Nature of the Condition

BreadThe actual incidence of Celiac Disease in the United States is unknown, but may run as high as 3 percent of Americans. Celiac Disease is a digestive disorder that results in damage to the small intestine. It interferes with absorption of nutrients from food. People who have CD cannot tolerate gluten, a protein in wheat, rye, and barley. If people with celiac disease eat foods or use products that contain gluten, their immune system responds by damaging or destroying the lining of their small intestine. The lining is made of villi (small digit like protrusions) that allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished overtime.

CD is both a disease of malabsorption (nutrients are not absorbed adequately) and also an abnormal immune reaction to gluten. CD is also known as Celiac Sprue, Nontropical Sprue, and Gluten-Sensitive Enteropathy. By any other name, CD is a genetic condition: it runs in families.

Predisposing Factors

Both men and women are at risk for Celiac Disease. People of any age or race can develop this autoimmune condition. However, there are some factors that can increase your risk of developing CD. It is not clear what makes some individuals suffer from CD, but it’s been determined that the disease can be triggered by surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

Celiac Disease is genetically based, so it is more common in those with a family history of the condition. If you have a first or second-degree relative with CD, you are at an increased risk for developing it too. This autoimmune condition occurs in up to 5-10% of family members of persons diagnosed with celiac disease. About 95% of people with celiac disease have the HLA-DQ2 gene and most of the remaining 5% have the HLA-DQ8 gene.

Common Symptoms

CD manifests singularly in different individuals. Symptoms may occur in the digestive system but also in other parts of the body. Digestive symptoms are more common in infants and young children.

  • abdominal bloating and pain
  • chronic diarrhea
  •  vomiting
  • constipation
  • pale, foul-smelling, or fatty stool
  • weight loss

Children most commonly present irritability as well. The lack of nutrients during the first years can impede normal growth and development, resulting  in serious issues, such as failure to thrive in infants, short stature, delayed puberty and dental enamel defects of the permanent teeth.
On the other hand, adults show fewer digestive symptoms. Instead they may develop other perplexing symptoms.

  • unexplained iron-deficiency anemia
  • fatigue
  • bone or joint pain
  • arthritis
  • bone loss or osteoporosis
  • depression or anxiety
  • tingling numbness in the hands and feet
  • seizures
  • missed menstrual periods
  • infertility or recurrent miscarriage
  • canker sores inside the mouth
  • dermatitis herpetiformis

People with Celiac Disease may have no symptoms but can still develop complications of the disease over time. Long-term complications include malnutrition leading to anemia, osteoporosis, and miscarriage. Additionally, liver diseases and cancers of the intestine can develop if untreated. Furthermore, having an autoimmune disorder makes you more likely to develop other autoimmune diseases. Other examples of autoimmune conditions can include thyroid disease, Type 1 diabetes mellitus and primary biliary cirrhosis.

Nutritional Support

Despite its challenges, maintaining a healthy, balanced diet is possible with education and planning. The only current treatment for CD is a gluten-free diet. There are plenty of foods that are naturally gluten-free such as fruits, vegetables, beef, poultry, fish, nuts and eggs. However, managing CD is not just about eliminating gluten from your diet. It also involves making sure you get all the vitamins and nutrients you need, in particular iron, calcium, fiber and the B-vitamins thiamin, riboflavin, niacin and folate. For adults, weight gain can be an unwelcome side effect for people with celiac disease once they start following a gluten-free diet. The body is finally able to start absorbing more nutrients and calories from food.

It is recommended that celiac patients supplement their gluten free diet with the addition of enzymes (such as lactase), iron, Vitamin D, folate and Vitamin B12.

References
Autodore, Jennifer and Muralidhar Jatla. “Nutritional Complications of Celiac Disease”. Practical Gastroenterology. July 2009: 34-39.
Bauman, E., Friedlander, J. (2011). Therapeutic Nutrition. Penngrove, CA: Bauman College.
Case S, Kaplan CR. “Gluten-Free Guidance: Practical Tips for Dietitians and their Celiac Patients”. Today’s Dietitian. March 2003: 44-49.
Malterre, Tom MS, CN. “Digestive and Nutritional Considerations in Celiac Disease: Could Supplementation Help?” Alternative Medicine Review Vol. 14, Number 3, 2009: 247-257.