Tag Archives: Disorder

Baked cake.

What is gluten intolerance, and what are its symptoms?

Gluten is a protein naturally found in cereals such as wheat, barley, and rye. Harmless for most of us, gluten can cause quite a lot of headache (and bellyaches, among other things) for certain people. Today, we’ll take a look at the different kinds of gluten intolerance and the symptoms they can cause.

Baked cake.

Gluten makes dough elastic, knead-able, and bouncy. You can see how it works in this cake, keeping those stringy bits in the middle from breaking.
Image credits Andreas Lischka.

Wheat (genus Triticum) makes the world go round. Not literally, but it does play a big role in keeping us humans fueled up. It was one of the first domesticated food crops, and for roughly 8 millennia now, wheat has been the staple food of major civilizations in Europe, North Africa, and West Asia. More land area is dedicated to growing wheat than any other commercial crop on Earth, and global production of wheat outstrips that of any other crop — including rice, maize, and potatoes.

Barley (Hordeum vulgare) is another long-time companion of human farmers. First cultivated around 10,000 years ago, it was the fourth most-produced grain in the world in 2016, although output has somewhat declined since then. Barley is very useful as an animal feed but is perhaps most celebrated for its role in beer and distilled beverage production.

Both of these cereals, along with rye, their related species, and various hybrids, are part of the grass (Poacea) family of plants. Altogether, they supply a huge part of the calories and nutrients consumed by us and our livestock. They also supply the majority of raw materials used in producing alcohol.

Apart from their economic importance, these crops are also notable for their high content of gluten and gluten-like proteins. This is a bit of a bummer for around 1.5% to 14% of the world’s population, who have to contend with various forms of gluten intolerance.

What is gluten intolerance

Gluten intolerance is a somewhat-umbrella term that refers to adverse reactions to gluten. I say ‘somewhat-umbrella’ because it tends to be improperly applied to several conditions that — while similar in effects — are different in origin. These include celiac disease (CD), non-celiac gluten sensitivity (NCGS), wheat allergy, dermatitis herpetiformis, and (more rarely) gluten ataxia.

The most extreme form of gluten intolerance is celiac disease (also known as gluten-sensitive enteropathy, sprue, or coeliac). Roughly 1 in 100 Americans contend with CD, and this percentage seems to hold true for the rest of the world as well. CD is basically an autoimmune disorder. The body of a CD patient reacts with extreme violence to the presence of gluten in one’s food — to the point where their immune system will attack the inner lining of the small intestine to ‘protect it’ from gluten. Such offensives cause immediate symptoms for the patient. If exposure to gluten is maintained over a longer period of time, sustained damage to the gut’s lining leads to problems in absorbing nutrients (malabsorption).

Celiac disease gut lining.

High-magnification image of intestinal lining damaged by celiac disease.
Image credits Nephron / Wikimedia.

Non-celiac gluten sensitivity is more controversial. We don’t know, really, what causes this condition (or if it’s even an actual thing). Our best guess is that it has something to do with gluten-associated proteins and/or other chemical compounds present in gluten-containing crops. Since we don’t know what causes it and how, NCGS is generally diagnosed by eliminating other possibilities (namely CD and wheat allergies). Roughly 0.5% to 13% of the world’s population has NCGS. While its exact symptoms are debated, NCGS seems to share most gastrointestinal symptoms of CD, wheat allergies, and irritable bowel syndrome, but with a different interval between exposure and onset of symptoms. NCGS also seems to entail a host of extraintestinal (not related to the gut) symptoms that CD lacks.

Wheat allergy is your run-of-the-mill allergy, but rather misleadingly-named. Like other allergies, it can manifest as a food- or contact-allergy. Unlike other allergies, it can be caused by a range of compounds (rather than a particular allergen) contained in wheat. The European Center for Allergy Research Foundation (ECARF) states that “wheat allergy generally appears in infancy,” noting that roughly 0.3% of European children under the age of 5 and around 0.1% of all Europeans are allergic to wheat, making it a relatively rare condition.

