You wouldn't expect a car to run without gas and so you can't expect your body to run without food energy and essential nutrients!?
Celieac disease is not easy to understand, I am conscious about that. Nonetheless, more is known nowadays and individuals struggling with this autoimmune disorder have better chances to regain health, when accepting a lifetime commitment with a gluten free diet.
I find the information provided by the National Digestive Diseases Information Clearinghouse (NDDIC) under their Celiac Disease section, clear and easy enough to understand.
I am sharing this with you with the hope that we all better capture the seriousness of the disease and the need to support people affected by it.
Celiac Disease
On this page:
What is celiac disease?
Celiac disease is a digestive disease that damages the small
intestine and interferes with absorption of nutrients from food. People
who have celiac disease cannot tolerate gluten, a protein in wheat, rye,
and barley. Gluten is found mainly in foods but may also be found in
everyday products such as medicines,
vitamins, and lip balms.
When people with celiac disease eat foods or use products containing
gluten, their immune system responds by damaging or destroying villi—the
tiny, fingerlike protrusions lining the small intestine.
Villi normally
allow nutrients from food to be absorbed through the walls of the small
intestine into the bloodstream. Without healthy villi, a person becomes
malnourished, no matter how much food one eats.
Villi on the lining of the small intestine help absorb nutrients.
Celiac disease is both a disease of malabsorption—meaning nutrients are
not absorbed properly—and an abnormal immune reaction to gluten. Celiac
disease is also known as celiac sprue, nontropical sprue, and
gluten-sensitive enteropathy. Celiac disease is genetic, meaning it runs
in families. Sometimes the disease is triggered—or becomes active for
the first time—after surgery, pregnancy, childbirth, viral infection, or
severe emotional stress.
What are the symptoms of celiac disease?
Symptoms of celiac disease vary from person to person. Symptoms may
occur in the digestive system or in other parts of the body. Digestive
symptoms are more common in infants and young children and may include
- abdominal bloating and pain
- chronic diarrhea
- vomiting
- constipation
- pale, foul-smelling, or fatty stool
- weight loss
Irritability is another common symptom in children. Malabsorption of
nutrients during the years when nutrition is critical to a child's
normal growth and development can result in other problems such as
failure to thrive in infants, delayed growth and short stature, delayed
puberty, and dental enamel defects of the permanent teeth.
Adults are less likely to have digestive symptoms and may instead have one or more of the following:
- unexplained iron-deficiency anemia
- fatigue
- bone or joint pain
- arthritis
- bone loss or osteoporosis
- depression or anxiety
- tingling numbness in the hands and feet
- seizures
- missed menstrual periods
- infertility or recurrent miscarriage
- canker sores inside the mouth
- an itchy skin rash called dermatitis herpetiformis
People with celiac disease may have no symptoms but can still develop
complications of the disease over time. Long-term complications include
malnutrition—which can lead to anemia, osteoporosis, and miscarriage,
among other problems—liver diseases, and cancers of the intestine.
Why are celiac disease symptoms so varied?
Researchers are studying the reasons celiac disease affects people
differently. The length of time a person was breastfed, the age a person
started eating gluten-containing foods, and the amount of
gluten-containing foods one eats are three factors thought to play a
role in when and how celiac disease appears. Some studies have shown,
for example, that the longer a person was breastfed, the later the
symptoms of celiac disease appear.
Symptoms also vary depending on a person's age and the degree of damage
to the small intestine. Many adults have the disease for a decade or
more before they are diagnosed. The longer a person goes undiagnosed and
untreated, the greater the chance of developing
long-term complications.
What other health problems do people with celiac disease have?
People with celiac disease tend to have other diseases in which the
immune system attacks the body's healthy cells and tissues. The
connection between celiac disease and these diseases may be genetic.
They include
- type 1 diabetes
- autoimmune thyroid disease
- autoimmune liver disease
- rheumatoid arthritis
- Addison's disease, a condition in which the glands that produce critical hormones are damaged
- Sjögren's syndrome, a condition in which the glands that produce tears and saliva are destroyed
How is celiac disease diagnosed?
