Celiac Disease (Gluten Intolerance)

Celiac Disease

by JP Saleeby, MD

The genetic malabsorptive disorder Celiac Disease (or celiac sprue) a condition where the body has an immunologic reaction to gluten may be more widespread than previously thought. It is estimated that one in 300 Americans have celiac disease. Since this condition can manifest itself from infancy to old age it is sometime overlooked or undiagnosed mainly due to low suspicion and its protean presentation. Symptoms may fall on a continuum from mild to severe, but there are certain key symptoms and signs that should trigger a complete work up for this disorder.

Celiac disease is an inherited disorder and results when gluten proteins from many of the grains we eat spark an immune reaction resulting in a malabsorptive digestive disorder. Rye, wheat and barley are some major offenders, but gluten hides in many prepared foods such as hotdogs. Think of it as an intestinal allergy to gluten and the consequences can be grave. It is important for an individual who is diagnosed with celiac disease to refrain from eating gluten containing foods, as this is the treatment of choice.

Celiac disease often causes diarrhea, fatigue, borborygmus (rumbling stomach), abdominal pain, weight loss, distention of the abdomen, flatulence and iron deficiency anemia. Additionally, signs that present on examination of a patient are a skin disorder called dermatitis herpetiformis, aphthous ulcers (canker sores), low blood counts (anemia), with Diabetes mellitus (Type I) and autoimmune Thyroid disease as associated illnesses. The skin eruptions know as dermatitis herpetiformis is almost pathognomonic for celiac disease as those who present with it should be screened for it is found in up to 20% of patients with celiac disease. Under or misdiagnosis is certainly a problem. According to one study up to 36% of celiac patients were misdiagnosed as having irritable bowel syndrome until the true diagnosis was realized. Left untreated celiac disease can ultimately lead to osteoporosis and intestinal lymphoma.

When it is suspected there are serum (blood) tests that should be ordered first and they include immunoglobulin A (IgA) tissue transglutaminase antibodies (tTG) and anti-endomysial antibody (IgA) analysis. For confirmation a small intestine biopsy can be performed under endoscopy. The Anti-gliadin test has fallen out of favor in recent years due to its lack of specificity and low sensitivity. Additionally, genetic markers such as the HLA phenotypes DQ2 and DQ8 may be helpful as they are found in 99% of people with celiac disease.

Those with celiac disease have a higher mortality due to a risk three to six times higher for developing gastrointestinal cancers and in particular a non-Hodgkin’s lymphoma. Patients with celiac disease need close and routine follow up care. Cancer screening along with routine testing for diabetes, thyroid disease, vitamin deficiencies, anemia and osteoporosis should be performed by their family doctor.

Along with stick avoidance of gluten containing foods, replacement of key nutrients is essential. Those who suffer from celiac disease are prone to deficiencies of iron, calcium, folic acid, vitamin B12 and some fat-soluble vitamins (notably Vitamin D). Therefore, it is good practice to supplement with these vitamins and minerals. There are alternatives to wheat, rye and barley that provide a good balance of fiber and a health supply of vitamins usually associated with the offending grains. While corn, potato, and rice make up the mainstay of starches for celiacs, soybeans, tapioca, arrowroot, carob, buckwheat, millet, amaranth and quinoa are allowable and suitable additions.

A good adjunct to a gluten free diet is a new product on the market offered by BeachBody. This product launched in March 2009 was directed to the health and fitness market as a meal replacement dietary supplement for attaining health weight goals. However, this product is guaranteed gluten free and caries many additional nutrients someone with celiac disease would benefit. Shakeology (www.shakeology.com) has benefits for keeping a celiac patient out of a malnutrition state as it has a health helping of protein (from whey), a well balanced supply of multivitamins and minerals, pre and probiotics, digestive enzymes, fiber and adaptogen herbs. It could conceivably be the healthiest meal of the day for any person suffering from celiac disease.

More information is available about this disease, diagnosis and treatments (including a list of gluten free foods) at the Celiac Disease Foundation web site: www.celiac.org.

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JP Saleeby, MD is an integrative medicine physician and emergency room doctor with years experience in nutritional medicine and a formulator of several dietary supplements on the market. He authored a book on adaptogen herbs entitled Wonder Herbs: A guide to Three Adaptogens (Xlibris) in 2006. He recently reviewed the research study supporting the new meal replacement shake Shakeology for Product Partners. He can be reached for comment at jpsaleeby@aol.com.

Reference:

Presutti, R.J., et al, Celiac Disease, Am Fam Physician 2007; 76:1795-1802.

Pruessner, H., Detecting Celiac Disease in your Patient, Am Fam Physician 1998; 57;1023-1039

© 2009