Implications of Diarrhea In Person With celiac disease on gluten-free Diet

[plumbago]

If after having been gluten-free for several years, you get D after ingesting gluten, does that mean you have an unhealed gut? In other words, what is the pathogenesis of the D reaction in celiac disease – or better put: is D only a symptom of celiac disease when the villi are flattened? If true, that means after 6 years of being 99.5% compliant, my villi still are not healed!!!???

As Peter Greene says, “The system’s first line of defense is an intact mucosa [small intestines].”

Plumbago

[GFinDC]

1 hour ago, plumbago said:

If after having been gluten-free for several years, you get D after ingesting gluten, does that mean you have an unhealed gut? In other words, what is the pathogenesis of the D reaction in celiac disease – or better put: is D only a symptom of celiac disease when the villi are flattened? If true, that means after 6 years of being 99.5% compliant, my villi still are not healed!!!???

As Peter Greene says, “The system’s first line of defense is an intact mucosa [small intestines].”

 

Plumbago

Hi plumbago,

No, D is not a symptoms only associated with severe celiac disease damage, if that's what you are thinking.  Every time we ingest gluten the immune reaction is kicked off again, and the damage starts all over.  If we ingest gluten daily, the immune reaction never stops, and we end up  with significant damage.  If we stop eating gluten, the immune reaction will decrease over time, and the damage will decrease also.  Healing will also happen as well.

The moral of the story is Stop Eating Gluten!

[plumbago]

Thank you for responding. Yes, I understand not to eat gluten.

I suppose, I wasn’t clear. I understand that there are reasons for D other than celiac disease. What I am asking is, within the context of celiac disease, is there another reason apart from villi blunting for D? My suspicion is there is not. In which case, if, after being gluten-free for six years, I get D when I accidentally ingest gluten, it is likely a sign that my SI/duodenum has not healed, which would be a major bummer. That’s basically the gyst of and background for my question.

[GFinDC]

On 10/22/2016 at 4:25 PM, plumbago said:

Thank you for responding. Yes, I understand not to eat gluten.

I suppose, I wasn’t clear. I understand that there are reasons for D other than celiac disease. What I am asking is, within the context of celiac disease, is there another reason apart from villi blunting for D? My suspicion is there is not. In which case, if, after being gluten-free for six years, I get D when I accidentally ingest gluten, it is likely a sign that my SI/duodenum has not healed, which would be a major bummer. That’s basically the gyst of and background for my question.

Hmm, we may be talking in circles a bit.  My take on your words in red is that you think having D when glutened 1) means you your villi never healed even though you were gluten-free for years?  Or do you mean, 2) your villi healed, and you ate gluten, and then the new damage from the recent glutening caused villi damage and D?

#2 gets my vote.  Anytime we ingest gluten the immune system kicks in and starts "protecting" us.  That protection includes attacking and damaging the gut llning where the nasty gluten is hiding.  That can cause D.  The D doesn't mean you never healed, but that you got new, recent damage.  The celiac disease reaction is not forgotten by the immune system.  The immune system always knows how to fight the gluten threat.  But our bodies do know how to heal also.  Our guts are continually rebuilding the gut lining even in non-celiacs.  The gut takes a lot of damage from just plain digesting food.  Add in the immune system attack the healing process can get left behind  in the dust.

[cyclinglady]

There really aren't many studies done that follow Celiacs and their levels of healing.  Here is an article about a study that I once saw (but can not locate at the moment):

Open Original Shared Link

As far as diarrhea, being a sign of damaged villi, I can only speak for myself.  I had flattened villi (patches) and I had no diarrhea, but only anemia (little did I know of the bone damage).  I have had follow-up blood work, but no biopsies.  Healed or not my symptoms improve by maintaining a gluten-free diet. 

[RMJ]

I think this is the journal article:

Open Original Shared Link

[plumbago]

Yes, GFinDC you've got the gyst of what I am after. If I am reading your response correctly then, you think that inflammation in the gut caused by gluten ingestion is enough to trigger diarrhea, quite apart from the state of one's mucosa? That would be good news for me. More information on this inflammation reaction in the gut with gluten ingestion is precisely what I am after, but cannot seem to find. Because, as stated, as far as I know, D is mostly if not only, caused by flattened villi.

OTOH, how interesting to hear from you, cycling lady, that you had flattened villi and no D!

RMI, the link is quite depressing. Many appear not to have healed mucosas after a gluten-free diet. A repeat endoscopy is what is so clearly needed by many of us, but honestly I am a little wary of the risks.

[plumbago]

UPDATE: 

So as I have said, I was worried that my occasional D was indicative of an unhealed gut/small intestine/duodenum. I thought and thought about this. If my gut were really unhealed, wouldn’t I be having a lot more that occasional diarrhea?  I think I would be.

So now I’m thinking that the diarrhea may be a result of IBS. Here's why: it seems the more I’m sitting at home, ie on the weekends, sitting and eating, the greater the frequency of stools, and the fattier they get with each BM. Whereas, during the weak, I eat (less), get up and go to work, don’t eat as much while I am at work and don’t have BMs, and if I do, they are not fatty - and I do not have D. All of which is to say that I think it's possible that the fattiness is caused by the increased transit time of IBS, leading to more water in the stool,  less time for the fat and water to be absorbed.

Now, what is causing the IBS? (First of all, the medical line is, no one knows.) I am fairly certain I am not getting glutened. However, on the weekends, I will eat a high fiber, high protein meal followed by hours of sitting, consuming coffee with milk and sugar. I think the problem or the issue lies in what I am consuming. I tend to think the culprit is the milk. (The coffee is not always caffeinated.) 

 

Edit to add: Now I'm reading that most floating stools are not caused by an increased fat content - not to say the floating stool is free of fat, but from what I'm reading, the cause for floating is gas.

 

"Most floating stools are not caused by an increase in the fat content of the stool. However, in some conditions such as chronic pancreatitis, the fat content is increased." Open Original Shared Link