Celiac Disease

Celiac disease (also known as celiac sprue) is a life-long intolerance to the gliadin prolamin (gluten protein) in wheat, rye and barley.  Many individuals are also sensitive to oats, which may be due to cross contamination with other grains during processing.  When susceptible individuals eat these gluten proteins, the body modifies the prolamin which leads to a cross reaction of the immune system in the small intestine, causing  inflammation.  The small intestine is the part of the digestive tract where vitamins and minerals are absorbed.  It is lined with microscopic hair-like projections called villi (Latin for shaggy hair) or brush border.  Enzymes on brush border (dextrinase, glucoamylase, peptidase, maltase, sucrase and lactase) are essential for digestion of carbohydrates, protein and fats.  With continued inflammation from injestion of gluten, the villi become flattened, decreasing their ability to absorb nutrients.
Symptoms include fatigue, intermittent diarrhea, gas and bloating, abdominal pain, constipation, weight loss or weight gain. Without diagnosis and treatment, further damage occurs to the intestinal villi, which leads to greater degree of malabsorption of nutrients, resulting in vitamin deficiencies.  These deficiencies affect your brain, liver, nervous system and bones and may lead or contribute to depression, dementia, neuropathy, skin rashes, easy bruising (lack of vit. K) eczema, dermatitis herpetiformis, lactose intolerance, osteoporosis, anemia and fatigue, and stunted growth (in children).   As availability of lactase decreases, (aids in digestion of the milk sugar lactose) lactose intolerance often develops.

Diagnosis through testing is important to prevent further damage to intestinal villi.  In many instances, healing of the intestines occurs in a year or less by maintaining a gluten free diet.

Celiac disease may be mis-diagnosed as other gastrointestinal diseases with similar symptoms such as irritable bowel, Crohn’s disease, gastric ulcers, parasitic disease and anemia.  Occurance of celiac disease is increasing, with over 1 in 100 or more than 3 million Americans presently diagnosed.  Diagnosis for celiac disease is made through anti-tTG and IgA blood testing.  Endoscopy and tissue biopsy of the small intestine may also be performed.  Further testing for iron, vitamin B12,  vitamin D and folic acid deficiency as well as for hypocalcemia may be performed.  Thyroid function testing may be done to rule out hypothyroidsm (more common with celiac disease).  Other food intolerances are common with celiac disease (dairy, corn, oats).  Diabetes is also more common in people with celiac disease.



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