Grannymom's Spot: Celiac Disease

Most of our family has celiac disease, or Gluten Sensitive Enteropathy. The list of symptoms family members have or have had is extensive: chronic anemia, bloating, dysmenorrhea, bowel problems, skin problems, canker sores, gut pain, sore joints, arthritis, seizures, migraines, dark circles under the eyes, etc. We are thankful that my sister discovered she had a problem with wheat in 1999, and told me about it. We are hopeful that our grandchildren won't suffer the same way we have for many years. Both my mother and my grandmother died at a young age of cancer. I hope that I have changed my lifestyle early enough and drastically enough to prevent the same illness for myself.

A lifelong autoimmune intestinal disorder, found in individuals who are genetically susceptible. Damage to the mucosal surface of the small intestine is caused by an immunologically toxic reaction to the ingestion of gluten and interferes with the absorption of nutrients. Celiac Disease (CD) is unique in that a specific food component, gluten, has been identified as the trigger. Gluten is the common name for the offending proteins in specific cereal grains that are harmful to persons with celiac disease. These proteins are found in all forms of wheat (including durum, semolina, spelt, kamut, einkorn, and faro), and related grains: rye, barley, and triticale and must be eliminated.

What Happens With Celiac Disease

When individuals with CD ingest gluten, the villi, tiny hair-like projections in the small intestine that absorb nutrients from food, are damaged. This is due to an immunological reaction to gluten. Damaged villi do not effectively absorb basic nutrients -- proteins, carbohydrates, fats, vitamins, minerals, and, in some cases, water and bile salts. If CD is left untreated, damage to the small bowel can be chronic and life threatening, causing an increased risk of associated disorders -- both nutritional and immune related.

Some long-term conditions that can result from untreated CD:

Iron deficiency anemia
Osteoporosis
Vitamin K deficiency associated with risk for hemorrhaging
Vitamin and mineral deficiencies
Central and peripheral nervous system disorders -- usually due to unsuspected nutrient deficiencies
Pancreatic insufficiency
Intestinal Lymphomas and other GI cancers
Lactose intolerance
Neurological manifestations

Other associated autoimmune disorders:

Dermatitis Herpetiformis (DH)
Insulin-dependent Type I Diabetes Mellitus
Thyroid Disease
Systemic Lupus Erythematosus
Liver Diseases

Less commonly linked to CD:

Addison’s Disease
Chronic Active Hepatitis
Down Syndrome
Rheumatoid Arthritis
Turner Syndrome
Williams Syndrome
Sjögren’s Syndrome
Fibromyalgia
Alopecia Areata
Scleroderma

Cause

The cause of Celiac Disease, also known as celiac sprue, or gluten sensitive enteropathy (GSE), is unknown. Research indicates that CD is strongly associated with a group of genes on Chromosome 6. These genes (HLA class II) are involved in the regulation of the body's immune response to the gluten protein fractions.

One out of 133 people in the United States is affected with celiac disease. CD occurs in 5-15% of the offspring and siblings of a person with celiac disease. In 70% of identical twin pairs, both twins have the disease. It is strongly suggested that family members be tested, even if asymptomatic. Family members who have an autoimmune disease are at a 25% increased risk of having celiac disease.

Symptoms

Celiac Disease may appear at any time in a person's life. The disease can be triggered for the first time after surgery, viral infection, severe emotional stress, pregnancy or childbirth. CD is a multi-system, multi-symptom disorder. Symptoms are extremely varied and can often mimic other bowel disorders. Infants, toddlers, and children often exhibit growth failure, vomiting, bloated abdomen and behavioral changes.

Classic symptoms may include:

abdominal cramping, intestinal gas, distention and bloating
chronic diarrhea or constipation (or both)
steatorrhea -- fatty stools
anemia - unexplained, due to folic acid, B12, or iron deficiency (or all)
weight loss with large appetite, or weight gain

Other symptoms:

dental enamel defects
osteopenia, osteoporosis
bone or joint pain
fatigue, weakness and lack of energy
infertility - male/female
depression
Aphthous ulcers

Dermatitis Herpetiformis (DH) is skin manifestation of celiac disease characterized by blistering, intensely itchy skin. The rash has a symmetrical distribution and is most frequently found on the face, elbows, knees and buttocks. DH patients can have gastrointestinal damage without perceptible symptoms

Treatment

The only treatment for CD/DH is the lifelong adherence to a gluten-free diet. When gluten is removed from the diet, the small intestine will start to heal and overall health improves. Medication is not normally required. Because osteoporosis is common and may be profound in patients with newly diagnosed CD, bone density should be measured at or shortly after diagnosis. Consult your physician regarding specific nutritional supplementation to correct any deficiencies. The diagnosed celiac should have medical follow-up to monitor the clinical response to the gluten-free diet. Dietary compliance increases the quality of life and decreases the likelihood of osteoporosis, intestinal lymphoma and other associated illnesses.

Adapting to the gluten-free diet requires some lifestyle changes. It is essential to read labels which are often imprecise, and to learn how to identify ingredients that may contain hidden gluten.

Be aware that hidden gluten can be found in some unlikely foods such as: cold cuts, soups, hard candies, soy sauce, many low or non-fat products, even licorice and jelly beans.