Celiac Disease...

What is Celiac Disease ?

Celiac Disease is an autoimmune disorder caused by exposure to gluten in a genetically susceptible individual. In an auto-immune disorder the body’s defense system mistakenly reacts to what is normally a harmless protein, gluten and begins to attack itself. Two things are necessary to develop Celiac Disease. The individual must inherit a gene for Celiac and be exposed to gluten. It is a lifelong disorder. The symptoms vary from the classic gastrointestinal symptoms such as abdominal pain, frequent diarrhea and bloating to other less obvious symptoms such as headaches, anemia, weight loss bone pain and neurological symptoms. In children the symptoms may include failure to thrive and short stature for age. These symptoms are referred to as “extra-intestinal symptoms.” The large majority of Celiac patients display these types of symptoms rather than the gastrointestinal distress.


How do I know that I Have Celiac Disease?

Because of the varied types of symptoms associated with Celiac Disease, it is often difficult to diagnose. If unexplained gastrointestinal symptoms or unexplained anemia, which does not respond to treatment, occur, Celiac Disease may be suspected. Individuals with other autoimmune disorders such as Diabetes Type 1, Hashimotos’s Thyroiditis, Turner’s Symdrome , Williams’s Syndrome or Graves Disease are at higher risk for developing Celiac Disease. Your doctor will order a series of blood tests to check for the antibodies to gluten. If there is a high index of suspicion, an endoscopy is the next step. An endoscopy will reveal any damage to the lining of the small intestine which is characteristic of Celiac Disease. The small intestine is the section of the digestive tract where nutrients are absorbed to be transported throughout the body. It is very important to continue eating gluten prior to testing. Without the presence of gluten in the diet, there will not be antibodies and the test may appear negative.


At What Age Does Celiac Disease Develop?

Celiac Disease was once thought to be a childhood condition. However, recent studies have shown that Celiac Disease can begin at any age. Having the gene predisposes and individual to Celiac Disease. However, there is much yet to be understood about the role the environment and exposure to gluten play in the development of the disease. The majority of those in the US diagnosed with Celiac Disease are adults.


What Types of Testing Used to Diagnose Celiac Disease?

The first test your doctor will perform is a simple blood test. This test will detect the antibodies to gluten. If the results of the test are indicative of possible Celiac Disease, an endoscopy will be performed to confirm the diagnosis. During an endoscopy tiny samples of the lining of the small intestine are taken and sent for detailed analysis at a laboratory. If the small intestine, shows damage the diagnosis is confirmed. Marsh Scores are used to describe the the level damage to the small intestine. It is important to continue eating gluten prior to testing or the results will be falsely negative. If gluten is removed from the diet, there will be no antibodies to detect in the blood test. The other type of test used is a genetic test. This test is only useful to rule out Celiac Disease. Since Celiac Disease is a genetic disorder, the person must have the gene in order to develop it. However, just having the gene does not mean you have Celiac Disease. Approximately, forty percent of the population has the gene but does not have Celiac. Although it has limited value, this test can be useful to test individuals who do not wish to resume eating gluten or for screening relatives of those with diagnosed Celiac Disease.


How is Celiac Disease Treated?

At this time, the only treatment for Celiac Disease is lifelong adherence to the gluten-free diet. This can be difficult at first. However, with expert guidance and emotional support from a knowledgeable Registered Dietitian, patients learn to lead happy, healthy lives. Gluten can be found in myriad places in prepared products in addition to its presence in grain foods. Because of gluten’s wide distribution in the food supply, expert guidance is needed to learn the rudiments of the gluten-free eating plan. Beyond eliminating gluten, it is important to ensure that nutrient needs for vitamins and fiber are met. The gluten-free diet, if not carefully chosen, can be high in calories and fat and low in certain vitamins and fiber.


Can the Gluten-Free Diet Help with Weight Loss?

In spite of assertions in the popular press, the gluten-free diet is not a weight loss diet plan. In fact, gluten-free food items may be much higher in calories than their gluten containing counterparts. When gluten is removed from a product, it may lose some elasticity and texture. Fat and sugar are often used as replacements for the missing gluten, making gluten-free items higher in calories. There is no basis for the claim that the gluten-free diet will improve athletic performance.


What is “Gluten Sensitivity” ?

Gluten Sensitivity is a “rule out diagnosis”. After testing for Celiac Disease as well as wheat allergy, if symptoms persist after the ingestion of gluten, the condition is termed gluten sensitivity. There is no accepted test for gluten sensitivity other than to rule out the conditions for which there are evidence-based testing – Celiac Disease and wheat allergy. The occurrence of gluten sensitivity in the general population is not known. There have been some preliminary studies indicating that exposure to gluten may cause microscopic changes in the small intestine. Gluten is a difficult molecule for the body to process and some individuals notice a marked improvement in their symptoms after removing gluten from the diet. Some patients with diarrhea predominant Irritable Bowel Syndrome have reported improvement after adopting gluten-free eating style. It is not known if the same gene involved in Celiac Disease is also present in gluten sensitivity. It is important to rule out Celiac Disease by continuing to eat gluten and to be tested. While exposure to gluten in the gluten intolerant may cause distress, exposure to gluten in an individual with Celiac Disease is far more serious. Exposure to gluten in Celiac Disease must be monitored through follow-up antibody titers done on a yearly basis.