Dermatitis herpetiformis (DH), or Duhring-Brocq disease, is a tell-tale sign of celiac disease, although the exact mechanism by which one causes the other remains unknown. The condition is a skin inflammation characterized by chronic rashes on the skin with red, liquid-filled blisters. They’re also very itchy. Estimates of DH prevalence range from 10 in 100,000 to around 80 in 10,000 individuals.

Gluten ataxia is a proposed condition. It’s basically gluten-induced ataxia, a condition characterized by dysfunctions in the central nervous system leading to loss of voluntary control or coordination over muscle movements. Gluten ataxia “usually presents with gait and lower limb ataxia” and may account for “15% amongst all [cases of] ataxias and 40% of all idiopathic sporadic ataxias,” according to a study published in 2015.

It’s important to note that there are several varieties of gluten intolerance going forward. Each has its own particularities of symptoms. However, there are some general symptoms that are indicative of such disorders.

Symptoms of gluten intolerance

Abdominal pain.

Most of them have to do with your belly. But not all of them.
Image credits Darko Djurin.

Abdominal pain after ingesting gluten — from grains and derived products such as flours, bread, baked goods, or beer — is the most common symptom of gluten intolerance at large. Up to 83% of those with gluten intolerance experience abdominal pain and discomfort after eating gluten.

Abdominal bloating is a close second. It’s a sensation of ‘swollenness’ or ‘fullness’ in one’s belly, caused by the release of gases in the gut. Generally uncomfortable, abdominal bloating can become painful and/or cause shortness of breath. Around 87% of people suspected to have NCGS experience bloating, but a majority of CD patients also report this symptom.

Bowel inflammation after consuming gluten is a common symptom of celiac disease. Damage of the gut lining causes inflammation resulting in significant digestive discomfort. In the long run, it can also lead to poor nutrient absorption.

Over 50% of gluten-sensitive individuals (both CD and NCGS) regularly experience digestive symptoms such as diarrhea, while about 25% experience constipation. Patients also report alternating between the two states. Celiac disease patients may also experience pale and foul-smelling feces (due to nutrients left over in the stool).

Tiredness after consuming gluten can also be a symptom. This is a bit trickier to diagnose, as life by itself tends to be quite tiresome. However, if you regularly (or constantly) feel fatigue and tiredness, especially after eating foods that contain gluten, it could be indicative of underlying gluten intolerance. Around 60% to 82% of gluten-intolerant individuals commonly experience tiredness and fatigue. Gluten intolerance can also cause iron-deficiency anemia, which in turn will make you feel tired and spent overall.

Dermatitis herpetiformis, as we’ve seen above, is a pretty dead giveaway for celiac disease. Other skin conditions — psoriasis, alopecia areata, and chronic urticaria — have also shown improvement under gluten-free diets, which suggests a link between them and gluten intolerance.

Gluten intolerance may also predispose individuals to depression and anxiety, especially those suffering from CD. While the mechanism underlying this link remains unknown, it has been proposed that changes in gut flora and exorphins formed during gluten digestion may interfere with serotonin levels in the brain. It also seems that switching to a gluten-free diet makes some patients “feel better” even if their gastrointestinal symptoms persist; all of which suggests a link between the two.

What to do about it

Brad and grains.

TL;DR don’t put these things in your mouth.
Image credits National Cancer Institute / National Institutes of Health.

The best course of action is to go talk to a doctor. But there are some preventive measures you can take if you think you’re suffering from gluten intolerance.

