GLUTEN SENSITIVITY AND CELIAC DISEASE
What You Should Know: Celiac disease (CD) is an inherited autoimmune disorder which affects nearly two million Americans. One study conducted by the Mayo Clinic and the National Institute of Health estimates about one in every 141 people in the U.S. have Celiac disease and is reported more often in Caucasians.
Celiac disease occurs when the small intestine reacts in a negative way after gluten is digested from wheat and grains. The small intestine becomes inflamed and damaged, creating problems with absorption of nutrients. Though no cure is available, a strict avoidance of gluten-free products can alleviate symptoms and allow the small intestine to heal. It’s also important to recognize that you can have sensitivity to gluten but not have Celiac disease.
The word “gluten” originates from Latin, meaning “glue” and is a sticky protein found in wheat and other grains. Celiac disease is also known as “sprue” or “gluten sensitive enteropathy” (GSE) and can occur at any age, even among the elderly who may have tolerated gluten for decades. Celiac disease is often misdiagnosed or undiagnosed because of symptoms that can mimic other disorders. A blood test will help determine whether high levels of certain antibodies are present that can indicate Celiac disease. Genetic testing is helpful to see if you carry the DQ2 or DQ8 genes considered necessary to develop the disease.
Highlighted Gluten Sensitivity And Celiac Disease Resources
At Risk for Celiac Disease? Knowing the Symptoms is Essential
Diet Plan for People with Celiac Disease
COMMON QUESTIONS ABOUT GLUTEN SENSITIVITY AND CELIAC DISEASE
What is the link between gluten sensitivity and Celiac disease?
In people with Celiac disease, gluten insensitivity triggers the immune system, resulting in antibodies attacking the intestinal lining. Tiny, hair-like projections called villi, which reside in the small bowel, become inflamed or damaged. Over time, nutrients that are normally absorbed into the body, pass through unabsorbed and are eliminated, leading to malnutrition and a host of other problems. Those diagnosed with Celiac disease are at higher risk for developing diabetes, osteoporosis, neurological disorders, infertility and even some forms of cancer.
What is the underlying cause of Celiac disease?
Researchers aren’t sure of the precise cause. What is known is that certain factors put some people more at risk than others for developing Celiac disease. (See: “What are my risks for Celiac disease?”)
Mutations in genes appear as a major risk. But not everyone who carries the gene will develop Celiac disease. In some cases, Celiac disease is triggered from severe high-stress, surgical procedures, childbirth or viral infections.
Is having Celiac disease the same as having a wheat or gluten allergy?
No. That’s because Celiac disease is an autoimmune disorder that is characterized by an intolerance or sensitivity to wheat or gluten products. Those with wheat allergies can eat grains that a person with Celiac disease cannot.
What confuses some individuals is that symptoms for wheat or gluten insensitivity without the presence of Celiac disease can be similar: abdominal pain, diarrhea and weight loss, anemia, joint pain, headaches and fatigue, among others. Some people experience few or no symptoms, which contributes to the disease being undiagnosed.
What products contain gluten?
Gluten is a common food antigen that is found in wheat, barley, rye, and triticale. It gives bread dough its elasticity and chewiness, and is also used in a variety of processed foods and personal care products. Not all grains and flours contain gluten. For example, rice, quinoa, buckwheat, corn, flax, and nut flours are all gluten-free.
Many may find it surprising to know just how many products contain gluten. It is used not only in food products, but in personal care items as well. Cosmetics, body lotion, toothpaste, and dietary supplements are just several examples of items where gluten may be found.
Is wheat-free the same as gluten-free?
Many people tend to confuse wheat-free with gluten-free. Even if a product does not use wheat, it may still contain gluten from other sources. A strict gluten-free diet also requires that contact not be made by way of machinery, utensils, and other equipment that has come into contact with gluten.
