Celiac disease is an inflammatory disease of the upper small intestine caused by intolerance to the gluten affecting many genetically susceptible individual. Gluten is a protein found in wheat, and other similar proteins found in rye, barley and oats. These proteins damage the small finger-like projections (villi) that line the small intestine.When damaged and inflamed, the villi are unable to absorb water and nutrients such as vitamins, folic acid, iron and calcium. This causes the celiac to be susceptible to a variety of other conditions related to malabsorption, including lactose intolerance. Clinical and mucosal recovery after incorporating a gluten free diet is objective evidence that the problem is gluten induced.
Causes and Symptoms
The causes are presently presumed to be:
- Genetic susceptibility to the illness.
- A trigger, which could be one of:
- An environmental agent, probably a virus or other infection
- Stress
- Pregnancy
Possible exposure to gluten as a young baby before the gut barrier has developed fully. This association is currently under investigation.
The timing of the first exposure to gluten is also thought to be important. Babies who were introduced to wheat, barley, or rye at any time in the first three months had five times the risk of developing celiac over those exposed at 4 to 6 months. Those exposed later had a slightly increased risk relative to those exposed at 4-6 months. Celiac disease has many and varied symptoms, and adult symptoms are different from those of children. A range of symptoms and signs may be associated with untreated celiac disease. Diarrhea is one of the most common symptoms to affect people of all ages with celiac disease. Children may not gain weight or grow properly, while adults may find they lose weight. Malabsorption may also leave people tired and weak, because of anaemia caused by iron or folate deficiency.
Babies:
chronic diarrhea
abdominal distension
poor feeding
poor weight gain
muscle wasting.
Children:
chronic diarrhea or constipation vomiting
poor weight gain or growth
poor feeding
irritability
muscle wasting.
Adults:
chronic diarrhea
weight loss
anemia
weakness
fatigue
Additionally, complications, including poor absorption, may occur if the patient continues to eat gluten-containing foods. When the intestinal lining is damaged, patients have difficulty absorbing nutrients.
It has not been determined what triggers this reaction in celiac patients. However, celiac disease is associated with autoimmune disorders, such as lupus. Autoimmune disorders occur when the patient's immune system mistakenly identifies body cells as harmful invaders, such as bacteria. As a result, the immune cells in celiac patients attack the patient's intestinal cells.
Researchers estimate that one out of 133 people in the United States have the disease. Prevalence is even higher, one out of 22 people, among patients who have immediate family members (parent or sibling) who have the disease. This suggests that the disease may be inherited (passed down through families) in some cases.
Individuals can develop the disease at any age, but it is most commonly diagnosed in patients who are eight to 12 months old or in patients ages 30-40.
Celiac disease can be managed with a gluten-free diet. In general, patients who strictly follow a gluten-free diet can expect to live normal, healthy lives. Symptoms will subside in several weeks and patients will be able to absorb food normally once they avoid eating gluten. A dietician or certified nutritionist may help a patient with celiac disease develop a healthy diet. Patients with celiac disease may also find gluten-free cookbooks to be a helpful resource. Many products, including rice flour and potato flour, can be used as substitutes for gluten.
Gluten-free diet: Patients should avoid all foods that contain gluten. This includes any type of wheat (including farina, graham flour, semolina, and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt, and triticale. Therefore, foods such as bread, cereal, crackers, pasta, cookies, cake, pie, gravy, and sauce should be avoided unless they are labeled as gluten-free.
Many less obvious foods contain gluten. For instance, grains that contain gluten are often used in food additives, such as modified food starch and malt flavoring. Also, some medications, herbal supplements, and vitamins may contain gluten as a binding agent. Lipstick and postage stamps may contain gluten.
Studies have shown that a gluten-free diet may improve iron deficiency (anemia), malnutrition, anxiety, and depression. Some reports exist of mood swings or depression after adopting a gluten free diet, purportedly due to issues relating to dietary adherence. However, the overwhelming body of scientific evidence concludes that a gluten-free diet will reduce these symptoms.
