Celiac Disease

A lifelong digestive disorder, found in individuals who are genetically susceptible, that results in damage to the small intestine by interfering with the absorption of nutrients.  Celiac Disease (CD) is unique in that a specific food component, gluten, has been identified as the culprit.  Gluten is the common name for the offending proteins in specific cereal grains that are harmful to persons with CD.  These proteins are found in all forms of wheat (including durum, semolina, spelt, kamut, einkorn, and faro), and related grains, rye, barley, tritcale and possibly oats. Damage to the mucosal surface of the small intestine is caused by an immunologically toxic reaction to the ingestion of gluten. 

What Happens

When individuals with CD ingest gluten, the villi, tiny, hair-like projections in the small intestine that absorb nutrients from food, shrink or disappear.  This is a destructive immunological reaction to gluten.  Damaged villi interferes with the body's ability to absorb basic nutrients -- proteins, carbohydrates, fats, vitamins, minerals, and, in some cases, water and bile salts.  If CD is left untreated, damage to the small bowel can be chronic and life threatening, causing an increased risk of associated disorders -- both nutritional and immune related.

Some long-term conditions that can result from untreated CD:

· Iron deficiency Anemia

· Osteoporosis

· Vitamin K deficiency associated with risk for hemorrhaging

· Vitamin and mineral deficiencies

· Central and peripheral nervous system disorders -- usually due to unsuspected nutrient deficiencies

· Pancreatic insufficiency

· Intestinal Lymphomas and other GI malignancies

· Other food sensitivities/lactose intolerance

Other associated autoimmune disorders:

· Dermatitis Herpetiformis (DH)

· Insulin-dependent Diabetes Mellitus

· Thyroid Disease

· Systemic Lupus Erythematosus

· IgA Nephropathy & IgA Deficiency

· Primary Biliary Cirrhosis

Less commonly linked to CD:

· Chronic Active Hepatitis

· Scleroderma

· Myasthenia Gravis

· Addison's Disease

· Rheumatoid Arthritis

· Sjogren's Syndrome

· Down's Syndrome

Symptoms

Many patients are asymptomatic for years, with the disease becoming active for the first time after surgery, viral infection, severe emotional stress, or pregnancy and childbirth.  CD may appear at any time in the life of a person with a hereditary pre-disposition.  Symptoms of CD are as varied as the nutritional deficiencies caused by the malabsorption.  Infants, toddlers and children may exhibit growth failure, vomiting, bloated abdomen and behavioral changes.

Classic symptoms may include:

· abdominal cramping, intestinal gas, distention and bloating

· chronic diarrhea or constipation (or both)

· steatorrhea  -- oily stools

· anemia - unexplained, due to folate, B12, B6, or iron deficiency (or all)

· weight loss with large appetite, or weight gain

Other symptoms:

· dental enamel defects

· osteopenia, osteoporosis

· bone or joint pain

· fatigue, weakness and lack of energy

· infertility

· depression

Dermatitis Herpetiformis (DH), is the associated skin condition characterized by blistering, intensely itchy skin.  The rash has a symmetrical distribution and is most frequently found on elbows, knees and buttocks.  DH patients can have gastro-intestinal damage without perceptible symptoms.

Cause

The cause of Celiac Disease, also called celiac sprue, or gluten sensitive enteropathy (GSE), is unknown.  Current research indicates that CD is strongly associated with a group of genes on Chromosome 6.  These genes (HLA class II antigens) are involved in the regulation of the body's immune response to the gluten protein fractions.

Who gets CD - Genetics

Celiac Disease is most commonly found in genetically susceptible Caucasians.  Recent studies suggest that at least 1 in 250 persons in the United States is affected.  Many cases go undiagnosed or are asymptomatic for years.  CD occurs in 5 - 15 % of the offspring and siblings of the celiac.  In 70% of identical twin pairs, both twins have the disease.  It is suggested that family members be tested.

Diagnosis

A person seeking preliminary diagnosis must be consuming gluten.  Specific antibody blood tests are used to identify the possibility of Celiac Disease and are the initial step in screening individuals who are at risk (first-degree relatives of biopsy diagnosed celiacs).  Certain antibodies are produced by the immune system in response to substances that the body perceived to be threatening, i.e. gluten.  Current research shows that people with CD have higher than normal levels of these antibodies in their blood.  It is recommended that patients with positive antibody tests have a small bowel biopsy to confirm the diagnosis and assess the degree of mucosal damage.  Dermatitis Herpetiformis (DH) is diagnosed by a biopsy of a skin lesion and staining for IgA in the tissues.  More than 85% of DH patients have small-bowel sensitivity to gluten.  An experienced CD/DH pathologist is essential to establish these diagnoses.  The diagnosed celiac should have medical follow-up to monitor the clinical response to the gluten-free diet. Click here for celiac screening information.

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Treatment 

The only treatment for CD/DH is the life-long adherence to gluten-free diet.  When gluten is removed from the diet, the small intestine will start to heal and overall health improved.  Medication is normally not required.  Because osteopenic bone disease is common and may be profound in patients with newly diagnosed Celiac Disease, bone densomitry should be measured in adults at or shortly after diagnosis.  Consult your physician regarding specific nutritional supplementation to correct any deficiencies.  All patients should be monitored by their physician to ensure compliance with, and response to the gluten-free diet.  Dietary compliance decreases the likelihood of osteoporosis, lymphoma and other associated illnesses.

Adapting to the gluten-free diet requires some lifestyle changes.  It is crucial to read labels which are often imprecise, and learn to identify ingredients that may contain hidden gluten.  

Be aware that hidden gluten can be found in some unlikely foods such as: cold cuts, soups, hard candies, soy sauce, many low or non-fat products, even licorice and jelly beans.  Potential harmful ingredients include:

· unidentified starch

· modified food starch

· hydrolyzed vegetable protein-HVP

· hydrolyzed plant protein-HPP

· texturized vegetable protein-TVP

· binders, fillers, excipients, extenders

· malt & other natural flavorings

Gluten may also be used as a binder in some pharmaceutical products.  Request clarification from food and drug manufacturers when necessary.

Alcohol and vinegar that are properly distilled should not contain any harmful gluten peptides (or prolomines).  Research indicates that the gluten peptide is too large to carry over in the distillation process.  This leaves the resultant liquid gluten-free unless a gluten-containing additive is inserted after the distillation process.  Alcohols and vinegars should be carefully investigated for additives before use.  Malt vinegars are not distilled and therefore are not gluten-free.

 

Recipe for pasta:

Chef Mario's recipe for gluten-free pasta. It is as follows: Take 350 g of rice flour, 100 g of maize starch, 100 g of potato starch, and 8 whole eggs. This will yield 1 kg of fresh pasta. Put the ingredients together and knead for 5 minutes. Asian "glutinous" rice flour is preferred. It is easier to produce tagliatelle or other pasta shapes when using this type of rice flour. Roll the pasta out and cut it with an inexpensive pasta-cutting device (a knife serves just as well). A kilogram of fresh pasta, left to dry overnight at room temperature, will yield a final 750 g of dried product. Stored at 4°C, the pasta will remain stable for at least 2 months. Season with 100 g of tomato sauce (92 g processed tomato, 8 g olive oil and salt), and there is your gluten-free pasta. Serve dente.