About Celiac Disease
What is Celiac Disease?
Celiac disease (also called coeliac, nontropical sprue, celiac sprue, gluten intolerant enteropathy, or gluten sensitive enteropathy) is a condition in which there is a chronic reaction to certain protein chains, commonly referred to as glutens, found in some cereal grains. This reaction causes destruction of the villi in the small intestine, with resulting malabsorption of nutrients.
There is clear evidence of a family tendency toward celiac disease. 5-10% of the first-level relatives (parents, children, and celiacs) of diagnosed celiacs may develop celiac disease. The disease affects both sexes, and it can begin at any age, from infancy (as soon as cereal grains are introduced) to later life (even though the individual has consumed cereal grains all along). The onset of the disease seems to require two components: genetic predisposition (two specific genetic markers, called HLA subfactors, are present in well over 90% of all celiacs in America), and some kind of trigger. The trigger may be environmental (as in overexposure to wheat), situational (perhaps severe emotional stress), physical (such as a pregnancy, an operation), or pathological (a viral infection).
Once thought to be a childhood disease that would be outgrown, recent evidence indicates that it is not uncommon for the symptoms of celiac disease to disappear during late childhood or adolescence, giving the appearance of a cure. Unfortunately, damage still occurs during these years of apparent health, and later in life these celiacs may find they have suffered considerable damage to the small intestine, and have for years deprived themselves of important nutrients.
What are the symptoms of celiac disease?
There is no typical celiac. Individuals range from having no symptoms (asymptomatic or “latent” forms of the disease) to extreme cases where patients present to their physicians with gas, bloating, diarrhea, and weight loss due to malabsorption.
In between these two extremes lie a wide variety of symptoms that include:
Steatorrhea (fatty stools that float rather than sink)
Any problem associated with vitamin deficiencies
Iron deficiency (anemia)
Easily fractured bones
Abnormal or impaired skin sensation (paresthesia),
Including burning, prickling, itching or tingling
Peripheral Neuropathy* (tingling in fingers and toes)
Individuals have reported such varied symptoms as:
White flecks on the fingernails
Fuzzy-mindedness after gluten ingestion
Burning sensations in the throat
In children, the symptoms may include:
Failure to thrive
Inability to concentrate
Pot belly with or without painful bloating
Pale, malodorous, bulky stools
Requent, foamy diarrhea
In addition to all of these, dermatitis herpetiformis, a disease in which severe rashes appear (often on the head, elbows, knees and buttocks) is related to celiac disease.
Reactions to ingestion of gluten can be immediate, or delayed for weeks or even months.
The amazing thing about celiac disease is that no two individuals who have it seem to have the same set of symptoms or reactions. A person might have several of the symptoms listed above, a few of them, one, or none. There are even cases in which obesity turned out to be a symptom of celiac disease.
What is gluten? What is gliadin?
Traditionally, gluten is defined as a cohesive, elastic protein that is left behind after starch is washed away from a wheat flour dough. Only wheat is considered to have true gluten. Gluten is actually made up of many different proteins.
There are two main groups of proteins in gluten, called the gliadins and the glutenins. Upon digestion, the gluten proteins break down into smaller units, called peptides (also, polypeptides or peptide chains) that are made up of strings of amino acids–almost like beads on a string. The parent proteins have polypeptide chains that include hundreds of amino acids. One particular peptide has been shown to be harmful to celiac patients when instilled directly into the small intestine of several patients. This peptide includes 19 amino acids strung together in a specific sequence. Although the likelihood that this particular peptide is harmful is strong, other peptides may be harmful, as well, including some derived from the glutenin fraction.
It is certain that there are polypeptide chains in rye and barley proteins that are similar to the ones found in wheat. Oat proteins have similar, but slightly different polypeptide chains and may or may not be harmful to celiac patients. There is scientific evidence supporting both possibilities.
When celiac patients talk about “gluten-free” or a “gluten-free diet,” they are actually talking about food or a diet free of the harmful peptides from wheat, rye, barley, and (possibly) oats. This means eliminating virtually all foods made from these grains (e. g., food starch when it is prepared from wheat, and malt when it comes from barley) regardless of whether these foods contain gluten in the very strict sense. Thus, “gluten-free” has become shorthand for “foods that don’t harm celiacs.”
In recent years, especially among non-celiacs, the term gluten has been stretched to include corn proteins (corn gluten) and there is a glutinous rice, although in the latter case, glutinous refers to the stickiness of the rice rather than to its containing gluten. As far as we know, neither corn nor glutinous rice cause any harm to celiacs.
What is the treatment for celiac disease?
There is no prescriptive drug celiacs can take to effect a cure. In fact, there is no cure, though there is every opportunity for celiacs to lead normal, healthy lives by following a diet that contains no gluten. This means avoiding all products derived from wheat, rye, barley, oats, and a few other lesser-known grains.
Extra vitamins may be taken, if necessary, but the only way for a celiac to avoid damage to their intestinal villi and the associated symptoms, is by maintaining a gluten-free diet.
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