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Celiac Disease

A high percentage of clients visiting my office share that they are #gluten free; most having never been tested. While I appreciate that elimination diets can do wonderful for various dis-ease, they are also quite restrictive. We are huge fans of the Mediated Release Testing, but of course, if symptoms persist then we dig deeper. I am not a huge fan of encouraging #elimination tests without some objective data to show this is, in fact, the trigger and why.

Celiac disease is not the same as gluten sensitivity or intolerance, or even wheat allergy. One can be sensitive to gluten, but not have full immune-mediated, multi-system dysfunction when eating gluten-containing grains such as #wheat, barley, and rye. This happens in only about 1 percent of people, although can manifest at any age and is a little more prominent in those with autoimmune #thyroid disease and insulin dependent diabetes. The most important genetic risk factor for Celiac disease is the presence of HLA alleles DQ2 and DQ8. A negative test for both essentially rules out Celiac disease. About ten percent of first-degree relatives are found to also have Celiac disease.

Symptoms of Celiac disease are often #diarrhea, weight loss, abdominal pain, bloating, malabsorption, and failure to thrive. Most adult clients will present with nonclassic symptoms, including less specific gastrointestinal symptoms or symptoms such as #anemia, osteoporosis, transaminitis, atopic dermatitis, dermatitis herpetiformis, alopecia, and aphthous ulcers, and recent miscarriage.

During the first year of life, an infant may manifest Celiac disease with intermittent vomiting, diarrhea, growth delay, and failure to thrive. The incidence of this early presentation in infants has decreased. However, to prevent significant growth problems in infants, confirmation of Celiac disease is important.

Older children may present with shorter stature, anemia, hepatitis, epilepsy, and other symptoms beyond the gut. With age, these become more vague, although abdominal pain, aphthous stomatitis, and atopic dermatitis were the more common presentations. Young adults will often present with dermatitis herpetiformis after eating foods with a high amount of gluten. Alopecia is a presentation consistent with Celiac disease and with elimination of gluten, can be resolved (although this accounts for about one in 85 cases).

Celiac disease has also been associated with #epilepsy, folate deficiency, liver disease, insulin dependent diabetes, #thyroid disease, and Down Syndrome. Celiac disease should be ruled out in these scenarios.

How Do I Know if I have Celiac Disease?

Humans have digestive enzymes that help us break down food. Protease is the enzyme that helps our body process proteins, but it can't completely break down gluten. Undigested gluten makes its way to the small intestine. Most people can handle this undigested gluten, but in others it triggers a severe autoimmune response and a cascade of unpleasant symptoms. It is this autoimmune response that defines Celiac Disease and unfortunately, this can lead to damage within the small intestine.

Other have similar symptoms as those with Celiac disease when they eat gluten - still suffering bloating, diarrhea, headaches, and skin rashes, but the underlying cause differs. When Celiac disease is ruled out, this response is more likely due to poorly digested carbohydrates, not just gluten. These carbohydrates, called #FODMAPS, ferment in the gut and that causes their discomfort. More often these individuals do better with whole grains and should avoid processed foods that are stripped down.

Immunoglobulin A tissue transglutaminase serologic testing is the way to go with regards to initial screening for Celiac disease is essentially everyone. The esophagogastroduodenoscopy with small bowel biopsy is recommended to confirm the diagnosis in most everyone, including those with negative serologic test for whom clinical suspicion of Celiac disease persists.

In the little ones with a high immunoglobulin A tissue transglutaminase and a positive test for immunoglobulin A endomysial antibodies, a biopsy can typically be avoided.

What Does This Mean?

A gluten-free diet for life is the primary treatment, which really is very encompassing on a client's life. Avoiding gluten means avoiding bread, pasta, beer, and sometimes oats even cosmetics and nutritional supplements so a big deal? Absolutely. Gluten is naturally occurring, but it can be extracted, concentrated and added to food and other products to add protein, texture and flavor. It also works as a binding agent to hold processed foods together and give them shape.

Eliminating gluten willy nilly can be devastating beyond what the clinician may recognize. The client has to think of hidden sources of gluten, learn to read food labels, plan all their meals including those when they dine out and when they travel, and avoid cross-contamination.

When clients do try the elimination diet though and really understood the assignment and still don't have success, then they too should have the accuracy of diagnosis confirmed, have their diet reassessed, and be evaluated for coexisting conditions.

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