When food becomes the enemy
Imagine what it would be like if eating pizza, pasta, most breads, cookies, cakes, candy bars, canned soup, luncheon meats or drinking beer left you with cramps, diarrhea, anemia and chronic fatigue. For many people with celiac disease, that's reality.
Celiac disease occurs when a protein called gluten - found in wheat, barley, rye, and possibly oats - generates an immune reaction in the small intestine of succeptible people. Food normally doesn't provoke a response by the body's immune system - the body's defense against microbes and other threats to health.
"Basically, part of your body is attacking itself," says Joseph A. Murray, M.D., a gastroenterologist and celiac disease expert at Mayo Clinic, Rochester, Minn. "Gluten in the diet triggers a reaction from the immune system that causes the lining of the small intestine to become swollen and inflamed."
As a result, tiny hair-like projections in the small intestine called villi shrink and sometimes disappear. Microscopically resembling the deep pile of a plush carpet, villi absorb vitamins, minerals and other nutrients from food.
"You no longer have a carpet," says Dr. Murray. "It looks more like a tile floor. You lose the ability to digest and absorb nutrients from the food you eat."
Malabsorption can deprive the brain, nervous system, bones, liver and other organs of nourishment and cause vitamin deficiencies that may lead to other illnesses.
A HEREDITARY DISEASE
Although celiac disease, also called celiac sprue, is inherited and tends to occur in families of northwestern European descent, it can affect anyone. It can develop at any age. Symptoms in infants only appear after food containing gluten is introduced. The condition should be strongly suspected in pale, irritable infants who fail to thrive and who have a pot belly with flat buttocks and malodorous, bulky stools.
Pregnancy, severe stress, physical trauma, or a viral infection can trigger celiac disease in susceptible people for reasons that aren't well-understood. Celiac disease also is more common among people with type 1 diabetes and thyroid disease.
DIAGNOSIS SOMETIMES DIFFICULT
Some speculate that celiac disease has been around since humankind first switched from a foraging diet of meat and nuts to a cultivated diet that included high-protein grasses like wheat.
"Celiac disease may have been around for thousands of years, but it's only been in the last 50 years that we've gained an understanding of the disease and how to treat it," says Dr. Murray. "People with celiac disease are now able to lead nearly normal, healthy lives. That wasn't always the case."
There is no "typical" celiac case. Most people with the disease, according to Dr. Murray, have general complaints like intermittent diarrhea and bloating, or they may have no gastrointestinal symptoms at all. The symptoms of celiac disease also can resemble those of other conditions such as irritable bowel syndrome, gastric ulcers, anemia, skin disorders or a nervous condition.
Dr. Murray says that recent advances in blood testing have helped detect celiac disease. A diagnosis made on the basis of blood tests can be confirmed with a biopsy of intestinal tissue obtained through an endoscopic tube or by observing the results of a strict, gluten-free diet. It is important that people not go on a gluten-free diet before seeking a medical evaluation. Doing so may change the results of blood tests and biopsies so that they appear to be normal.
Once thought to be a rare disease, it is now known that celiac is quite common, effecting approximately 3 million people in the U.S.
LIVING WITH CELIAC DISEASE
If you have celiac disease, a gluten-free diet is the only way to avoid doing further damage to your intestinal lining and villi. Once gluten, found in hundreds of common foods, is removed from the diet, the digestive tract may begin healing within several days. Significant healing and regrowth of the villi may take several months in younger people and as long as 2 to 3 years in older individuals.
Foods allowed in a gluten-free diet include:
• Fresh meats, fish and poultry
• Milk and unprocessed cheeses
• Dried beans
• Plain fresh or frozen fruits and vegetables
• Corn, rice, quinoa, buckwheat
Foods not allowed in a gluten-free diet:
• Any bread, cereal or other food made with wheat, rye, barley and oat flours or ingredients byproducts made from those grains.
• Processed foods that contain wheat and gluten derivatives as thickeners and fillers like hot dogs, ice cream, salad dressings, canned soups, dried soup mixes, non-dairy creamers, processed cheeses, cream sauces, and hundreds of other common foods.
• Medications that use gluten to bind a pill or tablet together
Identifying gluten-free foods can be difficult. People with celiac disease should discuss their food selections with their physician and a registered dietitian. A dietitian also can advise how to best improve the nutritional quality of a diet. Food manufacturers can be contacted to find out if a product contains gluten. Celiac disease support groups and internet sites also may have information on the ingredients found in food products.
The question of whether people on a gluten-free diet can safely eat oat products remains in the subject of scientific debate. Difficulties in identifying the precise amino acids responsible for the immune response and the chemical differences between wheat and oats have contributed to the controversy.
"Ninety-five percent of people with celiac disease will get completely better, if they stick to the diet," says Dr. Murray. "But they have to stay on the diet for life. Going on and off the diet may make it less effective and increase the risk of developing malnutrition and other conditions."
People with celiac disease who don't maintain a gluten-free diet have a much greater chance of getting one of several forms of cancer, especially intestinal lymphoma.
Improvements from eating a gluten-free diet may be especially dramatic in children. "Not only do the child's physical conditions improve, but his or her behavior often improves and their growth starts to pick up," Dr. Murray says.