People who suffer from celiac disease are especially sensitive to the effects of gluten and may exhibit a variety of symptoms. Approximately 1% of all Americans are affected, but there are many more who suffer from some level of gluten sensitivity.
Is gluten bad for everyone?
Gluten has been shown to increase gut permeability regardless of whether or not the person tests positive for celiac disease. When gluten passes through the intestinal tract, it tears the barrier-forming mucous lining. This barrier is intended to keep food particles and bacteria from passing through the intestinal wall and into the bloodstream. Gluten also shortens the villi, which are fingerlike projections that help move digested food through the intestines while promoting the absorption of nutrients. As the mucous lining breaks down and the villi are shortened, a condition called "leaky gut" arises, which can become the root cause of a variety of conditions from irritable bowel syndrome (IBS) to fibromyalgia.
What tests are available for gluten sensitivity and Celiac disease?
A Celiac Disease Blood Test may be performed to discover if a person has celiac disease, but negative results do not necessarily rule out the possibility of celiac disease or some level of gluten sensitivity. In order to determine if a person is allergic to gluten a Gluten Sensitivity Blood Test can be performed. The harmful effects of any level of gluten intolerance may be avoided through the maintenance of a gluten-free diet and appropriate food allergy testing.
A Screening test for celiac disease if not foolproof. A person who tests negative for celiac disease may, in fact, fall within a spectrum of gluten sensitivity. The combination of a bowel biopsy and a monitored reaction to a gluten-free diet is the most effective way to discover the presence or absence of celiac disease. This is especially true for young children who still have immature immune systems and do not effectively produce the antibodies that are measured in order to make a firm diagnosis.
Two types of antibodies are measured using blood tests. One set of antibodies are called anti-gliadin IgG and IgA (immunoglobulins). These are the "anti-gluten" antibodies. Another type of antibodies, the "anti-self" antibodies, include the anti-endomysial IgA and anti-tissue transglutaminase IgA (tTG).
It is common for a person to have celiac disease and yet produce a negative result from the antibody tests as an inherent deficiency in IgA may produce a low antibody test result. Human error also comes into play since IgA antibodies are viewed under a microscope. Analysts without much experience in reading IgG and IgA tests may determine a false negative result. Different labs can use test kits that vary in sensitivity and may yield conflicting results. Finally, it is important that the person who is being tested has recently ingested gluten, as a gluten-free diet will naturally reduce the levels of anti-gluten antibodies.
Those who test positive for celiac disease do not always exhibit symptoms even though damage is done to the intestine with the consumption of gluten. The only treatment option is to avoid all gluten in the diet. Grains that should never be consumed by someone with celiac disease include any type of wheat, such as durum, kamut, semolina and spelt. Gluten is also often used in sauces and other processed foods, but may be difficult to pinpoint since there are no label laws, as of yet, that require food manufacturers to alert consumers of gluten in their products.
Whether they exhibit symptoms or not, the effects of gluten are devastating to those who suffer from celiac disease. The negative result of an antibody test does not necessarily rule out celiac disease or some degree of gluten intolerance, but a bowel biopsy may provide a more reliable result. A gluten-free diet is necessary to relieve the various symptoms of celiac disease and dramatically improve health.
What is “gluten rash”?
The medical term is dermatitis herpetiformis, an itchy blistering skin disorder that can come from gluten intolerance. This reddish rash often appears on elbows, knees, scalp and the main torso.
Usually, treatment involves a gluten-free diet and medication to control the itching and rash. It is not considered a symptom of Celiac disease but a separate disease that can develop alongside either Celiac disease or gluten intolerance.
How do I avoid gluten?
