Understanding Celiac Disease

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Understanding Celiac Disease

http://www.wholefoodsmarket.com/healthinfo/celiacdisease.html

 

* Celiac disease defined

* Cause of celiac disease

* Prevalence of celiac disease

* Symptoms of celiac disease

* Medical conditions associated with celiac disease

* Diagnosing celiac disease

* History of celiac disease research

* What is gluten?

* Safe grains for celiacs

* Sources of gluten

* Gluten contamination

* Gluten and Baking

* Additional considerations

 

Celiac disease defined

 

Celiac disease, also known as coeliac disease, gluten-sensitive

enteropathy, non-tropical sprue, celiac sprue, and gluten intolerant

enteropathy, is a chronic digestive disorder found in individuals who

experience a toxic immune response when they ingest gluten. Dermatitis

herpetiformis is a related skin condition experienced by some celiacs.

There is no cure for celiac disease. The only known treatment is lifelong

adherence to a gluten-free diet. Ingesting gluten affects the function of

the small intestine of celiacs by damaging and/or destroying the absorptive

villi. The body then becomes unable to properly absorb nutrients, resulting

in potentially life-threatening nutritional deficiencies and even

intestinal lymphoma.

Cause of celiac disease

 

Celiac disease is thought to have a strong genetic component. The onset of

celiac disease has been associated with genes on Chromosome 6 called Human

Leukocyte Antigens (HLA) class II. HLA II genes affect an individual's

susceptibility to disease by mediating the interactions between cells of

the immune system. An individual may be genetically predisposed to celiac

disease, but the actual mechanism of onset is not fully understood.

Emotional stress, physical trauma, viral infection, pregnancy, and surgery

are some of the factors implicated in the onset of celiac disease.

Prevalence of celiac disease

 

Celiac disease is the most common genetic disease in Europe. In Italy about

1 in 250 people and in Ireland about 1 in 300 people have celiac disease1.

A University of Maryland study of over 13,000 subjects demonstrated the

prevalence at 1 in every 133 Americans have celiac disease. This study was

released in February 2003.

 

Celiac disease is most common in whites, but has been diagnosed in Asians

from India and Pakistan. It is rarely diagnosed in Japanese, Chinese or

Africans. Because of the genetic component of the disease, it is found in 5

to 15 percent of siblings and offspring of celiacs. There is a 70 percent

concordance among identical twins.

Symptoms of celiac disease

The term " celiac " or coeliac is of Greek origin and means " of or in the

cavity of the abdomen. " The condition known as celiac disease was so named

because many of the cardinal symptoms and effects of the disorder are

related to the gastrointestinal tract.

 

However, the full range of symptoms of celiac disease are varied and may

occur at any time in the life of an individual who is genetically

predisposed to the disorder. A significant number of people show no

clinical symptoms, but are still incurring intestinal damage. Some symptoms

include:

 

* diarrhea

* intestinal bloating or " pot belly "

* intestinal gas

* steatorrhea (fatty, floating and voluminous stools)

* fatigue

* weakness

* lack of energy

* bone or joint pain

* depression or irritability

* dental enamel defects

* anemia

* folate deficiency

* osteopenia and osteoporosis (bone mineral loss)

* infertility problems in women

* failure to thrive in children

* vomiting

* weight loss or wasting

 

Dermatitis Herpetiformis (DH) is a related skin condition characterized by

blistering, itchy rashes on the back, legs, buttocks, and arms. Between 60

and 80 percent of those who suffer from DH also incur damage to the

intestinal villi.

 

Medical conditions associated with celiac disease

(Note: the nature of the association between these conditions and celiac

disease is unknown. Celiac disease does not necessarily cause these

disorders or vice versa. Factors that predispose a person to contracting

celiac disease may also make them vulnerable to these other immunological

disorders.)

