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Celiac disease



Related terms
Background
Treatment
Author information
Bibliography
Causes
Symptoms

Related Terms
  • Antibodies, antibody, autoantibodies, autoantibody, autoimmune, autoimmune disease, autoimmune disorder, autoimmunity, biopsy, celiac, coeliac disease, cornmeal, digestive tract, endoscope, endoscopy, GFD, gluten, gluten-free, gluten-free diet, immune, immune defense system, immune reaction, immune response, immune system, intestinal lining, intestine, malabsorption, nutrient deficiency, potato flour, rice flour, vitamin deficiency, wheat.

Background
  • Celiac disease, also called celiac sprue, is a digestive disorder that occurs when an individual's immune system overreacts to the protein gluten, or other proteins within gluten such as gliadin, found in grains including wheat, rye, barley, and to some degree, oats. When a patient with the disease eats food that contains gluten, the immune system's response damages the intestinal lining. This causes symptoms of abdominal pain and bloating after consuming gluten.
  • Additionally, complications, including poor absorption, may occur if the patient continues to eat gluten-containing foods. When the intestinal lining is damaged, patients have difficulty absorbing nutrients.
  • It has not been determined what exactly triggers this reaction in celiac patients. However, celiac disease is associated with autoimmune disorders, such as lupus. Autoimmune disorders occur when the patient's immune system mistakenly identifies body cells as harmful invaders, such as bacteria. As a result, the immune cells in celiac patients attack the patient's intestinal cells.
  • Researchers at the National Digestive Diseases Information Clearinghouse (NDDIC) estimate that one out of 133 people in the United States have celiac disease. Prevalence is even higher, one out of 22 people, among patients who have immediate family members (parent or sibling) who have the disease. This suggests that the disease may be inherited (passed down through families) in some cases.
  • Individuals can develop this disease at any age, but it is most commonly diagnosed in patients who are eight to 12 months old or in patients ages 30-40.
  • Although there is currently no known cure for celiac disease, the condition can be managed with a gluten-free diet. In general, patients who strictly follow a gluten-free diet can expect to live normal, healthy lives. Symptoms usually subside in several weeks and patients will be able to absorb food normally once they avoid eating gluten. A dietician or certified nutritionist may help a patient with celiac disease develop a healthy diet. Patients with celiac disease may also find gluten-free cookbooks to be a helpful resource. Many products, including rice flour and potato flour, can be used as substitutes for gluten.

