Celiac disease

Whenever you go for a family dinner, you have to order separately for your wife. She is intolerant to wheat based products. Whenever she consumes anything made with wheat, she develops abdominal pain and diarrhea. It becomes quite difficult to choose foods that do not have a wheat base. Most of the time, she orders rice based foods, vegetables and fruits. Eating out becomes quite a challenge!

The condition is called as celiac disease, also called celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. A change in lifestyle and precaution can help you to keep up the quality of your life and have good health.

Understanding celiac disease

Celiac disease is an autoimmune disease. The defense system of the body called the immune system which reacts to invading disease causing germs mistakenly recognizes the intestinal enzyme called tissue transglutaminase (tTG) as harmful, and mounts an attack causing inflammation.

Our intestines have villi, or thin finger like protrusions in the luminal surface which help in absorption of the digested food. Due to the immune attack, these villi get flattened and do not aid in absorption. In the long term, it causes malnourishment as it hampers the absorption of major nutrients from the intestines into the blood.

Gluten, a protein found in wheat, rye, triticale and barley, is the culprit. It triggers the immune response in patients with celiac disease. Such people are also intolerant to other gluten containing products like lip balms and some medicines.

Celiac disease is a genetic disease meaning that it runs in families. You may first get to know of it after surgery, pregnancy, childbirth, viral infection, or severe emotional stress. You may have or may be at risk to develop other autoimmune disorders like diabetes type 1 or thyroid disorders.

You may need nutritional supplements to make up for the deficiencies the disease has caused in you. No other medication will usually be required. Rarely, you may need steroids to suppress the immune activity.

A drug called dapsone may help in dermatitis herpetiformis.

Living with celiac disease

Celiac disease is a serious condition. You may develop deficiencies of various essential nutrients like vitamins and minerals. You may develop anemia due to deficiency of iron and also show easy bruising and bleeding due to deficiency of vitamin K. It can affect numerous organs like the liver, pancreas, gallbladder, bones, heart, nervous system, etc.

You may have fertility problems. Lastly, you may stand a risk of developing cancers in the digestive system.

Celiac disease cannot be ignored. There is no cure for celiac disease. The best bet is to remain on a gluten free diet. As the intestine heals, symptoms both trivial and severe, respond dramatically to gluten restriction. Change your food habits and learn to avoid even small amounts of gluten. Read the food labels carefully.

Beware! Wheat free is not gluten free. It may have other grains that you may need to avoid. These include rye, barley, einkorn, kamut, spelt, and triticale.

You may need to avoid breads, broth, commercial cereals, wafers with grains, pastas, cakes, marinades, sauces and stuffings, vegetable gums, food starch, dextrin, etc. Avoid cross contamination with gluten products. Keep a separate toaster for yourself. Do not use a knife that has been used to spread jam or butter on a bread slice. Buy you food in a bakery that has as separate gluten free machinery.

You can enjoy fruits, vegetables, eggs, corn, rice, buckwheat, sorghum, arrowroot, garbanzo beans, chickpeas, quinoa, tapioca, teff, and potatoes, meat, fish, chicken, legumes, nuts, seeds, oils, milk, and cheese!

Celiac disease may manifest a variety of symptoms either related to the digestive system or other systems. Symptoms may be deceptively absent until late adulthood. The commonest celiac disease symptoms are:

  • Diarrhea
  • Bloating
  • Abdominal pain
  • Stools may be frothy due to unabsorbed fats
  • Anemia
  • Unexplained weight loss
  • Skin rash
  • Depression
  • Brittle bones
  • Bone and joint pain
  • Mouth ulcers
  • Fatigue
  • Tingling or numbness in hands and feet
  • Infertility

15-25% patients with celiac disease may have an itchy and blistering skin rash on areas like elbows, knees and buttocks. The rash may be the sole sign of celiac disease and may not really be accompanied by digestive or other complaints. This condition is called dermatitis herpetiformis (DH).

Babies and children may have the following symptoms:

  • Pale and deficient in red blood cells
  • Anemia
  • Diarrhea
  • Bloating
  • Abdominal pain
  • Weight loss
  • Delayed puberty
  • Stunted growth
  • Irritable
  • Behavioral problems

Celiac disease is diagnosed by detecting antibodies in blood. These are proteins produced by the hyperactive immune system.

You may need to undergo an endoscopy wherein a flexible tubing with a camera mounted tip would be inserted into the digestive system to view the interior and retrieve a piece of your intestine for a detailed microscopic and laboratory examination.

Gene analysis is rarely done. You should also have your family screened for celiac disease.

Your doctor may require you to take a gluten unrestricted diet for few days before you undergo tests so as to facilitate the celiac disease diagnosis.