Celiac Disease, Op-ed

Celiac disease is a chronic immune-mediated disorder induced by dietary exposure to gluten in genetically predisposed inpiduals. The proximal small intestine is the major site of disease.

What is Gluten?

Gluten is a general name for a group of proteins in cereals such as wheat, barley, and rye. Gluten helps foods maintain their shape, acting as a glue that holds food together. Gluten can be found in many types of foods, even ones that would not be expected.

Wheat gluten is composed of mainly two types of proteins: the glutenins and the gliadins, which in turn can be pided into high molecular and low molecular glutenins and α/β, γ and Ω gliadins. Its homologous seed storage proteins in barley, are referred to as hordeins; in the rye, secalins; and in oats, avenins. These protein classes are collectively referred to as "gluten".

Global Prevalence of Celiac Disease

Celiac disease is a major public health problem worldwide. Although initially it was reported from countries with predominant Caucasian populations, it now has been reported from other parts of the world. On searching for the prevalence of Celiac disease, the pooled global prevalence of celiac disease was 1.4% in 275,818 inpiduals, based on positive results from seroprevalence. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 inpiduals.

The prevalence values for celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was higher in female vs male inpiduals (0.6% vs 0.4%; P < .001). The prevalence of celiac disease was significantly greater in children than adults.

Risk Factors

Celiac disease can develop in anyone. It is more common in white people and in females. Also, it runs in families. A person with a parent or sibling who has celiac disease has a 1 in 10 chance of developing it, too. Celiac disease is more common in people with other conditions, including Down syndrome and Turner syndrome.

Celiac disease is more common in people who have certain other autoimmune diseases, including type 1 diabetes, rheumatoid arthritis, and Addison’s disease.

Health issues such as surgery, pregnancy, infections, or severe stress can sometimes trigger celiac disease symptoms.

Villous Atrophy

Intestinal villi are tiny, finger-like projections made up of cells that line the entire length of the small intestine. The villi (villus is the singular, villi is the plural) absorb nutrients from the food we eat and then shuttle those nutrients into the bloodstream so they can travel where they're needed.

Celiac disease is the best-known cause of villous atrophy. Coeliac disease is caused by a reaction to gluten. It occurs in people who are genetically predisposed. Upon exposure to gluten, an abnormal immune response may lead to the production of several different autoantibodies that can affect a number of different organs. In the small bowel, repeated exposure gradually damages the small intestine causing an inflammatory reaction and may produce shortening of the villi lining the small intestine (villous atrophy). This affects the absorption of absorbing minerals and nutrients from food, frequently leading to anemia.

Symptoms

The symptoms of celiac disease can range from mild to severe. They can change over time, and they vary from person to person. Some people have no symptoms or only experience them later in life. A person may not know that they have the celiac disease until they develop a nutrient deficiency or anemia.

Children are more likely to develop digestive symptoms than adults. These symptoms include abdominal pain, bloating, gas, chronic diarrhea or constipation, nausea, vomiting, pale stool with a foul smell, and fatty stool that floats.

Symptoms of celiac disease that are not digestive can include weight loss, fatigue, depression or anxiety, joint pain, mouth sores, a rash called dermatitis herpetiformis, and nerve damage in the extremities, called peripheral neuropathy, which can cause tingling in the legs and feet.

Variations in symptoms may depend on: age, damage to the small intestine, the amount of gluten consumed, the age at which gluten consumption began, and how long the person was breastfed, as symptoms tend to appear later in those who were breastfed for longer.

Infants and toddlers tend to have more obvious symptoms which usually manifest in the gastrointestinal tract. Symptoms include, but are not limited to vomiting, bloating, irritability, poor growth, abdominal distention, diarrhea with very foul stools, and malnutrition.

Vomiting is less common in school-age children than in infants and toddlers. Symptoms include, but are not limited to stomach aches or abdominal pain, abdominal distention, diarrhea, constipation, trouble gaining weight, or weight loss.

Older children and teenagers may have symptoms or concerning signs that are not obviously related to the intestinal tract, which are called “extra-intestinal” or “atypical” symptoms. These symptoms are what may convince a physician to test for celiac disease. Some of these manifestations include stunted growth, weight loss, delayed puberty, achy pain in the bones or joints, chronic fatigue, recurrent headaches or migraines, itchy skin rash, recurring mouth sores. Adolescents with celiac disease may also have mood disorders, including anxiety and depression, as well as panic attacks.

Nutrient Deficiencies

Nutrient deficiencies are caused by vitamins and minerals in the intestine that do not get absorbed. They can also come from a diet low in vitamins and minerals. In newly diagnosed or untreated celiac disease, damage to the small intestine can lead to poor absorption of vitamins and minerals. Diarrhea that is often seen in celiac disease can also add to this problem. A person with celiac disease must avoid foods containing wheat, rye, and barley. These foods are high in B vitamins, iron, and other minerals. He/she may also need to avoid dairy products (high in calcium and vitamin D) due to lactose intolerance. Avoiding these foods can lead to many low vitamin and mineral levels.

Common deficiencies in newly diagnosed and untreated celiac disease are vitamin B12, iron, calcium, vitamin D, zinc, and copper. This depends on how severe the disease is and the person's diet. Low vitamin and mineral levels can cause health problems, such as feeling tired and poor bone health. Beyond malnutrition, celiac disease can also cause damage to the large intestine and more subtle damage to other organs.

Diet

For most people with celiac disease, switching to a gluten-free diet greatly improves the symptoms, and a person may notice an improvement in days or weeks.

In children, the small intestine usually heals in 3–6 months. In adults, full healing can take several years. Once the intestine heals, the body is able to properly absorb nutrients from food again.

Having a gluten-free diet is easier than ever in some parts of the world, where gluten-free options are becoming more widely available. The key is to understand which foods and products such as toothpaste tend to contain gluten. A qualified dietitian can help.

Gluten occurs naturally in wheat, rye, and barley. Most cereals, grains, and pasta, as well as many processed foods, contain gluten. Beers and other grain-based alcoholic drinks can also contain it. Soy sauce is often made with wheat. Gluten may be used as a thickener. Omelets and eggs may be made with pancake batter. Salad dressings may contain gluten. It is crucial to check labeling because gluten can be an ingredient in some unexpected products.

Gluten may be used as a filler or coating in medications and supplements. Always review the ingredients list on any over-the-counter medications or vitamin/mineral supplements. Any prescribed medications should be reviewed by your doctor to be sure they don’t contain gluten — and find Gluten-Free Alternatives if you have celiac disease.

Triticale is a newer grain, specifically grown to have a similar quality as wheat while being tolerant to a variety of growing conditions like rye. It can potentially be found in bread, pasta, and cereals.

Chips, fries, potatoes, and corn are naturally gluten-free, but potato chip seasoning may contain malt vinegar and wheat starch. Also, be aware that chips and French fries may be fried in the same oil/fryer as foods that contain gluten. This will contaminate the oil and may cause harm to someone with celiac disease.