Celiac disease
Celiac disease, or gluten intolerance, is a digestive disorder. Individuals with this illness are sensitive to a tiny protein, known as gluten, which is found in wheat, barley and rye. For these individuals, eating gluten prompts an abnormal response of the immune system causing damage to the small intestine.
The precise cause of celiac disease remains unknown; however, it is known that it is most often inherited. It is also known that people with type 1 diabetes, other autoimmune diseases, microscopic colitis and Down syndrome seem to be at a higher risk for developing the condition.
Intestinal villi
Villi are tiny hair-like protrusions in the small intestine, which serve to increase the absorptive surface of the intestines. The role of villi in the body is to aid in the absorption of nutrients from the small intestine into the blood stream, nourishing the body. When the villi become damaged a person might become malnourished, due to an inability to absorb vital nutrients. Important enzymes that aid in the digestion of food are also found on the villi, such as the lactase enzyme that is required for digestion of food products containing lactose. When the villi are damaged, a person may experience difficulties digesting other foods, such as milk products.
Symptoms
As with many other autoimmune diseases, the symptoms of celiac disease may differ from person to person. Common symptoms experienced including bloating, abdominal pain or discomfort and intermittent diarrhea. Some people also experience joint pain, muscle cramping, depression, irritability, skin problems, sores in the mouth, sore joints and neuropathy. Still others experience bone disorders, such as osteoporosis. As the disease progresses, individuals might experience vitamin deficiencies, malnutrition, weight loss, bloating and gas, severe abdominal pain, and fatty or oily stools. In children, celiac disease can adversely affect growth, prompting children to be underweight or short in stature. In some individuals even a small amount of gluten can result in a medical emergency, requiring treatment.
Diagnosis
Celiac disease is typically diagnosed by blood tests looking for the presence of antibodies, specifically anti-endomysium and anti-tissue transglutaminase, in the blood indicating an autoimmune response to gluten. A negative blood test does not necessarily mean that celiac disease is not present, particularly if an individual has preemptively removed gluten from their diet. Doctors might also order an intestinal biopsy, where small samples of the intestine are harvested to examine for damage. Some doctors prefer to use a capsule endoscopy in order to diagnose celiac disease. This requires the individual swallow a small capsule camera that takes pictures of the intestine to examine them for damage.
Treatment
The only treatment for celiac disease itself is a gluten-free diet for life. This includes removing any food that contains wheat, barley, rye or any ingredients derived from these items. When an individual is diagnosed with celiac disease, checking labels becomes an absolute necessity. Many processed foods, sauces and snack items contain gluten. Some examples of food to avoid include malt, spelt, bulgur, semolina, durum, farina, graham and triticale. Most beer, unless specially marked “gluten free” is restricted on a gluten-free diet. However, wines and distilled alcohols, like rum and rye are fine. Full lists of dangerous food items are widely available on the internet, to include those found on the Celiac.com web site.
Many people are advised by their doctor to purchase food that is specifically labeled “gluten free.” This ensures that there is no chance the food has come in contact with gluten in the factory during production, as special measures have been taken to protect the integrity of the food product. In the home, it is vital that cooking surfaces be kept clean of gluten containing products. Other family members need to be educated so that they are aware of the importance of cleaning up crumbs and other proper cleanup techniques. It is helpful if the person with celiac disease maintains separate containers for items, such as margarine, peanut butter and jam, to protect against accidental cross-contamination by other members of the family using these products on gluten containing foods.
Symptoms of celiac disease might require additional treatments such as supplements for vitamin and mineral deficiencies caused by malnutrition, such as vitamin D, iron and calcium. Other medications to manage pain, neuropathy, osteoporosis and other complications of the illness might be required.
Prognosis
The outlook for someone with celiac diseases is quite good if they adhere to a strict gluten-free diet for life. The villi in the small intestine begin to regenerate after only a few days of following a strict gluten-free diet, and most people will start to feel better within a few days to several weeks. Full regeneration of the villi can take upwards of six months.
If an individual with celiac disease does not adhere to the diet, their prognosis might look quite different. Individuals with untreated celiac disease have a higher risk of certain types of cancers, such as bowel cancer and intestinal lymphoma. They are also at a higher risk from some neurological complications, such as seizures and peripheral neuropathy, or nerve damage. Some individuals suffer bone density loss caused by deficiencies of vitamin D and calcium.
Notes of caution
There are no known benefits to following a gluten-free diet in the absence of a diagnosis of celiac disease. In fact, there are risks associated with a gluten-free diet. A gluten-free diet might lead to insufficient consumption of vitamins and fiber that would otherwise be obtained by eating fortified cereals, breads and other grain products. It is important to review dietary needs with a qualified specialist, registered dietitian or nutritionist.
References
National Digestive Diseases Information Clearinghouse (NDDIC): Celiac Disease
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/
MayoClinic.com: Celiac Disease
http://www.mayoclinic.com/health/celiac-disease/DS00319/DSECTION=treatments-and-drugs
The University of Maryland Center for Celiac Research: Celiac Disease FAQ
http://www.celiaccenter.org/celiac/faq.asp#celiac
Celiac.com: nsafe Gluten-Free Food List (Unsafe Ingredients)
http://www.celiac.com/articles/182/1/Unsafe-Gluten-Free-Food-List-Unsafe-Ingredients/Page1.html
