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What is Celiac Disease?

Celiac disease is characterized by the inability of some people to tolerate gluten.  ďWhat is gluten?Ē, you may ask.  Gluten is a protein that is primarily found in wheat, rye and barley.  It is also found in many, many ingredients that you may not realize contain it, which is why going gluten free is harder than most people expect.  For example, most people would know that bread, pasta, cookies and pizza crust contain gluten, but what about foods that contain bromated flour, modified food starch, durum flour, enriched flour, Farina, graham flour, phosphated flour, plain flour, self-rising flour, semolina, or white flour as minor ingredients?  Thatís right, they contain gluten too and in order to go gluten free you must avoid every food that uses them as minor ingredients.  And those ingredients appear in small quantities in a lot of things that you donít usually associate with wheat, rye and barley.  Some preservatives and stabilizers are also wheat based.  What about beer?  You guessed it; it is not gluten free either.

When people with Celiac disease eat gluten, their immune system responds by overreacting and damaging their small intestine.  Specifically, there are tiny hair-like projections in the small intestine that help absorb nutrients into the bloodstream.  The immune response to gluten damages them by causing them to shorten and/or flatten.  The end result is a degraded ability to absorb necessary vitamins, minerals and other nutrients, such as vitamin D, calcium, folate and iron.  Vital nutrients are lost in the stool, rather than absorbed.  This leads to problems such as anemia, weight loss, stunted growth and delayed development in children, osteoporosis, and possibly even liver disease or cancers like intestinal lymphoma or bowel cancer.  With Celiac disease, a person can become malnourished, even if they eat plenty of healthy food because the small intestine canít do its job.  To stay healthy a person with Celiac disease must cook from completely gluten free recipes and ingredients. 

So how do you get Celiac disease?  Itís believed to be genetic and can be triggered by events such as surgery, pregnancy, childbirth, viral infection or severe emotional distress, which may activate the immune system into an abnormal state.  Although Celiac disease mostly affects people of European descent, it is not limited by racial background.  It affects at least 1 in 133 americans, including white, hispanic, black and asian populations.  The only treatment for Celiac disease is a completely gluten free diet.

Symptoms and Complications

There are no typical signs or symptoms associated with Celiac disease.  However, because Celiac is a digestive condition, it is often associated with intermittent diarrhea, abdominal pain and bloating.  Sometimes, people show no gastrointestinal symptoms at all.   Symptoms vary among different people, and children often display different symptoms than adults.  Some of the symptoms may include: 

∑  Abdominal upset, cramps, bloating, gas and pain
∑  Chronic diarrhea
∑  Vomiting
∑  Constipation
∑  Pale, foul-smelling or fatty stool
∑  Weight loss
∑  Irritability
∑  Iron-deficiency anemia
∑  Fatigue
∑  Bone or joint pain
∑  Arthritis
∑  Bone loss or osteoporosis
∑  Depression or anxiety
∑  Tingling numbness in the hands and feet (neuropathy)
∑  Seizures
∑  Missed menstrual periods
∑  Infertility or recurrent miscarriage
∑  Canker sores inside the mouth
∑  Itchy skin rash called dermatitis herpetiformis
∑  Muscle cramps
∑  Lactose intolerance resulting from intestinal damage
∑  Neurological complications (seizures and nerve damage)
∑  Liver diseases
∑  Cancers of the intestine.
∑  In children, Celiac disease may lead to delayed growth, short stature, delayed puberty and dental enamel defects in the permanent teeth.

Furthermore, people with Celiac disease are more prone to other diseases in which the immune system attacks healthy cells and tissues.  These include:

∑  Type 1 diabetes
∑  Autoimmune thyroid disease
∑  Autoimmune liver disease
∑  Rheumatoid arthritis
∑  Addisonís disease (glands that produce critical hormones are damaged)
∑  Sjogrenís syndrome (glands that produce tears and saliva are destroyed)

If you think you may have Celiac Disease Ö

The first thing to do is see your doctor.  Because the symptoms vary so widely, only a doctor can accurately diagnose Celiac disease, or direct you to a professional who can.  The only treatment for Celiac disease is adherence to a 100% gluten free diet for life.  For most people, a gluten free will stop the symptoms, heal the existing intestinal damage, and prevent further damage.  Improvement actually begins within days of eliminating gluten from the diet, but complete recovery can take some time.  The small intestine usually heals completely in 3-6 months for children, but may take years for adults.  Adhering to a completely gluten free diet can be difficult for several reasons.  First, even small amounts of gluten in the diet can curtail improvement.  Eliminating most of the gluten often doesnít do the trick and there are many hidden sources of gluten, including food additives such as modified food starch, preservatives, and stabilizers made with wheat.    Even many corn and rice products are contaminated with wheat gluten because they are produced in factories that also produce wheat products.  Switching to a completely gluten free diet requires significant effort and diligence.  It is imperative to find gluten free recipes and make sure all minor ingredients are also completely gluten free.  Even trace amounts can cause problems. 
Sources:

1.  "Celiac Disease", U.S. Department of Health and Human Services, National Digestive Disease Information Clearinghouse (NDDIC),NIH Publication No. 08-4269, , September 2008, http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/

2.  "Celiac disease", Mayo Clinic, http://www.mayoclinic.com/health/celiac-disease/DS00319

3.  Adams, S., "Definition of Celiac Disease", Celiac.com, July 26, 1996, http://www.celiac.com/
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