Celiac Disease Overview


The Achilles' heel of a person with celiac disease: wheat.
The Achilles' heel of a person with celiac disease: wheat.
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According to Greek mythology, the infant Achilles was dunked by his mother into the River Styx, a baptism that conferred upon the warrior his invincibility in battle. However, the water didn't touch the skin where his mother was holding him, which was at the ankle. Achilles was killed by a wound to the area, and the term Achilles' heel has come to signify a hero's one weakness or vulnerability. Most notably, Superman was rendered powerless by kryptonite. But should a scribe want to give a character a new yet relatable Achilles' heel, he or she might consider using celiac disease. Those who suffer from this autoimmune disorder are affected by even the smallest amount of gluten, which is a protein found in wheat, barley and rye.

Our small intestine is tasked with absorbing nutrients from our food, which it does with wavy protrusions known as villi. In someone with celiac disease, however, gluten damages the small intestine's lining, so that the villi lie flat or are even nonexistent. As a result, the villi can't trap the nutrients and transfer them to the bloodstream for the rest of the body; instead, all the nutritional value heads out of the body with the stool. That leaves the sufferer malnourished and at risk for a number of conditions including anemia and osteoporosis.

Celiac disease is much more than a mere food allergy to gluten. Though researchers are still sussing out the interplay of various factors, it appears that 95 percent of celiac disease sufferers possess one of two histocompatibility leukocyte antigens (HLA), which makes it likely that the close family members of a sufferer will also possess the genes [source: Fasano]. Recent research by Alessio Fasano of the Center for Celiac Research at the University of Maryland suggests that some people may also have a weakened gut, which predisposes them to this type of gastrointestinal condition.

But even if doctors aren't quite sure of all the precise causes, they do know that celiac disease is on the rise; a study published in 2009 revealed that celiac disease is about 4.5 times more common now than it was 50 years ago, perhaps because gluten-containing wheat products have become dietary staples in the West [source: Mayo Clinic]. It's estimated that about one person in every 133 suffers from it [source: Fasano]. Still, despite knowledge that celiac disease is on the rise, the condition remains woefully underdiagnosed. Find out what you should be on the lookout for on the next page.

Symptoms and Diagnosis of Celiac Disease

Irritability in infants may be a sign of celiac disease.
Irritability in infants may be a sign of celiac disease.
Kraig Scarbinsky/Digital Vision/Getty Images

There are many ways that celiac disease can present itself, and this wide spectrum of symptoms often causes doctors to misdiagnose the condition. For some, the condition rears its head in infancy, often when the child begins eating solids like cereal. For others, diagnosis doesn't come until adulthood, sometimes as a result of surgery, pregnancy or severe stress.

Some of the most common symptoms of celiac disease include chronic diarrhea, abdominal pains, weight loss despite a hearty diet, foul-smelling bowel movements and excessive gas. However, there are some non-gastrointestinal hints as well, including muscle cramps, joint pain, fatigue, irritability and depression. One big clue can be the presence of a skin rash known as dermatitis herpetiformis, which causes blistering and itching, usually on the elbows, knees and rear end.

The severity of these symptoms can vary from person to person, and indeed, some people are completely asymptomatic. It's easy to write off occasional fatigue and diarrhea, but regardless of whether the symptoms interfere with daily life, they're doing severe damage to the intestinal lining. As malnutrition sets in, sufferers are at risk for anemia, infertility, osteoporosis and cancer. Infants may demonstrate a failure to thrive that is easily detectable to doctors, but adults with the condition may continue to stumble through life not knowing why they feel so bad. Studies suggest that for every one person who has received a diagnosis of celiac disease, about 30 people walk around unaware of their condition [source: Mayo Clinic].

Yet, even those who suffer from the symptoms of celiac disease may have to wait years for a correct diagnosis from their doctor. The symptoms mimic many other conditions, such as cystic fibrosis, irritable bowel syndrome and Crohn's disease. In many cases, it's up to the patient to suggest the condition to a doctor. It's particularly important, given the genetic nature of the disease, for close relatives of someone who has received a diagnosis to seek testing.

To test for celiac disease, doctors will usually perform a blood test to check for the presence of certain antibodies; these antibodies attack the enzymes the body produces to deal with the consumption of gluten. Doctors may follow up the blood test with a biopsy to check for damage to the small intestine.

Once a diagnosis of celiac disease has been established, what are the patient's options?

Celiac Disease Treatment

Currently, there is no cure for celiac disease. The only treatment for the condition is a strictly gluten-free diet. A gluten-free diet is notably difficult to stick to; once you start looking for it, you'll see gluten lurking everywhere. People with celiac disease are forced to become strict label readers and grand inquisitors of restaurant waiters.

The holy trinity of gluten-containing grains to avoid is wheat, barley and rye. That means no breads, cereals, pastas, crackers or baked goods made from any of these sources. Additionally, gluten can be found in salad dressings, soy sauce, peanut butter, fat-free sour cream, ice cream, pudding and beer. Soups, sauces and gravies that have been thickened with flour are no-no's, as are processed meats and meats prepared in a breaded style. Surprising sources of gluten include vitamins, toothpaste, lipstick and envelope adhesive.

In recent years, though, many products on that forbidden list have entered the marketplace with a huge gluten-free label, so those with celiac disease have been able to indulge in pizza, cookies and beer once more. These items tend to be more expensive than their gluten-containing counterparts, however, and still require extreme diligence when it comes to checking the label. Some restaurants, even Italian restaurants with gluten-laden menus, have been able to concoct gluten-free substitutes. When you can't check a label, spend some time talking to the waiter or the chef about ingredients and preparation practices.

Many with celiac disease may find it easier to stick to this list of safe foods, which includes any vegetable or fruit, clear soups, nuts, dried beans, milk, eggs, unprocessed cheeses and meats, jellies and jams, sugar and products made with gluten-free grains and starches, which include corn, rice, soy, potato and quinoa.

It's very important for people with celiac disease to avoid cheating on this diet, which requires an immense amount of willpower in this carb-laden world. Even if the symptoms they experience after a piece of pizza are mild, the gluten can still damage the small intestine. However, there are benefits to this strict diet; celiac disease symptoms should disappear within a few days or weeks of eating gluten-free foods, and the small intestine will begin to recover and absorb nutrients soon after that. Those that suspect that they'd be helped by the diet shouldn't begin it until they've been tested by a doctor, though, as eating gluten-free can distort the blood tests that lead to a conclusive diagnosis of celiac disease. For more on starting a gluten-free lifestyle, see How to Eat a Gluten-free Diet.

Though a gluten-free diet is the only option for now, many companies are working on a pill that could be popped to treat the condition. Such medication would likely work in the same way that pills work to allow the lactose intolerant to consume milk, or it may stall the autoimmune responses that interfere with the digestion of gluten.

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