Celiac disease more common than once believed
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Celiac disease, celiac sprue or gluten-sensitive enteropathy is a chronic autoimmune intestinal disorder. When people who are genetically susceptible to the disease eat certain proteins contained in the grains of wheat, rye and barley, the absorptive surface of the small intestine is damaged.
The surface of the small intestine contains very tiny finger-like projections called villi that become inflamed and flattened due to the allergic-like reaction to gluten. When the villi become damaged or flattened, this can cause a problem for the absorption of key nutrients for good health, including iron, calcium and folate. If damage progresses further into the small intestine, problems with lactose absorption, fat and fat-soluble vitamins like A, D, E and K, protein and other nutrients often occur.
The prevalence of celiac disease is far more common than once believed. It affects 1 percent of the population in the U.S. and Europe and is considered the most common inherited diagnosed condition. It is more prevalent in families of Italian or Irish heritage or families with autoimmune conditions such as diabetes, thyroid disease and Sjogrens syndrome. In Italy, all children are tested for celiac disease by age 6.
Symptoms are as varied as the individual. The most common symptoms are iron or vitamin B-12 deficiency, anemia, chronic fatigue and weakness, abdominal pain, bloating and gas, indigestion/reflux, nausea and vomiting, diarrhea or constipation, lactose intolerance, weight loss, bone and joint pain, easy bruising, and swelling of hands and feet. Other symptoms are migraine headaches, depression, canker sores, menstrual irregularities, infertility, recurrent miscarriages and elevated liver enzymes.
Additionally, children can suffer irritability and behavioral changes, concentration and learning difficulties, delayed growth and short stature, delayed puberty and dental enamel abnormalities.
Celiac disease can be misdiagnosed in adults for as many as 10 years before the problems are resolved. If you suspect you might have celiac disease, speak to your primary care physician, who can order some specific antibody blood tests. While not 100 percent accurate, they can lead you in the right direction for diagnosis. The gold standard for diagnosis is multiple biopsies of the small intestine. A gluten-free diet should never be started before the blood tests or biopsies are done. This could interfere with the results.
There is no drug remedy for celiac disease. A gluten-free diet is the only treatment. It works phenomenally well if it is followed completely. It will stop the allergic reaction damage to the small intestine and allow for the inflammation process to subside and for the villi to repair or heal. It may also be necessary to eliminate lactose from your diet during this time of healing.
Gluten is found primarily in wheat, rye and barley. It is often recommended to avoid oats and oat products because of cross-contamination of these foods. There are at least 23 additional wheat/gluten containing subgroups that need to be avoided, nine additional barley derivatives and four oat containing subgroups. But despite the large number of foods that must be eliminated from one's diet, there are many foods that can be enjoyed.
A registered dietician can help put together guidelines for a gluten-free diet that incorporates all the important nutrients one needs. Two good resources for product information about celiac disease are "Gluten-Free Diet: A Comprehensive Resource Guide, Expanded Edition," April, 2006, by Shelley Case, RD, and "The CSA Gluten-Free Product Listing," 11th edition, Oct. 2006, by CSA/United States of America, Inc, P.O. Box 31700, Omaha, NE 68131-0700 or www.csaceliacs.org .
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Claudette M. Novak is a registered dietician with Nutrition for Health in Amesbury.
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