SUMMARY

Celiac disease and lactose intolerance are two multifactorial gastroenterologic diseases: genetic, immunologic and environmental. Evolutive medicine's explanations brings of their occurrence among different populations and environmental facts precise why they occur among homogenous group of people. Homeopathy, by taking into account the huge amount of sodium in our nutrition can add its explanations and its remedies.

Gluten intolerance and lactase deficiency are two diseases, which are usually associated in the textbooks of gastroenterology, first because they are due to two basic foods: bread and milk, secondly because they have in common signs of malabsorption, and finally because they have the same pathologic signs in the intestinal mucosa.

I looked for more similarities between these two entities: first these two diseases are often associated, the patients suffering from celiac disease have frequently a lactose intolerance, secondly from an homeopathic point of view I was impressed by the fact that the remedies of these two diseases are frequently similar, finally because in the light of evolution cow milk and wheat gluten appeared late in human alimentation.

Key words: celiac disease, lactose intolerance, homeopathy

Let's take the third point: the evolutionary view of human alimentation in general and of gluten and milk in particular. Few words about t evolutionary medicine: the enterprise of studying medical problems in an evolutionary context has been termed Darwinian medicine. Most medical research tries to explain the causes of an individual disease and seek therapies to cure or relieve deleterious conditions with the help of physiology, biochemistry and other medical sciences. In contrast, Darwinian medicine asks why the body is designed in that way, thus offering a broader context in which to conduct researches (1).

The evolutionary explanations for the body's flaws fall into surprisingly few categories. First, some discomforting conditions such as pain, fever, cough, vomiting and anxiety are actually neither diseases nor design defects but rather are evolved defenses. For instance, morning sickness has long been considered an unfortunate side effect of pregnancy. The nausea, however, coincides with the period of rapid tissue differentiation of the fetus, when development is most vulnerable to interferences by toxins. Pregnant women especially at the beginning of the human species were eating food contaminated by germs, parasites and toxins.

Adaptation by restricting their alimentation due to nausea protected the fetus. This defense is still present in our times although it is not useful. Second, conflicts with other organisms like antibiotic resistance can be the explanation for the body flaws. Third some circumstances, such, as the ready availability of dietary fats, is so recent that natural selection has not yet had the time to deal with them. Fourth the, the body may fall victim to tradeoffs between a trait's benefit and its costs. A good example is the sickle cell gene, which also protects against malaria.

To conclude this first part of my paper, a Darwinian approach makes sense only when the object of explanation is changed from diseases to the traits, which make us vulnerable to diseases. Selection maximizes the reproductive success of genes even if they compromise the individual's health in the end.

LACTOSE INTOLERANCE AND CELIAC DISEASE IN THE LIGHT OF EVOLUTION

As I mentioned before milk and cereals appeared recently according to Evolution. If we consider that the nearer ancestor of man homo erectus lived one or two millions years ago, that the anatomically modern human homo sapiens appeared only 10000 years ago, it's really recent in view of evolution and we shall see that this timely proximity will have medical consequences (2, 3).

It seems that the range of diets available to preagricultural human beings determines the range that still exists for men and women living in the 20th century: the nutrition for which human beings are in essence genetically programmed. Differences between the dietary patterns of our remote ancestors and the patterns now prevalent in industrialized countries appear to have important implications for our health and the specific pattern of nutritional disease is a function of the stage of civilization. Physicians and nutritionists are increasingly convinced that the dietary habits adopted by western society over the past 100 years make an important etiologic contribution to coronary heart disease, hypertension, diabetes and some types of cancer. These conditions are virtually unknown among the few surviving hunter-gatherers populations whose way of life and eating habit most closely resemble those of preagricultural human beings.

The foods we eat are usually divided into four basic groups: meat and fish, vegetables and fruit, milk and milk products, breads and cereals.

The adults living before the development of agriculture and animal husbandry derived all their nutrients from the first two groups. They apparently did not consume cereal grains and dairy foods. With a diet containing 35 per cent meat their calcium intake far exceeded the highest estimate of the minimal daily requirement, sufficient quantities of iron and folic acid, the proteins constituted a percentage of total calories much more elevated than ours. The 65% of fruits and vegetables they consumed brought them a quantity of fibers much higher than ours and comparable to the one in rural Africa where diseases due to a poor intake of fibers are rare.

A last point to underline, the 35% of meat they consumed gave them 1/6 of our sodium intake and we shall see later the implication of this fact.

LACTASE DEFICIENCY

In most of the world's population the ability to digest lactose declines sharply after infancy. High lactose digestion capacity in adults is common only in populations of European and circum-Mediterranean origin and is thought to be an evolutionary adaptation to millennia of drinking milk from livestock (4).

If lactase is an inducible and adaptive enzyme, its persistence after weaning could indeed be the result of evolutionary selection. This selection process could determine the incidence of lactase deficiency in a population, and this incidence, of course, would differ among various ethnics groups, since it would depend on the time which has elapsed from the inception of their dietary use of milk (a biologically new food for the adult), an innovation which various cultures adopt at different historical periods. This of course, would depend on the development of agricultural and nomadic pastorals or, nowadays, on foreign trade and aid, economic phenomena which are historically conditioned.

This hypothesis seems to be substantiated by studies conducted in Australia on Asian students and among recently de-tribalized Australian aboriginal children. Milk is a recent innovation in the diet oft those two ethnic groups and significantly they manifested practically a 100% incidence of lactase deficiency (5).

