To Wheat or Not to Wheat: May is Celiac Disease Awareness Month

Celiac disease is a digestive condition elicited by the consumption of gluten. Gluten is a protein found primarily in foods containing wheat, barley, or rye. When a person with celiac disease consumes any of these foods, it causes an immune reaction in the small intestines causing damage and impacting absorption of nutrients. In this entry we will discuss celiac disease in more detail, including what causes this condition and the clinical effects it has on those affected.

Who is affected by celiac disease?

Approximately 1 in 133 people in the United States are thought to be affected with celiac disease, a type of gluten sensitivity. Most people who have the disease are not aware of it because symptoms are variable and are often thought to be due to a variety of other reasons. Diagnosis of celiac disease may be missed or delayed, sometimes for years.¹

What is gluten sensitivity?

The term “gluten sensitivity” is used to describe a variety of clinical complaints caused by the ingestion of gluten. The most commonly known gluten sensitivity is celiac disease, or gluten sensitive enteropathy (GSE) with genetic predisposition. GSE is an autoimmune disease of the small intestines whereby the ingestion of gluten results in inflammation and loss of villus structure (Figure 1). Villi are the finger-like projections in the intestines that are responsible for the absorption of nutrients. Loss of villi results in decreased area of the intestines leading to issues with absorption. In celiac disease, the immune system overreacts to the presence of gluten, resulting in the production of antibodies to gliadin (one of the main protein groups in gluten) and tissue transglutaminase (an intracellular enzyme present in the endomysium and released upon cell damage).

Figure 1. Biopsy specimen showing normal villi structure (A) and biopsy-proven changes of untreated celiac disease (B). Villi are “flattened” and rudimentary in celiac disease (Adapted from Freeman, 2008).

A second type of gluten sensitivity is known as non-celiac gluten sensitivity. This type of sensitivity also involves an inappropriate immune response to gluten and some of the same symptoms, but not the intestinal damage and antibody response. It can occur in any individual and is typically induced by intestinal barrier distress and enhanced intestinal permeability.

What is celiac disease and what causes it?

Celiac disease is genetic, so people with a family history of celiac should be tested for the disease if symptoms are present to prevent long-term health issues that can result from undiagnosed celiac disease. Many patients have celiac disease, but do not develop symptoms until the disease is triggered (becomes active for the first time) which can happen after stressful events such as surgery, pregnancy, childbirth, viral infection, or severe emotional stress.¹

Alessio Fasano, in his article Surprises from Celiac Disease, has proposed “a trio of causes,” discussed in the graphic below, that may underlie celiac disease. These include an environmental trigger (the consumption of gluten), a genetic susceptibility, and an unusually permeable gut.

Figure 2. A trio of causes that may underlie celiac disease including an environmental trigger, a genetic susceptibility, and an unusually permeable gut.

How is celiac disease treated?

The only treatment available at this time is the total elimination of gluten-containing food from the diet. This can be very difficult as gluten is found in many foods: bread, pasta, cookies, and can even be found in foods such as salad dressing. Additional nutritional support, such as vitamin D supplementation, and regular laboratory testing of gliadin and transglutaminase antibodies should be performed to determine if gluten has been successfully removed from the diet and to monitor for accidental contamination.

Who should be tested for gluten sensitivity and celiac?

Tests for gluten sensitivity and/or celiac disease include markers such as gliadin, tissue transglutaminase, and endomysial antibody levels. There are a number of individuals that can benefit from assessing possible gluten sensitivity or celiac disease including those with:

Common symptoms of celiac disease or unexplained GI conditions
A family history of celiac disease
Food testing results that indicate gluten sensitivity

Testing can monitor compliance to a gluten-free diet and can be helpful in evaluating the effectiveness of treatment. Gliadin, tissue transglutaminase, and endomysial antibody levels should fall when gluten is removed from the diet.

Celiac disease can lead to other diseases

Celiac disease can lead to other diseases in which the immune system attacks the body’s healthy cells and tissues. These can include the following:^1-4

In addition to leading to other diseases, celiac disease and gluten sensitivity can act as immune stressors that may impact other systems in the body such as the nervous system, detoxification, adrenal system and metabolism.

Celiac disease or gluten sensitivity is a problem for a large number of individuals. For patients whose symptoms seem resistant to other therapies, identification and elimantion of dietary stressors – such as gluten – may be beneficial.

Guest author: Rachel Rixmann is a manager of the Clinical Support & Education Department at NeuroScience, Inc. and the resident expert in gastroenterology and nutrition.

References:

National Institute of Diabetes and Digestive and Kidney Diseases. Sept. 2008. Publication No. 08-4269.
NIH Consensus Statement on Celiac Disease. (2004). NIH Consensus and State-of-the-Science Statements, 21(1): 1-22.
Kumar, V. Mount Sinai Medical Center (1996). Predictive Value of Serology Testing in Celiac Disease. http://www.enabling.org/ia/celiac/diag-tst.html.
American Association for Clinical Chemistry – Lab Tests Online. March 2009.
Fasano, A. (2009). Surprises from Celiac Disease. Scientific American, Inc., 301: 54-61.
Freeman, H.J. (2008). Pearls and pitfalls in the diagnosis of adult celiac disease. Can J Gastroenterol, 22: 273-280.