Celiac Disease - Detailed Info

Celiac disease or Gluten intolerance or Celiac sprue is a digestive disorder that can affect people of all ages and in the USA this disorder is found in the ratio of 1 in 130. People with celiac disease are intolerant to gluten protein gliadin, a prolamin, found in wheat, barley, rye. This disorder induces abnormal immune reaction to gluten which damages the small intestine, preventing it from properly absorbing nutrients from food that are essential for good health. 

Intake of foods or use of products containing gluten by people suffering from celiac disease can cause reaction in the immune system thereby damaging tiny finger-like protrusions called villi lining the small intestine. Villi aid in absorption of essential nutrients from food through the walls of the small intestine into the bloodstream. Damaged or destroyed villi prevents the absorption of nutrients from food, making person malnourished. Celiac disease is considered a genetic disorder, however the disease can originate after surgical treatment, pregnancy/childbirth, viral contamination, or severe anxiety. There is some evidence that extensive use of Antibiotics may also cause this disease.

Symptoms of Celiac Disease
Person suffering from celiac disease may have varied symptoms from some other person suffering from same disease. Symptoms can be gastrointestinal or may occur in other parts of the body. Digestive or Gastrointestinal symptoms are: Pain in abdomen or bloating, gas, indigestion; Constipation; Decreased/Increased appetite; Chronic diarrhoea; Lactose intolerance; Nausea and vomiting; Foul smelling, floating, fatty stool; Weight loss.
Other symptoms that may appear over time due to malabsorption of important nutrients are: Irritability or weariness; Depression or anxiety; Bruising easily; Delayed growth and short stature in children; Delayed puberty or missed/irregular menstrual periods; Itchy skin rash (dermatitis herpetiformis); Hair loss; Ulcers in mouth; Cramps in muscles or bone/ joint pain; Bleeding of nose; Seizures; Itchiness or lack of sensation in hands or feet; Infertility or repeated miscarriages.
Absorption of nutrients is critical for child’s growth and development and malabsorption during this stage can have adverse affect on child’s growth and behaviour. Therefore, children with celiac disease may show symptoms such as permanent dental enamel defects or changes in tooth color; delayed growth or shorter height than normal for their age; delayed puberty; irritability; weight loss; and digestive symptoms such as diarrhoea, constipation, fatty or foul-smelling stools, nausea, or vomiting.
People with celiac disease may not show any symptoms during early stages of life but they can still be at the risk of developing the complications of the disease over time. The complications that can take place due to prolonged malnutrition are anaemia or iron deficiency, osteoporosis or bone loss, and miscarriage. Other complications can be liver ailments and malignancy of the intestine.

Causes of Celiac Disease
What causes Celiac disease is still a question and researchers are continuously trying to find the answer of this question. It is believed that more than one factor is essential for the development of celiac disease condition. Considering the genetic factor, if a person does not have one of the two specific genes (HLA-DQ2 and DQ8) linked to celiac disease, then the chances of developing this condition is quite low. However, almost forty percent of the population carries one or both of those genes. Hence, genetic factor is not the only factor necessary for the disease to manifest.
Intake of food or use of products with prolamins or gluten proteins, which are commonly found in cereal grains with different grains having varied though related prolamins, are responsible for the immune reaction in celiac disease. Inspite of that, gluten is a common part of diets of large majority of people. Masses of people intake gluten on regular basis and even several times e day, still celiac disease is apparent in only about 1% of this majority. There are people who intake gluten everyday for numerous decades without any signs of problem and then all of a sudden they are manifested by celiac disease. Whereas there are people who exhibits the symptoms of celiac disease at very young age or as soon as gluten rich food is introduced into their diets.
So researchers have hypothesized that cause of celiac disease can be summarized as having the precise genes, intake of gluten rich food or use of products having gluten proteins, and possibly some kind of potential trigger (a health issue or emotional stress). However, theory of “trigger” is not yet proved.

Risk associated with Celiac Disease
People with type 1 diabetes are commonly manifested by Celiac disease and it is found that approximately 10% of type 1 diabetic patients also have celiac disease. People with celiac disease are at more risk of developing other autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and Sjogren syndrome. Other risks associated are Thyroid disease, Intestinal cancer or lymphoma, Lactose intolerance, Bone loss/disease such as osteoporosis, kyphoscoliosis, fractures, Low blood count or Iron deficiency (anemia), Low blood sugar (hypoglycemia), Infertility or recurring miscarriages and Liver disease.

Diagnosis of Celiac Disease
Diagnosing celiac disease is quite difficult as its symptoms resemble many other diseases and often it is misdiagnosed as irritable bowel syndrome, diverticulitis, iron-deficiency anaemia, intestinal infection, inflammatory bowel disease and chronic fatigue syndrome. Therefore, now the doctors have become more aware of the varied symptoms of the disease and more reliable blood tests are available, increasing the diagnosis rate.

