Celiac disease and gluten sensitivity

Celiac disease (also known as celiac sprue or gluten-sensitive enteropathy) damages the small intestine. This occurs after exposure to gluten – a protein in wheat, barley, and rye. The intestinal damage impedes nutrient absorption from food.  Celiac disease affects 2 million Americans, or about 60,000 people in the Chicago area.

The immune system causes the injury – celiac disease is an ‘autoimmune’ disease. People with celiac disease may have other autoimmune diseases – inflammatory bowel disease, type I diabetes, rheumatoid arthritis, lupus, or thyroid disease.  Finding those diseases may require specialized testing.  Additionally, celiac disease can run in families – first-degree relatives (parent, sibling, or child) have a risk of about 5%.

Symptoms of celiac disease

• Abdominal pain
• Diarrhea
• Bloating
• Weight loss (in children, diminished growth)
• Anemia (low blood count)
• Fatigue
• Osteoporosis, osteopenia, or fractures
• Persistent rash (dermatitis herpetiformis)
• Infertility
• Abnormal liver tests
• Vitamin, calcium, or iron deficiency

Many patients have no symptoms at all – celiac disease is underdiagnosed.

Diagnosis of celiac disease

Celiac disease can be similar to non-celiac wheat sensitivity, in which people have symptoms with wheat consumption but do not have the intestinal damage that occurs with celiac disease. Other conditions, such as irritable bowel syndrome, inflammatory bowel disease, chronic fatigue, intestinal infection, or cancer may have symptoms in common with celiac disease, or may co-exist with celiac disease.

Celiac disease can be diagnosed using a blood test for antibodies – called IgA TTG (immunoglobulin A anti-tissue transglutaminase with total IgA). Other tests include IgG DGP (immunoglobulin G deaminated gliadin peptide) and anti-endomysial antibody. These tests are most accurate on a normal diet that contains gluten (although genetic tests, if needed, are not affected by diet). The gold standard for diagnosis is endoscopy with biopsy of the small intestine (duodenum).

Treatment of celiac disease

The only known effective treatment for celiac disease is a gluten-free diet for life. Although improvement begins within days, healing can take a couple of years. In the meantime, it is important to be tested for nutrient deficiencies (including iron, folic acid, vitamin D, vitamin B12 at a minimum). It is also important to check with doctor before supplementing these. Because vitamin D deficiency is very common, and osteoporosis can result in bone fractures, it is important to check bone density.

Gluten-free diet

A gluten-free diet eliminates wheat, barley, and rye. Most processed food, pasta, cereal, and croutons should be avoided. Gluten is also in basting, breading, stuffings, food thickeners and preservatives, imitation meat, processed meat, and sauces. Beer and ale often contain gluten. Medicines may also contain gluten.

Gluten should not be present in quinoa, potato, rice, vegetables, fruits, pure fish or meat, sorghum, or tapioca. With increased awareness and more people on gluten-free diets, there now are gluten-free versions of just about anything, including pasta and bread.