Dr. Assmus on Managing Celiac Disease

Dr. Alison Assmus is a Kamloops based Naturopathic Physician who is knowledgeable in diagnosing, treating and managing celiac disease. Dr. Assmus works to develop a treatment plan that is individually tailored to each patient. If you would like to make an appointment to discuss treating and managing celiac disease, please call 250 377-3077. The Kamloops Naturopathic Clinic is now located at 754 Seymour Street, Kamloops BC.

Q: First, what is a naturopathic doctor and how do they differ from the traditional medical doctor?

A: Basically as naturopathic doctors we do similar education; we do eight years of post secondary education (four years a bachelor of science and four years of medical school). The medical schools that we do go to are naturopathic medical schools, not the conventional [medical schools] but we actually do the same sciences and use the same textbooks. We specialize in more natural therapies and the biggest difference with us is that we are so lucky we get to spend a lot of time with out patients trying to figure out the cause of what’s going on. So the main difference is that if we have time to figure out the cause versus treating people symptomatically.

Q: What can a naturopathic doctor offer to someone who has celiac disease?

A: It depends on how far along they are in their diagnosis. As naturopathic doctors we have full access to labs so we can actually see a patient in office and then diagnose them with celiac disease, so we do have access to all the different labs.

With a patient who has celiac disease, there are tons of different treatments. The first thing is to remove gluten from the diet, but not just go gluten-free; here are tons of hidden sources [of gluten]. When you eat something that you are allergic to it causes irritation or inflammation of the gut, you know if you banged your wrist it swells up and gets puffy? That is basically what is going on internally so that can predispose to other conditions like other food allergies, hormonal imbalance like hypothyroidism so instead of just seeing a patient and saying “you have celiac disease, this is the typical treatment.” You have to individualize the treatment plan; figure out any preexisting conditions and then there are certain things in specific like nutritional therapies like glutamine and probiotics, vitamin C which are known to actually rebuild the intestinal tract and can help to desensitize to the rest of the allergies. There are different herbs you can use to help protect the insides [of the gastrointestinal tract] and it depends on every patient. Some people with celiac disease don’t have any symptoms and some have a ton, so you’d have to manage the symptoms with other medications and natural therapies.

Q: Do naturopathic doctors have the means to diagnose celiac disease?

A: Yes! We do it with a blood test. The gold standard is to do it with a biopsy, but we don’t have access here to do a biopsy so we’d get the patient to go back to their MD. If a patient has celiac disease you are going to see it most likely in the serum, the blood draw, and we also do another set of blood draws for other allergies, and gluten is in that as well, so it’s another serological test.

Q: What sort of diet would you advise for someone recently diagnosed with celiac disease?

A: Definitely gluten free, there’s no getting over that. When a patient comes in and you tell them they can never eat wheat again, it’s really overwhelming, so our job is to go through and tell patients what gluten is in, and also give them other things that they can eat as an alternative. We really try to make the process as easy as possible. The good news is that there are tons of different places that cater to people with food allergies at the same time. Lots of times, people have coexisting food allergy conditions so we have to be able to diagnose that also and take those out of the system.

Q: What sorts of supplements to a gluten-free diet do you suggest a celiac take?

A: Supplement wise to help heal that gut inflammation, glutamine, probiotics and essential fatty acids are absolutely key. Those are the three top ones. The other supplements depend on a patient’s symptoms. Say someone has diarrhea, we have a herbal mix called Robert’s formula with demulcent herbs in it so we could give them that. It’s really tailored to the individual. Also, it’s not a supplement but we have another treatment plan that we are really excited about; it’s called low dose antigen therapy, basically it is a series of injections that a patient would do so you would do it once then take a two moth break, and what it does, is it helps to desensitize your system to food allergies by actually injecting a tiny bit under the skin surface, and it is so low-dose that it isn’t going to cause a huge flare-up of the immune system. They get your immune system able to tolerate it, and it has a specific enzyme in it called beta-glucuronidase so it is something that is really new to the clinic. It’s not going to take away celiac disease but it is going to reduce the symptoms, it’s going to decrease the severity of the inflammatory response and help to desensitize towards the other allergies that celiac patients can develop as well.

Q: Why do people that have celiac disease also commonly develop lactose intolerance?