Blood Tests
To diagnose celiac disease, blood tests are the first-line investigations used to assess the level of certain autoantibodies (proteins that respond against the body’s own cells or tissues). People with celiac disease show higher than normal levels of certain autoantibodies - anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA) - in their blood. In some cases where celiac disease is suspected, however blood test shows negative results then doctors may go for additional blood tests.
Before going for a blood test, one should continue eating gluten rich food diet such as breads and pastas, then only accurate results will be assessed in the blood test otherwise the results may be inaccurate or negative celiac disease even though the disease is present.
If high level of autoantibodies is assessed in the blood test then the next in line investigation is to get biopsy of the small intestine performed, to assess whether there is any damage or not to the parts of the small intestine that aid in absorption of nutrients.

Endoscopy
Once the blood tests results and symptoms imply the development of celiac disease in body, upper endoscopy is usually performed to remove a tiny piece of tissue (biopsy) from the first part of small intestine (duodenum) to verify damage to the villi. The biopsy of people with celiac disease show flattening of the villi in the parts of the intestine beneath the duodenum.

Dermatitis Herpetiformis
Usually people with celiac disease suffer from Dermatitis herpetiformis (DH) which is a condition of intense itching and blistering skin rash.  Dermatitis herpetiformis typically infects body parts such as elbows, knees, and buttocks. People infected with DH show no gastrointestinal or digestive symptoms of celiac disease.
Common methods of diagnosing DH are blood tests and a skin biopsy. Patients with positive autoantibodies blood tests and the skin biopsy of those patients confirm the existence of Dermatitis herpetiformis then they do not need to go for an endoscopy or intestinal biopsy. If the patient starts taking a gluten free diet then within few weeks the intestinal damage as well as the affects of skin disease begins to restore to health and reappear if gluten is added back into the diet.

Screening
Screening is a measure of diagnosing celiac disease in people without any symptoms which involves testing for the presence of autoantibodies in the blood. Screening would aid in detecting previously undetected cases of celiac disease and avert its complications in those patients. Since celiac disease is genetic in nature, it is advised to investigate the family members of a person with the celiac disease to ascertain the presence of disease in them too. As per statics, the family members of 4 to 12 percent of people suffering from celiac disease also suffer from the same disease.

Treatment of Celiac Disease
Celiac disease is an incurable disease however at present the only effectual treatment is an enduring gluten free diet. There is no medication treatment to prevent the damage to the villi or prevent the immune system from reacting when gluten protein is present. A person diagnosed with celiac disease can work out a gluten free diet plan with the aid of a dietician (a health care expert specializing in food and nutrition). Dietician can help the affected person to make informed decisions while purchasing grocery and eating out by teaching the person how to read constituents lists to make out which foods contain gluten.
Strict adherence to the gluten free diet allows healing of the intestines leading to vanishing of all symptoms in most cases of celiac disease. Improvement can be realised within few weeks of starting the diet. In children, healing of damaged intestine can normally take 3 to 6 months and in adults it can take years. A healed intestine means a person now has villi that can absorb nutrients from food into the bloodstream.

Several people with celiac disease do not show any positive progress to the gluten free diet. The typical cause for deprived response to the diet is that there is still small amount of gluten being consumed unknowingly. Unknown or concealed sources of gluten in the diet are additives such as medicines, modified food starch, preservatives used in various consumable products, and stabilizers prepared from wheat. Corn and rice products can also be contaminated with wheat gluten since they are produced in factories that also produce wheat products.
The phrase gluten-free is normally used to specify a hypothetical non-dangerous level of gluten in the diet to a certain extent, than an absolute absence. The precise level at which gluten is risk-free is tentative and debatable. In a methodical check it was tentatively deduced that intake of not more than 10 mg of gluten per day is not likely to trigger off histological deformities.

Seldom will the intestinal damage remain in people affected from celiac disease even though a stern gluten free diet is followed. This state is known as refractory celiac disease and the people suffering from refractory celiac disease have harshly damaged intestines that cannot be healed or damage affect cannot be reversed. Since enough essential nutrients are not being absorbed in their intestines of such people, there may be a requirement of injecting the nutrients directly into their bloodstream through a vein or intravenously. Researches are also going on to assess the drug treatments for patients with refractory celiac disease.
The main reason for deterioration of health even after intake of gluten free diet in refractory celiac disease patients may be the time of presence of disease. The disease may be present for a long time that it has damaged the intestines completely and are no longer able to heal only on diet. Other reasons may be non-adherence to the diet or the patient is inadvertently eating foods that are contaminated with gluten such as medicines, preservatives, etc.

