Celiac Disease: A Medical Overview
What is Gluten?
Gluten is a protein found in wheat (durum, emmer, spelt, farina, farro, Kamut khorasan wheat and einkorn), rye, barley and triticale, as well as all other derivatives of these cereal grains. Gluten helps foods maintain their shape, acting as a glue that holds food together.
What is Celiac Disease?
It is an autoimmune disease of the digestive track. When the protein, gluten, is ingested, it damages the villi in the small intestine, thus interfering with the adsorption of nutrients from food. The body essentially attacks itself when gluten enters the body. When gluten is continually ingested (before diagnosis) the villi become so damaged, the small intestine so inflamed, that your body begins to breakdown because it is becoming malnourished since nutrients are unable to be absorbed into the bloodstream. Diagnosis is so important because when left untreated, the body can develop more autoimmune diseases, severe nutrient deficiencies, anemia, osteoporosis, infertility, thyroid disorders, cancer, and even death.
What are the symptoms?
This can be the tricky part as some people never experience any direct symptoms that they can relate to a digestive problem. Let me explain. Children are more likely to be the ones to experience severe digestive issues but adults can also experience these including: abdominal pain and bloating, gas, distended abdomen, chronic diarrhea, vomiting, constipation, or oily/foul-smelling/fatty stool. Other symptoms include: fatigue, weight loss, irritability, discolored teeth or dental problems, delayed growth or puberty (failure to thrive), anemia, bone/joint pain, arthritis, bone loss/osteoporosis, depression or anxiety. Other symptoms include, tingling numbness in hands or feet, seizures and migraines, loss of menstrual cycle, infertility, miscarriages, canker sores inside the mouth, an itchy skin rash called dermatitis herpetiformis. However, some people can go for years without any severe symptoms, maybe they just get some bad headaches, but they would never think they have a severe autoimmune disorder.
Who is at risk?
Celiac Disease is not restricted to gender, age, or race. But some people will be at greater rick due to these factors. Being a 1st or 2nd degree relative with someone who has Celiac. Celiac is a genetic based disease so if someone in you family is diagnosed, your risk is increased. 10% of family members will develop the condition. Having the HLA-DQ2 and DQ8 genes puts you at risk. 95% of those with Celiac have the HLA-DQ2 gene and the others will have the DQ8. Having other autoimmune disorders puts you at risk for developing others. If you currently have an autoimmune disorder, you are more likely to develop Celiac.
How am I Diagnosed?
Remember in elementary school when you are sitting at your table coloring a picture and the girl to your left picks up the same crayon that you just put down. She then proceeds to copy the exact picture you have in front of yourself. You can’t even tell whose is whose, they are so similar. Well that girl to your left is Celiac Disease. Diagnosing Celiac is so difficult because it mimics the symptoms of so many other diseases like irritable bowl syndrome, Crohn’s, intestinal infections, lactose intolerance, and even depression. Tests for Celiac are often rarely accurate and you have to be still eating a gluten-filled diet to get any positive results.
The most common tests are blood tests which measure your total IgA, IgA-tTG, Iga-EMA, IgG/IgA-DGP, or IgG-AGA. These all measure your body’s response to gluten. If these results come back with positive results, you doctor will most likely call for an endoscopy to take a biopsy of the small intestine to confirm the diagnosis. However, you results may come back very ambiguous, but that does not mean you do not have Celiac. In this case you may want to start an elimination diet for a few weeks to see if your body begins to heal without any gluten in your system.
What about treatment?
Well, if you have Celiac Disease, the one any only treatment is a strict lifelong gluten-free diet. That means no gluten, no matter how small or in what form, must ever enter your body. You must avoid all forms of gluten which include the main 3: wheat, barley, and rye. But this also includes all of their derivatives like spelt, triticale, khorasan, farro, durum, modified food starch, and even contaminated oats. Any product that contains more than 20ppm of gluten is not safe, and even 20ppm can be too much for most Celiacs. But you are not deprived of all grains. There are so many alternatives including: rices, quinoa, buckwheat, corn, nut flours, amaranth, teff, etc. Plus you are still able to eat all fruits, veggies, clean meats, dairy, eggs, beans, and nuts.
What about gluten intolerences and allergies?
A gluten intolerance or allergy is not the same thing as Celiac Disease. They are both not autoimmune diseases, but other bodily reactions. An intolerance is when you experience the symptoms of Celiac, but lack the antibodies and intestinal damage seen with Celiac Disease. It is an innate immune response (not antigen specific) unlike Celiac which is an adaptive immune response. A gluten allergy (or more likely a wheat allergy) is exactly what is says, an allergy. It is an allergic reaction to foods containing wheat (usually not all gluten). Wheat is one of the top 8 allergens.
It generates an allergy-causing antibody to the proteins found in wheat, but not just gluten. Symptoms will also include more “allergic type reactions” as seen in the other top 7 allergens. Including swelling or tightness of the throat, chest pain or tightness, difficulty breathing, trouble swallowing, pale/blue skin (lack of oxygen), dizziness or fainting, increased heartbeat. Essentially you will have an anaphylaxis reaction requiring immediate medical care and will need to carry an Epi-Pen.
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