CELIAC DISEASE
WHAT IS CELIAC DISEASE?
Celiac Disease is an autoimmune disorder in which the body mistakenly reacts to gluten, a protein found in wheat, barley and rye, as if it were a poison. It affects one in 100 people, although most have not been diagnosed.
Important: Do not self-diagnose. If you think you have celiac disease or gluten sensitivity, talk to your doctor about testing before you start a gluten-free diet. This is the only way to ensure accurate test results and protect your long-term health. If you don't have celiac disease, a wheat allergy or a gluten sensitivity, you're unlikely to benefit from a gluten-free diet. That's because whole grains, which contain gluten, are a good source of fiber, vitamins and minerals. Gluten-free products are often made with refined grains and are low in nutrients and high in carbohydrates.
SYMPTOMS
When someone with celiac disease consumes gluten, their immune system reacts by destroying the part of the small intestine that absorbs vital nutrients. This malabsorption can lead to serious illness. Symptoms of celiac disease can include bloating, gas, diarrhea, weight loss or gain, constant fatigue or weakness, headaches, infertility, depression that does not respond to medication, abdominal pain, bone pain and anemia.
For children, symptoms include failure to thrive, short stature, distended abdomen, dental enamel defects, and unusual behavior changes.
Celiac disease is tricky, however, and sometimes has no outward symptoms. Since it is a genetic disease, relatives of those who have been diagnosed have an increased risk.
ADDITIONAL SYMPTOMS
Some of the most common signs and symptoms of Celiac disease include:
- Anemia
- Anxiety
- Bloating or gas
- Constipation
- Delayed growth in children
- Depression
- Diarrhea
- Discolored teeth
- Fatigue/tiredness
- Headaches or migraines
- Infertility
- Irritability
- Itchy skin rash (dermatitis herpetiformis)
- Joint pain
- Pale mouth sores
- Poor weight gain
- Thin bones
- Tingling/numbness
DERMATITIS HERPETIFORMIS
There is also a skin form of Celiac disease called dermatitis herpetiformis (DH) which appears as an itchy, blistering rash. It is diagnosed through a special skin biopsy and is also treated with the gluten-free diet.
FIRST STEP FOR DIAGNOSIS
The First Step: tTG-IgA Test
Diagnosis is made through a series of blood tests, followed by a biopsy of the small bowel to see if the absorbing lining is damaged.
There are many screening blood tests for celiac disease but the most sensitive and commonly used, whether symptoms are present or not, is the tTG-IgA test. Tissue Transglutaminase Antibodies (tTG-IgA) – The tTG-IgA test will be positive in about 98% of patients with celiac disease who are on a gluten- containing diet. This is called the test’s sensitivity. The same test will come back negative in about 95% of healthy people without celiac disease. This is called the test’s specificity. There is a risk of a false positive especially for people with associated autoimmune disorders like Type 1 diabetes, chronic liver disease, Hashimoto’s thyroiditis, psoriatic or rheumatoid arthritis and heart failure, who do not have celiac disease.
NEXT STEP ENDOSCOPY
The endoscopic biopsy is necessary to confirm a celiac disease diagnosis. The blood tests indicate whether there is a possibility of celiac disease but you cannot confirm the diagnosis until an endoscopic biopsy is taken. This procedure takes a little less than thirty minutes and, for adults, sedatives and local anesthetics are used. Children are usually put under general anesthesia. During the biopsy, the gastroenterologist will insert a small tube with a camera through the digestive tract to the small intestine. Once there, the physician will examine the duodenum and take multiple tissue samples due to the “patchy” nature of villous atrophy. The tissue samples will then be examined by a pathologist under a microscope and assigned a Marsh classification.
MARSH STAGES
STAGE 0
Known as the “pre-infiltrative stage. The mucosa (intestinal lining) is normal, so Celiac disease is unlikely. .”
MARSH 1 - 2
The cells on the surface of the intestinal lining (the epithelial cells) are being infiltrated by white blood cells known as lymphocytes. This is also seen in tropical sprue, giardiasis, acute infective enteropathy, H. pylori gastritis, Crohn’s disease, during NSAID usage, and in various autoimmune disorders. Therefore, it is not specific for celiac disease. Marsh II: The changes of Marsh I are present (increased lymphocytes), and the crypts (tube-like depressions in the intestinal lining around the villi) are “hyperplastic” (larger than normal).
MARSH 3 - ABC
The changes of Marsh II are present (increased lymphocytes and hyperplastic crypts), and the villi are shrinking and flattening (atrophy).
Most patients with celiac disease are Marsh III. There are three subsets of Marsh III: Partial villous atrophy, Subtotal villous atrophy and Total villous atrophy.
MARSH 111c
The villi are totally atrophied (completely flattened) and the crypts are now shrunken, too.
CELIAC TREATMENT & GLUTEN SENSITIVITY
The only treatment for Celiac disease is to follow a gluten-free diet. When gluten is taken out of the diet, the small intestine heals and a return to full health can be expected. Long-term complications of undiagnosed Celiac disease include malnutrition, lymphoma, osteoporosis, neurological complications and miscarriage.
Gluten Sensitivity: People with gluten sensitivity can experience symptoms such as “foggy mind”, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, but other symptoms are also possible. While these are common symptoms of celiac disease, these individuals do not test positive for celiac disease or for a wheat allergy.
Individuals who have been diagnosed with gluten sensitivity do not experience the small intestine damage or develop the tissue transglutaminase (tTG) antibodies found in celiac disease.
Since there is currently no blood test for gluten sensitivity, the only way to be diagnosed is to undergo the screening and diagnostic tests required to confirm celiac disease. A diagnosis of gluten sensitivity is confirmed when you are not diagnosed with celiac disease or wheat allergy, and your symptoms diminish after starting a gluten-free diet, followed by a return of symptoms when gluten is reintroduced into your diet.
There is no cure for gluten sensitivity, and the only treatment is to follow a gluten-free diet.
YOU'VE BEEN GLUTENED! NOW WHAT?
- Peppermints and Ginger tea – Usually being glutened happens when I’m out in public... Although there is no magic pill to reverse the damage, I immediately begin searching for ways to calm down my intestinal system. Peppermint candies calm my stomach, and the ginger tea helps to reduce bloating.
- Sleep to allow your body to repair – As soon as I can, I rest. Your body is under an extreme physiological attack. Your intestines are being destroyed and your body is on high alert to prevent further damage. Sleep allows your body to rejuvenate and repair any damage that is done. It allows your body to heal quicker and feel better faster.
- Water to Flush Toxins Out – Water is so good for your body and many of us fail to drink the right amount on a daily basis. While it won’t fix your glutened problem or heal your intestines, it will help to flush out the toxins and reduce the bloating you are experiencing. This is especially important if you are experiencing diarrhea as a symptom, as it can lead to dehydration.
- Epson Salt Bath Whether you are experiencing muscle or joint pain, intestinal flare ups or mental anxiety during a gluten attack, nothing soothes the soul better than a nice relaxing bath. It can change your state of mind, relax your muscles and help you get the much need rest your body deserves. By adding Epson salts into your bath, you are not only getting the above benefits, but the Epson salts also help remove the toxins from your body.
- Digestive Enzymes (Probiotics) I haven’t actually tried this theory yet, but I have heard from fellow Celiac prone people that it does work. While digestive enzymes won’t prevent the damage caused by gluten, it is thought that may ease the symptoms associated with being glutened.
RESOURCE'S
For GIG's (Gluten Intolerance Group) website
Celiac & Gluten Sensitivity Support Group in the Seattle
Free Gluten Free Recipes
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