Gluten Free Diet Plan
A gluten-free diet excludes foods that contain wheat, rye, and barley grains. The foods and products containing these grains should be avoided such as pasta, cereal, and many processed foods. A well-balanced diet with a variety of foods works best for people with celiac disease. Instead of using wheat flour; potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour can be used. Gluten-free bread, pasta, and other products are also available in mainstream stores.
Gluten free diet can include plain meat, fish, rice, fruits and vegetables. Oats can also be included in diet in small amounts however on condition that the oats are not contaminated with wheat gluten during processing. Decision to include oats into the diet can be made with the help of health care team. Examples of allowed foods that are harmless to eat are legumes, seeds, amaranth, arrowroot, sorghum, millet, nuts, buckwheat, soy, cassava, potatoes, tapioca, teff, corn, quinoa, rice, flax, Indian rice grass, yucca, sago.
Foods to be avoided are: wheat including einkorn, emmer, spelt, kamut; wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein; barley, rye, triticale; wheat products and processed foods that may contain wheat, barley or rye.

Change in Lifestyle
People with celiac disease have to make significant changes to their eating habits that govern their lifestyle. A complete new approach is needed to change to the gluten free diet. People recently diagnosed with the disease and their families may take help of support groups to learn to adjust to a new lifestyle. Affected people must cautiously make decision about which food to eat and what to buy for lunch at school or work place. They must be extra careful while deciding of what to purchase at the grocery store and what to eat at restaurants or parties. In order to make decision, one should be well informed of the ingredients of the food they are going to eat or purchase.
Some medications also include gluten protein so people with celiac disease should enquire from a pharmacist whether the prescribed medications contain wheat or not.

Probiotics
Mutilation of the intestinal fence or lining is the major event in celiac disease and various other gastrointestinal diseases. Latest studies have verified that probiotic bacteria have favourable effects in these diseases by successfully reversing the damage to intestinal barrier and improving its function. With regular ingestion of probiotics condition of celiac disease may be prevented or even reversed.
Today antibiotics are opted as a widespread medical solution though it causes immense damage to useful gut flora. Therefore, it has become very important to make every endeavour to reinstate the good bacteria in the body. Probiotics, also acknowledged as good or friendly bacteria that reside in the gut, are vital for optimal health and have been shown to guard the body against a unfavourable health conditions. They have also shown to have anti-inflammatory potential and perform many vital functions in the body such as:
·         Digest and absorb certain carbohydrates and convert these into key source of vital energy and nutrients.
·         Promote mineral absorption minerals, produce vitamins such as vitamin K and B, aid in metabolism and the eradicating of toxins.
·         Keep control over bad bacteria by supplying required adequate nutrition to body and starving out excess bad bacteria. Also aids in killing of harmful microbes.
·         Prevent allergies by training the immune system to discriminate among pathogens and non-harmful antigens thus responding appropriately.
·         Provide imperative support to the immune system and play a fundamental role in the development and function of the mucosal immune system in the digestive tract.
·         Aid in the production of antibodies to pathogens.

Enzymes Therapy
Pepsin is the main gastric enzyme. It breaks proteins into smaller peptide fragments.
Ptyalin – Converts starch to simple soluble sugars
Amylase – Converts starch to soluble sugars
Pancreatic amylase – Degradation of carbohydrates to simple sugars
Digestive enzymes can help with digestion as the gastrointestinal tract is recovering, allowing for better absorption and nutrition. Please consult your health provider before starting Enzyme Supplements.

Myths about Celiac Disease
Obsolete and unreliable sources of information about celiac disease may sometimes build incorrect beliefs in the minds of people. These myths can prove to be very dangerous for the people suffering from celiac disease. Some of these myths and common misperceptions about the gluten-free diet are:
·         Celiac disease can be completely treated.
Fact is that it is not possible to outgrow celiac disease. Celiac disease remains even if the apparent symptoms have vanished.
·         Celiac disease is an allergy to wheat.
Celiac disease is not an allergy but is an autoimmune disorder. It is often misunderstood as an allergic illness since allergy reaction is triggered by a foreign substance.
·         People with Celiac disease need to use gluten free cosmetics.
Celiac disease is triggered by eating gluten and using of products and cosmetics containing gluten do not trigger disease unless they are swallowed. Therefore, use gluten free toothpaste, lipsticks, lip balms, and any other product will not help.
·         Improvement is seen as soon as intake of gluten is stopped.
The amount of time taken to realize the improvement starting gluten free diet varies from person to person. Some people may see the improvement instantly however for others positive results may show up in weeks or months.
·         The only concern of people with celiac disease is avoiding gluten.
Even though complete gluten-free diet is followed, people with celiac disease must pay great attention to their cholesterol levels, vitamin status and weight. Further, they need to be conscious of a variety of symptoms and medical conditions that can be related to celiac disease. And they should take medical help as soon as the symptoms prevail.