Celiac Disease: When the Grain Goes Against You (part 1 of 2)

What is Celiac disease and how is it diagnosed?  This is part 1 of a 2-part article on Celiac Disease. Click here to read part 2.

Celiac disease is an inherited autoimmune disease in which the lining of the small intestine is damaged from eating the gluten protein (gliadin) found in wheat, barley, rye, and commonly oats.

If you have celiac disease, the consumption of any flours made from those grains or products containing them such as breads, pastas, cookies, baked goods, pizza crust, sauces, gravies, and flavorings, is detrimental to your health. Celiac disease can develop at any point in life, from infancy to late adulthood. The symptoms (see below) can be mild to severe depending on the degree of your genetic expression of celiac.

Who Is at Risk?

If you have a family member with celiac disease, you are at greater risk for developing the disease. The disorder is most common in Caucasians and those of European ancestry particularly Irish, Scottish, Welsh, English, German, Italian, and Nordic descent. Women are affected more commonly than men. Latest estimates of occurrence in the population of persons at greatest risk are estimated to be between 1 person in 100 to 1 person in 300. More people are being diagnosed later in adulthood.

What are the Health Problems Associated with Celiac Disease?

Malabsorption and Nutritional Deficiencies: If you have celiac disease and eat products containing gluten, an immune, inflammatory reaction occurs in your small intestine causing damage to its mucosal surface leading to an inability to absorb essential nutrients like iron, vitamin B12, zinc, calcium, and other vital micro and macro nutrients.

The decreased absorption of nutrients (malabsorption) that occurs with celiac disease eventually causse vitamin and mineral deficiencies that deprive your brain, peripheral nervous system, bones, liver and other organs of vital nourishment leading to osteoporosis, stunted growth in children, and many other illnesses.

“Leaky Gut” and Systemic Inflammation: The intestinal reaction caused by celiac disease also causes the development of a “leaky gut” by damaging the intact, intestinal barrier and immune surveillance systems of your gastrointestinal tract. This, in turn, leads to systemic exposure to and “bombardment” of your whole body by large, immune-reactive, gut-associated proteins that should not normally be circulating in your blood. These immune-reactive proteins from food and gut bacterial byproducts coming from your gut cause inflammation wherever they go. They commonly end up causing inflammatory havoc in the connective tissues of your joints and vascular system and can initiate autoimmune inflammatory reactions throughout your body especially in your joints, stomach, intestines, liver, kidneys, thyroid and pancreas. The result of these inflammatory reactions is detrimental to your health causing many of the following disorders and diseases.

Diseases and Conditions Commonly Associated with Celiac Disease:

• Anemia
• Asthma
• Thyroid disease
• Eczema and psoriasis
• Psoriatic arthritis and other reactive arthritic conditions
• Autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosis, mixed connective tissue disorders, and autoimmune liver diseases
• Inflammatory bowel disease (ulcerative colitis, Crohn’s disease, microscopic colitis)
• Irritable bowel syndrome (IBS)
• B cell lymphoma and certain types of intestinal cancer
• Dermatitis herpetiformis
• Down syndrome
• Lactose intolerance
• Miscarriage or unexplained infertility
• Neurological conditions
• Autism, ADD and Asperger syndrome
• Depression and schizophrenia
• Osteoporosis or osteopenia
• Diabetes
• Developmental delays and retarded growth in children

Most Common Symptoms of Celiac Disease

• Gastrointestinal
• Abdominal pain and cramping
• Gastroesophageal reflux disorder (GERD)
• Abdominal distention, bloating, gas, indigestion
• Constipation
• Decreased appetite (may also be increased or unchanged)
• Diarrhea, chronic or occasional
• Lactose intolerance (common upon diagnosis, usually goes away following treatment)
• Nausea and vomiting
• Stools that float, are foul smelling, bloody, or “fatty”
• Unexplained weight loss (although people can be overweight or of normal weight upon diagnosis)

