Celiac disease (CD) is a condition in which there is intolerance to gluten from food. It is fairly common; some estimates indicate that up to one percent of people in the US have CD. Because it tends to run in families, among family members, CD may be present in one in 20 to 30 members.
Besides those with CD, many other people feel they can benefit from avoiding gluten. To meet this market, more and more gluten free foods have become available.
Symptoms of CD are well known. The most typical symptoms are loose stools and poor absorption of dietary fats. This malabsorbtion can lead to weakness, fatigue, and weight loss, among other problems.
CD can be present without a lot of diarrhea, and in some cases, it has been reported without any diarrhea (but with malabsorption).
CD is not a food allergy. It is the result of a direct interaction of a substance derived from gluten on cells lining the small intestine. The interaction causes inflammation and impedes the absorption of food nutrients.
Celiac Disease Diagnosis
It is most often diagnosed in children, but sometimes it is not diagnosed until middle age or later. Blood tests are available. Often clinicians will start with the transglutaminase test, a test for an IgA antibody. If that is positive, the next step often is the endomysial antibody test. Ultimately though, an intestinal biopsy is usually needed. Anyone who feels they may have celiac disease should consult with a gastroenterologist or another experienced clinician.
Celiac Disease Treatment
The poor nutrient absorption is caused by damage to intestinal villi, which are the microscopic fingers in the gut that provide a large surface area for nutrients to enter the body. Technically it's not gluten that destroys the villi, it's gliadin, but gliadin is made in the intestines from gluten. So the way to treat CD is to avoid gluten. Gluten is present in wheat, rye, and barley. Triticale is a hybrid of wheat and rye, so it also definitely contains gluten.
Gluten free diets are widely available. Totally gluten free eating, however, is generally impossible. Nutritional supplements are usually recommended to quickly reverse vitamin deficiencies.
Specialists may recommend certain medications, at least for a short time.
Celiac Disease and Oats
Oats don't contain gluten, but some factories that process oats also process other grains, so some clinicians recommend avoiding oats, at least at first. Some individuals are also sensitive to other proteins in oats, so whether to continue to avoid oats requires an individual decision. Many people with CD can comfortably eat small amounts of oats, which are a good source of fiber (Nutr Rev 2011 (Feb); 69: 017–15; PMID 21294744).
What Happens with Treatment
Most people improve. However, improvement is not uniform. A recent study included intestinal biopsies to assess the effect of treatment on intestinal villi. About one third of the subjects on a gluten free diet returned to normal. Another third had marked improvement. However, another third persisted with abnormal villi (Rubia-Topia, et al.; Am J Gastroenterol 2010; 105: 1412–1420; doi: 10.1038/ajg.2010.10).
The authors suggested that there are four reasons why improvement was not 100%.
- Americans have a culture of "dining out," and wheat flour is ubiquitous in restaurant food;
- there is a limited availability and high cost of gluten-free foods;
- foods are poorly labeled, and gluten is not clearly listed as an ingredient; and
- there is inadequate awareness and education about the disease.
Risks for Other Diseases
Restless legs syndrome and Hodgkin's lymphoma are more common in people with CD (J Natl Cancer Inst 2011 (Mar); 103: 436–44). Ischemic heart disease is more common when CD is active, but not when it is latent, according to a large study (Circulation 2011 (Feb); 123: 483–90).
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James Cooper - I'm on the faculty of a health science department at a large university. Most of my articles derive from conferences or presentations ...
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