Celiac Disease

Autoimmune Disease: An illness that occurs when the body tissues are attacked by its own immune system. The immune system is a complex organization within the body that is designed normally to "seek and destroy" invaders of the body, including infectious agents. Patients with autoimmune diseases frequently have unusual antibodies circulating in their blood that target their own body tissues.

Signs and symptoms: It is important to remember that celiac disease affects different people in different ways. Symptoms may occur in the digestive system or in other parts of the body. For example, one person may be experiencing depression and irritability while another may be experiencing recurring abdominal bloating and pain. Some of the symptoms of celiac disease include:

To further complicate things, a person with celiac disease may have no symptoms at all. People without symptoms are still at risk for the complications of celiac disease, including malnutrition. The longer a person goes undiagnosed and untreated, the greater the chance of developing malnutrition and other complications. Anemia, delayed growth and weight loss are all signs that the body is not getting enough nutrients (malnutrition). Malnutrition is an especially serious problem for children because they need adequate nutrition to develop and grow properly.

What is celiac disease?
Celiac disease is a digestive disorder that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten, found in wheat, rye, barley, and oats. Gluten is found mainly in foods, but is also found in products we use every day, such as stamp and envelope adhesive, medicines, and vitamins. Gluten causes the intestine to have an autoimmune response which in turn causes damage to the intestine causing it to lose its ability to absorb nutrients, regardless of the quantity of food that is eaten.

How is celiac disease diagnosed?
Recognizing celiac disease can be very difficult because its symptoms very closely reflect those of other diseases. In fact, sometimes celiac disease is confused with irritable bowel syndrome, iron-deficiency anemia (due to menstrual blood loss), Crohn’s disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease is commonly under or misdiagnosed.

Researchers have discovered that those with celiac disease have higher than normal levels of certain autoantibodies in their blood. Whereas antibodies are protective proteins produced by the immune system in response to substances that the body perceives to be threatening, autoantibodies are proteins that react against the body’s own molecules or tissues. To diagnose celiac disease, physicians will usually test blood to measure levels of immunoglobulin A (IgA), anti-tissue transglutaminase (tTGA), and/or IgA anti-endomysium antibodies (AEA).

Before being tested, one should continue to eat a regular diet that includes foods with gluten. If the person stops eating foods with gluten before being tested, the results may be negative for celiac disease even if it is actually present. If the tests and symptoms suggest celiac disease, the doctor will perform a small bowel biopsy. During the biopsy, the doctor removes a tiny piece of tissue from the small intestine to check for damage.

What is the treatment?
Unfortunately there is no magic pill to cure celiac disease. The only treatment is to follow a gluten-free diet. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. The small intestine is usually completely healed in 3 to 6 months in children and younger adults and within 2 years for older adults.

In order to stay well, people with celiac disease must avoid gluten for the rest of their lives. Eating any gluten, no matter how small an amount, can damage the small intestine. The damage will occur in anyone with the disease, including people without any noticeable symptoms. Depending on the person’s age at diagnosis, some problems will not improve, such as delayed growth.

Some people with celiac disease show no improvement on the gluten-free diet. The condition is called unresponsive celiac disease. The most common reason for poor response is that small amounts of gluten are still present in the diet. Advice from a dietitian who is skilled in educating patients about the gluten-free diet is essential to achieve best results.

Foods that contain gluten:

Going Gluten Free
Despite the restrictions that celiac disease places on your diet, people with celiac disease can, and should, eat a well balanced diet with a variety of foods, including gluten-free bread and pasta. For example, people with celiac disease can use potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat. Retailers are making it increasingly easier to obtain gluten-free products by enhancing their gluten-free specialty sections.

Checking labels for "gluten free" is important since many corn and rice products are produced in factories that also manufacture wheat products, and therefore may become contaminated. Hidden sources of gluten include additives such as modified food starch, preservatives, stabilizers and sauces (for example, many brands of soy sauce contain gluten). Wheat and wheat products are often used as thickeners, stabilizers, and texture enhancers in foods.

Those with celiac disease are allowed to eat plain meat, fish, rice, fruits, and vegetables at will because they do not contain gluten. Recommending that people with celiac disease avoid oats is controversial because some people have been able to eat oats without having symptoms. Scientists are currently studying whether people with celiac disease can tolerate oats. Until the studies are complete, people with celiac disease should follow their physician’s and dietitian’s advice.

Gluten is also used in some medications. Glucotrol, for example, may contain gluten. One should check with the pharmacist to learn whether medications used contain gluten. If your medication does contain gluten stop taking it and talk to your doctor about other safe options. Since gluten is also sometimes used as an additive in unexpected products, it is important to read all labels. If the ingredients are not listed on the product label, the manufacturer of the product should provide the list upon request. With practice, screening for gluten becomes second nature.

The gluten-free diet is challenging and requires a completely new approach to eating the affects a person’s entire life. People with diabetes have additional challenges in going gluten-free because they must change many of their usual sources of carbohydrate which also will very likely affect blood sugar levels. People with celiac disease have to be extremely careful about what they buy for lunch at school or work, what they purchase at the grocery store, what they eat at restaurants or parties, or what they grab for a snack. Eating out can be a challenge. If a person with celiac disease is in doubt about a menu item, ask the waiter or chef about ingredients and preparation, or if a gluten-free menu is available.

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Celiac Disease