May is Celiac Awareness Month

Celiac disease is a genetic disease, affecting estimated 1 in 133 Americans, or about 1% of the population. This autoimmune disorder is signified by an allergy to gluten, a protein found in wheat, rye, and barley, that when ingested, leads to damage of the lining of the small intestine. This process then interferes with the adequate absorption of nutrients from food, which can lead to multiple vitamin deficiencies and malnutrition.

Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease have a 1 in 10 risk of developing celiac disease. This condition can develop at any age after people start eating foods or medicines that contain gluten. Left untreated, celiac disease can lead to additional serious health problems. These include vitamin and mineral deficiencies, the development of other autoimmune disorders like Type I diabetes and multiple sclerosis, osteoporosis, thyroid disease, dermatitis herpetiformis (an itchy skin rash), anemia, osteoporosis, infertility and miscarriage, neurological conditions like epilepsy and migraines, and intestinal cancers.

There are no pharmaceutical cures for this condition, and currently, the only treatment for celiac disease is lifelong adherence to a strict gluten-free diet. People living gluten-free must avoid foods with wheat, rye and barley.

Celiac disease can be difficult to diagnose because it affects people differently. There are about 300 known symptoms which may occur in the digestive system or other parts of the body. Some people with celiac disease have no symptoms at all. However, all people with celiac disease are still at risk for long-term complications, whether or not they display any symptoms.

Symptoms are not limited to this list, but can include nausea, erratic bowel movement patterns, bloating and abdominal pain, joint and muscle pain, fatigue, migraines, missed menses, infertility, and mood disorders.

Who should get screened? Children older than 3 and adults experiencing symptoms of celiac disease; first degree relatives of individuals with diagnosed celiac disease, and individuals with a related autoimmune disorder.

Testing can involve a blood test that detects antibodies related to an abnormal immune response. If this test is positive; a gastrointestinal doctor can perform an endoscopy with biopsies to confirm there is inflammation in the lining of the small intestine.

There is a subset of patients diagnosed with “gluten sensitivity”. The symptoms of gluten sensitivity are similar to those of celiac disease. People who are gluten sensitive experience symptoms in response to eating gluten, but do not have intestinal damage and will test negative for celiac disease antibodies. This condition could actually represent evolving celiac disease.
There has been a surge of interest in a gluten free diet, with the market for gluten-free products now exploding. It is unclear why this is so, but many people may perceive a gluten-free diet to be healthier. So, is there actually a health benefit to adopting a gluten-free diet if you are not allergic to gluten? In other words, what is wrong with the whole world going “gluten-free”??

To start with, a gluten elimination diet is highly restrictive, and also eliminates many common and nutritional foods. While gluten itself may not offer special nutritional benefits, the many whole grains that contain gluten do. Gluten-containing grains are rich in a multitude of vitamins and minerals, such as B vitamins and iron, as well as fiber. Numerous studies have repeatedly shown that whole grain foods, as part of a healthy diet, may help lower the risk of heart disease, diabetes, and some cancers. The 2010 Dietary Guidelines for Americans recommends that half of all carbohydrates in the diet come from whole grain products. Some whole grains that do not contain gluten include amaranth, millet, and quinoa, but they are less commonly found and can be costly.

A gluten-free diet is a complete dietary overhaul, and requires fastidiousness in all food choices. Most gluten-free alternatives, such as pasta or bread, are considerably more expensive that their conventional counterparts. Furthermore, the American Dietetic Association in 2005 issued a report warning that gluten-free products tend to be low in a wide range of important nutrients, including B vitamins, calcium, iron, zinc, magnesium, and fiber. Unless you genuinely have celiac disease or gluten sensitivity, there is not a good reason to take the risk of these deficiencies and radically change your eating patterns.

The allergy to gluten is ALL or NONE and there is little point in eliminating just some gluten, either symptomatically or medically. For people who are sensitive, even trace amounts can cause damage to the small intestines. Strict 100% adherence is critical to healthy well-being in affected individuals.

The basis of a healthy gluten-free diet, as with any diet, should be natural foods. Lean meats and fish, fruits and vegetables, and low-fat dairy products are all safe for people with celiac disease. Grains that don’t contain gluten, such as quinoa and amaranth, are another healthy option. More and more products are being made with such grains, from breads to cereals to pastas.

Clinical trials are currently underway for drugs that may help ease celiac disease and a vaccine for celiac disease is also under investigation. These treatments are unlikely to cure the condition entirely, but may lessen the damage caused by “cheating” with occasional gluten intake. People with celiac disease will continue to have to eliminate wheat products from their diet. Fortunately, growing awareness of the prevalence of these conditions should continue to make that challenge easier.

If you think you may be harboring an allergy to gluten or have concerns over symptoms that could reflect celiac disease, contact your doctor to be referred to a gastroenterologist and get tested!

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