How to avoid gluten: Patients should carefully read the labels of their foods. To help patients identify foods like gluten, the U.S. Congress passed the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA). The law, which went into effect January 1, 2006, requires food manufacturers to clearly state on their packages whether the food is made with any ingredients that contain products derived from milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, or soybeans. This act also requires the FDA to develop and finalize rules for the use of the term "gluten-free" on product labels by August 2008.
Food products can become cross-contaminated with gluten if they come into contact with gluten. For instance, a knife that was used to cut bread should be washed thoroughly with soap and water before it is used to cut food for a patient with celiac disease. Cross contamination may also occur if bread and vegetables were cut on the same cutting board.
Hidden gluten can be found in some unlikely foods, such as cold cuts, soups, hard candies, soy sauce, and many low or non-fat products (such as licorice and jelly beans). Gluten may also come in forms such as vegetable proteins and starch, modified food starch (when derived from wheat instead of corn), maltodextrin, malt flavoring, and glucose syrup. Many common ingredients contain wheat or barley derivatives.
Patients with celiac disease should always ask about the ingredients in food when dining at a restaurant or someone else's home.
Patients should consult their healthcare providers and pharmacists before taking any drugs, herbs, or supplements because they may contain gluten. Read the labels of cosmetics because some beauty products, such as lipstick, may contain gluten. Use self-adhesive postage stamps because stamps that require moistening may be contaminated with gluten.
Foods that are safe to eat: Today, patients can choose from a wide variety of gluten-free products at grocery stores. There are gluten-free substitutes for many foods and beverages, including cookies and beer. If gluten-free foods are not readily available at the local supermarket, they can be purchased online.
Patients can eat fresh meats, fish, and poultry that are not breaded or marinated. Most dairy products are safe to eat, as well as fruits, vegetables, rice, potatoes, and gluten-free flours that are made from rice, soy, potato, or corn.
Although amaranth, buckwheat, and quinoa are gluten-free when they are grown, they may become contaminated with other grains during harvesting and/or processing. Even though oats may not be harmful for most patients with celiac disease, they are often contaminated with wheat. Therefore, oats should be avoided as a precautionary measure.
Cooking: Patients with celiac disease do not necessarily have to give up their favorite foods because they cannot eat gluten. Substitutes for wheat flour can be used for many recipes. For instance, if a recipe calls for one teaspoon of wheat flour, patients can use 1.5 teaspoon of potato starch, cornstarch, rice flour, or arrowroot starch instead. One cup of wheat flour may be substituted with one cup of fine cornmeal, 3/4 cup of coarse cornmeal, 3/4 cup of rice flour, or 5/8 cup of potato flour. Gluten-free cookbooks are widely available to help patients maintain their quality of life with respect to food.
Gluten-free grains and grain products
Breads: 1 slice or piece Breads, English muffins and bagels ready-made from rice, potato, bean, soy, corn, sorghum, teff or other flours Frozen, gluten-free waffles
Gluten-free pizza crust made from a mix or frozen ready-made H
omemade breads, biscuits, pancakes, waffles, muffins or quick breads made from gluten-free flours
Corn tortillas
Cereals: 1/2 to 1 cup
Cooked cereal made from corn (hominy, grits), rice, pure buckwheat or quinoa
Gluten-free puffed rice
Gluten-free cornflakes, rice flakes, amaranth flakes or other dry cereals.
Snacks: 1 ounce (check label) Crackers or crispbreads made from rice or corn Popcorn, Rice cakes, Pretzels made from gluten-free flours Other: 1/2 to 1 cup
Brown, wild or white rice
Pasta made from rice, corn, amaranth, quinoa or pure buckwheat, Kasha made with pure buckwheat Corn, Quinoa, Flax, Millet
What You Should Avoid:
NO foods that have little or no fiber such as ice cream, cheese, meat, snacks like chips and pizza, and processed foods such as instant mashed potatoes or already-prepared frozen dinners. Too much white flour and refined sugar.
