Sprue can be corrected by daily injections of 25 micrograms of folic acid, but because food is so poorly absorbed, a diet containing 60 times that amount brings no improvement. After an injection is given, patients may improve in a single day and absorb the vitamin well by mouth within a few days. A physician will give injections and/or tablets of folic acid, but the diet for sprue must make up for the multiple severe deficiencies brought on by the diarrhea. Although oils rather than solid fats should be used, fats need not be restricted nor a smooth diet adhered to Two tablespoons of lecithin daily tremendously increases the absorption of fats and fat-soluble vitamins.
Without folic acid, persons with sprue have improved when given cortisone or ACTH; therefore the anti-stress program should be followed to stimulate the natural production of these hormones. A regime similar to that suggested for colitis might be adhered to until recovery is complete. Because the problem is one of absorption rather than digestion, enzymes, hydrochloric acid, and bile are usually not needed.
This disease, which occurs mostly in infants and small children but is said to be increasing among adults, is also called idiopathic steatorrhea, gluten enteropathy, and non-tropical sprue. It appears to result from difficulty in digesting gluten, a protein found mostly in wheat, but may prove to be largely a deficiency of vitamin B6.
When gluten is eaten by persons with celiac disease, diarrhea becomes severe, most of the fat intake is lost in the feces, the appetite decreases, vomiting may occur, and eczema, or seborrheic dermatitis, is common. Gas distention and abdominal pain is usually acute, and the stools often contain so much gas that they are frothy. The tiny finger-like protuberances on the walls of the small intestine clump together, become sore and inflamed, or may completely disappear, making the absorption of food practically impossible. Before gluten-free diets were used, a large percentage of the children with celiac disease died, chiefly because fats and fat-soluble vitamins could not be absorbed. If wheat protein is strictly avoided, however, dramatic improvement is made and the symptoms disappear. Mild symptoms of this disease have been produced in volunteers who ate large amounts of gluten (100 grams) daily for ten weeks.
Fat-free diets were formerly used and, although harmful, are sometimes still recommended. Oils but not solid fats are well absorbed by persons with celiac disease, especially when taken with lecithin. At the present time, however, the entire dietary emphasis is being placed on avoiding all foods containing gluten: wheat, rye, barley, oats, buckwheat, and prepared foods containing these grains. Even wheat starch is highly toxic to some people with celiac disease. After gluten has been avoided for months or years, some patients can eat foods containing this protein, but in others the symptoms quickly recur, and biopsies of their intestinal walls show them to have become abnormal again.
A diet can be made adequate without gluten, but it is a nuisance. The finding that celiac patients are severely deficient in vitamin B6-the lack of which causes vomiting, eczema, much gas, and diarrhea-has been reported so recently that it is not yet known if this vitamin can clear up the disease. Probably no less than 5 milligrams of this vitamin should be given daily to infants with celiac disease and 30 milligrams or more to adults. Magnesium, necessary to utilize vitamin B6, is also severely deficient in persons with celiac, and may playa causative role.
As with other kinds of diarrhea, deficiencies of magnesium, potassium, proteins, fats, calories, and practically all vitamins quickly develop. Many symptoms of patients with celiac disease, including changes in the intestinal walls, are identical to those of persons with folic-acid deficiencies. Furthermore, the body’s reaction to the diarrhea is similar to that of any stress. At first too much salt is retained, potassium is lost, and dropsy may develop; when prolonged, too much salt is lost and salty foods should be eaten. For many reasons, therefore, the diet should not only be gluten-free but extremely high in all nutrients.
The problem, of course, is not gluten itself; grains are excellent foods, which have sustained nations for centuries. Probably persons with this disease have unusually high requirements for certain nutrients necessary to utilize gluten. It is known that celiac disease is triggered by nutritional deficiencies, intestinal infections or parasites, and psychological trauma, facts that have been summarized in an article with the delightful title of “Bread and Tears, Naughtiness, Depression, and Fits.” During World War II, celiac disease increased tremendously in Holland where malnutrition and psychological trauma were both severe. Furthermore, this disease is common in bottle-fed babies but does not occur in breast-fed infants until after they are put on inadequate diets.