Gluten Sensitivity and Celiac Disease

What Is It?

Celiac disease (also called non-tropical sprue, celiac sprue, gluten intolerance and gluten-sensitive enteropathy) is an intestinal disorder in which the body cannot tolerate gluten. Gluten is a natural protein in many grains, including wheat, spelt, barley, rye and oats. Most people can eat gluten without a problem. People with celiac disease have an immune reaction that is triggered by gluten. The immune reaction causes inflammation at the surface of the small intestine, where it damages small fingerlike protrusions called villi and the even tinier, hairlike protrusions called microvilli. Healthy villi and microvilli are needed for normal digestion. When they are damaged, the intestine cannot absorb nutrients properly and you can become malnourished.

Celiac disease is believed to be hereditary and is most common among people of northern European descent. As many as 1 in 250 people in the United States may have celiac disease, but most cases go undiagnosed. Celiac disease is not always recognized because the symptoms can be varied and can be wrongly blamed upon other common intestinal and systemic issues. Celiac disease can be diagnosed at any age. Experts think that surgery, pregnancy, childbirth, a viral infection or severe emotional stress may trigger the beginning of the disease in people who are genetically prone to it.

Celiac disease is an autoimmune condition because the body's own immune system damages the intestinal villi, even though the process is started by eating gluten. People with celiac disease also are more likely to develop other autoimmune diseases, such as thyroid disease and type 1 diabetes. A few conditions frequently coexist with celiac disease, including dermatitis herpetiformis (an itchy, blistering skin rash) and liver inflammation. People who have Down's syndrome have a higher risk of developing celiac disease than is typical. Lactose Intolerance (lack of milk sugar enzyme, lactase) is also common among people who are gluten intolerant.

Symptoms

Symptoms and their severity can vary. Some symptoms come from inflammation in the intestines. Other symptoms come from a lack of nutrients, due to the failure of your intestine to digest food properly.

Children generally develop symptoms only after they start eating foods that contain gluten. Common symptoms include:

• Upset stomach
• Failure to grow normally (often called "failure to thrive") or delayed growth
• Weight loss
• Painful abdominal bloating or distention
• Pale, foul-smelling, greasy stools
• Chronic (long-lasting) or recurring diarrhea
• Irritability

In adults, symptoms may include:

• Chronic diarrhea that does not get better with medication
• Foul-smelling, greasy, pale stool
• Gassiness
• Recurring abdominal bloating
• Unexplained weight loss/gain
• Fatigue
• Infertility, lack of menstruation
• Bone or joint pain
• Depression, irritability or mood changes
• Neurological problems, including weakness, poor balance, seizures, headaches, or numbness or tingling in the legs
• Itchy, painful skin rash (dermatitis herpetiformis)
• Tooth discoloration or loss of enamel, sores on lips or tongue
• Other signs of vitamin deficiency, such as scaly skin or hyperkeratosis (from lack of vitamin A), or bleeding gums or bruising easily (from lack of vitamin K)

Diagnosis

Traditional blood tests to look for specific antibodies (anti-gliadin, anti-endomysial and anti-tissue transglutaminase) are used to screen for celiac disease. These antibodies are found in almost everyone with celiac disease and they rarely are found in people who do not have this disease. Unfortunately, false negatives are possible, leading to additional doubt as to a diagnosis. If your gastroenterologist suspects celiac disease, he or she may recommend a biopsy of the intestine. A biopsy requires the procedure known as endoscopy (EGD or "esophagogastroduodenoscopy"), which allows your doctor to remove a tiny piece of tissue that can be examined under a microscope. Under a microscope, the biopsy sample can reveal damage to the tiny villi, which will appear flatter than usual. Inflammatory cells can also be seen on a microscope examination of a biopsy. If you test negative for the standard Celiac anti-bodies you can still be gluten intolerant, because celiacs are a subset of gluten intolerance.

Fortunately cutting edge laboratory tests are now available to screen for additional antibodies to gluten, beyond those currently being tested for. The kernel of various grains is composed of hundreds of potentially problem causing proteins called antigens. Cyrex Labs has developed a test, called the Array 3-Antibody, now available at OptimumHealth, that will accurately identify gluten sensitivity by looking at different types of gluten, peptides, lectins and enzymes associated with the development of Gluten Sensitivity and/or Celiac Disease. In all, 24 different compounds are evaluated which enhances the clinical sensitivity and specificity for the detection of Celiac Disease and Gluten Sensitivity.

Treatment

Effective treatment sounds simple: just eliminate gluten from your diet, the intestinal damage will be cured over time, and your symptoms will go away. That's easier said than done, however. Many of the foods Americans typically eat contain gluten. Gluten is present in many prepared foods, even though it may not be labeled as containing gluten. Your Optimum Health staff nutritionists and wellness coaches and organizations like the Celiac Foundation that specialize in celiac disease, as well as the shelf talkers at some grocery and natural food markets that identify gluten free foods can give you guidelines on how to avoid gluten in your diet. Many cookbooks contain specific gluten-free recipes.

Here are some tips on avoiding gluten:

• Foods you can eat that do not contain gluten include products made with soybean or tapioca flours, rice, corn, buckwheat or sweet potatoes and yams. Other gluten-free foods include nuts, fresh fish, meat or poultry, fresh/ frozen vegetables/fruits, wine, and plain, natural cheeses, kefirs and yogurts.
• Avoid cereals, breads or other grain products that include wheat, rye, barley, spelt or oats. This includes white or whole-wheat flour (including cookies, crackers, cakes and most other baked goods), semolina, couscous, breadcrumbs, most pastas and malt.
• Avoid processed cheese, cheese mixes, low-fat or fat-free cottage cheese or sour cream.
• Avoid any dairy products, such as yogurt or ice cream, that contain fillers or additives.
• Avoid canned soups or soup mixes.
• Avoid creamed vegetables.
• Avoid products that contain modified food starch, food starch, hydrolyzed vegetable protein, stabilizers, or fat replacers or substitutes.
• Avoid prepared or processed meats.
• Avoid beer, gin and whiskey.
• Avoid flavored coffee, malted milk or herbal tea with malted barley.
• Look for products marked "gluten-free." As more attention is being given to this disease, more products are becoming available. Publix and Kroger may carry these products. Whole Foods certainly does. Ask the department manager if they carry gluten free products.

Treatment at OptimumHealth might also include specific anti-inflammatory functional foods containing herbs like Ginger, Bromelain from pineapple, Turmeric and fish oils. This would include Pro InflaMed, Gluten Sensitivity Packs, Total Vegan, ImmunoG PRP and GlutaMed Rx. In addition, because of vitamin deficiencies caused by mal-absorption from the damaged intestinal lining, specific nutrients to help heal the gut and provide sustenance may be prescribed. Avoiding "Nightshade "plants like egg-plant, white potatoes and tomatoes may also help as they tend to promote inflammation.