Celiac disease (CD) is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten (or a gluten fraction called gliadin), which is found in wheat, rye, barley, and possibly oats. When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Specifically, tiny fingerlike protrusions, called villi, on the lining of the small intestine are lost. Nutrients from food are absorbed into the bloodstream through these villi. Without villi, a person becomes malnourished - regardless of the quantity of food eaten.
There is increasing evidence that most people with gluten sensitivity have latent CD with such mild manifestations in the digestive tract that the diagnosis is never made. An allergy or intolerance to specific grains, such as wheat, may be due to a gluten sensitivity, but may occur for other reasons as well.
CD is considered an autoimmune disorder because the body's own immune system causes the damage. Also classified as a disease of nutrient malabsorption, celiac disease is also known as celiac sprue, nontropical sprue and gluten-sensitive enteropathy. Approximately 0.5% of Americans have symptoms brought on by this condition.
While the gastrointestinal tract is the primary target organ, systemic disease is an important consequence of gluten ingestion in many patients. Latent disease may manifest itself as irritable bowel syndrome with iron deficiency anemia, but little or no diarrhea. There is increasing evidence that most people with gluten/gliadin sensitivity have latent celiac disease with such a mild manifestation that the diagnosis is never made. The undamaged part of their small intestine is able to absorb enough nutrients to prevent symptoms. However, people without symptoms are still at risk for the complications of celiac disease.
CD runs in families. Sometimes the disease is triggered by surgery, pregnancy, childbirth, viral infection or severe emotional stress. CD affects people differently; some develop symptoms as children, others as adults. One factor thought to play a role in when and how celiac appears is whether and how long a person was breastfed - the longer one was breastfed, the later and more atypical the symptoms appear. Other factors include the age at which one began eating foods containing gluten and how much gluten has been eaten.
Symptoms may or may not occur in the digestive system. For example, one person might have diarrhea and abdominal pain, while another person has irritability, depression or a rash.
To diagnose CD, physicians test blood to measure levels of antibodies to gluten. These antibodies are antigliadin, anti-endomysium and antireticulin. If the tests and symptoms suggest celiac disease, the physician may remove a tiny piece of tissue from the small intestine to check for damage to the villi. Gluten sensitivity should not be self-diagnosed, since other medical problems could be the cause of similar symptoms. A gluten-free diet should not be followed until you have been seen by your doctor. Tests for CD cannot produce a proper diagnosis if a person is not currently reacting to gluten in their diet. Once a diagnosis is made and a person responds to the gluten-free diet, the physician will know for certain that the diagnosis of celiac disease is correct.
Screening for CD involves testing asymptomatic people for the antibodies to gluten/gliadin. Because celiac disease is hereditary, family members - particularly first-degree relatives - of people who have been diagnosed may need to be tested for the disease. About 10% of an affected person's first-degree relatives (parents, siblings, or children) will also have the disease. The longer a person goes undiagnosed and untreated, the greater the chance of developing malnutrition and other complications.
James Braly and Ron Hoggan, have published a book, Dangerous Grains, claiming that what was thought to be a relatively rare condition may be more widespread than was previously thought. They claim that gluten sensitivity (GS) is at the root of a proportion of cases of cancer, auto-immune disorders, neurological and psychiatric conditions and liver disease. The implication is that the heavily wheat-based western diet - bread, cereals, pastries, pasta - is actually making millions of people ill.
Both authors claim great personal benefits from avoiding gluten. "After eliminating gluten grains," writes Hoggan, "I realized how uncomfortable and chronically ill I had been for most of my life."
Dr. Harold Hin, a GP from Banbury in Oxfordshire, England carried out a blood test on the first 1,000 patients who came to his surgery complaining of symptoms that might indicate CD, such as anemia or being "tired all the time". Thirty proved positive and a diagnosis of CD was confirmed by a biopsy. This was a rate 30 times more than expected.
The test for anti-gliadin antibodies is known as AGA and people who test positive to AGA often have no sign of gut damage.
Worldwide, CD 'out of the intestine' is 15 times more frequent than CD 'in the intestine'. Braly estimates that between 10% and 15% of the US and Canadian populations have anti-gliadin antibodies, putting them at risk of conditions as varied as psoriasis, multiple sclerosis, jaundice, IBS and eczema. The authors claim considerable clinical success in treating patients with conditions such as Addison's disease, lupus, rheumatoid arthritis and ulcerative colitis with a gluten-free diet.
If you suffer from any of the following, the possibility that you are GS may be worth investigating. Upper respiratory tract problems such as sinusitis, "allergies", "glue ear", symptoms related to malabsorption of nutrients such as anemia and fatigue, osteoporosis, insomnia, diarrhea, constipation, bloating and distention, spastic colon, diverticulitis, bursitis, certain forms of epilepsy, behavioral difficulties, ME and ADD. [The Guardian September 17, 2002]
It has been discovered that a relatively short fragment of the gluten protein is exceptionally toxic to CD patients. This gluten fragment is unusually resistant to breakdown by digestive enzymes in the intestine, where it remains intact to have a destructive effect on the intestinal lining. There is a a bacterial enzyme that can rapidly degrade this and other related toxic fragments from gluten, but it will not likely be available to patients in the near future. [Science 9/27/2002;297(5590): pp.2275-9 ]
Addison's Disease: Characterized by the chronic destruction of the adrenal cortex, which leads to an increased loss of sodium and water in the urine, muscle weakness and low blood pressure. The bronze color of the skin is due to the increased production of the skin pigment, melanin.
Allergy: Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Anemia: A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Antibody: A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Anxiety: Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Asymptomatic: Not showing symptoms.