A: Again it has to do with that gut again, so if you’re eating something on a regular basis you’re actually going to be causing that irritation of the gut, and so your system is really finicky. Not only have I seen lactose intolerance, I have seen a full-blown allergy to dairy, so that’s the biggest one. When we’re looking at the top three allergies in our society it would be gluten, dairy and eggs. Those are known to be hard for the body to be able to digest. If you think about it, we’re the only mammals that eat or drink another mammals milk products, so we’re don’t have the enzymes to break it down, so when you deal with the inflammation of the gut, it’s just not a good combination.

Q: Could a child affected by celiac disease be at risk for delayed growth if a diagnosis is made too late?

A: Not only in children, but also in adults we see a lot of malnourishment because again when you’re gut is inflamed you’re not going to be absorbing and assimilating a lot of your nutrients. So in adults for instance, vitamin B12 and Iron are ­­ones that might be deficient, and with children, they are definitely at risk of delayed growth if they’re not getting enough of the nutrients into the system because your body can’t absorb it as well as if you didn’t have that inflammation.

Q: How can you tell if a child has celiac disease?

A: It’s hard because with celiac disease, some are kind of asymptomatic and some are really symptomatic. It can be anything from digestive symptoms like constipation, gas, bloating, weight loss or weight gain, fatigue, things like unexplained anemia if someone has an iron deficiency and they’re not bleeding anywhere. So it can be a diversity of symptoms. Basically as naturopaths we sit down and we look at the whole symptom picture and we can figure it out from there. In children, behavior problems, fatigue, kids that look emaciated or who are not growing to the standard growth charts, those can be some red flags.

Q: In your opinion, does celiac disease often get misdiagnosed as other diseases such as IBS or Crones?

A: It’s interesting because with celiac disease, the prevalence of it is increasing, and it has to do with when you look at wheat in our society. There’s a really good book about it called the wheat belly, the actual form of the gluten that is in our diet is different than what it used to be and a lot of people can’t tolerate it. Also, gluten in terms of the prevalence, if you look at the label, the amount of things that contain gluten is astronomical. Before that might not have necessarily have been that big of an issue. With the increase of gluten as a thickening agent, it makes everything look nice and appealing. Loaves of bread look really appealing to eat so its increasing prevalence in terms of our society and it’s a matter of shifting that perspective and noticing that there is increase in gluten so we have to do some further screening for that.

Q: What are some ways other than gastrointestinal upset that celiac disease may manifest?

A: Some patients don’t have any symptoms and some have really extreme symptoms. The digestive stuff, a lot of times it can cause an inability to cope with stress because you body is stressed on a daily basis just fighting the celiac disease, so mood is huge predictor, and it can be something like infertility, missed menstrual periods, delayed growth. There are quite an abundance of conditions that it can predispose to. Or skin stuff as well; when your body is not functioning well, your body can actually dump the toxins through the skin. This can result in things like eczema, psoriasis and dermatitis. There’s a huge symptom profile that it can be.

Q: What treatments are available at the Kamloops Naturopathic Clinic?

A: If you think about it when you’re not absorbing through your gastro intestinal tract, you want to make sure you’re getting the nutrients into someone really quickly. We do lots of intravenous therapies that have things like all of your B vitamins, vitamin C, all your multi-trace minerals so that you’re not taking it through your mouth and it can bypass digestion and go directly into the system. So there’s tons of different treatments and as naturopaths we don’t treat the condition in specific, we treat the individual so we have to look at everything that is manifesting and treat accordingly.

Q: How long could it theoretically take for a celiac’s intestines to heal?

A: It can take a while. It’s hard to give an exact parameter, it can take years but I would say usually in terms of symptom management we can get symptom relief quite quickly.

There are three stages of gluten allergy. There’s celiac disease when your system is going crazy and attacking itself, there’s the sensitivity which a lot of people have and there is actually different antibodies present. We do a screening, that other blood draw I was talking about, it screens for IgE and IgG so that’s an actual allergy but it’s not as full blown as celiac disease. It’s really crazy in terms of people in our society who aren’t even allergic to it, even taking it out, the biggest thing cleared up is the brain fog. Looking at the increased prevalence of ADHD, you can get really great success screening for food allergies, like I said gluten, dairy and eggs are the three components that affect behavior in kids.

Q: How do naturopathic physicians work in conjunction with medical doctors?

A: It seems to be that the perspectives with the medical doctors are shifting, and a lot of doctors in town are referring patients to us for food allergy tests. If you screen for celiac disease and it comes back negative, there are other food allergies that we can see and it’s just not full blown celiac, but still an actual allergy to gluten. There are lots of Medical Doctors in town now that are sending us patients because we get really good results for food allergies. It’s really good to be able to have a team effort when we’re looking at things like this.

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