How Chinese Medicine helps the #1 genetic autoimmune disorder in the United States
Gluten Sensitive Enteropathy (GSE) encompasses both celiac disease and dermatitis herpetiformis. In both hereditary immune system disorders, proteins in wheat, rye, barley, spelt, and triticale set off a chain of events that result in tissue damage, in particular damage to the lining of the small intestine.
Once thought of as a childhood ailment, it can show up at any age and is most often diagnosed in middle-aged Americans. And once considered rare, it is now estimated that one in 105 Americans may have it, or roughly 3 million people in this country, according to an expert panel that presented findings to the National Institutes of Health.
The panel warned that most of those with the disease are undiagnosed and thus suffering unnecessarily. On average, patients suffer symptoms for 11 years before they’re diagnosed because the disease is so little understood even by physicians. If untreated, it can lead to serious vitamin deficiencies, bone-thinning osteoporosis, diabetes, and occasionally even gastrointestinal cancers.
GSE may present a wide range of symptoms, making diagnosis sometimes difficult. Health care professionals now know that gluten intolerance is not just a gastroenterological disorder but a varied-symptom disorder that can affect many bodily systems and engender more complicated problems.
Classic symptoms include diarrhea, abdominal pain, gas, bloating, vomiting, constipation, alternating diarrhea and constipation, and weight loss. These are most commonly recognized as celiac disease, or celiac sprue.
Less well known symptoms include anemia, chronic fatigue, bone pain, muscle cramps, balance problems, migraines, seizures, depression, behavioral challenges, lapses in memory, learning difficulties, growth and maturation problems, infertility, short stature, tooth enamel defects, easily fractured bones, and premature bone disease.
Those with dermatitis herpetiformis experience a blistering, itchy skin rash, often misdiagnosed as eczema, but they still have the diagnosis of celiac disease as well. The degree of damage to the small intestine is often less severe or more patchy than in those with only celiac disease.
Simple stool or blood tests can help diagnose GSE, and most patients recover with a gluten-free diet for life. But gluten can be hidden in foods not commonly associated with grains, such as some candies, salad dressings, soups, and sauces, making adherence difficult. The best approach is to learn as much as possible about the disease, maintain a lifelong gluten-free diet, identify any nutritional deficiencies by consulting a qualified nutritionist, and get support from others in an advocacy group.
There are numerous sources of information and support for those who have been diagnosed or who suspect that they have GSE. The following are some websites:
http://www.celiac.com
http://www.csaceliacs.org
http://www.gluten-free.com
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/
http://celiaccenter.org/
http://www.enterolab.com
Locally, the Bellingham Gluten Intolerance Group (GIG) is an excellent nonprofit support group serving Whatcom County and other communities of northwest Washington. They have regular meetings, lecturers, and community awareness events. This group’s website is www.GlutenFreeway.info
HOW CAN CHINESE MEDICINE HELP GSE?
Western medicine can provide blood testing for celiac disease, but once a diagnosis is determined, the individual now has to make his or her own way in the minefield of staying completely gluten-free, for life. At first, this can be a devastating diagnosis. We are surrounded by so much food that contains both obvious and hidden forms of gluten, and even non-food items present dangers: for example, there is gluten in the glue on some envelopes and stamps!
Moreover, some people with celiac continue to suffer symptoms even after going on a gluten-free diet: GI distress, fatigue, lowered immunity, “foggy brain,” depression, skin problems.
In Chinese medicine, Gluten Sensitive Enteropathy always involves what is known as Spleen Qi Deficiency. There may be other patterns present in addition to this, but an immediate goal in treatment is to nourish and tonify the Spleen-Stomach system.
Qi (pronounced “chee”) is the body’s life force energy. It needs to be abundant to produce radiant health, must flow freely in the body with no blockage or deficiency, and needs to be in a yin/yang balance.
Spleen Meridian
When we talk about the Spleen as it’s seen in Chinese medicine, we are not referring to the spleen itself but an energetic system that’s actually closer in function to the pancreas, which we know in Western medicine secretes pancreatic enzymes into the small intestine.
The health of the Spleen system determines our ability to absorb nutrients. The Spleen system, which is yin, is also linked to the Stomach system, which is yang.