Unsurprisingly, you should avoid items that contain gluten — wheat, barley, malt, rye, and their derived products (brewer’s yeast can also contain gluten, for example). Some common foods and drinks that contain gluten include:

  • pasta, noodles
  • bread, pastries, baked goods such as crackers, biscuits, and cakes
  • breakfast cereals
  • pancakes, waffles, crepes
  • many sauces and gravies use flour-derived gluten as thickening agents
  • beers, malt beverages
  • potatoes, maize, and rice can also become contaminated with gluten in facilities that also process gluten-rich grains

Gluten-free varieties of such items are commercially available, although they tend to be more pricey. So it’s possible to enjoy them without worrying about gluten. But, as a rule of thumb, if you suspect a food item contains or has been in contact with wheat, barley, rye, malt, or products derived from those (and you believe you might be suffering from gluten intolerance), don’t eat it.

Now, I think it’s important to note that there’s also somewhat of a witch hunt among fad diets regarding gluten. Many such diets suggest gluten itself is bad for your health even if you’re not gluten-intolerant. There’s no credible scientific evidence for such claims that I could find, so I’m comfortable calling it a myth. Another part of the issue is that the symptoms of gluten intolerance are widespread and can have a lot of different potential causes — which makes gluten intolerance easy to misdiagnose.

All in all, if you believe you might be suffering from gluten intolerance, the best course of action is to go talk to a doctor.

On oats

In response to numerous queries concerning the use of oats in various products, the North American Society for the Study of Celiac Disease (NASSCD) released a statement saying that “the use of oats uncontaminated by wheat, barley or rye by individuals with celiac disease and dermatitis herpetiformis in North America has been endorsed by most experts.” However, they also note that “regular (commodity) oats in North America are likely to be contaminated with wheat and barley,” and recommend consulting a doctor or dietitian before including oats in gluten-free diets, as well as monitoring after inclusion.

There is some evidence that avenin, an oat protein similar in form and function to gluten, “can activate gluten-reactive T cells”, the Celiac Disease Foundation reports citing a 2015 study. A different study, published in 2017, reported that avenin “can cause small bowel mucosal damage in some people with coeliac disease.” While the first paper concludes that “low-level oats consumption may be insufficient for clinical relapse in CD patients,” the second one does not recommend including this cereal in gluten-free diets.

It has to be noted, however, that the second study was performed in Australia, and differences in labeling requirements may confuse results to an extent. The NASSCD, for example, specifies that “oats used in labeled gluten-free foods may now include mechanically/optically-sorted oats, a process which separates oats from wheat, barley and rye by color, size, and shape. These methods are used to produce “clean” gluten-free oats.” The first study also suggests that certain types of oats may induce CD symptoms in patients while others do not.

“Inclusion of oats in a gluten-free diet might be valuable due to their nutritional and health benefits, and several countries currently permit oats to be included as an ingredient in such diets,” it explains.

“However, it is extremely important to remember that in vitro studies have shown that the immunogenicity of oats varies depending on the cultivar used. Future clinical studies should be directed to the development of clinical trials with varieties previously identified as safe by reliable in vitro methods”

If you’re intolerant to gluten, play it safe. Look for the “gluten-free” label, or talk to a doctor to decide if oats are right for you.

Bee.

Researchers want to vaccinate bees so we don’t run out of food

The world’s first bee-protecting vaccine raises new hope of saving these vital pollinators and preventing a global food crisis.

Bee.

Image via Pixabay.

Finnish researchers want to push back against colony collapse disorder (CCD) by giving our buzzing friends tiny little vaccines. The Helsinki University team hopes their work will help tackle the dramatic decline bees have seen in the last few years. Even if only a few percent of their overall population is kept alive by the vaccine, the team will have “saved the world a little bit,” they say.

Vacbeens

“If we can save even a small part of the bee population with this invention, I think we have done our good deed and saved the world a little bit,” said lead researcher Dalial Freitak for AFP.

“Even a two-to-three percent increase in the bee population would be humongous.”

Bees are, quite simply, the unsung heroes of farms everywhere. Our agriculture heavily relies on the work these animals provide for free — bees are directly involved in the pollination of three-quarters of the world. However, we don’t take particularly good care of them. In recent years, bee populations everywhere have been dying off from “colony collapse disorder“. This disorder is poorly understood and seems to be the work of mites, pesticides, virus, fungus, or some combination of these factors — however, no explanation has managed to impose itself thus far.

