Celiac disease is a hereditary autoimmune disease. It is a life long, multi-symptom disease that is often mis-diagnosed. Celiac disease is triggered by gluten, which is the main storage protein found in certain grains, primarily wheat, rye and barley. It is diagnosed through symptoms and confirmed by biopsy.
The gluten damages the small intestine by atrophying the villi. The villi are the part of the small intestine responsible for most of the absorption of nutrients. When they are damaged, the small intestine has a difficult time absorbing the needed nutrients, and malabsorbtion may result.
Occasionally celiac disease is referred to as a gluten allergy, or gluten sensitivity. The authors of “Celiac Disease, a Hidden Epidemic” stress that this is not the case. Allergies produce antigens, which trigger the body to produce antibodies. The main antibody involved in food allergies is immunoglobulin E (IgE). The presence of IgE antibodies is suggestive of food allergies. Patients who suffer from celiac disease do not generally posses this antibody, as celiac disease is a delayed immune reaction, and not an allergy. (Green and Jones, pg 43)
Symptoms are grouped into four major categories:
Intestinal problems– gas, acid reflux, diarrhea
Malabsorbtion– vitamin deficiency, anemia, chronic fatigue
Autoimmune diseases and systematic inflammatory reactions– Autoimmune diseases often appear in tandem. If a patient is diagnosed with one, they are likely to later be diagnosed with a
Malignancies– patients with celiac disease have twice the risk to develop a malignancy than the general population (Celiac Disease Foundation)
There are at least two things that must be present in order for celiac disease to be manifested. The patient must be ingesting gluten. It is a crucial trigger. Celiac disease is currently the only autoimmune disease that has had the environmental trigger so clearly pinpointed. For most autoimmune diseases, we know the bodily response, but not the trigger. It has been hypothesized that the amount of gluten, and at what age it is introduced into the diet, may have an effect on the manifestation of the disease. Researchers are still unclear on that issue, however.
The other key factor is genetics. You must posses specific genes in order to develop celiac disease. If one identical twin is diagnosed with the disease, seventy percent of their twin siblings will also be diagnosed. Ten percent of their first degree relatives will have the disease. If two siblings within a family are both diagnosed, the risk doubles for their first and second degree relatives. (Green and Jones, pg 70-72)
There has been some evidence that breastfeeding may help prevent the onset of
celiac disease, or may cause it to be less severe. There is also controversial evidence that indicates that smoking may decrease the chances of the disease manifesting itself.
Celiac disease is a serious medical condition that can take a lifetime to master. Like diabetes, it has long-term consequences that need to be understood and treated. Initial treatment should begin with a dietary consult. There are many stumbling blocks to a gluten-free diet. Gluten can be found in many unexpected places, such as the food starch in deli meat. To get a handle on both the basics and the subtleties, a dietary consult is highly recommended.
The patient should also be assessed for nutritional deficiencies. One of the complications of celiac disease is malabsorbtion. Because of this, patients should have full blood work to determine any deficiencies, as well as a bone density determination.
Thirdly, the patient should have a medication assessment. Many people take medications on a daily basis. Including over the counter drugs and vitamins. These are often hidden sources of gluten. They often include binders or suspensions that contain gluten. For this reason, patients need to have their medication assessed, to make sure it is gluten free.
A repeat biopsy is often performed. It is not needed to confirm the diagnosis, but is often done to assess the body’s response to the gluten-free diet. If done too early in the course of the diet, significant improvement may not yet be present. Often patients can take between 1-3 years to fully normalize. Some older patients may never fully heal.
Because of the increased risk of malignancies, the patient should have a screening on a regular basis. Studies have shown, however, that after five years on the diet, the risk falls to the same level as the general population.
Green, Peter MD and Jones, Rory Celiac Disease, a Hidden Epidemic (Collins, 2006)
Celiac Disease Foundation, accessed 3/12/2009 (http://www.celiac.org/)
Korn, Danna Kids with Celiac Disease (Woodbine House, 2001)
Smith, Terry FAQ about Celiac Disease (Rosen Publishing, 2007)