Most people agree that it’s difficult, though not impossible, to eat totally gluten-free. Gluten is often “hidden” in foods and products where you least expect them. Common foods to avoid include:
But other foods can also contain gluten:
- Processed meat
- Potato chips
- French fries
- Breaded foods
Wine and distilled alcohol is usually safe, but not most beers. (Beer is made from grains). Even some lipsticks and over-the-counter medications may contain gluten. One recent study showed that gluten was even found in an orthodontic retainer, through its plastic polymer. (Source: www.celiaccentral.org/research-news)
In general, meat, fish, beans, fruit and vegetables are all acceptable in a gluten-free diet as long as they are prepared without gluten ingredients. Read the labels and watch for food additives including starch, preservatives and food stabilizers.
Though you should always talk with your healthcare provider on what diet is best for you, in general the following choices are safe:
- Soy and other beans
New, gluten-free products are constantly coming on the market made with safe flour ingredients. Look for labels that read “gluten-free”, or if you’re not sure, avoid purchasing until you can contact the manufacturer. The U.S. Food and Drug Administration is establishing rules for the use of gluten-free product labels, and more public restaurants are now offering gluten-free options on their menus.
What are my risks for developing Celiac disease?
Though health experts agree Celiac disease can strike most anyone, those at highest risk include individuals that have:
- A family member with Celiac disease
- Early exposure to gluten (before three months of age according to WebMD)
- Type 1 diabetes
- Irritable bowel syndrome
- Autoimmune thyroid disease
- Down syndrome or Turner syndrome
- Experienced a major life event resulting in high stress or emotional distress
(For a complete list of risk factors visit the American Gastroenterological Association (AGA) at www.gastro.org.
What is late-onset Celiac disease?
Though most researchers say a genetic link is necessary to developing Celiac disease, it can develop at any age after years of gluten tolerance, even in the elderly. Referred to as “late-onset Celiac disease,” its occurrence is still being studied. One university study in Maryland found a doubling of Celiac disease every 15 years since 1974, yet no one is sure why. (Source: WebMD, 08/18/11).
What is refractory Celiac disease?
These are cases in which intestinal injury continues to take place even after a gluten-free diet is followed for six months to year. Though rare in occurrence, refractory Celiac disease requires further testing and monitoring. Some healthcare providers recommend steroid treatment or an immune system medication to reduce intestinal inflammation. Refractory Celiac disease is more common in older people with long-term damage to the small intestine. Healing and re-growth of the villi inside the intestine tends to happen more rapidly in children than in adults.
What treatments are currently being used to treat Celiac disease when diet control is not enough?
Most cases of Celiac disease are controlled and symptoms alleviated once a gluten-free diet is followed. Some patients work with a nutritionist or dietician to help them follow a lifelong gluten-free diet. But when diet changes are not working, medications that reduce inflammation are generally prescribed. One drug used is dapsone, an antibacterial medication that helps disrupt the normal functioning of inflammatory cells called monocytes.
Other treatments include steroids, to ease severe signs and symptoms of Celiac disease. If nutritional deficiencies are found, vitamin and mineral supplements are also normally recommended. They can be given by pill form or by injection. A Vitamin Profile blood test may be needed to determine if nutritional levels are normal.
What new research is available in the treatment of Celiac disease?
Research through clinical trials continues on what causes Celiac disease, the effectiveness of medications to treat it and ways enzymes can block the autoimmune reaction. Some health experts recommend early screening as a standard tool to help patients avoid long-term complications.
The Digestive Disease Research Core Center at the University of Chicago reported one mechanism by which people lose tolerance to gluten. By blocking an inflammatory protein called Interleukin-15 ((IL-15), help may be available to treat Celiac disease symptoms and prevent the disease from developing in high-risk individuals. (Source: WedMD Health News, 02/09/11) More recently, a new, non-invasive blood test for intestinal damage in Celiac disease patients is being studied and looks promising. The serum-based test would assess small intestine damage without having to biopsy, an invasive procedure currently required to take a close look at the villi inside the small intestine. (Source: www.celiaccentral.org/research-news.
For more information on Celiac disease contact the National Foundation for Celiac Awareness at www.celiaccentral.org
By Keith Kloss, Health Testing Centers