CELIAC DISEASE

Celiac Disease, also known as celiac spruce and nontropical spruce, is a congenital, hereditary sensitivity to gluten, the protein found in wheat and other grains. It’s an interesting disorder. When I was in medical school, celiac disease was considered rare; I don’t know that I ever expected to diagnose a case of it in my practice. But over the years, I’ve encountered many cases of celiac disease, and I suspect that it has been considered rare because it’s difficult to diagnose and is often overlooked.

Someone with celiac disease may have diverse symptoms. Chronic indigestion, gas, and bloating are the most common symptoms, but they may also include irritability, vomiting, loss of appetite, fatigue, pallor, and general symptoms including lethargy and depression. All these symptoms occur as a result of the destruction of the villi, or threadlike projections of the small intestines. The villi are damaged to the point where they are unable to transfer nutrients from food into the blood to nourish the systems of the body.

Some cases of celiac disease manifest themselves in childhood. The usual symptoms have different degrees of severity, and there can be different symptoms. Usually when a baby is introduced to cereals at the age of six months to a year the symptoms will first appear. Often one of the symptoms that parents notice with babies, in addition to increasing irritability, is a pale foamy diarrhea that has a particularly unpleasant odor. Sometimes there is a lag of a few weeks between introduction of the food containing gluten and the symptoms. In adults, symptoms often develop after overindulgence in foods that are rich in gluten, typically pasta or bread. Gas and bloating are the most common symptoms. Often a child will outgrow the reaction to gluten, but when an adult develops the reaction, it’s there to stay.

The patients whom I later diagnose with celiac disease usually come to see me with vague digestive complaints, fatigue, and depression. I pinpoint their problem by process of elimination. There are various degrees of gluten sensitivity; some people are extremely sensitive while others are only mildly so. Many patients who I suspect suffer from celiac disease tell me that they become depressed after they eat foods that contain gluten. It’s interesting to note that there’s a connection between celiac disease and schizophrenia; researchers have long known that children of schizophrenics are much more likely to develop celiac disease than others. In any case, it does argue for the psychological symptoms of celiac disease.

It’s difficult to diagnose celiac disease not because there’s no reliable test but because it’s often confused with other problems such as lactose intolerance, irritable bowel syndrome, and cystic fibrosis. A doctor usually has to have a high degree of suspicion to test for celiac disease. A biopsy of the small intestine used to be the definitive diagnostic procedure, but there is now a blood test -an antigluten antibodies test- that is highly accurate. Here are some questions I ask a patient who I suspect suffers from celiac disease:

• Do you have Irish, Scotch, English, or Scandinavian heritage? (Celiac disease is more common among people of these extractions; recent statistics reveal that 1 in every 215 Irish suffer from the disease.)
• Is there a history of intestinal disease in your family? Does anyone in your family experience similar symptoms including chronic gas, bloating, and indigestion?
• Have you ever had a blistery rash on the inside of your elbows, behind your knees, or at other body folds?
• Is your abdomen ever swollen?
• Is chronic fatigue a serious problem in your life, affecting your job performance and social obligations?
• Do you have frequent diarrhea or constipation?
• Does your family have a history of stunted growth or delayed maturity?

If the answers to these questions are primarily yes, celiac disease is a real possibility, and I suggest that you see a doctor for a definitive diagnosis.

The cure for celiac disease seems simple: Eliminate gluten from your diet. But the reality isn’t that easy. Gluten is present in oats, rye, barley, wheat, and buckwheat as well as countless processed foods including breads, cereals, pasta, crackers, and most commercial baked goods. In addition, ice cream, puddings, desserts made from commercial mixes, cheese spreads, commercial salad dressings, meat, chicken, and fish products prepared with bread or breadcrumbs, soups, gravies, and sauces thickened with flour all can contain gluten as thickening agents, emulsifiers, stabilizers, and hydrolyzed vegetable protein. Malt, which is primarily used as a flavoring and coloring agent, can be a hidden source of gluten. It’s present in beer and ale and most, though not all, dry breakfast cereals. Grape-Nuts contain a great deal of malt and is a good test food for gluten intolerance.

I think it’s important to get guidance and encouragement on a healthy diet for those with celiac disease, and I encourage you to investigate sources of information including the National Digestive Disease Information Clearinghouse, Box NDDIC, Bethesda, MD 20892, (301) 4686344, and the Celiac Sprue Association, 2313 Rocklyn Drive, Des Moines, IA 50322, (515). 270-9689. There are a number of cookbooks that are geared to a gluten-free diet, and these associations should help you find them.

When the diet is gluten-free, symptoms of celiac disease should clear up in a week or two. But that doesn’t mean that gluten can be reintroduced. While children often begin to tolerate gluten after five years or so of a carefully monitored gluten-free diet, a doctor should be involved in trying to reintroduce gluten, and it’s usually recommended that children stick with a gluten-free diet until they’re fully grown. Adults who develop celiac disease later in life will usually have to remain gluten-free for life.

While suffering from the symptoms of celiac disease, it’s important to hold to a lactose-free diet (see Lactose Intolerance), at least until the digestive system has a chance to recover. For the same reason, it is advisable to follow a low-fiber diet, and to avoid fatty foods at least until the symptoms disappear.

Vitamin and mineral supplementation is important for people who have celiac disease to replace the nutrients lost through diarrhea and also the nutrients that the villi of the small intestine were unable to absorb. It’s therefore important to take a daily supplement as well as the supplements described below. Your doctor will tell you if you suffer from anemia, and, if so, you should take an iron supplement under medical supervision.

There is a skin disease called dermatitis herpetiformis closely associated with celiac disease. It usually develops over a period of time and it’s characterized by tiny, blisterlike burning and itching hives on the elbow or knees, the back of the head, the base of the spine, or the buttocks. Like other symptoms of celiac disease, dermatitis herpetiformis will clear up once the sufferer adopts a gluten-free diet.

NATURAL TREATMENTS FOR CELIAC DISEASE

• Eliminate all foods containing gluten from the diet, including: Ale, Candy, ice cream, Baby cereal, Canned’ meats, ice cream cones, Beer biscuits, Coffee, instant and brewed, infant formula, Bread Liquors, Breakfast cereal, Coffee substitutes, Macaroni, Cake mixes, Cookies, Milk (malted and powdered), Cakes, Frankfurters, Noodles, Pudding mix, Tea, Pancake syrup, Salad dressings, Wheat flour, Pancakes, Soda crackers, Whipped cream substitutes, Potato chips, and Spaghetti.
• While symptoms are evident: Follow a lactose-free diet.
• Follow a low-fiber diet.
• Avoid fatty foods.

IN ADDITION TO YOUR DALLY SUPPLEMENTS, TAKE:

• Vitamin C: 1,000 mg, daily.
• Vitamin E: 400 I.U. daily.
• Beta-carotene: 10,000 I.U. daily.
• Calcium: 1,000 mg, dally along with 400 mg. of magnesium daily,
• Iron: 60 mg. daily if you have had a blood test that indicates you are iron deficient.