Gluten Intolerance & Celiac Disease

Celiac Disease (CD), also called Gluten Enteropathy, has until recently been known as Gluten Intolerance.

CD is a hereditary disorder of the immune system in which eating gluten leads to damage of the lining of the small intestine. This results in mal-absorption of nutrients and vitamins.

CD is the result of IgA and IgG antibody responses to gluten.

It is important to differentiate between CD, mediated by IgA and IgG antibodies, and wheat allergy, which is mediated by IgE antibodies.

In people with celiac disease, consumption of gluten, a major protein in wheat, rye, and barley products, causes inflammation and damage to the lining of the small intestine, resulting in diarrhea, mal-absorption, fat in the stool, and nutritional and vitamin deficiencies.

Quite simply, if you suffer from Celiac disease you have a genetic disorder that makes you intolerant to gluten.

Celiac disease can affect all types of people. However, it seems to be more prevalent among people of Northern European descent.

In the USA about 1 in 133 people suffer from Celiac disease.

Celiac disease also goes by the names gluten-sensitive enteropathy, nontropical sprue, and celiac sprue.

Many people blame wheat, found in most of the grain-based products for causing their abdominal pain, gas, bloating and diarrhea.

"But more likely, gluten is what’s irritating your gut," says Leslie Bonci, MPH, RD, author of the American Dietetic Association Guide to Better Digestion.

What is gluten?

Gluten is the elastic, rubbery protein present in wheat, rye, barley and to a lesser degree in oats. It binds the dough in foods such as bread and other baked goods. It contributes to spongy consistency. Rice and maize do not contain gluten.
However, gluten is only one protein found in wheat, rye and barley. These foods, like all other foods, contain a number of discreet proteins that all can result in adverse reactions, including allergies.

For example, wheat protein comprises 4 main groups of proteins: water-soluble, salt-soluble, alcohol-soluble and alcohol-insoluble. The major proteins in wheat-albumin, globulin, gliadin and glutenin (gluten)-vary in proportion according to the type of wheat.

Gluten, the protein found in wheat, rye, and barley, is the common denominator in most of the grain-based products we eat, such as cereals, breads, and pasta.

Simple gluten intolerance can be uncomfortable, but the symptoms are fleeting. The good news is that gluten intolerance is not a food allergy, and eating gluten does not usually cause damage – unless you have Celiac Disease.

The inability to sufficiently digest gluten protein can lead to all sorts of symptoms, including skin rashes, irritability, aggression, moodiness, ‘brain fog,’ cognitive problems, cramping, bowel problems, pain, and sleep disturbances.

More serious gluten intolerance is called celiac disease. That’s when gluten actually triggers the body’s immune system. When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging the villi — tiny, fingerlike projections in the small intestine that absorb the nutrients from food. For this reason it’s considered an autoimmune disease.

What are the complications of celiac disease?

Damage to the small intestine and the resulting nutrient absorption problems put a person with celiac disease at risk for malnutrition, anemia, and several other diseases and health problems.

• Lymphoma and adenocarcinoma are cancers that can develop in the intestine.

• Osteoporosis is a condition in which the bones become weak, brittle, and prone to breaking. Poor calcium absorption contributes to osteoporosis.

• Miscarriage and congenital malformation of the baby, such as neural tube defects, are risks for pregnant women with untreated celiac disease because of nutrient absorption problems.

• Short stature refers to being significantly under the average height. Short stature results when childhood celiac disease prevents nutrient absorption during the years when nutrition is critical to a child’s normal growth and development. Children who are diagnosed and treated before their growth stops may have a catch-up period.

How common is Celiac Disease?

Celiac Disease is one of the commonest life-long disorders in Western countries. CD is frequently under-diagnosed, particularly in adults, who may present with subtle symptoms. In some countries the incidence is as high as 1 in 200 (Sweden) or 1 in 10,000 (Denmark). The incidence in South Africa has not been ascertained, but is thought to be low, although the disease is most probably under-diagnosed.

What are the symptoms of Celiac Disease?

Typically, CD presents at the age of 6-24 months with symptoms of intestinal mal-absorption, impaired growth, abnormal stools, abdominal distension, muscle wasting, poor muscle tone (hypotonia), poor appetite or irritability, following the introduction of cereals into the diet.

In adults, the symptoms of CD may be quite varied, from severe weight loss and diarrhea and bulky, offensive stools to subtle complaints of cramps, abdominal bloating, flatulence and even constipation. These individuals are often mistakenly diagnosed as having Irritable Bowel Syndrome. Recent studies show that some individuals with CD present with no symptom but a form of ataxia. Recurrent oral aphthous ulcers are common and should arouse suspicion of the condition. Other symptoms may include persistent iron-deficiency anemia, folate deficiency anemia or a calcium metabolism disturbance.
Dermatitis herpetiformis is a variant of Celiac Disease in which clusters of itchy blisters occur, usually over the buttocks, knees and elbows.

Doctors must have a low threshold of suspicion when seeing patients with symptoms such as those described above.