Systemic symptoms

• Anemia (low blood count)
• Bone and joint pain
• Bone disease (osteoporosis, kyphoscoliosis, fracture)
• Breathlessness (due to anemia or asthma)
• Bruising easily
• Dental enamel defects and discoloration
• Depression
• Fatigue
• Growth delay in children
• Hair loss
• Hypoglycemia (low blood sugar)
• Irritability and behavioral changes
• Malnutrition
• Mouth ulcers and recurrent canker sores
• Muscle cramps
• Nosebleed
• Seizures
• Short stature, unexplained
• Skin disorders (particularly dermatitis herpetiformis)
• Swelling, general or abdominal
• Vitamin or mineral deficiencies, single or multiple nutrient (for example, iron, folate, vitamin K)

Testing for Celiac Disease

Biopsy: Historically an endoscopy (scope looking into your stomach) with biopsy of the mucosal lining of the intestine has been the “gold standard” for diagnosing celiac disease. However, recent medical studies have shown a number of people with celiac disease to be biopsy negative for the disease. This can happen when a person has avoided eating gluten for a few months or longer. But new evidence suggests the pathological changes in the intestine may be more “patchy” and not as confluent as was previously believed. This can make it more difficult to obtain a “positive” specimen by missing the patches.

Blood tests (serology): There are blood tests (serological screening) that can detect several special antibodies and immunologic reactions to gliadin. The most sensitive of these tests is the transglutaminase or tTG test. However, in my years of clinical experience since these tests have been available, I have seen this test come back negative in some people with true celiac disease even when they have been continually ingesting gluten. Like the biopsy testing, however, these tests can also be negative if the person has not been eating gluten for some time.

Genetic testing: For me, the best testing to do if celiac disease is suspected is the genetic testing which can be done via a simple blood test. There are two genes associated with celiac disease. They are the HLA-DQ2 and HLA-DQ8 genes. Approximately 97% of people with confirmed celiac disease will have either one or both of these genes present. 3% of persons with celiac disease will have variants of these genes. 

Diagnosing Celiac Disease (Building the Case)

Through my over 20 years of diagnosing and treating celiac disease and keeping up with the latest research on celiac, I believe the best way to diagnose celiac disease is by “building a strong case against the suspect.” First we must look at the evidence:

• Is there a sufficient symptom picture both gastrointestinal and systemic? (See the symptoms listed above.)
• Does the person have any of the related diseases or conditions as described above?
• Is there a family history of celiac disease or related conditions/disorders?
• Is the person in the high risk groups as described above?
• Is the genetic testing positive for any of the genes or their variants?
• Are any of the serology tests positive?

If the majority of these questions are answered in the affirmative (yes) and the genetic tests are positive, the suspect needs to be picked up and questioned and the witness must come forward to testify. What is the witness? “The witness” is FULL and COMPLETE elimination of gluten from the person’s diet for at least three months or more before following up. If the person is feeling markedly better and symptoms have significantly begun to resolve, we have our witness!

In other words, if it looks like a duck, quacks like a duck, waddles like a duck and swims in the pond, it must be a duck…not a turtle.

In our next article we'll talk about how to heal the gut (and rehabilitate the suspect).

Supplements for Celiac-related Conditions - The Dispensary Online

BCQ
Powerful botanical antioxidants and anti-inflammatories for your gut and joints.

Finest Pure Fish Oil - Liquid Orange
Great tasting, pure omega-3 fish oil from sardines and anchovies. Orange flavored.

Finest Pure Fish Oil - Liquid Orange Great tasting, pure omega-3 fish oil from sardines and anchovies. Orange flavored.

HLC high-potency
HLC Maintenance is advised in all circumstances where maintenance of an already balanced G.I. tract flora is appropriate. As such, HLC Maintenance often follows the use of HLC High Potency.

Glutamine Capsules
Major amino acid for gut repair and health.

Intestinal Repair Complex
Intestinal Repair Complex is a comprehensive nutritional formula desgined to assist in the repair and restoration of a normal, healthy gastrointestinal lining. It contains a combination of plant enzymes, mucilaginous herbs and amino acids.

Glutenzyme
Digestive enzyme for the gluten intolerant.

Ultra Pure Fish Oil - Liquid
High-potency in a single teaspoon, no more Tablespoons!!

Ultra Pure Fish Oil - Softgel Capsules
High-potency capsules, no more handfuls of capsules to get the therapeutic doses of fish oil!

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