Disease, Illness and Condition Library
Celiac Disease
common than once thought. This disease is now thought to affect as many as 2.5 million Americans. A recent University study indicated that as many as 1 in 133 otherwise healthy individuals are affected. For those with interrelated symptoms, the incidence could be as high as 1 in 56. Celiac disease is sometimes referred to as celiac sprue. This chronic disorder is caused by a hereditary intolerance to gluten. Gluten is a component of wheat (including durum, semolina, and spelt), rye, oats, barley, and related grain hybrids such as tritcale, and kamut. The cause of celiac disease is currently unknown, although it is known to affect mostly Caucasians or European descent. When a person with celiac disease consumes gluten, damage to the small intestine occurs. It is thought that the body responds to gluten as if it was an antigen, and launches an immune system attack when it is absorbed by the intestine. This, in turn, causes the lining of the small intestine to swell. As a result, tiny hair like projections called villi are damaged and destroyed, which limits the bodies ability to absorb vital nutrients. Malabsorption becomes a serious problem, and the loss of vitamins, minerals, and calories result in malnutrition despite an adequate diet. Diarrhea is a common symptom that only makes matters worse. Because celiac disease impairs digestion, food allergies may also occur. Celiac disease affects both adults and children, and it can appear at any age. It often first appears when a child in initially introduced to cereal foods, at around three or four months of age. In others, the disease can be triggered by emotional stress or physical trauma, such as surgery or pregnancy. The first signs are usually diarrhea, weight loss, and nutritional deficiencies. Additional symptoms can include abdominal swelling; nausea; large, pale, light yellow colored stools that float; depression; irritability; muscle cramps; wasting; and joint and/or bone pain. Infants and children may exhibit stunted growth, vomiting, an intense burning sensation in the skin, and a red itchy rash called dermatitis herpetiformis. A baby with celiac disease may gain weight more slowly than normal or may lose weight. The infant may have a poor appetite, gas, and odious smelling bowel movements. The child is likely to have an anemic, undernourished appearance. Ulcers may develop in the mouth. When left untreated, celiac disease can be quite serious, even life threatening. Bone disease such as osteoporosis, central and peripheral nervous system impairment, seizures caused by inadequate absorption of folic acid, internal hemorrhaging, pancreatic disease, infertility, miscarriages and birth defects, and gynecological disorders are just some of the long term maladies that can affect those with celiac disease. There is also a chance of developing intestinal lymphoma and other intestinal malignancies. Certain autoimmune disorders also can be associated with celiac disease, including nephrosis, sacrcoidosis, insulin dependent diabetes mellitus, systemic lupus erythematosus, thyroid disease, and rarely, chronic active hepatitis, scleroderma, myasthenia gravis, Addison’s disease, rheumatoid arthritis, and Sjogrens’s syndrome. Celiac disease is often challenging to diagnose because the symptoms are similar to those of other diseases, such as irritable bowel syndrome, gastric ulcers, and anemia. The average time it takes for a person to be diagnosed is eleven years. Advances in blood testing have made it easier to detect celiac disease. A diagnosis based on a blood test should be followed up with a biopsy or the intestinal tissue, which is usually an outpatient procedure. However, due to the fact that symptoms are so diverse, and some people with celiac disease do not show obvious symptoms, many people go a long time before being diagnosed correctly. Because celiac disease is hereditary, if one family member is diagnosed with it, other family member should also be tested.
When the diagnosis has been confirmed, the treatment is very straightforward: a gluten free diet. The diet does not contain any oats, wheat, rye, barley, or triticale. Buckwheat and millet are frequently excluded as well. Even though buckwheat is not in the grass family, and millet appears to be more closely related to rice and corn, they do contain proteins that are comparable to alpha gliadian. A recent study of fifty two adults with celiac disease suggests that modest amounts of oats may be tolerated without adverse side effects. Additionally, other foods should be rotated (see Allergy), and milk and milk products should be eliminated until intestinal structure and function return to normal. Often, major improvement will be seen within a few days or weeks; 30% of celiac sufferers respond within three days, another 50% within one month, and 10% within another month. Nevertheless, 10% of people with celiac disease only respond after twenty four to thirty six months of gluten avoidance. If you have celiac disease and you do not appear to be responding to a gluten free diet after two months, the following should be considered: 1. You may have an inaccurate diagnosis 2. You may be being exposed to veiled sources of gliadin 3. You may be suffering from some complications of celiac disease, such as zinc deficiency. The later possibility highlights the importance of multivitamin and mineral supplementation for anyone with an intestinal disorder. In addition to treating any fundamental deficiency, supplementation provides the essential cofactors for growth and repair. Celiac disease will often not clear up if there is an underlying nutrient (e.g. zinc) deficiency. Pancreatic Enzymes The effect of pancreatic enzyme substitution therapy during the two months following initial diagnosis of celiac disease was investigated in a double blind study. The study sought to clarify the benefit of pancreatic enzyme therapy because previous studies had shown that deficiency of pancreatic enzymes is found in 8 to 30% of celiac patients. In the study, patients followed a gluten free diet and received either two capsules of pancreatic enzymes or two placebo capsules with every meal. The patients who received pancreatic enzymes took six to ten capsules per day depending upon the number of meals they consumed, with each capsule containing 5,000 IU of lipase, 2,900 IU of amylase, and 330 IU of protease. Complete nutritional evaluations were conducted at day zero, thirty, and sixty. Results indicated that pancreatic enzyme supplementation improved the clinical benefit of a gluten free diet during the first thirty days but did not provide any greater benefit than the placebo after sixty days. |
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