Celiac Disease More Common

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Celiac disease is an autoimmune disease that afflicts primarily the small intestine but can also affect the skin and other tissues. People of northern European ancestry are far more likely to develop it than those of Asian or African descent.

Like all autoimmune diseases, the severity of the disease can vary considerably among patients. Some experience severe malabsorption problems that can lead to weight loss and multiple nutritional deficiencies. Other patients experience such mild effects from the disease that they may never seek medical attention or get properly diagnosed.

Celiac disease is also called nontropical sprue and gluten sensitive enteropathy. Unlike most autoimmune diseases, such as lupus, multiple sclerosis or rheumatoid arthritis, doctors know what triggers celiac disease in genetically susceptible people. Indeed, celiac disease is the only autoimmune disease that is generally completely reversible simply by avoiding the environmental trigger.

The environmental trigger for celiac disease is gluten. Gluten is a protein found in wheat, barley and rye. These three grains, even when consumed in small amounts, trigger the immune system to destroy the cells that make up the villi. The villi, which makes up the surface of the small intestine, is where most nutrients are absorbed.

Other grains such as rice, corn and millet have no gluten and do not trigger the disease. Oats do not have gluten but are almost always contaminated with barley, so it is necessary to avoid oats as well. However, given the widespread use of wheat and wheat products in countless processed foods, it is difficult to completely avoid gluten.

It was once believed that only about one in ten thousand people had celiac disease, but new research has found it to be far more common.

Researchers at the University of Maryland and the University of Chicago examined blood samples from more than 13,000 people. They determined that 1 in 22 people who were considered to be at risk for the disease because of symptoms such as unintentional weight loss, stomach pain, vomiting, diarrhea and bloating, or because they had a close relative with celiac disease, were afflicted. However, about 1 in 133 people, who were considered to be low risk because they were without a close relative with celiac disease and had no intestinal complaints also turned out to have celiac disease.

The results of their research were published in the Archives of Internal Medicine in February 2003. Before this latest research, most health professionals believed only about 1 in 10,000 had this autoimmune disease. Because it was thought to be so rare, many were misdiagnosed with irritable bowel syndrome, chronic fatigue syndrome, depression, anorexia nervosa and other ailments. Celiac disease can also cause arthritis and dermatitis. Misdiagnosis leads to ineffective treatments and a lot of frustrated patients.

Celiac disease most commonly begins before age 20 but can begin much later in life in some people.

In people who are genetically prone to develop celiac disease, it may be some physical or psychological stress or pregnancy that triggers overt symptoms. Because the symptoms may be mild and can come on gradually, many people with celiac disease don’t seek medical treatment. What’s worse is that when they do see a physician, even with classic celiac disease symptoms, they are more often than not misdiagnosed, sometimes for many years. When left untreated, celiac disease can lead to intestinal cancer, anemia and osteoporosis. Addison’s disease and most recently schizophrenia are also more common in those with gluten intolerance.
Physicians generally prefer to do a biopsy of the intestine to confirm the diagnosis of celiac disease. However, if all sources of gluten are completely removed from the diet, the symptoms usually start to disappear within a week or two. A gluten-free diet is very difficult to follow without the help of a knowledgeable dietitian.

Within a month or two of completely eliminating gluten from the diet, most people with celiac disease will see improvement in all or most of their symptoms. However, some symptoms may last much longer, although it is not clear if this is due to irreversible damage or the occasional inadvertent consumption of gluten.

By James Kenney PhD, RD, LD, FACN.

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