Celiac Disease and Gluten Sensitivity

By Rebecca K. Kirby, M.D., M.S., R.D.

Gluten sensitivity and the autoimmune disorder called celiac or sprue affects approximately 1 in 100 Americans. It has been estimated that as many as 97% of those with the condition go undiagnosed and untreated. Although celiac disease is considered common in patients with bloating, irritable bowel, chronic diarrhea, and thyroid disease, a study found that only 35% of those newly diagnosed had chronic diarrhea. Then what are other symptoms of celiac disease other than bowel issues? There are over 300 possible symptoms, ranging from osteoporosis to hair loss. There is even an itchy skin rash called dermatitis herpetiformis that is diagnostic of celiac disease. Age of onset can be from early childhood to adulthood, and how severely people are affected varies a great deal; 38% of people are asymptomatic.

So, what is the underlying mechanism of this somewhat stealth condition? The gastrointestinal tract is the major site of injury. The gliadin protein in wheat gluten invades the mucosal wall and initiates an immune response with the production of antibodies. The result is inflammation of the small bowel mucosa where the villi of the small intestine become inflamed, resulting in malabsorption.

As an autoimmune disorder with the production of autoantibodies, there is a high prevalence of celiac with other autoimmune conditions such as Type I diabetes, lupus, rheumatoid arthritis, Raynaud’s, Sjogren’s syndrome, and thyroid disease. However, predisposition depends on other genes that affect adaptive immune responses, intestinal permeability, and predisposition to autoimmunity. Another factor that may predispose someone to celiac is the length of time of breast-feeding as an infant. Children are 4 times more likely to develop celiac if breast fed for less than 30 days. Also, children are at increased risk who have had recurrent infections or for whom solid foods and cereals with gluten were introduced in the diet too early. Children with celiac are often diagnosed within the first 5 years of life due to their poor growth, behavioral changes, or failure to thrive.

The diagnosis of celiac disease has been traditionally by biopsy of the intestinal wall with 4 stages of damage to the intestinal lining described to indicate the degree of severity. Blood tests have also been developed that look for the auto antibodies that are characteristic of celiac disease. For both of these methods to be accurate, the person must still be eating wheat. Going off wheat in the diet before these tests may result in a false negative or an indeterminate conclusion. There is a test that has been developed to look for autoantibodies in the stool where it is not critical whether wheat is in the diet or not. Genetic typing can also be useful to describe risk of celiac or gluten sensitivity since the genes that predispose to celiac disease have been found, plus another array of genes has been described that characterize gluten sensitivity. Gluten sensitivity is considered a less severe reaction to gluten than the celiac autoimmune response.

Does someone recover from this inflammation and malabsorption of the small bowel? Yes, and the road to healing is to meticulously avoid wheat. In celiac disease there are some similar proteins to the gliadin in wheat which require the avoidance of rye and barley as well. There may also be a problem with oats; however, if the oats are not contaminated with wheat, rye, or barley, some people seem to tolerate them fine. Besides avoidance of wheat, rye, and barley, it is important to address bacterial overgrowth and intestinal villi inflammation with the use of probiotics. The ‘good bacteria’ help to maintain the permeability of the bowel wall among many other feats.

A gluten-free diet consists of exploring other unlike grains such as buckwheat, quinoa, amaranth, or millet. Grasses may be used such as rice, teff, or montina. Other starches such as potatoes, beans, and corn may also be used as well as thickeners like arrowroot, tapioca, and guar gum, to name a few.

There is a variety of flours, pastas, and pre-prepared foods that utilize these non-gluten foods, including flours from nuts and seeds. The most straight forward and nutritious way to approach the gluten-free diet is to eat whole foods pretty much the way nature produced them. Then, mysterious ingredients or additives can be avoided and a more wholesome diet of unrefined foods can be enjoyed. Eat out less and eat more legumes (dry beans and peas), nuts and seeds, whole fruits and vegetables, fish, poultry, and eggs, using fresh herbs for seasoning. Interesting recipes abound so explore, enjoy, and insure yourself a healthy future.