resistance by doctors in the U.S. The Enterolab testsEnterolab, though very popular within the gluten sensitivity and Celiac disease community, currently only test for stool IgA antibodies for gluten sensitivity (anti-gliadin and tissue transglutaminase), chicken egg, soy, cow’s milk (casein) and dietary yeast (saccharomyces cerevisiae). For those in whom parasites, abnormal levels of yeast or bacteria or looking for additional IgA antibody stool testing Doctor's Data laboratory's comprehensive gastrointestinal panels are another option but again the validity is questioned by some doctors and insurances, most of which do not cover the tests. People failing to respond adequately to elimination of limited foods tested or who cannot afford the out of pocket expense of these tests often must resort to a strict elimination diets, followed by food challenge as the only way to try to link specific foods to their symptoms.

Food sensitivities or intolerance are a common cause of many chronic conditions. Though only about 8% of people have true food allergies confirmed by allergy testing, food allergies are only a subset of a larger problem of food reactions. The difference between food allergy and intolerance are explained in my Food Doc video and website. Food intolerance and sensitivity affect 15-20% of the population by conservative estimates and possibly affect as many as 60-80%. Food sensitivity or intolerance that is not due to the immediate immune response or IgE antibody reactions cannot be diagnosed by testing based on that reaction. Skin tests and food allergy blood tests or RAST IgE antibody tests will be negative if you are not allergic to a food or foods but you can still have an abnormal immune response to foods and food additives. The immune system can be triggered to release chemicals as a reaction to food or chemicals in foods resulting in various symptoms and feeling sick.

When the immune system perceives foods as a foreign invader or potentially harmful like most bacteria, viruses, parasites or toxic chemicals, various defensive measures are triggered by the body. Some foods or protein products produced from those foods, such as various lectins, may in fact be harmful or toxic to the human digestive and immune system. However, other times it may be a case of mistaken identity. Either way, the results of the body’s perception of a food or food protein as foreign can lead to production of various immunoglobulin antibodies (Ig) and the release of toxic chemicals from infection fighting cells. These chemicals are called "mediators".

The immune mediators include numerous substances such as histamine, cytokines, tumor necrosis factor, and prostaglandins that are being studied vigorously. Recent research is focusing on the role of these mediators and their effects, including the resulting leaky gut, in the presence of altered levels and types of bacteria and yeast. Such interactions are being investigated in the context of how they result in various diseases especially those that are autoimmune in the genetically predisposed. Though many medications have been discovered that are effective blocker of these mediators, like anti-histamines and various cytokine blockers like Remicade.

However, once these mediators are released, the inflammatory and pain-inducing effects of these chemicals give rise to the various symptoms that make us feel sick. The toxic effects of these chemical mediators can also cause damage to our bodies, not just in the gut, where their effects usually result in a leaky gut that predisposes to even more risk of food sensitivity and entry of bad bacteria and yeast into our body. When the mediators or foreign bacteria, yeast or food proteins, get into the blood stream they can travel to remote parts of the body resulting in damage and symptoms in the muscles, bones, nerves, brain, skin and glands.

Research is accumulating indicating patients with irritable bowel syndrome (IBS), migraine headaches, fibromyalgia, chronic depression, chronic fatigue, diabetes, thyroid problems, and chronic inflammatory bowel diseases (IBD) have higher than normal levels of these mediators circulating throughout their bodies. For many people, the "trigger" that causes these mediators to be released can be linked to foods or chemicals in their diet.

Food sensitivity symptoms are often chronic because the mediators are released every time we reactive foods that we frequently habitually exposing ourselves in our diet. So, how do you identify the foods your body is recognizing as foreign and triggering mediator release to so that you can avoid those particular foods? This is done testing for mediator release to specific foods. That is what MRT testing, Signet Diagnostic Corporation, provides. However, they also go one step further by providing an elimination diet followed by a rotation diet based on the specific test results. Further, they provide about three hours of personalized dietary education, counseling, and coaching from a trained dietician.

This combined with a physician experienced in food sensitivity has resulted in some dramatic results in patients who previously had given up getting better. I consider this testing a powerful new weapon in the war against food related illness. If you are in need of consultation and a doctor to order the testing for you please visit my secure on-line consultation website. After you register for secure communication you may request on online consultation. I can review your symptoms and previous testing before making recommendations regarding further evaluation and testing.

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com

Celiac Disease Negative or Inconclusive But You Think You Have Food Sensitivity?

Do you have symptoms or health issues that won’t go away and tests for food allergies and Celiac disease have been negative or inconclusive? Have you been told you have IBS, fibromyalgia, migraines, chronic fatigue or depression but feel that the medications and treatments recommended for you by doctors have not helped and you wonder if your symptoms might be related to your diet? Do you believe foods or chemicals in the foods you eat may be contributing to how poorly you feel and your unexplained symptoms yet doctors have told you that food allergy tests are negative or inconclusive? If you feel this way you are not alone. Now there may be help in a new form of food sensitivity testing to determine if your body is reacting negatively to the foods you are eating. The Food Doc is now partnering with Signet Diagnostic Corporation to bring this testing to patients on-line.