The main function of the Stomach system is the transforming and digesting of food, what the Chinese call “rotting and ripening.” The Spleen system separates the distilled food essences and transforms and transports the food and liquids. It then becomes the Small Intestine’s function to reabsorb the pure part of the liquids, and the Large Intestines job to reabsorb the pure part of foods or solids. However, the burden of digestion is mainly dependent on Spleen Qi’s ability to transform and transport food and fluids.
With GSE, the Spleen system becomes compromised, depleted, and deficient in many ways. An additional condition known as “dampness” can be involved, which slows down the flow of Qi even more. Acupuncture works to help strengthen and build the Qi, unblock and move stagnant Qi, resolve dampness, and restore balance in the entire system. This includes balance of yin, yang, blood, fluids, and Qi.
There are specific acupuncture points to nourish and tonify the Spleen system, smooth the Liver system, heal damaged tissues (Chinese medicine is especially effective in rebuilding and strengthening), “calm the spirit,” alleviate pain and other symptoms, drain dampness, normalize stomach acid secretion and bowel function, and address other organ systems where indicated.
The acupuncture points are like vortexes or whirlpools in rivers (the meridians) where the needles are able to access and stimulate Qi and keep it moving.
With my patients who are living with gluten sensitivity or gluen intolerance, I discuss dietary recommendations that fit with theories in Chinese medicine about thermal properties of food.
We know that in order to assimilate food, the body has to first warm it to body temperature. With gluten intolerance, the digestive Qi, or Spleen Qi, is already injured and overwhelmed, the digestive process requires extra work to warm up the food, and this further weakens the Qi. It’s important, therefore, to eat as many slowly cooked and warming foods as possible, or at least food that is at room temperature, and limit cooling foods that injure the Spleen. Slowly cooked or lightly cooked food is already partially broken down, making it easier to digest. I can provide a list of warming foods, plus foods that are best to avoid when trying to strengthen the Spleen system.
How we eat is also important. Food should be consumed in moderate amounts and in a harmonious environment. It’s best to eat food that’s organic and simply prepared, and to chew in a slow, deliberate way.
An excellent resource on nutrition that’s based on Chinese medical theories is Healing With Whole Foods: Oriental Traditions and Modern Nutrition by Paul Pitchford, which is available at the Co-op and elsewhere.
Chinese herbal formulas can also be extremely helpful in restoring the digestive tract and keeping things flowing smoothly when staying healthy while living with GSE. There are numerous classic, effective formulas that can boost Spleen Qi, smooth Liver Qi, and replenish depleted stores of energy.
WHEN GOING GLUTEN-FREE IS STILL NOT ENOUGH
For some people with a diagnosis of celiac, following a gluten-free diet helps to a degree, but symptoms persist, recovery is incomplete.
When the intestines are inflamed―whether from celiac, ulcerative colitis, Crohn’s disease, irritable bowel syndrome, diverticulitis, or other GI disorders―they can lose the ability to break down molecules that are too large to be transported across the small intestinal surface into the bloodstream. Instead of entering the bloodstream, the undigested starch and sugar molecules serve as a continual source of food for bacteria and fungi. They remain in the intestinal tract, thus encouraging microbes to multiply by providing food for them. This can lead to the formation of acids and toxins which can injure the small intestine. Once bacteria multiply within the small intestine, they can destroy the enzymes on the intestinal cell surface, preventing carbohydrate digestion and absorption. At this point, production of excessive mucus may be triggered as the intestinal tract attempts to "lubricate" itself against the irritation caused by the toxins, acids, and the presence of incompletely digested and unabsorbed carbohydrates.
The Specific Carbohydrate Diet (SCD), outlined in Breaking the Vicious Cycle by Elaine Gottschall, eliminates all sources of carbohydrates whose molecular structure is too large for direct entry into the bloodstream. The SCD is based on the principle that specifically selected carbohydrates requiring minimal digestion are well absorbed, leaving virtually nothing for intestinal microbes to feed on. As the microbes decrease due to lack of food, their harmful by-products also diminish. No longer needing protection, the mucus producing cells stop producing excessive mucus and carbohydrate digestion is improved.
The SCD corrects malabsorption, allowing nutrients to enter the bloodstream and be made available to the cells of the body, thereby strengthening the immune system's ability to fight illness. Further debilitation is prevented, weight can return to normal, and ultimately there is a return to health.