Saturday, September 8, 2007

Introduction to Celiac Disease

What is celiac disease?
Celiac disease is an autoimmune digestive disease that damages the villi of the small intestine and interferes with absorption of nutrients from food. To put it simply, the body is attacking itself! It is NOT an allergy to wheat!

Celiac disease is triggered by consumption of the protein called gluten, which is found in wheat, barley, rye and other grains like spelt, triticale and kamut.

When people with celiac disease eat foods containing gluten, their immune system responds by damaging the fingerlike villi of the small intestine. When the villi become damaged, the body is unable to absorb nutrients into the bloodstream, which can lead to malnourishment.
Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy.
Researchers have determined that celiac disease is a genetic condition, meaning that it is inherited. In some cases, celiac becomes active or is triggered by events such as surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

Roughly one out of every 133 Americans has celiac disease, but 97% remain undiagnosed. This means that almost three million Americans have celiac disease and only about 100,000 know they have it.

Left untreated, people with celiac disease can develop further complications such as other autoimmune diseases, osteoporosis, thyroid disease, and cancer.
There are a number of medical problems that are associated with undiagnosed celiac disease including cancer, osteoporosis, diabetes Type 1, thyroid problems and reproductive health issues.

What are the symptoms?
The symptoms of celiac disease vary amongst different people. Some patients develop symptoms as early in life, while others feel healthy far into adulthood.
Symptoms of celiac disease may or may not occur in the digestive system. For example, one person might have diarrhea and abdominal pain, while another person has irritability or depression. In fact, irritability is one of the most common symptoms in children.

Some of the most common symptoms of celiac disease include:
Bloating or Gas
Diarrhea
Constipation
Fatigue
Itchy Skin Rash
Tingling/Numbness
Pale Mouth Sores
Joint Pain
Delayed Growth
Poor Weight Gain
Thin Bones
Infertility
Headaches
Depression
Irritability
Discolored Teeth

Anemia, delayed growth, and weight loss are signs of malnutrition. Malnutrition is a serious problem for anyone, but particularly for children because they need adequate nutrition to develop properly. Failure to thrive during childhood development is a common indicator of celiac disease.

Some people with celiac disease may not have symptoms or what is called asymptomatic. The undamaged part of their small intestine is able to absorb enough nutrients to prevent symptoms. However, people without symptoms are still at risk for the complications of celiac disease.

How is celiac disease diagnosed?
Accurately diagnosing celiac disease can be quite difficult largely because the symptoms often mimic those of other diseases including irritable bowel syndrome, Chron's's disease, ulcerative colitis, diverticulosis, intestinal infections, chronic fatigue syndrome, and depression.

To gain a proper diagnosis of celiac disease, a physician will order the following blood tests:
Total IgA
IgA antitissue transglutaminase (tTG)
IgA antiendomysial antibody immunofluorescence (EMA) (It is important to continue eating a normal, gluten-containing diet before being tested for celiac.)

If the blood tests and symptoms indicate celiac, a physician may suggest a biopsy of the lining of the small intestine to confirm the diagnosis.

What is the treatment?
The only treatment for celiac disease is a lifelong gluten-free diet. A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, and barley.
Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods, including bread and pasta. For example, instead of wheat flour, people can use potato, rice, soy, or bean flour. Or, they can buy gluten-free bread, pasta, and other products from specialty food companies.

Safe gluten-free cooking substitutes:
Brown Rice Flour
Guar Gum
Potato Starch
Buckwheat
Quinoa
Aramanth
Almond Flour
Teff
Corn Flour
Tapioca Starch
Soy Flour
Xanthum Gum
Corn Starch
Potato Flour
Sweet Rice Flour
Lentil

The gluten-free diet is a lifetime requirement for people with celiac disease. Eating any gluten, no matter how small an amount, can damage the intestine. This is true for anyone with the disease, including people who do not have noticeable symptoms. DO NOT CHEAT!

Following a gluten-free diet may seem difficult at first, but, with a little creativity, anyone can make delicious gluten-free meals!

For example, plain meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat as much of these foods as they like. Places in the Chicagoland area that have the largest gluten free selections are Whole-Foods, Fruitful Yield, and Wild Oats. Other places, such as Meijer and Jewel have a small selection of gluten-free foods, but are getting bigger everyday. There are smaller stores in the Chicagoland area, but I haven't visisted them yet. There are also many online stores-just google gluten free foods.

Support groups are particularly helpful for newly diagnosed people and their families as they learn to adjust to a new way of life. I attend the Gluten Free Wikaduke group down in Plainfield, IL. See others in the Chicagoland area listed on the blog.

What Are The Complications of Celiac Disease?
Damage to the small intestine and the resulting problems with nutrient absorption put a person with celiac disease at risk for several diseases and health problems:


  • Lymphoma and adenocarcinoma are types of cancer that can develop in the intestine.

  • Osteoporosis is a condition in which the bones become weak, brittle, and prone to breaking. Poor calcium absorption is a contributing factor to osteoporosis.

  • Miscarriage and congenital malformation of the baby, such as neural tube defects, are risks for untreated pregnant women with celiac disease because of malabsorption of nutrients.

  • Short stature results when childhood celiac disease prevents nutrient absorption during the years when nutrition is critical to a child's normal growth and development. Children who are diagnosed and treated before their growth stops may have a catch-up period.

  • Seizures, or convulsions, result from inadequate absorption of folic acid. Lack of folic acid causes calcium deposits, called calcifications, to form in the brain, which in turn cause seizures.

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