Avoid alcohol and sugar, because they tend to worsen the situation. Too much sugar can rob our body of essential nutrients. Simple carbohydrates from baked goods, pastries, most crackers and cookies must be limited to a very small portion that are gluten free only or completely removed from the diet.
Curb your caffeine. One or two cups of coffee can work to kick you into gear in the morning, but its benefits usually end there. Too much caffeine is just as bad as too much of anything. Drinking it throughout the day for an energy boost can actually backfire.
Reduce Processed and Refined Foods: Avoid fried foods, white pasta, white rice, full fat dairy, white potatoes, white bread (baguettes, bagels, pita).
Processed food can rob your food of nutrients and vitamins that your body needs to fight off stress and promote good health. Try to buy whole foods, unprocessed foods and try and stay away from "instant" foods, preservatives, artificial flavors, saturated fats, refined foods, hydrogenated food and MSG.
Supplements
Acidophilus: The normal, healthy colon contains "friendly" bacteria (85% lactobacillus and 15% coliform bacteria). It is the friendly bacterial flora found in yogurt and is essential to the digestive system. When these bacteria are not in balance, then the person may experience bloating, flatulence, constipation, and malabsorption of nutrients. Acidophilus taken as a dietary supplement may help to detoxify and to rebuild a balanced intestinal flora. It is used for the prevention of Candida as well as for treatment. Acidophilus aids the digestion and helps to replace the "friendly" intestinal flora.
Alpha Lipoic Acid is a unique antioxidant that is both water and fat soluble, which allows it to enter all parts of the cell to neutralize free radicals. Alpha Lipoic Acid contributes to and is important for the production of energy inside the cell by utilizing sugar to produce energy contributing to mental and physical stamina, reducing muscle fatigue and neutralizes free radicals. Alpha Lipoic Acid recycles and enhances the effects of both Vitamin C and Vitamin E.
Calcium and Magnesium can be effective for pain associated with muscle spasms. Take 500 mgs of each, two-three times per day.
A diet that includes Flaxseed, flaxseed oil and fish oils contain omega-3 polyunsaturated fatty acids and decrease pain. Omega-3 fatty acids help lower cholesterol, may help reduce the risk of irregular heart rhythms and may also improve certain factors, like high blood pressure. 1000 mg, divided doses 2x/day.
Nutritional supplements such as the combination of Potassium Aspartate and Magnesium Aspartate has shown benefits for those people with poor assimilation in several studies. Usually 1 gram is taken twice per day. Results have been reported within one to two weeks.
A probiotic will fortify your intestinal flora, which are essential for proper digestion and nutrient absorption. This is key to good health and a strong immune system. Studies have shown that patients who begin a course of probiotics with fiber a few days prior to surgery are less likely to pick up a post-operative infection during their hospital stays. This demonstrates a strong connection between intestinal flora and immune function. The fiber, which provides the friendly bacteria both food and sanctuary, can be as simple as an apple or banana.
Vitamin B deficiency can cause a host of problems. Pantothenic acid (vitamin B5) is essential to all life and is a component of coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Traditionally, pantothenic acid (vitamin B5) has been used to treat celiac disease, but scientific studies have not been conducted to evaluate the safety and efficacy of this treatment. Human scientific studies are needed before a firm conclusion can be made. Take a liquid blend of B's.
Vitamin K: Vitamin K is found in green leafy vegetables like spinach, broccoli, asparagus, watercress, cabbage, cauliflower, green peas, beans, olives, canola, soybeans, meat, cereals, and dairy products. Although vitamin K deficiency is rare, patients who have celiac disease have an increased risk of developing this condition. Therefore, vitamin K has been suggested as possible treatment for patients with celiac disease. However, there are currently no human studies available on the safety and efficacy of this treatment.
References
1. Wellness.com/Celiac
2. Mayo Clinic
3. Alternative Answers Health Community
