Celiac disease is caused by a disorder in the body’s immune system. The food protein gluten interacts with the lining of the small intestine causing inflammation and damage. Gluten is found in wheat, rye, and barley. It may also be present in some preparations of oats. The lining of the small bowel is where all nutrients, vitamins, and minerals are absorbed in the body. This immune inflammatory reaction at this site can cause many problems but they all are a result of the inability of the small intestine to absorb these nutrients. The symptoms may include abdominal discomfort or pain, weight loss or inability to grow, change in bowel pattern such as constipation and diarrhea and symptoms in the brain, nervous system, bones, liver and other organs. While the disorder is genetically transmitted it does not always show up in childhood. It can present itself in adult life.
Here are some of the problems that may occur in the Celiac patient:
- Reflux of acid into the esophagus
- A skin condition called dermatitis herpetiformis with itching and blisters
- Anemia or low red blood count
- Osteoporosis and weak bones
- Numbness, burning and tingling in the feet and/or hands
Over 1000 thousand years ago a person living in northern Europe had a gene mutation in the immune system. This resulted in the individual and many of his or her subsequent offspring having the genes necessary to have Celiac disease. It is the reason the people with a genetic background from northern Europe have a higher incidence of Celiac disease. In addition, it was at this time that wheat was being domesticated and considerable gluten from wheat entered the human diet. But it remained until World War ll when some chronically ill Dutch children were living in a famine and had no wheat to eat. They actually got better. When wheat was introduced into their diet after the war, they became sick again. It was soon found that wheat gluten was the culprit. It is known that if a person has the gene for Celiac, then a close blood relative will frequently have this abnormal antibody and will develop this disease.
The Immune System
We all begin to develop our immune system the day we are born when mother’s bacteria reach our colon and generate a strong immune system that protects us from infections our entire life. However, the immune system can overreact and be a problem in and of itself. Type 1 diabetes, rheumatoid arthritis, and lupus are just a few of the disorders that involve dysfunction of the immune system. Celiac, too, involves the immune system. When gluten comes in contact with the lining of the small bowel, Celiac patients have an inflammatory reaction that badly damages the lining and leads to all the medical problems that are known to occur. If you have one immune-related disorder, then it is more likely that you will get Celiac disease.
Celiac in Childhood
As noted Celiac disease often does not show up in childhood. When it does, many of these children are often overweight. While they may have a variety of digestive symptoms, some of them have none. Infants may experience failure to thrive, a swollen abdomen, abdominal discomfort, and diarrhea. Older children also may show a failure to develop or grow normally, changes in bowel patterns, late onset of puberty and mental changes such as attention deficit disorder and learning problems.
Untreated Celiac disease
Untreated Celiac disease can lead to serious medical problems. These include:
- Malnutrition. Various forms of poor nourishment may occur including anemia, vitamin deficiencies and failure to grow normally.
- Dermatitis herpetiformis. This is a blistering itchy condition of the skin that, fortunately, is responsive to diet and medications
- Osteoporosis and weak bones. This occurs because calcium and vitamin D are so poorly absorbed from the bowel.
- Infertility and miscarriage. Both of these may be present or occur in the female celiac patient.
- Lactose intolerance. Milk sugar is normally broken down by the enzyme lactase in the small bowel. This enzyme may be missing in this condition and the patient may have symptoms like bloating, gas and diarrhea when dairy products are eaten.
- Cancer. It is important that Celiac patients remain on a gluten-free diet. Otherwise, they are at risk for a serious form of bowel cancer called lymphoma.
A Gluten Free Diet
Wheat in all its forms is a basic part of the diet all over the world. Perhaps as many as 25% of the world’s calories come from wheat. So avoiding wheat and all its sources is a major task for the Celiac patient. Yet, it can be done as many Celiacs have stopped their disease dead in its tracks and now lead very healthy and productive lives. This section provides just an overview of a gluten free diet. To get the full diet in detail go to the Gluten Free Diet page. In the meantime, the following are where you can get help.
- Physician-your physician, ideally a gastroenterologist, has a great deal of information for celiac patients.
- Registered dietitian- Plan on spending at lease 2-3 sessions with this person. The dietitian will be the one who can provide basic information and tips on how to avoid gluten in the diet.
- Internet- there is now a large number of support groups for the Celiac patient on the web. Search them out. The larger ones are: National Foundation for Celiac Awareness and Celiac Support Association
- Local support groups your physician and her or his nurses will know of local support groups where you can exchange information and ideas. Become involved. It will pay off in your better health and give you satisfaction in helping others down the road.
Just to get you started, here are the common foods that have gluten and must be avoided:
- Wheat in all its forms
- Graham flour
Be especially careful of packaged foods, sauces and soups. Wheat in many of its forms may be part of the ingredients. Read labels very carefully. If you don’t recognize a word, look it up before purchasing the food. Finally, most food stores now have gluten-free sections, which make shopping a lot easier. These foods are always a bit more expensive but until you learn to do-it-yourself, trust them.
Minerals and Vitamins
Your doctor will be checking you for deficiencies in minerals and vitamins. Ask the physician about:
- Vitamin D
- Vitamin B-12
- Vitamin K
Poorly Responsive Treatment
Failure to respond to a gluten-free diet occurs in a minority of patients. This can occur for one of two reasons:
- Hidden gluten getting into your food. This is the first thing to check. Often a dietitian is helpful in finding the source of hidden gluten. The extra effort here is always worthwhile.
- Complicated immune disorders. At times Celiac disease is just one part of a more complex immune problem within the body. A gastroenterologist with extra training and experience in this field can often be helpful. Certain medications will sometimes be helpful in smoothing out such a complex situation.
Prebiotics are a certain type of non-caloric carbohydrate found in many foods including wheat. It is separate from gluten. The technical names for these are inulin and oligofructose. These substances go through the gut unchanged and are then used by the best colon bacteria for their own growth. It is known that Celiac patients often have a bad bacterial mix, called dysbiosis. When the bad unwanted bacteria predominate and dysbiosis develops, a leaky gut can occur and allow toxins from the gut to enter the blood. Getting enough prebiotic foods is critical. 70% of the prebiotics that Americans eat come from wheat so when gluten and wheat are given up, prebiotics must be ingested from other sources. Prebiotics are plentiful in the following foods, which are also gluten-free:
- Most root vegetables
It may be worthwhile for a Celiac patient to use a prebiotic supplement such as Prebiotin.
It has recently been shown that there are a significantly large number of people who do not have Celiac disease with inflammation of the small bowel, but they do have an intolerance to gluten. This means that they just don’t feel good eating gluten containing foods and they often have a variety of abdominal symptoms such as bowel irregularity, gas, bloating and abdominal discomfort. They do not have inflammation in the gut nor are they prone to get true Celiac disease and its complications. It seems that these people often can consume some gluten without problems, which is not the case with a true Celiac patient.
Finally, there are now lots of younger people who have gotten on a gluten free diet just because it seems the thing to do and it might make a person feel better. There is nothing really wrong with this. However, it should be remembered that wheat is a terrifically nutritious food with lots of nutrients, vitamins, minerals and prebiotics, which feed the good bacteria in the lower gut. Many people who go on a gluten-free diet end up with a bad mix of gut bacteria because they are not ingesting enough prebiotics. Prebiotic-rich foods and/or a prebiotic supplement such as Prebiotin is recommended.
Author: Frank W Jackson MD