Nothing Silly About Celiac Disease

By Riva Preil

May marks National Celiac Disease Awareness Month. Celiac Disease (CD) is an autoimmune disorder of the small intestine that can occur in people of all ages, many of whom have a genetic predisposition. This genetic predisposition is a variation of the typical HLA allele (with the variant being either HLA-DQ2 or HLA-DQ8), however some people who have the variant allele do not develop CD.  It is a polyfactorial disease, which means that several genes are involved with the development of or lack thereof of the disease.

The pathophysiology of CD is that the body responds negatively to gliadin (a gluten protein found in wheat), and the immune system creates an inflammatory reaction in the small intestine. This interferes with nutrient absorption through the microvilli of the small intestine walls.  Spelt, semolina, durum, barley, rye, triticale, and Kamut may also create celiac-like symptoms.  The symptoms of CD include chronic constipation and/or diarrhea (pale and foul smelling), abdominal pain, discomfort, and cramping, fatigue (due to impaired ability of the small intestine to absorb essential and energy providing nutrients), and failure to gain weight, especially in children. In addition, failure to absorb iron can lead to anemia, and failure to absorb calcium and/or vitamin D can create osteopenia or osteoporosis (if severe).  Ulcers of the mouth may also be present.  Furthermore, CD is associated with increased risk of developing adenocarcinoma (cancer of the small intestine) and lymphomas. CD can be confused with irritable bowel syndrome (IBS), so it is important to undergo appropriate testing to ensure proper differential diagnosis.  These tests include serological blood tests and tissue biopsy (with or without endoscopy).

The best form of treatment for CD is a GLUTEN FREE DIET to prevent symptoms.  Corn-based cereals, rice, wild rice, millet, sorghum, quinoa, buckwheat, potatoes, and bananas are recommended for individuals with gluten sensitivity.  Not all “gluten free” foods are created equally- in fact, the FDA allows the term “gluten free” to be used with foods that contain up to 20 ppm (parts per million) of gluten due to the fact that most people with CD will not respond adversely to such low levels of gluten.

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