GLUTEN INTOLERANCE

The inception of gluten and cereals in the diet of humans is like milk recent, when populations stopped their nomads to develop agriculture.

Before agriculture hunter-gatherers ate meat and wild plants for food.

Roots, beans, nuts, tubers and fruits were the most common major dietary constituents. Agriculture over a period of few thousand years changed profoundly human nutrition by reducing the percentage of meat and increasing the percentage of vegetal till 90% of the diet. These events occurred 10000 years ago.

As for the lactose, our ability to digest gluten was induced by a selectory evolution during the few thousands years during which we ate bread and cereals. The wheat also underwent active selection during the centuries to improve his percentage of gluten, an essential quality to make bread. From a low quantity of gluten, the bread reached the percentage of 50% of the total proteins of wheat.

A significant percentage of the population didn't adapt to this change and developed gluten intolerance or more precisely an intolerance to the protein fraction of gluten called gliadine. This population develops an immunologic reaction to gliadine peptides, which is sometime a sensitivity or a real intolerance. The patients are now identified by the dosage of antigliadine and antiendomysial antibodies. It is a multifactorial disease: genetic, immunologic and environmental (6, 7).

Concerning the environment, much has been written about the difference between the number of swedish children suffering from celiac disease and the number of danish children. The Swedes and the Danish people have the same genetic patrimoine and there is no difference of duration of breast-feeding.

The researches showed that during the first year of life swedish children received much more gluten (40 times more gliadine at 8 months and 4 times more at 12 months) and that was the reason that swedish children had 6 times more celiac disease than the danish children.

ENVIRONMENTAL FACTORS

If the recent introduction of milk and cereals may be one of the reasons for lactose and gluten intolerance among determined populations, it doesn't explain the differences between populations having a common genetic pool like European and Mediterranean people for lactose intolerance or swedish and danish people for celiac disease. It's at this point that the environmental factor intervenes. We already saw that the time of introduction of gluten in the nutrition is determinant for the celiac disease.

We are now going to take in consideration the quantity of sodium in our nutrition.

Our ancestors few thousand years ago produced, used and ate salt in small quantities. Natural selection induced electolytes retention and specially sodium. Sweat essential for thermoregulation induced electrolyte loss. Human beings were in danger due to the rarity of sodium in their nutrition and evolutive selection was probably very strong for salt retention (8).

When people stopped to be nomads to be agriculture it must have been much more difficult to obtain food than when they were hunter-gatherers. It was essential for them to put salt in food or meat in salty solution to keep it eatable. The salt became a magic and medicinal element. We became dependent of salt and from 1 gram of NACL per day we reached 9 to 12 grams per day now. This recent increase of sodium (in evolutive terms) in our nutrition when we are still programmed (Especially our kidneys) to keep our sodium is certainly one of the main factors of hypertension in the ageeing population (9).

LACTOSE AND GLUTEN INTOLERANCE AND SODIUM

If as I showed it before our quantity of sodium ingested increased very much during these 4000 last years, did this fact influence our tolerance to? gluten or lactose?

It's here that homeopathy intervenes. If we study the pathogenesis of sodium salts as NATRIUM MURIATICUM, NATRIUM SULFURICUM, NATRIUM CARBONICUM, NATRIUM PHOSPHORICUM, NATRIUM ARSENICUM, we are impressed by the fact that all of them have in their signs an intolerance to bread, starches, and milk. NATRIUM SULFURICUM with an intolerance to bread and farinous is a remedy known of celiac disease. NATRIUM CARBONICUM with an intolerance to milk is a remedy to lactose intolerance. The other sodium salts resemble to the formers (10).

The question that I asked to myself was this one: was it possible that a pathogeneses, a proving at the human level by introducing “recently” huge quantities of sodium in our nutrition was done? It could explain that even among populations which adapted to lactose or sodium there would be sensible type who developed a pathogeneses to sodium salts.

If it were the case, it would be interesting:

- to see if the reduction of sodium in the diet of patients suffering from celiac disease or lactose intolerance improves their condition;

- to see if remedies as the sodium salts can also increase the urinary

excretion of sodium among these patients.

It's up to us homeopaths to give to our patients suffering from celiac

disease or lactose intolerance these remedies and to look for their effects.

REFERENCES

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2. Eaton SB, Konner M. Paleolithic nutrition. N Engl J Med 1985; 312(5): 283-289.

3. Garn SM, Leonard WR. What did our ancestors eat? Nutr Rew 1989; 47(11): 337-345.

4. Holden C, Mace R. Philogenetic analysis of the evolution of lactose digestion in adults. Hum Biol 1997; 69(5): 605-628.

5. Shatin R. Evolution and lactase deficience. Gastroenterology 1968; 54(5): 992.

6. Pena AS, Crusius JB. Food allergy, coeliac disease and chronic inflammatory bowel disease in man. Vet Q 1998; 20(3): 49-52.

7. Greco L, Percopo S. The coeliac disease task force “free from gluten”. Act Paed Suppl 1996; 412: 25-28.

8. De Wardener HE. Sodium and hypertension. Arch Mal Coeur Vaiss 1996; 89(Spec No 4): 9-15.

9. Jackson FLC. An evolutionary perspective on salt, hypertension and human genetic variability. Hypertension Suppl 1991; 17(1): 129-132.