 

* neurological complications

* kidney and liver disease

* insulin dependent diabetes mellitus

* systemic lupus erythematosus

* selective IgA deficiency

* thyroid disease

* lactose intolerance

* chronic active hepatitis

* scleroderma

* myasthenia gravis

* Addison's disease

* rheumatoid arthritis

* Sjogren's syndrome

 

Diagnosing celiac disease

Definitive diagnosis of celiac disease is complicated by the similarity of

many of the symptoms to other conditions. Individuals may be screened for

celiac disease using antigliadin, antireticulin, and antiendomysium

antibody tests. Raised blood serum levels of these antibodies in patients

with active celiac disease have been shown to correlate well with the

degree of damage occurring in the small intestine. However, intestinal

biopsy is still considered the most reliable diagnostic tool. A biopsy

before and after the adoption of a strict gluten-free diet allows the

physician to observe the pre- and post-exposure status of the intestinal

villi. The complete diagnosis may take quite a long time because healing of

the villi may take months or years on a gluten-free diet. DH is diagnosed

by performing a biopsy of the affected skin and staining for the presence

of IgA.

 

Despite the difficulty in diagnosing celiac disease, early recognition of

the disorder may reduce the risk of the development of malignant intestinal

lymphomas, as well as serious bone mineral loss. Even celiac disease

sufferers who experience no observable symptoms are at risk for suffering

these problems.

 

History of celiac disease research

The symptoms of celiac disease, including the wasting and characteristic

stools, were described as early as the first century A.D. Celiac disease

and it's dietary component was detailed in the medical literature in 1888.

In 1950, a Dutch pediatrician named Dicke proposed wheat gluten to be the

cause of the disease. He based this theory on his observations that celiac

children improved during World War II when wheat was scarce in Holland.

Subsequent research isolated gliadin and the other peptides mentioned above

as the portion of the gluten that triggered the intestinal damage. In 1989,

research indicated a significant reduction in malignancies when celiac

disease was treated with a gluten-free diet. Researchers continue to

investigate celiac disease, honing in on the exact causes and implications

for treatment.

 

What is gluten?

" Gluten " is the general term for a mixture of many protein fragments

(called peptide chains or polypeptides) found in common cereal grains.

Wheat is the only grain considered to contain true gluten. The peptides

which predominate wheat gluten are gliadin and glutenin. Gliadin is thought

to be the peptide chain that instigates the toxic immune response and

subsequent intestinal damage in celiacs. However, other protein fragments

thought to be toxic to celiacs occur in rye, barley, and oats. They are

secalins, hordeins, and avenins, respectively. Even though some research

suggests that the avenins are not toxic, most celiacs still avoid oats just

to be safe. Minute amounts of any of these protein fragments can cause

intestinal damage in people with celiac disease. Because the disease is not

fully understood, it is thought there may be other peptide chains including

some derived from glutenin, that are also toxic. Because of the lack of

definitive research on the disease, celiacs must often live by the saying,

" when in doubt, leave it out. "

 

Safe grains for celiacs

Current scientific consensus is that rice and corn (maize) are considered

safe for celiacs. In addition, millet, sorghum, Job's Tears, teff, and ragi

are thought to be close enough to corn in their genetic make-up to be safe.

More research is needed to substantiate this. Other grains suspected, but

not proven, to be safe for celiacs include buckwheat, amaranth, quinoa and

rape. Although their safety is debated, they are only very distantly

related to wheat. Thus, it is unlikely their peptide chains are the same as

the problematic chains found in wheat, rye, barley, and oats.

 

Sources of gluten

Primary sources:

 

* wheat (including semolina, durum, spelt, triticale, and kamut)

* rye

* barley

* oats

 

Hidden sources: (ingredients/additives which may contain gluten)

The source of many of these ingredients must be carefully scrutinized to

ascertain whether or not any gluten is present. For example, modified food

starch from corn is acceptable, as long as no wheat starch is included.

Apple cider vinegar is acceptable, but distilled vinegars may contain

gluten. Pure buckwheat or buckwheat flour is acceptable, but many buckwheat

flours are contaminated with or have wheat flour added.

 

* Binders

* Bleu cheese

* Brown Rice syrup (if barley malt enzyme is used)

* Caramel coloring (made from barley malt enzymes)

* Coatings

* Colorings

* Dextrins

* Dispersing agents

* Emulsifiers

* Excipients (added to prescription medications to achieve desired

consistency)

* Extracts (in grain alcohol)

* Fillers

* Flavorings (in grain alcohol)

* Flours, Breads, Cereals, Crackers, Pasta, Sauces & Condiments made

with the above listed grains or their derivatives.