Autoimmune Disease: One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Biopsy: Excision of tissue from a living being for diagnosis.
Bursitis: The bursa is a fluid-filled pad that allows your muscles to easily slide over other muscles and bones. Bursitis occurs when this pad becomes inflamed. It usually occurs when you overuse or injure a specific joint, but it can also be caused by a bacterial infection. Symptoms include pain and inflammation around joints such as the elbow, hip, shoulder, big toe, ankle or knee.
Cancer: Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Canker Sores: Also known as Aphthous Ulcers, these are small, painful ulcers that occur on the inside of the cheek, lip or underside of the tongue. Caused by an assortment of viruses, doctors call this condition aphthous stomatitis. Canker sores usually clear up by themselves within a week or so, but they often recur, sometimes in the form of multiple sores.
Celiac Disease: (Gluten sensitivity) A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.
Chronic: Usually Chronic illness: Illness extending over a long period of time.
Cobalamin: Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Colitis: Inflammation of the colon.
Colon: The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.
Constipation: Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.
Diabetes Mellitus: A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Diarrhea: Excessive discharge of contents of bowel.
Diverticular Disease: Some people develop small pouches (diverticula) that bulge outward through weak spots in the colon. Diverticulosis is the condition of having these pouches; diverticulitis is an inflammation or infection in these pouches. The conditions diverticulosis and diverticulitis are both referred to as diverticular disease. Diverticulosis may not cause any symptoms but could include mild cramps, bloating and constipation - all of which are common to other conditions such as IBS or ulcers. The most common symptoms of diverticulitis are abdominal pain and tenderness around the left side of the lower abdomen. When infection is the cause, fever, nausea, vomiting, chills, cramping and constipation may also occur.
Eczema: Swelling of the outer skin of unknown cause. In the early stage it may be itchy, red, have small blisters, and be swollen, and weeping. Later it becomes crusted, scaly, and thickened.
Electrocardiogram: A test that shows a tracing of the electrical conduction of the heart.
Enzymes: Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Epilepsy: Chronic brain disorder associated with some seizures and, typically, alteration of consciousness.
Esophagus: Commonly called the "food pipe", it is a narrow muscular tube, about nine and a half inches long, that begins below the tongue and ends at the stomach. It consists of an outer layer of fibrous tissue, a middle layer containing smoother muscle, and an inner membrane, which contains numerous tiny glands. It has muscular sphincters at both its upper and lower ends. The upper sphincter relaxes to allow passage of swallowed food that is then propelled down the esophagus into the stomach by the wave-like peristaltic contractions of the esophageal muscles. There is no protective mucosal layer, so problems can arise when digestive acids reflux into the esophagus from the stomach.
Folic Acid: A B-complex vitamin that functions along with vitamin B-12 and vitamin C in the utilization of proteins. It has an essential role in the formation of heme (the iron containing protein in hemoglobin necessary for the formation of red blood cells) and DNA. Folic acid is essential during pregnancy to prevent neural tubular defects in the developing fetus.
Gastrointestinal: Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Immune System: A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.
Iron: An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Irritable Bowel Syndrome: (IBS) A condition that causes upset intestines for a long period of time. It is very unpleasant to the sufferer but tends to be harmless and usually does not lead to more serious complaints. The symptoms vary from person to person and from day to day. In order to be diagnosed with IBS, a person must have at least three of the following symptoms: pain in the lower abdomen; bloating; constipation; diarrhea or alternating diarrhea and constipation; nausea; loss of appetite; tummy rumbling; flatulence; mucous in stools; indigestion; constant tiredness; frequent urination; low back pain; painful intercourse for women.
Jaundice: Yellow discoloration of the skin, whites of the eyes and excreta as a result of an excess of the pigment bilirubin in the bloodstream.
Lymphoma: Any tumor of the lymphatic tissues.
Milligram: (mg): 1/1,000 of a gram by weight.
Multiple Sclerosis: Demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord, manifested by loss of normal neurological functions, e.g., muscle weakness, loss of vision, and mood alterations.
Neuroleptic: A therapeutic agent which produces a state of altered awareness and tranquilization.
Osteoporosis: A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.
Protein: Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Psoriasis: An inherited skin disorder in which there are red patches with thick, dry silvery scales. It is caused by the body making too-many skin cells. Sores may be anywhere on the body but are more common on the arms, scalp, ears, and the pubic area. A swelling of small joints may go along with the skin disease.
Rheumatoid Arthritis: A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).
Schizophrenia: Any of a group of psychotic disorders usually characterized by withdrawal from reality, illogical patterns of thinking, delusions, and hallucinations, and accompanied in varying degrees by other emotional, behavioral, or intellectual disturbances. Schizophrenia is associated with dopamine imbalances in the brain and defects of the frontal lobe and is caused by genetic, other biological, and psychosocial factors.
Seizure: While there are over 40 types of seizure, most are classed as either partial seizures which occur when the excessive electrical activity in the brain is limited to one area or generalized seizures which occur when the excessive electrical activity in the brain encompasses the entire organ. Although there is a wide range of signs, they mainly include such things as falling to the ground; muscle stiffening; jerking and twitching; loss of consciousness; an empty stare; rapid chewing/blinking/breathing. Usually lasting from between a couple of seconds and several minutes, recovery may be immediate or take up to several days.
Thyroid: Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Ulcerative Colitis: (Colitis ulcerosa): Ulceration of the colon and rectum, usually long-term and characterized by rectal bleeding or blood in the stool, frequent urgent diarrhea/bowel movements each day, abdominal pain.
Villi: Small processes protruding from absorptive or secretory surfaces.
Vitamin B6: Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.
Zinc: An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.