Sprue- whew!: Celiac sufferers pooped

One of my friends said I write and talk about poop better than anyone else he knows. Is that a compliment or an insult? I learned in college there are three sacred things in life: eat, sleep, and poop.

Let's face it: our lives revolve around bowel movements. If you don't poop enough, you get cranky and feel gross. If you poop too much, it can be an inconvenience. Almost all my patients tell me if they have a poop problem– not "pooped" as in exhausted. So when is pooping too much a problem?

Celiac disease has been described since the 2nd Century from Cappadochia (now Turkey). (Cappadochia sounds like a coffee drink.) Celiac disease is often called gluten-sensitive enteropathy and nontropical sprue. (Nontropical sprue makes me think of a Christmas tree.) Sprue occurs mostly in white people of northern European decent: 1 in 250, which is almost as common as cystic fibrosis!

Sprue is a condition in which gluten causes inflammation of the small bowel which results in diarrhea. Did you just say, "Huh?"

Okay, first of all, gluten is the alcohol-soluble fraction of wheat protein. Gluten is found in wheat, barley, rye, and possibly oats, so if you're into bagels, you're "poopy out of luck." If you're Italian, Mama Mia! That's why when you go to specialty grocery stores, you see signs galore saying, "Gluten Free," "Gluten Doesn't Live Here," "I'm Telling You Girl, There Ain't No Gluten!"

In people with sprue, the immune system actually attacks the gliadin component of gluten and unfortunately damages the lining of the small intestine. This leads to malabsorption, which can make you look like Kate Moss in the '80s.

Sprue usually presents in childhood. Normal cereals become colon blow for these kids. However, for some, symptoms don't present until up to 40 years of age.

Because the small bowels are damaged in sprue, steatorrhea can occur– this is stinky, fatty, floating stools, like Lake Erie in the '70s before the fire. Flatulence (as proper Princess Diana might have said vs. "farting") is another problem. Because of the malabsorption, nutrient and vitamin deficiencies usually occur, which can lead to neurological disorders, fatigue, anemia, abnormal bones, liver problems, skin rashes, and Lord knows what else.

No bread, please! Even the spleen can die in sprue.

Many people actually present with neuropsychiatric problems like depression, anxiety, epilepsy, and movement disorders. (Maybe that explains why Elaine from Seinfeld danced so weird?)

In kids with uncontrolled sprue, growth failure can occur. For some people, even diabetes, thyroid disease, infertility, and collagen vascular diseases can result from undetected sprue. Worst-case scenario is development of gastrointestinal cancers, in particular lymphoma. This is one reason a gluten-free diet is so important for people with sprue.

Unfortunately, many people with sprue cheat on their diet. Pizza, toast, cake– yum, yum– oh, oh. Even some medicines have preservatives that contain gluten. A reader recently complained to me that her sister eats bread all the time but yells at her pharmacist if her medicine contains gluten. (I guess everyone needs one healthy rationalization a day.)

Believe it or not, the following foods contain gluten: mustard, nondairy creamer, peanut butter (my favorite!), bullion cubes, ice cream, cheese spreads, tomato sauce and ketchup, salad dressings, and even more! (Is there anything left to eat?)

So a dietician consult is mandatory, and support is essential. I cannot imagine what it must be like to live with sprue. It must be like that mythological character who, every time he reached for fruit on a tree, the wind blew away the branches, and every time he bent to drink from the river, the water level dropped.

Terrible. But it beats diarrhea.