What we do know about CCD is that it is extremely deadly to bees as a species. Worker bees in a CCD-stricken hive will simply up and leave, abandoning the queen, the honey, the eggs, and a few nurse bees. The disorder is known to affect both feral and kept bees and is particularly troubling for the fact that those abandoned honey stashes are usually not robbed by other bees for a long time.

But the problem is best viewed in context. While the bees themselves are a key pollinating species, they’re not the only one — but all pollinators are struggling to cope with us. A UN-led 2016 study found that over 40% of invertebrate pollinators, particularly bees and butterflies, are facing extinction (with CCD as a leading cause). The study also found that 16.5% of vertebrate pollinators, such as birds and bats, are under threat. Diseases just one of a number of reasons for the loss of pollinators. Pesticide use and intensive farming, which reduces the diversity of insects’ nutrition, are also weakening pollinators

We rely on these species to put food on our table. That’s why the team decided to try and heal the bees.

Their vaccine works pretty much like human ones: it gives bees resistance to severe microbial diseases that can be fatal for whole communities. Where it differs is in how it’s administered: insects don’t really produce antibodies like we do (and on which human-use vaccines rely).

However, previous research by lead researcher Dalial Freitak found that feeding certain bacteria to moths will allow them to pass immunity to their offspring. They could quite literally eat their way to resistance against disease. However, the underlying mechanism was unclear, and Freitak worked with co-author Heli Salmela to get to the bottom of it.

“I met with Heli Salmela, who was working on honey bees and a protein called vitellogenin. I heard her talk and I was like, ‘OK, I could make a bet that it is your protein that takes my signal from one generation to another’.”

The two collaborated and developed a vaccine against American foulbrood, a vicious bee bacterial disease spread around the globe. The treatment is administered to the queen bee via a sugar lump. The queen then passes the immunity to her offspring, spreading it through the bee community.

The team is also working on making these vaccines commercially available. While feedback has been “very positive”, Freitak admits that the process is very slow and cites four to five years to market as “an optimistic estimate”.

Hopefully, their efforts will bear fruit. If they do manage to get this vaccine out in meaningful numbers, the team is confident that protection against disease will make pollinator species stronger, and therefore better able to withstand other threats.

Alarming number of children and teens suffer from mental health issues, British survey concludes

About 1 in 8 of 5- to 19-year-olds suffer from some form of mental disorder, a new survey conducted in the UK concludes. The situation is particularly concerning for young girls.

Credits: NHS.

The survey was carried out on 9,000 young people by the National Health Service (NHS) — the public health services in the United Kingdom. Similar surveys were carried out in 1999, 2004, and 2017, with slight age group variations.

Unlike most surveys of the type, which rely on simple questionnaires or shallow assessments, this survey used a detailed and thorough methodology, involving clinically-trained physicians who followed the International Classification of Disease (ICD-10) diagnostic criteria.

The mental disorders were split into our broad categories: emotional, behavioral, hyperactivity and other less common disorders. Emotional disorders were by far the most common type of disorder, but there are significant variations with age. There was also a major variation by gender — at the youngest age groups (5-10 age group), boys were twice as likely to suffer from some disorder, whereas in the 17-19 age group, a whopping 22% of girls suffered from a disorder, compared to just over 10% for boys. This type of information can help introduce preventive policy at the most vulnerable groups, officials say.

Credits: NHS.

Rates of mental disorders increased with age: 5.5% of 2 to 4-year-old children experienced a mental disorder, compared to 16.9% of 17 to 19-year-olds. However, since the data acquisition methodology was also different between age groups, the different age groups should probably be treated separately.

Credits: NHS.

However, all age groups experienced a significant increase over time. The prevalence of mental disorders in the 5-15-year-old group (which was analyzed in all surveys in this series) rose from 9.7% in 1999 to 10.1% in 2004, to 11.2% in 2017. The reasons for this growth are not clear, but as always, the social and family context is probably the most important factor.