There are various blood tests that can be used to support the diagnosis of CD

1. The anti-gliadin antibody (AGA) assay, which measures the amount of IgA and IgG antibody produced against the gliadin component of cereals. 
2. The anti-reticulin antibody (ARA) test, in which IgG antibodies are viewed in an immuno-fluorescent microscope examination.
3. The anti-endomysial antibody (AEA) assay, which identifies IgA antibodies against the endomysium tissue.

These tests offer simple and fast tools to investigate patients with suspected CD. They are particularly recommended for screening relatives of CD patients or patients who are affected by a related disease such as Malabsorption or Diabetes Mellitus, and for monitoring the compliance to a gluten-free diet.

None of these tests has shown 100% accuracy, and a small-intestinal mucosal biopsy remains the cornerstone for diagnosis. Any provisional diagnosis of Celiac Disease must be confirmed by this biopsy. The procedure is safe and usually performed at the time of gastrointestinal endoscopy.

Treatment of Celiac Disease

Medication is ineffective in treating this condition. The only treatment available is the complete removal of gluten from the diet. This usually entails life-long avoidance of all cereals containing gluten, including wheat, oats, rye and barley. Individuals on any avoidance diet are at risk of developing deficiencies of micro-nutrients (e.g., thiamine, riboflavin, niacin, iron, selenium, chromium, magnesium, folacin, phosphorus and molybdenum). It is therefore essential that patients be managed in collaboration with a dietician. Information on gluten-free diets is becoming increasingly available worldwide. Gluten-free products are also becoming more abundant and are readily available in many local food outlets.

Celiac Disease is a genetic disease. This means it can run in families. And it has far-reaching effects.  It is not a food allergy, but an autoimmune disorder (like diabetes), so it is not something you grow out of.

Gluten Free Diet

A gluten-free diet is a diet completely free of ingredients derived from gluten-containing cereals: wheat (including Kamut and spelt), barley, rye, oats and triticale, as well as the use of gluten as a food additive in the form of a flavoring, stabilizing or thickening agent.

Removing gluten from the diet is not easy. Grains are used in the preparation of many foods. It is often hard to tell by an ingredient’s name what may be in it, so it is easy to eat gluten without even knowing it. However, staying on a strict gluten-free diet can dramatically improve the patient’s condition. Since it is necessary to remain on the gluten-free diet throughout life, it will be helpful to review it with a registered dietitian.

An exception is oats. Although oats do contain gluten, research has found that eating moderate amounts of oats does not appear to cause problems for people with celiac disease.

In a study done, approximately 95 percent of people with celiac disease tolerated 50 grams of oats per day for up to 12 months.

The problem with oat products is not the grain but rather the manufacturing process. When oats are processed in the same facilities as wheat, contamination can occur even with the best cleaning protocol. Oat products can now be found that are not cross contaminated. These can be tried after an initial period of 6 months to see if they can be tolerated. Most, but not all patients can tolerate pure oat products.

There is at least one oat vendor, Gluten Free Oats®, that offers oats that can be considered safe for people who are gluten intolerant because they are tested to be below 10 parts per million (ppm) by the University of Nebraska FARRP Laboratory.

If you suffer from gluten intolerance, you will have to abstain from all grains, and all products that contain gluten. This can be quite a challenge since gluten is found in many commercially prepared food products.

Some examples are meat loaf, meat or fish patties, canned or frozen foods with thickened sauces, thickened soups, coffee substitutes made with grains, and soy sauce. You will have to learn to start reading food labels very carefully.

Processed Foods That May Contain Wheat, Barley or Rye

• Bouillon cubes
• Brown rice syrup
• Chips/potato chips
• Candy
• Cold cuts
• Hot dogs
• Salami
• Sausage
• Communion wafer
• French fries
• Gravy
• Imitation fish
• Matzo 
  Sauces
• Seasoned tortilla chips
• Self-basting turkey
• Soups
• Soy sauce
• Vegetables in sauce
• Rice mixes

To learn more about gluten intolerance, click on:

http://www.celiac.com/

www.go-symmetry.com/health/celiac.htm

www.gluten.net  [This is the official web site of the National Gluten intolerance group]. Here you will find a wealth of free information pertaining to Gluten intolerance.

Click here to browse through a selection of all-natural gluten-free baked treats.

Digestive Enzymes For Celiac Disease

As mentioned earlier, the standard treatment of celiac disease is to abstain from all forms of gluten. Recent research done by a team of investigators at Stanford University, suggests, that certain forms of digestive enzymes might be effective in controlling the symptoms of this disease.

A prime example of an enzyme known to be beneficial for controlling this condition is the papain enzyme, which is found naturally in the papaya fruit.

Research has shown that consuming fresh or dried papaya on a regular basis can help to prevent or help heal from celiac disease. Papain is a powerful protein- digesting enzyme which helps to digests fats and carbohydrates, therefore being beneficial in treating many chronic diseases.

Papain’s action resembles that of two well-known digestive enzymes in the human stomach – pepsin and trypsin. It has been shown to be able to digest wheat gluten (the protein portion of wheat), and render it harmless in celiac disease subjects.

Papain enzyme extracted from the ripe papaya fruit is also available in chewable caplet form, Taking a papain supplement with meals may therefore allow some individuals to tolerate gluten containing foods.