Things you need to know about celiac disease

Gluten free diet is not a trend, to some people, it is the only way to a healthy normal life


Many people are not aware how much Celiac disease is serious illness unless it is controlled. Not so few people feel some of the symptoms of celiac disease, but often due to the chameleon nature of the disease, they have difficulty finding the right diagnosis. That period of searching is often too long, followed with severe drug therapies, and the effects of the untreated celiac disease can be very serious.

Conscious of all the difficulties that untreated or unproperly controlled celiac disease can cause, I am opening this section with the text about celiac disease and some basic information that I believe will change people’s lives in a good way.

 Celiac disease is an autoimmune disease,
not an allergy

Celiac disease is a digestive disorder caused by an abnormal immune reaction to gluten – a protein found in foods made with wheat, barley, rye, triticale, but also in oats that have been made in processing plants that handle other grains. It can develop at any age after people start eating foods or medicines that contain gluten. In celiac disease, the immune response to gluten creates toxins that destroy the villi, a protrusions inside the small intestines. When the villi become damaged, the body is unable to absorb nutrients from food. This can lead to malnutrition and other serious health complications, including permanent intestinal damage.

Celiac disease may be divided into two types:
classical and non-classical.

In classical celiac disease, patients have signs and symptoms of malabsorption, including diarrhea, steatorrhea (pale, foul-smelling, fatty stools), and weight loss or growth failure in children.

In non-classical celiac disease, patients may have mild gastrointestinal symptoms without clear signs of malabsorption or may have seemingly unrelated symptoms. They may suffer from abdominal distension and pain, and/or other symptoms such as: iron-deficiency anemia, chronic fatigue, chronic migraine, peripheral neuropathy (tingling, numbness or pain in hands or feet), unexplained chronic hypertransaminasemia (elevated liver enzymes), reduced bone mass and bone fractures, and vitamin deficiency (folic acid and B12), late menarche/early menopause and unexplained infertility, dental enamel defects, depression and anxiety, dermatitis herpetiformis (DH is an intensely itchy skin rash made up of bumps and blisters. It may develop on the elbows, buttocks, and knees. DH affects approximately 15 to 25 percent of people with celiac disease. Those who do experience DH usually don’t have digestive symptoms), etc.

“There is also a Refractory celiac disease. A small subset of coeliac disease (CD) patients experience persisting or recurring symptoms despite strict adherence to a gluten-free diet (GFD). When other causes of villous atrophy have been excluded, these patients are referred to as refractory celiac disease (RCD) patients. RCD can be divided in two types based on the absence (type I) or presence (type II) of an, usually clonal, intraepithelial lymphocyte population with aberrant phenotype. RCDI usually runs a benign course and may be difficult to be differentiated from uncomplicated, slow responding CD. In contrast, RCDII can be defined as low-grade intraepithelial lymphoma and frequently transforms into an aggressive enteropathy associated Tcell lymphoma with dismal prognosis.” – Srdjan Markovic, MD, PhD, Clinical Assistant for Gastroenterology

“No thanks, I’m gluten-free” has become a staple phrase these days, but for about 1% of the population who has celiac disease, it’s not a fad, it’s a necessity.

Celiac disease affects 1 in 100 people worldwide. It occurs from an interaction between genes, eating foods with gluten and other environmental factors, but the precise cause isn’t known. Sometimes the celiac disease is triggered — or becomes active for the first time — after surgery, pregnancy, childbirth, viral infection or severe emotional stress.

Celiac disease can affect anyone. However, it tends to be more common in people who have:

– A family member with celiac disease or dermatitis herpetiformis
– Type 1 diabetes
– Down syndrome or Turner syndrome
– Autoimmune thyroid disease
– Microscopic colitis (lymphocytic or collagenous colitis)
– Addison’s disease
– Rheumatoid arthritis

It’s important to note that symptoms can vary from person to person depending on various factors, including:

– the length of time someone was breast-fed as an infant
– the age someone started eating gluten 
– the amount of gluten someone eats
– the severity of intestinal damage

Digestive symptoms are more common in infants and children. Here are the most common symptoms found in children:

– abdominal bloating and pain
– chronic diarrhea
– vomiting
– constipation
– pale, foul-smelling, or fatty stool
– weight loss
– fatigue
– irritability and behavioral issues
– dental enamel defects of the permanent teeth
– delayed growth and puberty
– short stature
– failure to thrive
– Attention Deficit Hyperactivity Disorder (ADHD)

Adults are less likely to have digestive symptoms, with only one-third experiencing diarrhea.  Adults are more likely to have:

– unexplained iron-deficiency anemia
– fatigue
– bone or joint pain
– arthritis
– osteoporosis or osteopenia (bone loss)
– liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, etc.)
– depression or anxiety
– peripheral neuropathy ( tingling, numbness or pain in the hands and feet)
– seizures or migraines
– missed menstrual periods
– infertility or recurrent miscarriage
– canker sores inside the mouth
– dermatitis herpetiformis (itchy skin rash)

Most people with celiac disease are undiagnosed. Long-term problems are serious, Don’t delay getting tested for celiac disease

Diagnosis of celiac disease requires a celiac disease panel blood test and an endoscopic biopsy of your small intestine. Preliminary testing for celiac requires a simple blood test. One is the tTG test, which screens for the tissue transglutaminase antibody, a protein often found in the blood of people with celiac disease. If a blood test is positive, a patient might go to a gastroenterologist who may run additional blood tests to confirm a celiac diagnosis. If blood tests aren’t clear, a specialist may want to do a biopsy of the small intestine or an endoscopy, a procedure where a small tube containing a camera is inserted down your throat to look for changes in the small intestine that would suggest celiac disease.  First-degree relatives (parent, child, sibling) should also be screened since they have a 1 in 10 risks of developing the celiac disease compared to the general population risk of 1 in 100.

Don’t stop eating gluten prior to being screened. You need to have at least two weeks (ideally four to six) where you’re eating gluten before taking the blood test. Otherwise, there’s a risk that the gluten will be cleared out of your system and antibodies won’t be present in your blood samples.

Untreated, celiac disease can cause:

– Malnutrition. The damage to your small intestine means it can’t absorb enough nutrients. Malnutrition can lead to anemia and weight loss. In children, malnutrition can cause slow growth and short stature.

– Loss of calcium and bone density. Malabsorption of calcium and vitamin D may lead to a softening of the bone (osteomalacia or rickets) in children and a loss of bone density (osteoporosis) in adults.

– Infertility and miscarriage. Malabsorption of calcium and vitamin D can contribute to reproductive issues.

– Lactose intolerance. Damage to your small intestine may cause you to experience abdominal pain and diarrhea after eating lactose-containing dairy products, even though they don’t contain gluten. Once your intestine has healed, you may be able to tolerate dairy products again. However, some people continue to experience lactose intolerance despite successful management of celiac disease.

– Cancer. People with celiac disease who don’t maintain a gluten-free diet have a greater risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer.

– Neurological problems. Some people with celiac disease may develop neurological problems such as seizures or peripheral neuropathy (disease of the nerves that lead to the hands and feet).

Anyone who suffers from an unexplained, stubborn illness for several months, should consider celiac disease a possible cause and be properly screened for it.

Consult your doctor if you have diarrhea or digestive discomfort that lasts for more than two weeks. Be sure to consult your doctor before trying a gluten-free diet. If you stop or even reduce the amount of gluten you eat before you’re tested for celiac disease, you may change the test results. 

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