“Gluten-free” seems to be the buzzword everywhere these days. It’s prominent on food labels and restaurant menus. But do you really know what it means or know anything about the condition that causes the body to react to gluten in food? It’s called celiac disease and there are many misconceptions about it and its treatment.
Defining Celiac and Gluten
Celiac disease is an abnormal reaction to gluten in the diet. It is sometimes called celiac sprue or non-tropical sprue and is based on the immune system’s reaction. The immune system usually protects us against germs and microorganisms that cause disease. In celiac disease, the immune system causes damage to the small intestine when exposed to gluten. Celiac disease can affect children or adults. In children it may cause growth retardation and it can cause problems with intestinal absorption in adults. Celiac disease is nothing new and has been around since at least the second century A.D. It is often under diagnosed today. There can be classic celiac disease with lots of symptoms but some people may have silent disease with few to no symptoms. Overall, the prevalence is about one percent in United States and Western populations.
Gluten is a protein found wheat. Other cereal grains such as rye and barley have a similar protein of a different name. Generally, they are all called “gluten,” they behave similarly and should be avoided. It is this protein (gluten) that causes a reaction in celiac disease. Gluten is found in foods and food products made of grains but may also be found hidden in vitamins or supplements, cosmetics or even children’s toys such as play dough, glue and crayons. Interestingly, cereal grains such as millet, corn, sorghum and rice do not contain gluten. However, some celiac patients may not tolerate pure oats.
What are the symptoms?
Patients develop symptoms when gluten is ingested. It makes their body’s immune system create antibodies that attack the small intestines and can damage the villi. The villi are finger-like projections that line the small intestinal wall. If the villi are damaged, the small intestine may not absorb nutrients and vitamins. When this occurs, patients typically have chronic diarrhea, weight loss, abdominal pain after meals, bloating and/or fatty stools. Some patients may have vitamin deficiencies or skin disorders.
Testing for suspected celiac disease is done first with specific blood tests. Your primary care or family doctor may order these tests. Skin, salivary and stool tests are not adequate, the gold standard is a biopsy of the small intestine done via upper endoscopy. Endoscopy is a procedure that uses a lighted endoscope to look inside the body. A gastrointestinal doctor can perform this test.
Some people find it easier to just stop eating gluten all together. Even people who do not have celiac disease may respond well to a gluten-free diet.
What are risk factors for celiac disease?
People with first-degree relatives (parents, siblings or children) with proven celiac disease and Type 1 diabetics are higher risk and should be tested. Other conditions such as autoimmune thyroid disease, iron deficiency anemia, Down’s syndrome, or osteoporosis can be associated with higher prevalence of celiac disease. Some patients with irritable bowel syndrome (IBS), inflammatory bowel disease (Crohns/Ulcerative colitis), certain liver conditions or fertility/reproductive issues may also be considered for testing. You should discuss your risk with your doctor.
Treatment and Resources
Celiac diseases is not curable but can be treated with a strict gluten-free diet for life. Patients should seek consultation with a dietitian skilled in celiac disease. Patients will need long term follow up with a physician for periodic blood tests, reassessing symptoms, continual education and repeat endoscopy. In some cases patients may need additional treatment such as steroids. New treatments are being investigated, including probiotics.
It is important for celiac disease patients to understand the disease. Patients may consider joining a support group in the community or on the Internet. Additionally, gluten-free diets may be more expensive than conventional diets. Many foods in our Western diet contain gluten. There are many options such as quinoa, tapioca, soy, wild rice or cassava that are gluten-free. Support groups can be helpful in connecting to local resources for coupons, recipes for food, suggestions on local restaurants and catering or physician and dietitian referrals.
By Suwebatu Odunsi-Shiyanbade, MD
Suwebatu Odunsi-Shiyanbade, MD is gastroenterologist on the medical staff at Texas Health Arlington Memorial Hospital.
Contact the hospital at 817-394-4300.