Celiac Disease Symptoms, Diagnosed, and Treatment

Celiac Disease Symptoms - Celiac Disease is an inherited autoimmune disorder that results in inflammation and/or damage of the absorptive surfaces of the small intestine. The response occurs with the ingestion of a protein called Gluten, typically found in wheat, rye, and barley.  The response can be activated by stress, viral infection, pregnancy, illness or surgery.

• Celiac Disease is also known as gluten sensitive enteropathy, sprue or celiac sprue.  The prevalence is 1 out of 133 people in the United States according to the Center for Celiac Research at the University of Maryland.  This equates to 1.5 million Americans, with only 15,000 diagnosed or 1% of population.  

• Occurrence in people with a first-degree relative (parent, child) is 1 in 22.  It occurs in 70% of identical twin pairs, but both twins may not get the disease. 

• 97% of people with celiac disease have the genetic markers Human Leucocyte antigen (HLA) DQ2 and / or DQ8.  30% of the U.S. population has DQ2 or DQ8 alleles.

• Type 1 diabetes and celiac disease are found on the same region of a specific HLA gene.  This is also a location for many other autoimmune diseases.

Symptoms of Celiac Disease:

•         Diarrhea (Chronic)

•         Steatorrhea

•         Anorexia

•         Weight loss

•         Malnutrition

•         Recurring Abdominal pain / bloating

•         Iron-deficiency anemia

•         Osteomalacia or premature osteoporosis

•         Nutrient / Vitamin Deficiencies (Ca, Iron, A, D,  E, K, Folate, B12)

•         Lactose Intolerance due to inflammation and damage to intestinal mucosa

•         Skin Rash or itchy skin (dermatitis herpetiformis)

Methods of Diagnosis:

• Small bowel biopsy – check villi for damage. 

• Physicians can test the blood (Celiac Blood Panel) to measure levels of antibodies to endomysium and tissue transglutaminase. 

• Tests for malabsorption, gut permeability, contrast radiologic studies, and tests for deficiency states are not accurate screening tests for Celiac Disease.

• Gluten – free diet should not be started before blood test and biopsy as this may interfere with making a correct diagnosis.

• Small bowel biopsy is currently the gold standard.

If you have a wheat allergy or Celiac Disease the only way to prevent a reaction is to strictly follow a Gluten Free Diet and avoid all possible Gluten containing foods.

What not to eat:

• Wheat, rye, barley, Oats, Bulgur, Kamut, Couscous, Spelt, Bread crumbs, pretzels, some flavored chips, white / wheat flour and their products.

• Chocolate milk / drinks, Ovaltine, malted milks, processed cheeses, some shredded cheeses (as they may be rolled in flour to prevent sticking), some puddings, ice cream.

• Breaded / fried foods.

• Beer, malt liquor, flavored coffees.

• Brown rice syrup, modified food starch.

• Malted Vinegar

• Various baked goods.

Hidden Foods That May Contain Gluten:

•         Canned Baked Beans

•         Broth or bouillon (U.S. vegetable broth is ok)

•         Imitation Seafood / Imitation Bacon

•         Processed Meats

•         Hydrolyzed vegetable protein.

•         Pie fillings (Modified food starch)

•         Non Dairy Creamers

•         Soy Sauce

•         Alcohol based extracts (vanilla)

•         Some Medications

•         Some Toothpastes

•         Communion Wafers

•         Root Beer Soda

•         Some Chewing Gum (wrapper)

•         Stamps

•         Envelope Adhesive

What foods are ok:

• Gluten Free products

• Brown / white rice, garbanzo bean, fava bean, teff, amaranth, quinoa, millet, corn (flour or starch), soy, potatoes, tapioca, buckwheat and flours made from these.

• Brewed coffee, Cocoa, Milk

• Plain popcorn, some rice cakes, plain potato chips, corn chips, i.e. Baked Lays, Fritos, regular ruffles, etc. 

• Peanut butter, eggs, bacon, fish, poultry, other meats.

• Cream of Rice, puffed rice cereal

• Fruits, vegetables

• Coffee, most soft drinks, wine, brandy, rum (except dark), tequila, vodka made from grapes or potatoes.

 Cross Contamination

•         Have a separate toaster

•         Separate hand towels

•         Separate refrigerator shelf

•         Separate items like peanut butter, jam, butter, etc.

•         Separate toothpaste, dental floss

•         Cross Contamination is a big issue.  Need for proper cleaning of common surfaces, cutting boards, utensils, flour sifters, oil for frying foods, and spreadable condiments is very important.  Just because you are not presenting symptoms or do not feel bad does not mean intestinal inflammation and / or damage is not occurring. 

Shopping

• Gluten free diet typically can cost 20% more than usual diet.

• There is possible reimbursement from 3rd party payers (insurance companies) for the cost difference with  receipt and you may also be eligible for a tax credit for the difference of a gluten free product and its’ gluten containing counterpart as it is a medically required diet.

• Wheat free does not mean gluten free!!!!

Adapted from: http://www.dorchesterhealth.org

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