Sunday, March 4, 2012

What is Celiac Disease

Many of you reading this blog have Celiac Disease just like me.  Some of you are here for recipes, or because you found this by accident, or I told you to check out my blog.

Well, don't worry if you don't know much about celiac disease.  I am a physician myself and I didn't know much about it.  I'm an Orthopedic Surgeon and all I could remember was a mention of Tropical Sprue during GI classes in medical school.  But I know a lot about it now.  Here is an explanation (I'm not an expert and the blog wasn't meant to be a forum for symptoms and diagnosis) if you have more questions I would recommend you followup with your physician.

First of all it is an inherited disease, so if you want to blame someone blame mom or dad - they passed on the gene to you.  You can't 'catch' it and it is not contagious.  It is more common in caucasians and those of European descent.  And it is more common in women than men (lucky me).

What is strange is that even if you have the gene that does not guarantee that you will develop Celiac Disease.  The gene test is great way to rule out Celiac Disease - if you do not have the gene you can not get Celiac Disease.  If you have the gene there also has to be some trigger - stress, virus, illness, something that turns the gene on - before you have symptoms and the disease.

1 in 133 Americans have the disease and 95% of people are undiagnosed.  The average time to diagnosis is 6 to 10 years.  This is because the symptoms are so varied.

Symptoms may include diarehea, constipation, weight loss, irritability, skin disorder (dermatitis herpetiformis), abdominal pain, fatigue, mouth ulcers, nose bleeds, poor tooth enamel in kids, depression and neuropathy.  Thus it can be very difficult to diagnose the disease.

This is what dermatitis herpetiformis looks like.

You can learn more about the disease at the National Foundation for Celiac Awareness they have a page to check off your symptoms along with many other useful pages and links.

Once your doctor has a concern for Celiac Disease he can do blood tests that look for abnormal antibodies.  For the blood test to be positive you have to be eating a gluten diet so don't diagnose yourself before you have the tests.

The other test - the gold standard - is an intestinal biopsy that requires a scope to be placed down your throat and into your stomach and small intestines.  The biopsy in a Celiac patient shows flattened villi.  When flattened they can not absorb nutrients.  Here you can see the long finger like projections called villi; the bottom shows flattened villi is Celiac Disease.

The other test is a positive response to diet change - thus you feel better going gluten free.  So with abnormal labs, followed by abnormal biopsy, followed by relief of symptoms on a GF diet and a normalization of your labs you most likely have Celiac Disease.

Celiac Disease is an auto-immune disease and once the disease is triggered you attack your own intestines.  After a period of time your gut can heal - this usually occurs in 3 - 6 months in kids and in 2 - 3 years in adults.

What is gluten?  It is a protein found in wheat, barley and rye.

The only way to treat Celiac Disease is a life-long avoidence of gluten.  There is no medicine to take and you do not grow out of it.

Even a few crumbs can cause damage to the intestine.

If you do not follow the diet you are at an increased risk of osteoporosis, anemia (low blood count), intestinal cancer, low blood sugar, infertility, liver disease and other autoimmune diseases.

Once you are diagnosed it is recommended that you consult a nutritionist to make sure with your change in diet that you are consuming the correct amount of nutrients.  Many reports recommend a multivitamin and supplemental vitamin D and Calcium.  You should check with your doctor about testing you levels and how much you should take.  The NFCA website has a link for your doctor to take an online course about Celiac Disease for free continuing medical education credits.  I would recommend you mention it to them.

I hope this helps.

The Un-Gluten Guy

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