If you are not sure you have symptoms from foods, take this food symptom survey on my secure website. High scores indicate the possibility that foods are making you ill. If you want me to review your history and symptoms register for secure communication with me and request an on-line consultation. As a food allergy and food sensitivity specialist – the Food Doc, I will review all of your information and provide you with a comprehensive on-line consultative opinion with recommendations.

There is now ample medical research that foods and food additives or chemicals may be to blame for many chronic debilitating symptoms and health problems especially chronic inflammatory or autoimmune diseases. Unfortunately, if your diet is contributing or causing your illness, medications prescribed for undiagnosed symptoms related to foods will fail to relieve your symptoms and may delay a correct diagnosis. Medications may simply mask the symptoms or treat the inflammation in the body triggered by foods without addressing the root cause. Many times the medications have side effects that are worse than the condition and can lead to other health problems. Many people end up suffering for years and spend thousands of dollars for tests and treatments that never identify the root problem and don’t work.

I have started using a new type of food sensitivity testing, called mediator release testing or MRT. I believe this testing takes a large element of the guessing out of the equation. I am now participating to make this testing available along with the dietary counseling program called LEAP© to those who participate in on-line counseling. By registering for online consultation I may be able to help you overcome your food sensitivity problems using MRT testing and the LEAP program.

First, you initiate an online consultation with me to review your symptoms and previous testing. Then we submit a request for MRT testing through Signet Diagnostic Corporation under my physician order. LEAP uses a patented blood test named MRT© (Mediator Release Test©) to isolate a safe foods diet for each patient. MRT eliminates the guesswork to give you definitive answers. Once the test is performed, an eating plan is developed and tailored to your individual results and dietary needs or restrictions. Included in the fee for testing is counseling from a trained LEAP Dietitian who will assist you in implementing your new, healthy eating plan under my oversight.

“The LEAP Program has helped thousands of IBS, migraine, fibromyalgia and other food sensitive patients quickly overcome their food sensitivities and find lasting relief, even to the point of feeling completely healthy again after years of suffering. In fact, most patients see noticeable improvement within 5-10 days on the program. And all without the ongoing costs and potential side effects of prescription medications that will never fix the underlying cause of the illness.”

Start by registering for secure communication and then submit an on-line consult to me to review your history. After reviewing your history we can submit a request for MRT testing. With your request and my doctor’s order, Signet Diagnostic Corporation will determine if your insurance covers the testing or if you will have to pay for the testing on your own. You will be notified of your benefit coverage and any out of pocket expense to have the testing.

Once you have decided to undergo testing, you will be set up to have a blood draw at a lab near you. The blood samples will be sent overnight mail to Signet's testing facility. Your blood will be tested for abnormal mediator release in response to over a hundred foods and chemicals. I will receive a copy of your tests to review and forward to you along with a diet plan based on your tests. The fee for the testing includes about 3 hours of personalized dietary counseling from an experienced LEAP dietician.

If you believe you have food and/or chemical sensitivities and you want to feel better, your improved health is in your hands. Consider registering for online consultation today or if you are already registered on my secure site submit your on-line consultation. I will determine if you may benefit from MRT testing. You may review MRT testing and LEAP at Signet Diagnostic Corporation website.

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com

Thursday, May 03, 2007

Lymphocytes, eosinophils and mast cells: What your "normal" appearing gut lining may be hiding under the microscope can be missed.

Thousands of people are undergoing endoscopic exams daily without having any biopsies performed though they have symptoms. Sadly, though their exams may visually appear normal, under the microscope may likely be microscopic findings that explain their symptoms. These findings also may direct a therapy that will relieve their symptoms. The gut is lined with larger cells that have in their tips a few immune cells. These immune cells, or lymphocytes, release chemical mediators that fight off infection and attract other cells to the area join the fight to protect the border of the gut from foreign invaders.

Lymphocytes are the primary immune cells normally present in small numbers in the surface cells of the gastrointestinal tract but in certain conditions they may be joined by eosinophils and mast cells. A few lymphocytes are present in the tips of the surface cells that are a type of epithelial cell. These lymphocytes act as the body’s scouts. They survey the barrier of the gut to the inside of the body, looking for signs of potential invading infectious agents. Once an attack is perceived, they signal reinforcements to join them on the front lines.

When persistent increased numbers of lymphocytes are present in the surface cells, a chronic inflammatory condition of the gut exists. In the duodenum, autoimmune reaction to gluten in genetically susceptible individuals is a common but frequently missed cause of chronic inflammation known more commonly as celiac disease or Sprue.

Eosinophils and mast cells are types of immune cells involved in allergy reactions in the body. They are less commonly present in the gastrointestinal lining except when there are parasites, food allergies, or chronic inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. Eosinophilic gastrointestinal disorders are less common and a newly recognized condition, mastocytic enterocolitis, is diagnosed when excess mast cells are present in the small bowel and colon. However, mast cells may be difficult to see on biopsies without a special stain for tryptase, an enzyme present in mast cells that are immunologically activated.

