By: Siobhan McLaughlinPeriod: A/B

CELIAC DISEASE

What is Celiac Disease?• People with celiac disease cannot eat gluten. Gluten is

the generic name for certain types of proteins contained in the common cereal grains wheat, barley, rye and must be eliminated from the diet.

• The cause of Celiac Disease, also known as celiac sprue or gluten sensitive enteropathy (GSE), is still a mystery.

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

Affected parts of digestive system•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 an autoimmune reaction to gluten. Damaged villi do not effectively absorb basic nutrients. • If CD is left untreated, damage to the small bowel can be chronic and life threatening, causing an increased risk of associated disorders – both nutritional and immune related

Signs and Symptoms• CLASSIC SYMPTOMS MAY INCLUDE• Abdominal cramping, intestinal gas• Bloating of the stomach• Chronic diarrhea or constipation (or both)• Steatorrhea – fatty stools• Anemia –(folic acid, B12 or iron deficiency )• Unexplained Fatigue, weakness and lack of energy• weight loss with large appetite or weight gain

• OTHER SYMPTOMS• Dental enamel defects• osteoporosis• Bone or joint pain• Infertility – male/female• Depression• Mouth ulcers• Delayed puberty• Migraine headaches• Tingling or numbness in hands or feet

Diagnosis• A person seeking diagnosis MUST be following a daily diet that contains

gluten for at least 4 weeks in order for test results to be accurate. Specific antibody blood tests are the initial step in screening for CD. Patients should always consult with a physician to ensure proper diagnosis.• Recommended Blood Tests:• Anti-tissue transglutaminase antibody (tTG – IgA and IgG)

commonly used whether or not symptoms are present and the most sensitive test available• Anti-endomysial antibody (EMA-IgA) – highly specific marker for celiac

disease• Anti-deaminated gliadin peptide (DGP – IgA and IgG)

used when tTG or EMA is negative and in cases where patient is IgA deficient• Total serum IgA – used to check levels to exclude selective IgA deficiency

that results in a false negative test• Anti-gliadin antibody (AgA – IgG and IgA) not considered sensitive or

specific enough for adults, but used for children under 2 because tTG and EMA antibodies may be absent. The anti-DGP test is sensitive in this group.

Prognosis• 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 gastrointestinal symptoms. ASSOCIATED AUTOIMMUNE DISORDERS• Insulin-dependent Type 1 Diabetes Mellitus, Liver diseases, Thyroid Disease-Hashimoto’s Thyroiditis, Lupus (SLE), Addison’s Disease, Chronic Active Hepatitis, Rheumatoid Arthritis, Turner Syndrome, Sjögren’s Syndrome, Raynaud’s Syndrome, Alopecia Areata and Scleroderma• OTHER DISORDERS LINKED WITH CELIAC DISEASE• Down Syndrome, Fibromyalgia, Chronic Fatigue Syndrome, Williams Syndrome

Treatments• Celiac Disease/Dermatitis Herpetiformis (CD/DH) are chronic

disorders. 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 required. Consult your physician regarding specific nutritional supplementation to correct any deficiencies. The diagnosed celiac should have medical follow-up to monitor the clinical response to the gluten-free diet.

Adapting to the gluten-free diet requires some lifestyle changes. It is essential to read labels which are often imprecise, and to learn how to identify ingredients that may contain hidden gluten. Even small amounts of ingested gluten can affect those with CD and cause health problems.

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

Gluten free diet• ALLOWED Grains/Flours

Rice, corn (maize), soy, potato, tapioca, beans, garfava, sorghum, quinoa, millet, buckwheat, arrowroot, amaranth, teff, Montina®, flax, and nut flours

• OatsResearch indicates that pure, uncontaminated oats consumed in moderation (up to 1/2 cup dry oats daily) are tolerated by most celiacs. Gluten-free oats are currently available in the United States. Consult your physician or dietician before including oats in your diet and for regular monitoring.

• Distilled alcoholic beverages and vinegars are gluten-free. Distilled products do not contain any harmful gluten peptides. Research indicates that the gluten peptide is too large to carry over in the distillation process. This process leaves the resultant liquid gluten-free.

• Wines and hard liquor/distilled beverages are gluten-free. Beers, ales, lagers and malt vinegars that are made from gluten-containing grains are not distilled and therefore, are not gluten-free. Gluten-free beers are available in the United States.

• NOT ALLOWED IN ANY FORMWheat (einkorn, durum, faro, graham, kamut, semolina, spelt), rye, barley and triticale

• Frequently overlooked foods that may contain gluten and need to be verified:• Brown rice syrup• Breading & coating mixes• Croutons• Energy Bars• Flour or cereal products• Imitation bacon

Prognosis• Gastrointestinal complaints and symptoms are less complained once the gluten free diet is followed• Patients with celiac disease have typical mortality rates compared to the general population• Cancer of the gastrointestinal tract (both carcinoma and lymphoma)• Small number of patients that develop a refractory type of celiac disease