Celiac Disease

Celiac disease (pronounced see-lee-ak), also known as gluten intolerance or gluten-sensitive enteropathy, is a little-known disease that was once thought to occur only in children and could be outgrown. It was known as far back as the second century, when a Greek physician referred to his patients as having “suffering in the bowels.”

Living Gluten Free

By Rebecca Rochat

What is known about celiac disease is that it is a genetic disorder that affects people in all parts of the world. It is believed that more than 2 million people in the United States alone suffer from the disease. Celiac disease can be triggered by surgery, pregnancy, childbirth or severe emotional stress. Because the symptoms of celiac disease can mimic the symptoms of other illnesses, it often goes undetected.

Celiac disease is a digestive disease that renders people unable to digest a protein called gluten. The disease damages the small intestine and interferes with the absorption of nutrients in food. The small intestine is lined with millions of microscopic, finger-like projections called villi, which absorb nutrients. The body’s immune system reacts to the gluten and, in so doing, damages the villi in the small intestine. The damaged villi are then unable to absorb vitamins, minerals and other nutrients.

People with celiac disease are at a higher risk for malnutrition, anemia and osteoporosis, and may be prone to developing other problems, such as thyroid disease, Type 1 diabetes and gastrointestinal cancer. Celiac disease is, therefore, both a disease of malabsorption and an abnormal immune reaction to gluten.

Symptoms of celiac disease, which may or may not be obvious, vary between children and adults. Children are more likely to have digestive symptoms, while adults are less likely to have digestive manifestations.

Symptoms vary depending on age, if or how long a person was breastfed as an infant, when he or she began eating foods containing gluten, and the degree of damage to the small intestine. What is known is that the disease can begin at any age, persist for life, and can affect multiple organs.

Celiac disease can be difficult to accurately diagnose. It can be confused with irritable bowel syndrome (IBS), anemia, inflammatory bowel disease, diverticulitis, intestinal infections and chronic fatigue syndrome. The good news is that there is a reliable blood test and correct diagnoses are becoming more common. Felicia Boyer, a registered dietician with Memorial’s Diabetes and Nutrition Center, says the Prometheus blood test for celiac disease has been available for about 4-5 years and has resulted in celiac disease being more accurately diagnosed.

As a starting point, a medical history and physical examination will be performed. Because people with celiac disease have higher than normal levels of transglutaminase antibodies, which react against the body’s own cells and tissues, a blood test will be ordered. It is important for anyone undergoing this testing to continue to eat a normal diet that includes foods with gluten, such as breads and pastas, in order to accurately detect the body’s reaction to gluten.

If a blood test does indicate celiac disease, a biopsy of the small intestine will be performed during an endoscopy to confirm the diagnosis. A biopsy will determine if the villi in the small intestine are shrunken and flattened, which occurs from inflammation as a reaction to gluten.HS2.09_4

Once a diagnosis has been made, treatment can begin. The Diabetes and Nutrition Center at Memorial Hospital sees only patients referred by their GI doctor and educates patients about a gluten free diet and how to read labels. Ms. Boyer notes it is also important to know what medications patients are taking as they may contain some amount of gluten.

There is no cure for celiac disease; it can only be managed by following a gluten-free diet. The good news is the small intestine can heal; this can take a year or only a few days on a gluten-free diet. However, because the body is still genetically predisposed to the disease and the body’s immune system will continue to react to the gluten, gluten must be avoided for life. The symptoms and problems will return if gluten is reintroduced into the diet.

The difficult part of adopting a gluten-free diet is giving up the foods that contain gluten. This can mean a major lifestyle change, especially when eating out. A gluten-free diet means eating foods that do not contain wheat (including spelt, wheat bran, wheat germ and cracked wheat), rye, barley and other wheat products, such as enriched flour, plain flour, self-rising flour and semolina. In other words, most grains, pastas, cereals and many processed foods.

The real challenge is that gluten is sometimes hidden in foods that are not obvious: soups, crackers, gravies, salad dressings, yogurt, soft cheeses, candy bars, dried spices and even some beers. It is the “caramel coloring” in soft drinks, the “natural flavoring,” “modified food starch” and “textured vegetable protein” additives found in many foods. Processed foods that may contain wheat, barley, or rye include bouillon cubes, cold cuts, hot dogs, salami, sausage, French fries, and potato chips. It can also be found in non-food products, such as lipsticks, toothpaste, mouthwash, envelope glue and even crayons.

Given the prevalence of gluten in our food today, how is it possible to totally avoid gluten? With time, patients with celiac disease learn how to avoid gluten by educating themselves about foods and food labels. Most patients end up feeling better than ever after adopting a gluten-free lifestyle.

If you have been diagnosed with celiac disease, here are five things to do:

1. Learn to read labels to find out which foods contain gluten. Remember that wheat-free does not mean gluten-free.

2. Learn about gluten-free foods, which include cassava, corn, flax, legumes, nuts, potatoes, rice, seeds, soy, tapioca, wild rice and yucca. You can also eat plain meat, fish, chicken, oils, milk, cheese, eggs, fruits and vegetables.

3. Find alternative flours and other grains, such as amaranth, millet and buckwheat

4. Find a support group. Greenlife Grocery has a celiac disease support group that meets monthly. For more information call (423) 267-1960.

5. Work with a dietitian who can help you with food selection, label reading and other options for managing the disease.

The good news is that there are many gluten-free options that didn’t exist even 10 years ago. Today, most grocery stores and health food stores carry some gluten-free products, such as bread, cereal, baking mixes, cookies, gluten-free flours and crackers. Many restaurants also offer gluten-free options, as well. With education and support, patients with celiac disease can empower themselves to live normal, healthy lives.

For more information about celiac disease, the following resources are available: Celiac Disease Foundation (www.celiac.org); American Dietetic Association (www.eatright.org); Children’s Digestive Health and Nutrition Foundation (www.cdhnf.org); National Foundation for Celiac Awareness (www.celiaccentral.org); and Gluten Intolerance Group of North America (www.gluten.net).

Rebecca Rochat is a resident of Chattanooga. She attended the University of Tennessee where she earned a BS in Child Development and MS degree in Textiles and Merchandising and Design. In addition to freelance writing, Rebecca serves as an adjunct instructor at the University of Tennessee at Chattanooga.