The esophagus normally contains no eosinophils. The two exceptions gastroesophageal acid reflux in which small numbers, up to 6-7 usually and no more than 10-12 per high power field (40X magnification) are found in the lower esophagus only not in the mid or upper esophagus. Allergic eosinophilic esophagitis is diagnosed when 15 or more eosinophils per high power field are found in more than two fields or more than 20 to 24 per high power field in one field are seen or lesser numbers are present in the upper esophagus. Mast cells that are activated have also been found associated with allergic eosinophilic esophagitis and their presence supports allergic esophagitis over reflux as the cause of the increase eosinophils though it is believed some people have both conditions coexisting.

In the stomach and small intestine more than 10 eosinophils per high power field defines eosinophilic gastroenteritis. In the small intestine and colon more than 20 mast cells per high power field found in association with otherwise unexplained diarrhea is now termed mastocytic enterocolitis. This newly recognized and described entity is previously unrecognized cause of diarrhea in some patients diagnosed with irritable bowel syndrome who may have been told they have a normal colon exam though no biopsies were done. Similarly, more than 20 lymphocytes per 100 epithelial cells in the colon are found in lymphocytic colitis, another form of microscopic inflammation of the intestine resulting in diarrhea that may be inappropriately diagnosed as IBS.

In many of these patients, gluten sensitivity is to blame and the lymphocytic colitis is felt to represent a colonic form of celiac disease. In celiac disease, 30 or more lymphocytes in the tips of the villi per 100 epithelial cells is the earliest sign of gluten injury occurring before the villi become flattened or blunted. This finding may noted before the specific blood tests, anti-endomysial (EMA) and anti-tissue transglutaminase (tTG) antibodies appear in the blood even though the intestine is damaged enough to result in nutrient malabsorption and diarrhea. Anti-gliadin antibodies are often present however when significant intra-epithelial lymphocytosis is present along with symptoms that respond to gluten free diet. Lesser degrees of intra-epithelial lymphocytosis have been proposed as highly suggestive of early celiac disease and or gluten sensitivity, in the range of 20-25 per 100 epithelial cells.

In the colon, the presence of eosinophils is considered one of the earliest findings of chronic inflammatory bowel disease. In the right colon more than 20 eosinophils per high power field and in the left colon greater than 20 per high power field is considered abnormal and suggests eosinophilic colitis, chronic inflammatory bowel disease or a parasitic infection.

Eosinophils and mast cells release chemicals that irritate the bowel, increase permeability (cause leaky gut), increase contractions of the gut, increase intestinal secretions and heighten pain. Both cells are related to allergies including food allergies. It is therefore not difficult to conceive of a link to adverse food reactions in the development of intestinal irritation.

The important point to be aware of if you have gastrointestinal symptoms and are undergoing or have undergone an endoscopic examination is that a normal appearing intestinal lining does not exclude the presence of damage or irritation sufficient to cause symptoms of pain, bloating, gas, and diarrhea nor exclude impaired digestion and absorption.

Only through obtaining tissue samples that are examined under the microscope can abnormal types and number of inflammatory cells be identified. It is through biopsies of normal appearing intestinal lining that the correct diagnosis of various microscopic forms of gastrointestinal inflammatory diseases is confirmed. So, if you are preparing to undergo an endoscopic exam, I encourage you to insist that your doctor perform biopsies even if your exam is visually normal. Based on the information I have reviewed above, a normal exam should be tip off that one of these microscopic conditions might be to blame for your symptoms.

Copyright © 2007, The Food Doc, LLC, All Rights Reserved.
www.thefooddoc.com


References:

Al-Haddad S and Ridell RH. “The role of eosinophils in inflammatory bowel disease.” Gut 2005; 54:1674-1675.

Guilarte M et al. “Diarrhoea-predominant IBS patients show mast cell activation and hyperplasia in the jejunum.” Gut 2007;56:203-209.

Jakarte S et al. “Mastocytic enterocolitis. Increased mucosal mast cells in chronic intractable diarrhea.” Arch Pathol Lab Med. 2006;130:362-367.

Kirsch R et al. “Activated mucosal mast cells differentiate eosinophilic (allergic) esophagitis from gastroesophageal reflux disease.” Journal of Pediatric Gastroenterology and Nutrition 2007;44:20-26.

Liacouras CA. “Eosinophilic gastrointestinal disorders.” Practical Gastroenterology March 2007. 53-67.

Rubio CA et al. “Lymphocytic esophagitis: a histologic subset of chronic esophagitis.” Am J Clin Pathol. 2006;125(3):432-437.

Yousef MM et al. “Duodenal intraepithelial lymphocytes in disorders of the esophagus and stomach.” Clinical Gastroenterology and Hepatology 2006;4:631-634.
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