Celiac Disease - Much More Common Than We Thought
Do you suffer from gas and bloating on a regular basis? Abdominal pain? Frequent diarrhea, or alternating diarrhea and constipation? What about fatigue, depression, anxiety, foggy thinking? Arthritis or other joint pain? Numbness or tingling in the legs? Is your skin itchy for no apparent reason, or covered in small blisters? Do you get canker sores frequently? Are you often irritable, but don’t know why?
All of these can be symptoms of multiple disorders, but if you’ve been searching for answers and finding nothing, consider this: all of these are symptoms associated with Celiac disease.
What is Celiac Disease?Celiac disease is a genetic autoimmune disease in which the lining of the small intestine is severely damaged by consumption of gluten containing grains (including wheat, rye, barley, spelt and some lesser known grains, and sometimes contaminated oats). This damage prevents absorption of vitamins, minerals and other nutrition, which leads to numerous health problems, some of which can be life-threatening if the disease goes untreated. It is widely believed that a person must suffer IBS-like symptoms of diarrhea, bloating, flatulence and gut pain in order to be a candidate for Celiac testing. We now know that many Celiac patients do not have any intestinal symptoms, but may show other symptoms of malnutrition and malabsorption such as canker sores, difficulty concentrating, frequent headaches, poor immune response, anemia, skin rashes or joint pain. Unfortunately, the possibility of Celiac disease is still largely ignored in those without classic symptoms, making the average time from onset of complaints to proper diagnosis around 11 years! Celiac disease affects one in every 133 people in the United States. Chances are you know someone with this disorder, even if they don’t know they have it. An astonishing 97% of people with Celiac are undiagnosed! If a first-degree relative (parent, child, or sibling) has Celiac disease, the chances of having it increase dramatically to 1 in 22. In Celiac disease, the ingestion of gluten causes the immune system to attack the small intestine. The lining of the intestine is damaged so severely that absorption of nutrients is impaired. With vitamin, mineral and other essential nutrient deficiencies, the biochemistry of the body breaks down and all tissues may be affected, including muscles, organs, bones and nerves. This is why Celiac disease may present with as many as 300 different symptoms, many seemingly unrelated. Because a person with Celiac disease has a greatly increased risk for certain types of cancer (30 times the risk for cancer of the small intestine, and an increased risk of other cancers like esophagus and thyroid cancer), it is important that diagnosis be made and treatment begun even when symptoms may seem minor to the patient. If you or your doctor suspect Celiac disease, appropriate testing should be done right away. What if I only have a couple of these symptoms?
Celiac disease is difficult to diagnose, and part of the reason is that so many patients do not present with digestive symptoms. We now know that many Celiac patients instead suffer only from a blistering rash or arthritic joint pain. Still others suffer from mild to severe depression or anxiety, even occasionally psychosis, mania, delusional behavior or what appears to be dementia. Why would a disease manifest in so many different ways? We don’t know all the answers, yet, but it makes sense that a disorder that causes multiple nutrient deficiencies may have many symptoms. If you have been struggling to find the cause of your discomfort, take a closer look at Celiac disease. How is Celiac Disease diagnosed?
Until recently, there were no very accurate tests for Celiac disease. Doctors used to test for a marker called anti-gliadin antibody. We now know that this antibody is negative in many with Celiac disease and positive in some who don’t have the disorder. Celiac can still be difficult to diagnose, but it is currently believed that four blood tests should be run, in order to cover the various markers that may be positive in Celiac patients. These tests include antibodies known as IgA antitissue transglutaminase (tTG), IgA antiendomysial antibody (EMA), and the aforementioned antigliadin antibody. In addition, patients should be tested for a marker known as total IgA, because many Celiac patients are deficient in IgA and, if this is the case, the other tests will show falsely negative and must be altered slightly. Traditionally, a biopsy of the small intestine has been used to confirm the diagnosis, if blood tests are positive. This invasive test is often waived, now. Sometimes a genetic test is done with a simple cheek swab. Doctors vary in how they handle this disease, which can be so tricky to diagnose. What is the treatment for Celiac Disease?
Lifelong avoidance of all gluten is the only treatment for Celiac disease. It is not like some childhood food intolerances that we may grow out of as adults. Gluten is found in wheat, rye, barley and spelt, and may contaminate oats as well. In addition, gluten is added to many foods in the form of a flavor enhancement or thickener, for example in many sauces and condiments. It is also often added to cosmetics and other beauty products like shampoos and conditioners, and many sensitive Celiac patients will be affected even by these small amounts of gluten absorbed through the skin. If you have Celiac disease, it is important to become very familiar with the many names for gluten, and with the many places it may hide in our food supply. For example, maltodextrin, a flavoring in many prepared foods, may be made from either corn or wheat. If the label doesn’t say, a Celiac must assume it comes from wheat and avoid that food. What happens if Celiac Disease goes untreated?
A multitude of symptoms are attributable to nutrient deficiencies. Malnutrition may present in the form of fatigue; difficulty thinking, speaking or writing; anemia; failure to thrive in infants or stunted growth later in life. Depression or anxiety may be present. Neurological damage may lead to balance problems, seizures, or severe headaches. Any person with osteopenia, osteoporosis, or easily broken bones before the age of 55 should be considered for Celiac testing. Because calcium and vitamin D are not absorbed, thinning bones is one of the ways undiagnosed Celiac disease may manifest. Infertility, recurring miscarriages or fetal deformities may also indicate undiagnosed or untreated Celiac disease. And, as mentioned, cancer – especially colon cancer – is suspicious for Celiac disease.