Treatment
  • General: Although there is currently no cure for celiac disease, the condition can be managed with diet. Symptoms will subside within several weeks and patients will be able to absorb food normally once they avoid eating gluten. However, it may take several months in children and two to three years in elderly patients for the intestine to fully recover.
  • Support: Healthcare providers may recommend a dietitian or nutritionist who can help a patient plan an appropriate gluten-free diet. These professionals can also help patients determine whether or not supplementation with vitamins and minerals is necessary.
  • Gluten-free diet: Patients should avoid all foods that contain gluten. This includes any type of wheat (including farina, graham flour, semolina, and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt, and triticale. Therefore, foods such as bread, cereal, crackers, pasta, cookies, cake, pie, gravy, and sauce should be avoided unless they are labeled as gluten-free.
  • Many less obvious foods contain gluten. For instance, grains that contain gluten are often used in food additives, such as modified food starch and malt flavoring. Also, some medications, herbal supplements, and vitamins may contain gluten as a binding agent. Lipstick and postage stamps may contain gluten.
  • Studies have shown that a gluten-free diet may improve iron deficiency (anemia), malnutrition, anxiety, and depression. Some reports exist of mood swings or depression after adopting a gluten free diet, purportedly due to issues relating to dietary adherence. However, the overwhelming body of scientific evidence concludes that a gluten-free diet will reduce these symptoms.
  • How to avoid gluten: Patients should carefully read the labels of their foods. To help patients identify foods like gluten, the U.S. Congress passed the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA). The law, which went into effect January 1, 2006, requires food manufacturers to clearly state on their packages whether the food is made with any ingredients that contain products derived from milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, or soybeans. This act also requires the FDA to develop and finalize rules for the use of the term "gluten-free" on product labels by August 2008.
  • Food products can become cross-contaminated with gluten if they come into contact with gluten. For instance, a knife that was used to cut bread should be washed thoroughly with soap and water before it is used to cut food for a patient with celiac disease. Cross contamination may also occur if bread and vegetables were cut on the same cutting board.
  • Hidden gluten can be found in some unlikely foods, such as cold cuts, soups, hard candies, soy sauce, and many low or non-fat products (such as licorice and jelly beans). Gluten may also come in forms such as vegetable proteins and starch, modified food starch (when derived from wheat instead of corn), maltodextrin, malt flavoring, and glucose syrup. Many common ingredients contain wheat or barley derivatives.
  • Patients with celiac disease should always ask about the ingredients in food when dining at a restaurant or someone else's home.
  • Patients should consult their healthcare providers and pharmacists before taking any drugs, herbs, or supplements because they may contain gluten.
  • Read the labels of cosmetics because some beauty products, such as lipstick, may contain gluten.
  • Use self-adhesive postage stamps because stamps that require moistening may be contaminated with gluten.
  • Foods that are safe to eat: Today, patients can choose from a wide variety of gluten-free products at grocery stores. There are gluten-free substitutes for many foods and beverages, including cookies and beer. If gluten-free foods are not readily available at the local supermarket, they can be purchased online.
  • Patients can eat fresh meats, fish, and poultry that are not breaded or marinated. Most dairy products are safe to eat, as well as fruits, vegetables, rice, potatoes, and gluten-free flours that are made from rice, soy, potato, or corn.
  • Although amaranth, buckwheat, and quinoa are gluten-free when they are grown, they may become contaminated with other grains during harvesting and/or processing. Even though oats may not be harmful for most patients with celiac disease, they are often contaminated with wheat. Therefore, oats should be avoided as a precautionary measure.
  • Cooking: Patients with celiac disease do not necessarily have to give up their favorite foods because they cannot eat gluten. Substitutes for wheat flour can be used for many recipes. For instance, if a recipe calls for one teaspoon of wheat flour, patients can use 1.5 teaspoon of potato starch, cornstarch, rice flour, or arrowroot starch instead. One cup of wheat flour may be substituted with one cup of fine cornmeal, 3/4 cup of coarse cornmeal, 3/4 cup of rice flour, or 5/8 cup of potato flour. Gluten-free cookbooks are widely available to help patients maintain their quality of life with respect to food.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Bardella MT, Velio P, Cesana BM, et al. Coeliac disease: a histological follow-up study. Histopathology. 2007 Mar;50(4):465-71. .
  2. Catassi C, Kryszak D, Louis-Jacques O, et al. Detection of Celiac Disease in Primary Care: A Multicenter Case-Finding Study in North America. Am J Gastroenterol. 2007 Mar 13; [Epub ahead of print]. .
  3. Celiac Disease Foundation. .
  4. Garsed K, Scott BB. Can oats be taken in a gluten-free diet? A systematic review. Scand J Gastroenterol. 2007 Feb;42(2):171-8. .
  5. Marmouz F. Adult coeliac disease. Allerg Immunol (Paris). 2007 Jan;39(1):23-5. .
  6. National Digestive Diseases Information clearinghouse (NDDIC). .
  7. Natural Standard: The Authority on Integrative Medicine. .
  8. No authors listed. NIH Consensus Development Conference on Celiac Disease. NIH Consens State Sci Statements. 2004 Jun 28-30;21(1):1-23. .
  9. U.S. Food and Drug Administration (FDA). .

Causes
  • General: When a celiac patient eats gluten, or other protein components of gluten, such as gliadin, the body's immune system overreacts. Gluten is present in all types of wheat (including farina, graham flour, semolina, and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt, and triticale. The gluten is mistaken for a harmful invader, such as bacteria, and an attack is launched. Immune system cells flood to the stomach and intestine to destroy the gluten. However, among these immune cells are autoantibodies that attack the lining of the intestine by mistake. As a result, the intestinal lining becomes damaged.
  • Gliadin is a protein component of gluten, found in wheat and several other cereal grains of the genus Triticum. Patients with celiac disease are sensitive to the ?, ?, and ? forms of gliadins. In response to gliadin, anti-gliadin IgA antibodies are produced, which are reportedly found in many patients with celiac disease.
  • Inheritance: Researchers believe that many cases of celiac disease are inherited (passed down through families). Researchers estimate that if someone in a patient's immediate family (parent or sibling) has celiac disease, the patient has a 5-15% chance of developing the disease as well.
  • Trauma: It also appears that many cases of celiac disease develop after trauma, such as an infection, stress, physical injury, surgery, or pregnancy.
  • Other disorders: Celiac disease is associated with autoimmune disorders. Autoimmune disorders occur when the immune system attacks the body by mistake. Autoantibodies in the blood bind to components of an individual's own cells, triggering other cells to attack the body. The most common autoimmune disorders associated with celiac disease are lupus erythematosus, type I diabetes, rheumatoid arthritis, thyroid disease, and microscopic colitis (disorder that causes inflammation of the colon).

Symptoms
  • In general, patients who follow a gluten-free diet can expect to live normal, healthy lives. Most patients with celiac disease experience nonspecific symptoms after consuming gluten, including intermittent diarrhea, abdominal pain, and bloating. Some patients may experience no symptoms.
  • If a patient is not absorbing enough nutrients, symptoms may include weight loss, diarrhea, abdominal cramps, gas, bloating, fatigue, foul-smelling or grayish stools that may be oily, stunted growth in children, and osteoporosis (hollow, brittle bones).

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.



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