For more than twenty years, while there may be nothing new about this Celiac disease, there are still a lot of questions, and confusion. Specifically about what it is, and who is at the highest risk.
What is Celiac Disease?
Celiac disease is a hereditary autoimmune disorder in which the small intestines are damaged and the absorption of essential nutrients is disrupted. Those individuals who live with celiac disease experience a severe inability to tolerate gluten, which is a common protein found in wheat, rye and barley.
When an individual with celiac disease ingests foods containing gluten, a response is triggered wherein their immune system immediately begins to attack the internal lining of the small intestine. This lining is made up of fingerlike protrusions known as “villi”, protrusions that vastly increase the surface area of the small intestine and facilitate the absorption of nutrients from foods that have been eaten and processed by the stomach.
In celiac disease (also known as “celiac sprue”), not only does the immune system attack and damage the sensitive and important lining of the small intestine in the presence of gluten, but the disease itself also causes a general malabsorption of nutrients from all foods ingested, thus the individual with celiac disease runs a constant risk of malnourishment, nutritional deficiencies, and the effects of those deficiencies.
What Are The Symptoms of Celiac Disease?
The digestive symptoms of celiac disease usually occur more frequently in children, and may include chronic diarrhea, vomiting, constipation, abdominal pain and bloating, foul-smelling stool that is pale and frequently fatty, as well as weight loss. Irritability, delays in growth, defects of the tooth enamel, and delayed puberty are also common.
In adults, common symptoms include but are not limited to anemia, fatigue, joint pain, arthritis, osteoporosis, depression, miscarriage, infertility, seizures, mouth sores, and a itchy rash known as dermatitis herpetiformis. However, many adults with celiac disease can be asymptomatic for years prior to the acute manifestation of the disease.
Since celiac disease involves poor absorption of nutrients, deficiencies can lead to anemia, bone loss and other significant problems, and some evidence exists that a predisposition to cancer is also possible.
Who Has Celiac Disease?
It is estimated that approximately 2 million Americans have celiac disease. It is more common in individuals with Down Syndrome and Turner Syndrome (a genetic disease affecting females), and it is also common in those living with Type 1 diabetes and autoimmune disorders related to the thyroid and liver.
Most sources state that celiac disease is rare in African Americans and those of Asian and Caribbean background, however data also demonstrates that African Americans susceptible to the disease can frequently be misdiagnosed. Based on information from several reputable sources, some African Americans with Type 1 diabetes have more potential of developing the illness than others, but many African American Type 1 diabetics test negative for the gene predisposing them to celiac disease. These findings notwithstanding, a general under-diagnosis of celiac disease in African Americans is reported in the literature.
Testing and Diagnosis
Celiac disease is generally diagnosed through blood tests and biopsies of the small intestine. For those individuals with close relatives with celiac disease, testing is generally recommended.
The only effective treatment for celiac disease is maintaining a gluten-free diet, a restriction that many individuals find difficult to manage, especially in a society where thousands of products contain gluten. In many cases, adherence to a strict gluten-free diet can prevent symptoms, help to heal previous intestinal damage, and prevent subsequent attacks. However, this type of diet is especially difficult for children and adolescents, and some individuals with celiac disease show no improvement, even with strict dietary practices.
What Foods Contain Gluten?
Many foods contain gluten, and gluten can unfortunately often be hidden in ingredients such as food starch, stabilizers and other additives.
Generally, most grains, cereals and processed foods contain some form of gluten, although specialty gluten-free foods are becoming more widely available, just as special foods for diabetics have gained ground in the marketplace over the last few decades.
Individuals with celiac disease can eat potato, rice, soy, amaranth, quinoa and buckwheat, and various forms of bean flour can be substituted for wheat flour. Oats are generally acceptable as well, but care must be taken to eat oats that have not been contaminated with gluten during processing. Unfortunately, some medicines also contain gluten, so those individuals with celiac disease should inform their doctor when being prescribed a new medication.
Celiac Disease: Education Is Key
Celiac disease, although rare in African Americans, can often be misdiagnosed, even in African Americans with Type 1 diabetes.
This disease can only be positively diagnosed through blood tests and biopsies, and untreated celiac disease can lead to serious illness. If you have a history of celiac disease in your family, testing is generally recommended.
Although gluten-free diets are restrictive and difficult to follow, many individuals with celiac disease successfully adhere to a gluten-free lifestyle and remain symptom-free for decades.
There are many support networks and a great deal of online information available about celiac disease. Also, speak with your health care provider if you or a member of your family have concerns about your risk for celiac disease.