Gluten & Celiac Disease

Gluten is composed of a group of proteins that are found in many different types of grains (wheat, barley, triticale, kamut, rye and spelt). Gluten can also be present in oats, often as a contaminant from mixed grain processing, and is often used as a "thickening agent" in processed foods, a filler in pills or supplements and it is even present in some cosmetics. The prevalence of "hidden" gluten in food and processed items can present a challenge to those who must avoid it.

Cause and Effect
Celiac disease is characterized by an inflammatory response in the lining of the small intestine caused by the exposure to ingested gluten. The mucosal damage affects the finger- like projections (villi) of the small intestine. This damage to the small intestine interferes with the transport of food and nutrients through the small intestine, which can lead to poor absorption and malnutrition.

Gluten is partially digested by an individual with celiac disease, resulting in a protein called gliadin. The alpha-gliadin fraction of gluten appears to be the substance that triggers the damage to the villi of the small intestine. There is a genetic tendency to gluten sensitivity which occurs most often in individuals of Northern European Origin (especially Celtic people, Scots and Irish). Although it's an inflammatory condition, celiac disease may be associated with autoimmune disorders (attack against the body's own tissues by the immune system). Thus, in some individuals, celiac disease can go hand in hand with Type I diabetes, thyroid gland hyperactivity or insufficiency, systemic lupus erthematosis (SLE) and rheumatoid disease.

The Clinical Picture - Problems & Symptoms
In its full blown state, celiac disease causes diarrhea, foul-smelling stool, gas, bloating and abdominal pain. That said, many cases of celiac disease are quite silent or result in vague digestive upset with variable nutrient deficiencies such as: anemia, folic acid, vitamin B12 deficiency and inadequate calcium absorption.

The list of potential effects from celiac disease is very long (and often subtle). Celiac disease can cause failure to thrive in children (growth stunting), psychological problems (depression, anxiety, irritability), muscle cramping, loss of energy, peripheral neuropathy, tooth decay and skin rashes (including Dermatitis herpetiformis, which causes intensely itchy lesions). In recent times scientists have started to link gluten sensitivity with other disorders, especially behavioral problems in children (autism and Attention Deficit Hyperactivity Disorder, ADHD).

For many reasons, celiac disease may be missed entirely or mistaken for other gastrointestinal or general medical problems. For example, damage to the small bowel makes the individual lactose intolerant. Some individuals who think they have simple lactose intolerance may actually have underlying celiac disease.

Diagnosis and Treatment
Diagnosis may be apparent with the use of special antibody testing on blood samples, but the most accurate test involves a biopsy the small bowel, with close examination of the tissue for lost or damaged villi. The lesions in celiac disease can be "patchy," and diagnosis is sometimes clouded. The most accurate test involves multiple small bowel biopsies.

The effective treatment of celiac disease is clear. The meticulous avoidance of gluten in the diet results in healing of the small bowel lesions (to a variable degree, over time). There is no cure for celiac disease, so this dietary exclusion of gluten must be a lifelong commitment. Reintroduction of gluten into the diet of an individual with celiac disease causes relapse of symptoms.

Long-Term Implications
Many studies show people who do not treat their celiac disease face an increased risk for lymphoma (especially Non-Hodgkin types), adenocarcinoma of the small intestine and neurological disorders. Young women with celiac disease who are not effectively treated have a higher risk of spontaneous abortion (miscarriage) and an increased risk of birth defects, including neural tube problems such as spina bifida, often related to folic acid deficiency.

The occurrence of gluten sensitivity is a major public health concern. On average, about one in 3,000 people in the US may be diagnosed with gluten sensitivity, but it has been proposed that its prevalence may be as high as about one in 130. For many years, celiac disease was a forgotten diagnosis, but modern research underscores the importance of gluten-free living for those affected by this disease.

Be Healthy!
Dr. Stephen Holt, M.D.

Dr. Stephen Holt, M.D. is a Distinguished Professor of Medicine (Emerite) and a medical practitioner in New York State. He has published many peer-review papers in medicine and he is a best-selling author with more than twenty books in national and international distribution. He has received many awards for teaching and research. Dr. Holt is a frequent lecturer at scientific meetings and healthcare facilities throughout the world. He is the founder of the Holt Institute of Medicine (www.hiom.org) and www.stephenholtmd.com

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