A DISEASE CALLED SPRUE.
WHAT DO YOU MEAN I CAN’T EAT WHEAT?

     A gentleman recently came to the clinic with a history of weight loss and diarrhea that had been going on for months.  He was a physically large, husky man who indicated that he once weighed 210 lbs.  His weight had now dropped to 175 lbs over the past year.  He said that initially he was not worried about his weight loss but he was very worried about the diarrhea amounting to 10 to 15 stools per day.  This resulted in marked soreness around his anal area.  He said that he was weak and fatigued much too easily compared to what he used to be able to do.  He just did not feel good.  He indicated that he was very hungry and ate a lot of food. He took no medications on a chronic basis.  He had no previous surgeries and he was not having fever.  He had no history of bleeding from his bowels.  He described his stools as large in amount, much too frequent, sometimes incontinent and associated with a great deal of very foul gas.

     Several tests were done demonstrating that he simply was not absorbing his food in a normal way.  A series of blood tests and x-rays were done.  This specific examination that led to a diagnosis was called an “anti-gluten antibody test”.  This was very positive and allowed for the specific diagnosis that he had “sprue”.

     When I told him the diagnosis, he winced.  He said that it sounded terrible.  He didn’t even like the name but he did want to know what it was.  I explained to him that he was allergic to wheat.  He said that he was a wheat farmer and had been raising it all of his life.  To stop eating wheat seemed almost South Dakotan unpatriotic.  Did this mean that he had to stop raising wheat?  I explained that he wouldn’t have to give up raising wheat but he would have to give up eating it.  His bowel had become allergic to a part of the wheat grain.  I indicated to him that this was going to be a difficult task because our society is permeated with wheat products in so many different foods.  Only a small amount of wheat getting into his system would be enough to propagate the problem.  He had to virtually remove all wheat from his diet.

     I explained to him that this disease has been known for many years.  We know now that it is a disease permitted by hereditary factors especially those of Northern European ancestry.  The name sprue comes from the Dutch word “spruw” which means mouth blisters.  It was named by a Dutch physician in the 1600’s to describe mouth sores that occurred in young children with sprue.

     The cause of the disease was unknown for many years until World War II.  At that time, there was massive malnutrition in Holland and the population ate primarily potatoes and home grown vegetables but had very little wheat or bread.  Children who had had sprue with marked diarrhea prior to World War II went into remission, gained weight, and felt much better during the time of famine.  At the end of World War II when bread was reintroduced to the population, these children became sick again.  Further research demonstrated that the culprit agent was a protein called “gluten” which is very rich in wheat.  It was later discovered that the basic problem was an allergy to the wheat protein gluten.  A person with sprue develops a severe allergic reaction to gluten in the bowel. This allergic reaction prevents normal absorption of everything that they eat.  The result is the weight loss and diarrhea described in the gentleman above.

     As you might imagine, trying to explain all of this to a person who has never heard it before leads to a lot of incredulous looks.  But I assured him of the information and the diagnosis.  Then came the hard part.

     The hard part is getting all of the wheat out of a person’s diet.  This is very difficult. Trying to cook with rice or corn in place of wheat leads to an entirely different kind of diet.  Of the several people I have cared for with this disease, each came in after the first 3-4 weeks explaining that they didn’t believe a word I said.  They felt that getting the wheat out of their diet hadn’t done them a bit of good.  In each case, I had to explain that they thought they had the wheat out of their diet,  The truth was that wheat products were creeping in through everything from salad dressing to gravy and to virtually anything a person buys in the usual restaurant.  With a renewed effort, finally the wheat can be excluded from the person’s diet and the diarrhea problem goes away.  Finally, creditability is established.

     The gentleman above was very difficult to convince.  He did eventually get the diarrhea to stop, he gained some weight and felt much better.  But like every single person I have seen with this disease, he had to test it.  He began to slack off on his diet and then one day tried eating a whole sandwich with white store bought bread.  The diarrhea again recurred and lasted almost a week before it finally stopped when he got back to the gluten-free diet.  He now believes the story above and is just very unhappy about his fate.  He complained that he always took good care of himself and didn’t do a thing to earn this condition but here it was.  With empathy, it was explained to him that nature does deal out very bad things to good people who did nothing to earn those bad things.  But it would be in his interest to muscle under and abide the dietary restrictions this disease requires.  I cannot ever imagine where the idea that “life is fair” came from.