by S. Todd Stolp MD
©November 2008
Perhaps our most intimate relationship with the world around us occurs in the digestive system. While the 30-foot tube that forms our digestive tract would portray itself as an internal organ, it is no more “indoors” than is the Caldecott tunnel traveling into the Bay Area. The interactions that take place between us and our food within our gut are really interactions with the outside world, and therefore take place under the watchful eye of our immune systems, with “Highway Patrol” carefully monitoring the complex transactions that occur. Sometimes the immune system itself can misbehave by reacting in an abnormal way to food products, resulting in illness. Since the conditions that result from this misbehavior occur only in specific unfortunate individuals, the illnesses that result seem somewhat mysterious and are not easy for health care providers to diagnose. Therefore, it is helpful for each person to pay attention to the traffic traveling through their nutrient highway in order to alert care-givers to potential signs of trouble.
“Celiac disease” or “Celiac sprue” is one of these health conditions. While a full understanding of this illness has not yet been achieved, we know that the immune system plays a roll. Celiac sprue (or “sprue” for short) is characterized by a sensitivity to “gluten,” a protein found in wheat and wheat products. It appears that abnormalities in the lining of the gut occur in response to an immune reaction to components of the gluten molecule. We also know that this abnormal reaction to wheat or wheat products runs in certain families, much like other immune-mediated disorders, and occurs in approximately 5 out of 1000 people. Symptoms may include bloating, foul-smelling diarrhea, gas and weight loss, and can develop after many years of symptom-free enjoyment of wheat foods. The solution for people with sprue is to avoid wheat products, a feat akin to avoiding a Starbucks franchise. Nevertheless, a strict wheat-free, gluten-free diet will bring about relief from symptoms for over 80% of people with sprue. If your health care provider recommends such a trial diet, you will receive instructions or you may be directed to a gluten-free diet on the internet.
A different category of digestive system illness that occurs at the hands of the immune system is known as “inflammatory bowel disease.” These conditions are generally considered to be “autoimmune disorders,” in which the immune system turns traitorous and begins to attack our own organs. Inflammatory bowel diseases, such as Crohn’s Disease and Ulcerative Colitis, are also associated with bloating, diarrhea, gas and weight loss, but in addition may be suggested by the appearance of blood in the stool. The diagnosis is often accomplished by performing a colonoscopy or upper gastrointestinal scope procedure with a biopsy of the lining of the bowel showing damage inflicted by inflammatory cells of the gut. As you might guess, treatment for these conditions is focused upon diminishing the intensity of the immune system activity within the bowels, with medications related to cortisone among others.
Some people with generalized allergic conditions, often with asthma or chronic skin rashes, may have food allergies that can be life threatening. These conditions can be dramatic, often due to the consumption of unrecognized food components to which the individual is hypersensitive. The increasing incidence of peanut allergy in school children is an example of a food allergy syndrome that has posed an increasingly costly and important challenge to schools and school health programs. Symptoms may include swelling of the lips, wheezing, rapid heart rate and collapse. These patients may have some indication that they have an allergic condition, such as a bracelet, and immediate treatment with medications may be life saving.
There are reasons why a person might develop intolerance to certain foods other than from a wayward immune system. Lactose intolerance may occur in infants or adults as a result of the inability to break down lactose sugar in dairy products, resulting again in bloating, gas and diarrhea. Monosodium glutamate (MSG) and aspartame may also be responsible for reactions, such as symptoms of headache, when consumed in significant amounts by certain people. These reactions are not, however, due to food allergy or the immune system but rather due to direct effects of the chemicals.
The responsibility of monitoring the traffic you allow to use your food highway is yours. That means attention to the inhabitants of your dinner plate, but also to the toilet boil before you flush. This season of thanks is a good time to appreciate the profoundly intimate relationship we have with the food we enjoy.