May is celiac awareness month. Celiac disease (CD) is an autoimmune disease once thought to be rare in occurrence. Even just ten years ago, anyone diagnosed with celiac disease was rushed into the dietitian’s office for appropriate counseling A.S.A.P. on label reading, food options, mineral supplementation and emotional support to tackle this significant change. The rarity of the diagnosis necessitated a full workup on vitamin and mineral levels in the blood and clear direction provided by licensed professionals. A friend of mine who was recently diagnosed with celiac disease was simply told over the phone by a doctor’s office staff member that she had CD with no direction on the next step forward. While it may seem more commonplace within the medical community and more individuals may know the word gluten, CD is a chronic medical condition and is no less serious than it was a decade ago.
No one is born with celiac disease, but it can occur at any age. Like other autoimmune diseases, the body decides to overreact and attack itself with an immune response. In susceptible individuals, damage occurs to the small intestine in response to consuming gluten. Gluten, a protein found in wheat, rye, and barley is obviously a common food ingredient in the United States. Gliadin, a part of gluten, cannot be fully broken down by the intestine in those with CD, and may pass through the barrier of the intestinal wall causing an inflammatory response. Over time as damage to the small intestine occurs from ingesting gluten, the ability of the small intestine to absorb nutrients is decreased. Experts believe that many cases of celiac disease remain undiagnosed, but according to studies in the United States and other countries, the prevalence is approximately 1 in 80 to 1 in 300 individuals.
Although physical problems related to CD can vary, signs and symptoms may include abdominal pain, abdominal bloating, diarrhea, constipation, gastrointestinal reflux, or vomiting. . Lactose intolerance can occur for many reasons, but it is often present in undiagnosed celiac disease due to the damage the body has inflicted on the area of the small intestine that produces enzymes which help us break down and absorb our food.
If the gluten free diet is not closely followed it may lead to nutrient deficiencies, specifically calcium, vitamins D and B-12, iron, folate, and zinc which can lead to poor growth in children, anemia, irregular periods and fertility issues, along with low bone density. More than 50% of people with CD have been found to be vitamin D deficient which effects both immune system health and increases risk of weak bones.
Testing for CD focuses first on blood markers of an immune response while on a diet that contains gluten, specifically high levels of IgA and IgG antibodies. The gold standard of testing though is a tissue biopsy of the gastrointestinal tract done by a doctor specializing in gastroenterology. Genetic testing is also available which also may help tell the difference between CD and a gluten intolerance. If an individual goes on a gluten-free diet prior to testing, the results of any blood or tissue tests are completely invalid. Celiac disease is actually the only autoimmune disease where the trigger for the disease is known and can be avoided. Once a person has one autoimmune disease or certain medical conditions it is likely that another may occur. This is why it is recommended that certain people with diagnoses of Type 1 diabetes, rheumatoid arthritis, Down syndrome, Turner syndrome and others routinely be screened for celiac disease.
Medical nutrition therapy for CD is vital as this currently is the only known treatment that helps to decrease damage which occurs when the small intestine is exposed to gluten. Patients must avoid all sources of gluten including wheat, rye, and barley including small amounts such as malt flavoring and cross contact in the home or in processed food items. Vitamin and mineral supplementation may be needed to correct deficiencies. Life time compliance with the gluten free diet is essential for health.
You would think that the increased awareness of gluten would be a helpful to those who truly need to avoid gluten. In many ways it is as there are many more food products available. On the other hand, well-meaning individuals may not realize how careful one must be to avoid allowing any gluten from coming in contact with gluten free food. Those with celiac disease can not eat a salad that once had a handful of croutons resting upon it or “cheat” on their gluten free diet every now and then. An immune response can’t be felt. We don’t feel our white blood cells attacking a cold or doing their awesome immune magic, so for individuals with celiac disease consuming even small amounts of gluten can have effects on the body without a physical outward sign. The root of what causes the signs and symptoms in celiac disease is the damage that has occurred because of the immune system attacking the gastrointestinal system, not the gluten itself
There are many items in food and especially highly processed options with amped up fiber counts that can lead to poor digestion. If you have GI problems such as bloating, diarrhea, or heartburn it is a poor choice to start a completely gluten free diet prior to being tested for celiac disease. Once gluten is removed the body will stop producing antibodies against gluten and a test for celiac disease would come up negative. It’s important to know the truth about your diagnosis as celiac disease is one medical condition in which mineral supplementation is often needed, bone density can be effected, and the gluten free diet must be adhered to 100% of the time, 365 days a year, for a lifetime. Not knowing celiac disease is present may encourage someone to not be as vigilant at sticking to gluten free choices.