Celiac - Information

The Health Nut Bakery wants to help those who suffer with celiac disease understand how to make healthy food and lifestyle choices. The folliwing information has been compiled and summarized from the Celiac Disease Foundation Brochure found on their website is www.celiac.org.

WHAT HAPPENS WITH CELIAC DISEASE

Celiac Disease (CD) is unique in that a specific food component, gluten, has been identified as the trigger. When individuals with CD eat gluten, the villi, tiny hair-like projections in the small intestine that absorb nutrients from food, are damaged. This is due to a toxic reaction to gluten. Damaged villi do not effectively absorb basic nutrients – proteins, carbohydrates, fats, vitamins, minerals and, in some cases, water and bile salts. If CD is left untreated, damage to the small bowel can be chronic and life threatening. This leads to malabsorption which can result in an increased risk of
associated disorders – both nutritional and immune related.

SOME LONG-TERM CONDITIONS THAT CAN RESULT FROM UNTREATED CD

Iron deficiency anemia
Early onset osteoporosis or osteopenia
Vitamin K deficiency associated with risk for hemorrhaging
Vitamin and mineral deficiencies
Central and peripheral nervous system disorders - usually due to unsuspected nutrient deficiencies
Pancreatic insufficiency
Intestinal lymphomas and other GI cancers (malignancies)
Neurological manifestations
Gall bladder malfunction

ASSOCIATED AUTOIMMUNE DISORDERS

Dermatitis Herpetiformis (DH)
Insulin-dependent Type 1 Diabetes Mellitus
Thyroid Disease – Hashimoto’s Thyroiditis
Systemic Lupus Erythematosus
Autoimmune liver diseases

LESS COMMONLY LINKED TO CD

Addison’s Disease, Chronic Active Hepatitis, Down Syndrome, Rheumatoid Arthritis, Turner
Syndrome, Williams Syndrome, Sjögren’s Syndrome, Fibromyalgia, Alopecia Areata and Scleroderma.

SYMPTOMS

Celiac Disease can appear at any time in a person’s life. In adults, the disease can be triggered for the first time after surgery, viral infection, severe emotional stress, pregnancy or childbirth. CD is a multi-system, multi-symptom disorder. gastrointetinal (GI) symptoms are extremely varied and can often mimic other bowel disorders.

Infants, toddlers and young children with CD may often exhibit growth failure, vomiting, bloated abdomen, behavioral changes and failure to thrive

CLASSIC SYMPTOMS MAY INCLUDE

Abdominal cramping, intestinal gas
Distention and bloating
Chronic diarrhea or constipation (or both)
Steatorrhea – fatty stools
Anemia – unexplained, due to folic acid, B12 or Iron deficiency (or all)
Weight loss with large appetite or weight gain

OTHER SYMPTOMS

Dental enamel defects
Osteopenia, osteoporosis
Bone or joint pain
Fatigue, weakness and lack of energy
Infertility – male/female
Pregnancy related problems
Depression
Aphthous ulcers
Delayed puberty

Dermatitis Herpetiformis (DH) is the skin manifestation of celiac disease characterized by blistering, intensely itchy skin. The rash has a symmetrical distribution and is most frequently found on the face, elbows, knees and buttocks. DH patients can have intestinal damage without obvious GI symptoms.

Dermatitis Herpetiformis (DH) is diagnosed by a biopsy of a skin lesion and staining for IgA in the tissues. More than
85% of DH patients have small bowel sensitivity to gluten. Everyone with DH needs to follow a gluten-free diet.

THE CAUSE

The cause of Celiac Disease, also known as gluten sensitive enteropathy (GSE), is still a mystery. One out of 133 people in the United States is affected with celiac disease. CD occurs in 5-15% of the offspring and siblings of a person with celiac disease. In 70% of identical twin pairs, both twins have the disease. It is strongly suggested that family members of a diagnosed celiac be tested, even if asymptomatic. Family members who have an autoimmune disease are at a 25% increased risk of having celiac disease.

Celiac Disease is not a food allergy - it is an autoimmune disease. Food allergies, including wheat allergy, are conditions that people can grow out of. This is not the case with Celiac Disease.

DIAGNOSIS

A person seeking preliminary diagnosis MUST be eating gluten. Specific antibody blood tests help identify the presence of CD and are the initial step in screening and should include the following tests:

Endomysial antibody (EMA-IgA)
Tissue transglutaminase antibody (tTG - IgA/IgG)
Anti-gliadin antibody (AGA-IgG, AGA-IgA)
Total serum IgA
The exception is children under the age of 2 years in which tTG and EMA may not be present. Consult your physician.

It is essential that patients with positive antibody tests, and those with an IgA deficiency have a small bowel biopsy (which is performed endoscopically) to confirm the diagnosis and assess the degree of damage to the villi in the intestinal lining.

Blood tests can only screen for RISK of celiac disease and cannot confirm it. When blood tests and biopsy are inconclusive, testing for specific HLA (human leukocyte antigen) DQ2/DQ8 genes associated with celiac disease may be helpful. As an autoimmune disease, CD is the result of the interaction between genes and the environment (gluten). All the necessary genes to develop CD are not known; however, HLA DQ2 and/or DQ8 are absolutely necessary to develop CD. Since one-third of the population also have these genes, the presence of DQ2 or DQ8 does not imply that the person will develop CD, rather, that they have a genetic compatibility with CD.

Genetic testing does not diagnose celiac disease – the absence of DQ2/DQ8 almost always rules it out. Patients should always consult with a physician to ensure proper diagnosis.

TREATMENT

Because CD/DH is a chronic disorder, the only treatment is the lifelong adherence to the gluten-free diet. When gluten is removed from the diet, the small intestine will start to heal and overall health improves. Medication is not normally equired. Consult your physician regarding specific nutritional supplements to correct any deficiencies. The diagnosed celiac should have medical follow-up to monitor the clinical response to the gluten-free diet.

Dietary compliance increases the quality of life and decreases the likelihood of osteoporosis, intestinal lymphoma and other associated illnesses.

Because osteoporosis is common and may be profound in patients with newly diagnosed CD, bone density should be
measured at or shortly after diagnosis.

Adapting to the gluten-free diet requires some lifestyle changes. It is essential to read labels and learn how to identify foods that are appropriate for the gluten-free diet and do not contain toxin gluten.