The rate of children with a mental disorder in a healthy, functional family is much lower than that of kids in a dysfunctional family. Tamsin Ford, one of the report co-authors, said that “a variety of family adversities” can be a part of the explanation, though many factors outside the family life can also be important.

Credits: NHS.

Aside from the usual suspects (drinking alcohol and smoking in teenagers, or the autistic spectrum, for instance), social media is a topic of growing interest — and growing concern.

For instance, the survey revealed that 29.4% of kids aged 11 to 19 with a mental disorder spent more than four hours a day on social media — compared to just 12% of those displaying no symptoms. However, it’s not clear if there is a cause-effect relationship or even a significant association there.

We need to better understand the causes and effects of the disorders, researchers urge. Over 1 in 4 teens aged 11-16 reported self-harm or a suicide attempt, and the long-term effects are presumably even more insidious and dangerous.

Gameboy.

The WHO includes gaming disorder in the International Classification of Diseases

The World Health Organization (WHO) will include “gaming disorder” as a new mental health condition in the 11th edition of the International Classification of Diseases (ICD), released earlier today.

Gameboy.

Image credits JD Hancock / Flickr.

The ICD is the end-all-be-all authority for doctors who are issuing a diagnostics. This document defines all known diseases, disorders, injuries, and related health conditions. It’s also the standard researchers use to quantify deaths, diseases, injuries, and symptoms. The document also affects us laymen — healthcare companies and insurers use the ICD as a basis for reimbursement.

Now, the WHO wants to include ‘gaming disorder‘ in the new edition of the ICD. This official recognition of the condition will raise awareness among doctors and healthcare networks, as well as improving the odds that “people who suffer from these conditions [will] get appropriate help.”

Disorderly gaming

Dr. Vladimir Poznyak, a member of WHO’s Department of Mental Health and Substance Abuse, which proposed the new diagnosis to WHO’s decision-making body, said diagnosing gaming disorder comes down to three major features:

  • Gaming behavior that takes precedence over other activities. The extent of this behavior is such that all other activity is pushed to “the periphery.”
  • The second feature is an “impaired control of these behaviors.” In other words, even if a person suffering from gaming disorder experiences negative consequences from gaming, he is unable to change his behavior. Gaming continues unabated or even escalates. To establish a diagnosis for gaming disorder, a “persistent or recurrent” behavior pattern of “sufficient severity” needs to emerge.
  • Finally, this behavior needs to lead to significant distress and impairment in somebody’s personal life, family dynamics, social relationships or occupational functioning. The impacts of gaming disorder may include “disturbed sleep patterns, like diet problems, like a deficiency in the physical activity,” Poznyak adds.

All in all, these characteristics are very similar to what you’d use to determine similar addiction-related behaviors, such as substance use disorder or gambling disorder. As is the case with these more veteran disorders in the ICD, a diagnosis of gaming disorder can only be applied after negative behavioral patterns have persisted for at least 12 months.

“It cannot be just an episode of few hours or few days,” Poznyak said. “Millions of gamers around the world, even when it comes to the intense gaming, would never qualify as people suffering from gaming disorder,” Poznyak said, adding that the overall prevalence of this condition is “very low.”

However, he also notes that exceptions to the 12-month rule can be made if enough criteria are met and the symptoms are severe.

“And let me emphasize that this is a clinical condition, and clinical diagnosis can be made only by health professionals which are properly trained to do that,” he adds.

As far as insurance coverage goes, that’s still up to authorities — the ICD has no power over those decisions. However, by officially recognizing gaming disorder, the document paves the way for prevention and treatment options that “can help people to alleviate their suffering.” Poznyak adds that most treatments for gaming disorder are “based on the principles and methods of cognitive behavioral therapy,” and social as well as family support is very important in helping patients overcome the disorder.