Recognizing celiac disease can be difficult because some of its
symptoms are similar to those of other diseases. Celiac disease can be
confused with irritable bowel syndrome, iron-deficiency anemia caused by
menstrual blood loss, inflammatory bowel disease, diverticulitis,
intestinal infections, and chronic fatigue syndrome. As a result, celiac
disease has long been underdiagnosed or misdiagnosed. As doctors become
more aware of the many varied symptoms of the disease and reliable
blood tests become more available, diagnosis rates are increasing.
Blood Tests
People with celiac disease have higher than normal levels of certain
autoantibodies—proteins that react against the body's own cells or
tissues—in their blood. To diagnose celiac disease, doctors will test
blood for high levels of anti-tissue transglutaminase antibodies (tTGA)
or anti-endomysium antibodies (EMA). If test results are negative but
celiac disease is still suspected, additional blood tests may be needed.
Before being tested, one should continue to eat a diet that includes
foods with gluten, such as breads and pastas. If a person stops eating
foods with gluten before being tested, the results may be negative for
celiac disease even if the disease is present.
Intestinal Biopsy
If blood tests and symptoms suggest celiac disease, a biopsy of the
small intestine is performed to confirm the diagnosis. During the
biopsy, the doctor removes tiny pieces of tissue from the small
intestine to check for damage to the villi. To obtain the tissue sample,
the doctor eases a long, thin tube called an endoscope through the
patient's mouth and stomach into the small intestine. The doctor then
takes the samples using instruments passed through the endoscope.
Dermatitis Herpetiformis
Dermatitis herpetiformis (DH) is an intensely itchy, blistering skin
rash that affects 15 to 25 percent of people with celiac disease.
3 The rash usually occurs on the elbows, knees, and buttocks. Most people with DH have no digestive symptoms of celiac disease.
DH is diagnosed through blood tests and a skin biopsy. If the
antibody tests are positive and the skin biopsy has the typical findings
of DH, patients do not need to have an intestinal biopsy. Both the skin
disease and the intestinal disease respond to a gluten-free diet and
recur if gluten is added back into the diet. The rash symptoms can be
controlled with antibiotics such as dapsone.
Because dapsone does not treat the intestinal condition, people with DH
must maintain a gluten-free diet.
Screening
Screening for celiac disease means testing for the presence of
autoantibodies in the blood in people without symptoms. Americans
are not routinely screened for celiac disease. However, because celiac
disease is hereditary, family members of a person with the disease may
wish to be tested. Four to 12 percent of an affected person's
first-degree relatives will also have the disease.
4
3Rodrigo L. Celiac disease. World Journal of Gastroenterology. 2006;12(41):6585–6593.
4Ibid.
How is celiac disease treated?
The only treatment for celiac disease is a gluten-free diet.
Doctors
may ask a newly diagnosed person to work with a dietitian on a
gluten-free diet plan. A dietitian is a health care professional who
specializes in food and nutrition. Someone with celiac disease can learn
from a dietitian how to read ingredient lists and identify foods that
contain gluten in order to make informed decisions at the grocery store
and when eating out.
For most people, following this diet will stop symptoms, heal
existing intestinal damage, and prevent further damage. Improvement
begins within days of starting the diet. The small intestine usually
heals in 3 to 6 months in children but may take several years in adults.
A healed intestine means a person now has villi that can absorb
nutrients from food into the bloodstream.
To stay well, people with celiac disease must avoid gluten for the
rest of their lives. Eating even a small amount of gluten can damage the
small intestine. The damage will occur in anyone with the disease,
including people without noticeable symptoms. Depending on a person's
age at diagnosis, some problems will not improve, such as short stature
and dental enamel defects.
Some people with celiac disease show no improvement on the
gluten-free diet. The most common reason for poor response to the diet
is that small amounts of gluten are still being consumed. Hidden sources
of gluten include additives such as modified food starch,
preservatives, and stabilizers made with wheat. And because many corn
and rice products are produced in factories that also manufacture wheat
products, they can be contaminated with wheat gluten.
Rarely, the intestinal injury will continue despite a strictly
gluten-free diet. People with this condition, known as refractory celiac
disease, have severely damaged intestines that cannot heal. Because
their intestines are not absorbing enough nutrients, they may need to
receive nutrients directly into their bloodstream through a vein, or
intravenously. Researchers are evaluating drug treatments for refractory
celiac disease.
The Gluten-free Diet
A gluten-free diet means not eating foods that contain wheat, rye,
and barley. The foods and products made from these grains should also be
avoided. In other words, a person with celiac disease should not eat
most grain, pasta, cereal, and many processed
foods.
