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What is Celiac Disease?
Celiac disease is an autoimmune medical condition in which damage to the epithelia (inner lining) of the small intestine occurs following ingestion of a substance called gluten. Gluten is a grain protein used in food processing because it binds, stabilizes, and prevents crumbling. The gluten protein in wheat has a portion called gliadin, which is toxic to people with celiac disease. Barley, rye, and triticale also contain proteins toxic to celiac patients.
It is important to note that some people may have gluten intolerance or allergy without having celiac disease. This means that they are sensitive to gluten, and may have some allergy-like symptoms, without measurable damage to the intestine, even though in some intolerant or allergic people, the mucosal lining of the intestine becomes inflamed.
How does Gluten Cause Damage?
Gluten triggers an abnormal immune response that flattens and alters the small intestinal villi. This decreases the lining's surface area and alters its absorptive abilities. Malabsorption of some or all nutrients occurs and the body cannot get the essential proteins, fats, carbohydrates, vitamins, and minerals necessary for good health. It is important to be aware that a tiny crumb of bread causes the same damaging response as a whole slice, because it takes only one molecule to trigger the destructive mucosal response.
Who Gets Celiac Disease?
There are variations in the figures for the incidence and prevalence of celiac disease around the world. It is more common in Caucasians. Some medical sources estimate that 1 in 200 Canadians have celiac disease. However, newer research in North America shows that the prevalence of celiac disease may be many times higher than previously thought, and that people with no obvious symptoms may have the condition. Researchers in a multi-centre coast-to-coast study examined blood from thousands of subjects, looking for the telltale abnormal antibodies typical in the blood of people with celiac disease. Most who tested positive also had an intestinal biopsy to confirm the diagnosis. Here are the results:
Prevalence
Description of Group
1 in 56
People who have gastrointestinal symptoms yet undiagnosed as celiac
1 in 22
People who have a first-degree relative (sibling, child, or parent) with celiac
1 in 39
People who have a second-degree relative (grandparent, aunt, uncle, or cousin) with celiac
1 in 133
Not at risk individuals
While celiac disease is more commonly first diagnosed during childhood when growth is affected, people in the 40-50-year-old age range may also be newly diagnosed. More than 90% of people diagnosed with celiac disease have a gene known as HLA-DQ2, which facilitates the initiation of an immune response to gliadin. Researchers suspect that environmental factors also play a role in the expression of this disease.
What are the Symptoms?
Common symptoms include anemia, chronic diarrhea, weight loss, fatigue, cramps, bloating, irritability, and skin problems. These symptoms may initially be confused with other gastrointestinal conditions such as irritable bowel syndrome or inflammatory bowel disease. Some people with celiac disease may not notice any symptoms.
Diagnosis may be difficult and/or delayed since the onset of symptoms can occur anytime from childhood through adulthood, and symptoms are extremely variable and often vague from person to person.
People with celiac disease have a higher incidence than the general population of these other conditions: type I diabetes, Down syndrome, anemia, arthritis, osteoporosis, liver disease, infertility, thyroid problems, depression, fatigue, neurological diseases, and short stature.
The symptoms of celiac disease may or may not appear in dermatitis herpetiformis, a related condition caused by a gluten allergy, which results in intense burning and itchy skin. The incidence of dermatitis herpetiformis is around 1 in 100,000. An individual can have either or both of these conditions.
How is Celiac Disease Diagnosed?
While some symptoms may alert a doctor to suspect celiac disease, he or she cannot diagnose this condition based on symptoms alone. Researchers encourage doctors to be vigilant in remaining aware of the risk factors for this relatively common genetic disorder and to test anyone who could be at risk. A blood test can determine with very high accuracy whether someone has celiac disease, but many doctors still prefer to biopsy the small intestine as a definitive diagnosis. Test results are most accurate if done while the person is consuming gluten. The bowel's positive response to a gluten-free diet can later help to verify the diagnosis.
What is the Treatment?
At present, the only approved treatment for celiac disease is lifelong avoidance of gluten in the diet. This can be difficult and costly for sufferers, who may also be at risk of cross contamination during food processing, and this can particularly be a problem when eating away from home.
Celiac patients must completely avoid all types of obvious gluten (e.g. breads, pasta) and must watch for hidden sources in all packaged, processed foods (e.g. soups, ice creams, and sauces), by reading all the labels all the time, as manufacturers sometimes change and include gluten in a previously gluten-free product. Some mouthwashes and toothpastes even contain gluten!
There is clinical evidence that the consumption of 50-70 grams per day of pure, uncontaminated oats may be safe for adults with celiac disease. However, exceptions can occur so it is best to discuss your ability to tolerate oats with your doctor. Also, be cautioned that there is no guarantee that oats available in Canada are uncontaminated with other grains.
The gluten protein in corn and rice is not toxic to celiac patients and so you may substitute these products in the diet with great success.
Eating out may pose certain problems. Well-meaning waiters, chefs, or even friends, who do not fully understand the implications of consuming even a molecule of gluten, may serve foods that contain it. Speaking personally with the cook and requesting gluten-free foods that are prepared with only known ingredients may help avoid problems. Many people with celiac disease find it easier to frequent restaurants where they know the chef and other staff understand this condition, and can guarantee appropriate compliance to the no-gluten rule. Others keep gluten-free snacks with them in case they cannot find safe food when dining out. While adapting to life with celiac disease may seem overwhelming, eventually screening for gluten, whether shopping for home supplies or approving menu selections, becomes second nature.
Following a gluten-free diet will stop symptoms in most people. The existing intestinal damage will begin to heal and, as long as no further exposure occurs, you will avoid further damage. Improvements usually begin within days of starting the diet, and the small intestine will heal in as little as three months, although for some older adults it may take up to two years for the villi to be fully functional.
Although strict diet adherence alone will affect healing in most patients, some may require a course of an immunosuppressive medication such as prednisone.
How does the Disease Progress?
Feeling "normal" or symptom-free does not mean that damage to the intestinal surface is not occurring due to known or unknown ingestion of gluten. If you don't adhere to a strict gluten-free diet, then severe symptoms may appear over time.
Only an absolutely gluten-free diet ensures no further damage to the bowel and, therefore, no progression of the disease.
Note: Some tax concessions are available to people with celiac disease due to the increased costs of purchasing gluten-free products. Contact our office at info@badgut.com for up-to-date information on this.
Are you taking prescription medication for any of the following stomach problems/symptoms:
Stomach pain or discomfort
Heartburn
Sour taste in mouth/acid regurgitation
Excessive burping/belching
Increased abdominal bloating
Nausea
Early satiety
If you answer yes to any one of the symptoms listed above then take this test to see if your current medication is adequately controlling your stomach symptoms.
The PASS Test
PPI* Acid Symptom Suppression Test
*PPI is short for proton pump inhibitor, a class of medication used to suppress the acid in your stomach. These include Losec®, Nexium®, Pantoloc®, Pariet™, and Prevacid®.
