Celiac Disease

December 01, 2009

Celiac Disease

Buying a loaf of bread can be an overwhelming, though mouth-watering experience. There are literally hundreds of varieties to choose from, and most consumers get a kick out of tasting the bevy of creative flavor combinations available at many retailers (potato scallion and rosemary raisin come to mind). For someone with Celiac Disease, however, bread shopping is a frustrating and often daunting task.

That's because gluten, the common name for specific proteins in cereal grains, is extremely harmful to people with the disease. Celiac Disease (CD), also known as Celiac Sprue, is an autoimmune intestinal disorder found in genetically susceptible individuals. When these individuals ingest gluten, their bodies experience an immunologically mediated toxic reaction that damages the tiny, hair-like projections in the small intestine, called villi. Damaged villi cannot take in nutrients from food.

Gluten proteins exist in all forms of wheat (faro, durum, semolina, spelt, kamut, and einkorn) and all related grains (barley and rye). When people with CD experience repeated exposure to these gluten proteins, they face an increased risk of both nutritional and immune related disorders, like anemia, osteoporosis, GI cancers, and nervous system disorders. The disease affects all people differently, making it difficult to diagnose. Some typical symptoms include gas, chronic diarrhea, constipation, weight loss or gain, fatigue, joint pain, bloating, and muscle cramps. One of the most common symptoms in children is irritability.

While the cause of CD is unknown, there seems to be a strong genetic component associated with a set of genes called Human Leukocyte Antigens (HLA) class II – genes that affect an individual's susceptibility to disease. If one member of a family has CD, about one out of ten other members of the same family is likely to have it as well. Sometimes the disease becomes active for the first time after undergoing stress from surgery, pregnancy, childbirth, or infection.

Celiac Disease affects 1 in 133 Americans, but could be underdiagnosed in this country, says the National Institute of Health. Dr. Ciaran Kelly, Director of the Celiac Center at Beth Israel Deaconess Medical Center in Boston, attributes this possibility to the fact that American physicians are not sufficiently aware of the many manifestations of CD.

Testing for the disease involves a blood test that measures Immunoglobulin A (IgA), anti-tissue transglutaminase (tTGA), and IgA anti-endomysium antibodies (AEA). Additionally, says Kelly, doctors can perform a secondary test in the form of a small bowel biopsy (to examine damaged villi). Preliminary screening for those without symptoms may be recommended for children with a family history of the disease.

There is no cure for Celiac Disease. The only known treatment is adherence to a gluten-free diet. A gluten-free diet means avoiding all products that contain wheat, rye, barley, and any of their derivatives. Gluten can be found in unidentified starches, binders, fillers, and malts. It can even be found in cold cuts, soups, soy sauce, and jelly beans.

The good news is that there are more products popping up on our supermarket shelves each day touting "gluten free" ... but dining out is still an issue, and we developed a free "food allergy buddy" card that you can print out at home and give to your waiter to make sure that the restaurant is fully informed about which ingredients may be a problem. It's free! Just go to www.foodallergybuddy.com to print yours.