Despite these restrictions, people with celiac disease can eat a
well-balanced diet with a variety of foods. They can use potato, rice,
soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour.
They can buy gluten-free bread, pasta, and other products
from stores that carry organic foods, or order products from special
food companies. Gluten-free products are increasingly available
from mainstream stores.
“Plain” meat, fish, rice, fruits, and vegetables do not contain
gluten, so people with celiac disease can freely eat these foods. In the
past, people with celiac disease were advised not to eat oats. New
evidence suggests that most people can safely eat small amounts of oats,
as long as the oats are not contaminated with wheat gluten during
processing. People with celiac disease should work closely with their
health care team when deciding whether to include oats in their diet.
Examples of other foods that are safe to eat and those that are not are
provided in the
table.
The gluten-free diet requires a completely new approach to eating.
Newly diagnosed people and their families may find support groups
helpful as they learn to adjust to a new way of life. People with celiac
disease must be cautious about what they buy for lunch at school or
work, what they purchase at the grocery store, what they eat at
restaurants or parties, and what they grab for a snack. Eating out can
be a challenge. When in doubt about a menu item, a person with celiac
disease should ask the waiter or chef about ingredients and preparation
or if a gluten-free menu is available.
Gluten is also used in some medications. People with celiac disease
should ask a pharmacist if prescribed medications contain wheat. Because
gluten is sometimes used as an additive in unexpected products—such as
lipstick and play dough—reading product labels is important. If the
ingredients are not listed on the label, the manufacturer should provide
a list upon request. With practice, screening for gluten becomes second
nature.
New Food Labeling
The Food Allergen Labeling and Consumer Protection Act (FALCPA),
which took effect on January 1, 2006, requires food labels to clearly
identify wheat and other common food allergens in the list of
ingredients. FALCPA also requires the U.S. Food and Drug Administration
to develop and finalize rules for the use of the term “gluten free” on
product labels.
The Gluten-free Diet: Some Examples
In 2006, the American Dietetic Association updated its
recommendations for a gluten-free diet. The following chart is based on
the 2006 recommendations. This list is not complete, so
people with celiac disease should discuss gluten-free food choices with
a dietitian or physician who specializes in celiac disease. People with
celiac disease should always read food ingredient lists carefully to
make sure the food does not contain gluten.
Allowed Foods |
amaranth
arrowroot
buckwheat
cassava
corn
flax
Indian rice grass
Job's tears |
legumes
millet
nuts
potatoes
quinoa
rice
sago |
seeds
sorghum
soy
tapioca
teff
wild rice
yucca |
Foods To Avoid |
wheat
- including einkorn, emmer, spelt, kamut
- wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein
|
barley
rye
triticale (a cross between wheat and rye) |
Other Wheat Products |
bromated flour
durum flour
enriched flour
farina |
graham flour
phosphated flour
plain flour |
self-rising flour
semolina
white flour |
Processed Foods that May Contain Wheat, Barley, or Rye* |
bouillon cubes
brown rice syrup
candy
chips/potato chips
cold cuts, hot dogs, salami, sausage
communion wafers |
French fries
gravy
imitation fish
matzo
rice mixes
sauces |
seasoned tortilla chips
self-basting turkey
soups
soy sauce
vegetables in sauce |
* Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer.
Source: Thompson T.
Celiac Disease Nutrition Guide,
2nd ed. Chicago: American Dietetic Association; 2006. © American
Dietetic Association. Adapted with permission. For a complete copy of
the
Celiac Disease Nutrition Guide, please visit
www.eatright.org.
Points to Remember
- People with celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley.
- Untreated celiac disease damages the small intestine and interferes with nutrient absorption.
- Without treatment, people with celiac disease can develop complications such as osteoporosis, anemia, and cancer.
- A person with celiac disease may or may not have symptoms.
- Diagnosis involves blood tests and, in most cases, a biopsy of the small intestine.
- Since celiac disease is hereditary, family members of a person with celiac disease may wish to be tested.
- Celiac disease is treated by eliminating all gluten from the diet. The gluten-free diet is a lifetime requirement.
- A dietitian can teach a person with celiac disease about food
selection, label reading, and other strategies to help manage the
disease.