* Grain alcohol (beer, ale, rye, scotch, bourbon, grain vodka)2

* Homeopathic remedies

* Hydrolyzed protein, hydrolyzed plant protein (HPP) hydrolyzed

vegetable protein (HVP)

* Malt or Malt Flavoring (Barley malt)

* Modified starch, modified food starch (when derived from wheat)

* Mono- and di-glycerides (made using a wheat starch carrier)

* Oils (wheat germ oil & any oil with gluten additives)

* Preservatives

* Soy Sauce (when fermented using wheat)

* Spices (if containing anti-caking agents)

* Starch (made from grains listed above)

* Vegetable gum (when made from oats)

* Vegetable protein

* Vinegars (distilled clear and white or with a mash starter)

* Vitamin E oil

 

Gluten contamination

When gluten-free grains are milled or processed, they may be contaminated

with other grains processed on the same machinery. Gluten contamination may

occur via baking pans, grills, utensils, cutting boards, toasters, etc.,

when foods are baked, cooked, or otherwise processed. Deep frying foods in

oils or fats that have been used for gluten containing foods may also lead

to gluten contamination. Many fast food chains fry french fries in the same

oil as wheat battered onion rings.

 

Additional considerations

Many over the counter and prescription medications may contain gluten.

Pills may be dusted with flour during manufacturing and capsules may have

gluten present in the oil inside.

 

Non-food products such as toothpaste and lipstick may also contain gluten.

Other non-ingested products such as skin lotion may contain gluten and may

be accidentally ingested when fingers come into contact with the mouth.

Ingredients in packaged foods can change without warning. Celiacs must be

constantly vigilant even with foods that have been previously deemed safe.

 

 

Footnotes

1 NIH Publication No. 02-4269 October 2001

2Although alcohol that is distilled does not contain gluten because the

gluten cannot pass over during the distillation process, many celiacs do

report problems with ingestion. Beer (fermented) also must be avoided

because malt (usually from barley) is an ingredient. Rice beers also use malt.

References

Bernard, B., M.D., " Gluten Sensitive Disorders/celiac Disease and

Dermatitis Herpetiformis, " (1995). Department of Pediatrics, University of

Southern California

 

Celiac Disease Foundation Newsletter, (1997). Volume 7-3.

 

Chartrand, L.J. & Seidman, E.G., " Celiac disease is a lifelong disorder, "

(1996). Clinical Investigation in Medicine, 19(5): 357-61.

 

Chartrand et al., " Wheat starch intolerance in patients with celiac

disease, " (1997). Journal of the American Dietetic Association, 97(6): 612-618.

 

Maki, M. & Collin , P., " Coeliac Disease, " (1997). The Lancet, 349: 1755-1759.

 

Malnick, S.D. et al., " Celiac disease: diagnostic clues to unmask an

impostor, " (1997). Postgraduate Medicine, 101(6): 239-244.

 

Alford, Jeffrey & Duguid, Naomi, " Flatbreads and Flavors; A Baker's

Atlas, " 1995, William and Morrow and Company, Inc.

 

Clayton, Bernard Jr.. " Bernard Clayton's New Complete Book of Breads, "

1987, Simon & Schuster.

 

Hagman, Bette, " The Gluten-Free Gourmet Cooks Fast and Healthy, " 1996,

Henry Holt & Company, NY.

 

McGee, Harold, " On Food and Cooking: The Science and Lore of the Kitchen, "

1984, MacMillen Publishing Company, NY.

 

Wittenberg, Margaret M., " Good Food: The Comprehensive Food and Nutrition

Resource, " 1995, The Crossing Press, CA.

 

More info:

 

* The Celiac Disease Foundation

* Gluten Intolerance Group

* Celiac Sprue Association

* Univ. of Maryland Center for Celiac Research

* The Food Allergy & Anaphylaxis Network

* National Digestive Diseases Information Clearinghouse

 

 

Last updated on July 23, 2004