Still, there is a lot we don’t yet understand about gaming disorder. While widely hailed as a good addition to the ICD, doctors also have some reservations — mostly that there is still relatively little research into this disorder. Some propose that it’s merely a coping mechanism for people struggling with anxiety or depression. We just don’t know yet.

The WHO hopes its inclusion in the ICD will stimulate debate as well as further research and international collaboration.

Mega-analysis proves ADHD is a real disorder caused by differences in brain structure

The largest brain-imaging study of ADHD to date identified differences in five areas of the brain that can be traced to the disorder. Furthermore, these differences were most pronounced in children rather than adults. The findings support ADHD’s recognition as a brain disorder.

Image credits Bob / Flickr.

Attention-deficit hyperactivity disorder (ADHD) symptoms include inattention, hyperactivity, and acting impulsively. The CDC estimates that this disorder affects roughly 5% of under-18-year-olds (although the exact figure is likely higher) and two-thirds of those diagnosed continue to experience symptoms as adults. But it often gets a bad rep as a smokescreen to hide difficult children or poor parenting, as a make-believe condition to excuse one’s behavior. Part of the problem stems from the fact that while investigations into the disorder have managed to link abnormalities in brain volume to ADHD, they’ve generally been performed on small samples — making some people refute their conclusions.

Now, the largest study to date of ADHD looked at the brain of more than 3,200 people to come up with clear, solid data on the condition. The authors say their findings further our understanding of ADHD and should offer solid footing for anyone who has to prove the validity of the disorder.

It’s all in the brain

The international study measured the differences in brain structure seen in 1,713 people diagnosed with ADHD and 1,529 who weren’t, between the ages of 4 and 63 years old. They each had an MRI scan performed to determine the overall brain volume and the size of seven areas previously linked to ADHD — the pallidum, thalamus, caudate nucleus, putamen, nucleus accumbens, amygdala, and hippocampus. The team also noted if those with ADHD had ever taken psychostimulant medication such as Ritalin.

They report that overall brain volume and five of the regional volumes were smaller in people with ADHD — the caudate nucleus, putamen, nucleus accumbens, amygdala, and hippocampus.

“These differences are very small — in the range of a few percent — so the unprecedented size of our study was crucial to help identify these. Similar differences in brain volume are also seen in other psychiatric disorders, especially major depressive disorder.” said lead author Dr Martine Hoogman from the Radboud University Medical Center, Nijmegen, The Netherlands.

Small differences can stand out in a big way,
Image via Pixabay

These differences were most obvious in the brains of children but were harder to pick out in the brains of adults (in both cases, diagnosed with ADHD.) The team proposes that ADHD is a brain disorder caused by delayed development in several brain regions. Beyond the caudate nucleus and putamen — which were linked by previous studies to the disorder — the team also showed that the amygdala, nucleus accumbens, and hippocampus play a part in the onset of ADHD.

They believe that the slower development of the amygdala can explain the difficulty ADHD patients have in regulating their emotions, while that of the nucleus accumbens — which plays an important part in reward processing — explains their motivational and emotional difficulties. The hippocampus’ role in the disorder might act through its involvement in motivation and emotion.

“The results from our study confirm that people with ADHD have differences in their brain structure and therefore suggest that ADHD is a disorder of the brain,” added Dr Hoogman.

“We hope that this will help to reduce stigma that ADHD is ‘just a label’ for difficult children or caused by poor parenting. This is definitely not the case, and we hope that this work will contribute to a better understanding of the disorder.”

At the time the MRI scans were taken, 455 people with ADHD were receiving psychostimulant medication and a further 637 had taken it at one point in their life. The five brain regions showed different volumes regardless of the fact that people had received this treatment or not, suggesting the differences in brain volumes are not a result of psychostimulants.

Still, while this study addressed the main critiques of previous work and established a strong link between ADHD and brain development, it cannot determine how the disorder develops throughout life. Studies tracking people with ADHD from childhood to adulthood to see how brain differences change over time will be an important next step in the research.

The full paper “Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis” has been published in the journal Lancet Psychiatry.