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Celiac Disease

 

Celiac Disease Introduction

Celiac disease is also known as non-tropical sprue, celiac sprue, or gluten-sensitive enteropathy. It is categorized as a chronic malabsorption disorder caused by an immune reaction to certain grain proteins called glutens. [1] Celiac disease causes the surface of the small intestine to be destroyed when gluten-rich foods are consumed, and hinders the absorption of critical nutrients, such as calcium, folate, iron, and some dietary fats. [2] The immune response is, more specifically, to the gliadin component of gluten. Gluten containing grains include wheat, rye, barley, and triticale. Other grains that may cause a reaction are oats, kamut, amaranth, quinoa, and soy. These grains contain proteins that are very similar in structure to gliadin. [3]

Celiac disease is very prevalent in the Western population. There does not appear to be any difference of occurrence between men and women. Interestingly, it is more prevalent in persons of Northern and Central European descent and is not common in persons of Asian, Jewish, and Mediterranean descent. [4, 5] There does seem to be a genetic component to celiac disease. Persons with a first degree relative who suffers, or has suffered from the disease, are at higher risk of contracting the disease. [6] Other risk factors include Type I Diabetes and other autoimmune diseases.[7]

Diagnosis of celiac disease peaks at two different ages. Initial diagnosis is usually discovered in children before the age of 3, and secondly in adulthood, between the ages of 30-50. [8] It is thought that incidence peaks in children as a result of the introduction of cereal grains into diet It is, however, unknown why the second peak occurs later in life. Individuals with celiac disease are at increased risk for multiple nutrient deficiencies, thyroid abnormalities, diabetes, dermatitis herpetiformis, urticaria, osteoporosis, cancer, and psychiatric disease. The occurrence of celiac disease is between 2.5 to 7.5 per 1000 people. For individuals with Type I Diabetes, the occurrence is as high as 46 to 104 per 1000 people. Those suffering from Hashimotos’s Thyroiditisas are at greatest risk, with an occurence as high as 78 per 1000 persons. [9]

Celiac Disease Symptoms

In many cases, Celiac disease can be asymptomatic. The most common symptom is steatorrhea (fatty stools). Children with celiac disease often exhibit specific indicators of disease, including:

  • poor weight gain
  • fatty, odorous stools
  • painful, bloated abdomens
  • possible development of an iron deficiency
  • anemia (low blood count)

Adults will often be of smaller stature and suffer from;

  • weight loss
  • infertility
  • apthous stomatitis
  • dermatitis herpetiformis

Long-term sufferers may develop bone pain, edema, paresthesia, and anemia, caused by severe nutrient deficiencies resulting from malabsorption.[10]

Celiac Sprue Disease Treatment

The only treatment shown to be effective for celiac disease is the complete elimination of gluten and gliadin containing grains from the diet. [11] Even the smallest amount can inhibit the healing process and cause an immediate relapse of the disease. Individuals with this condition should avoid wheat, rye, triticale, oats, barley, quinoa, amaranth, and soy. If symptoms of disease improve after the elimination of the aforementioned grains, certain grains are considered tolerable for consumption (i.e. buckwheat and millet). Recent studies have also shown that less than 50 grams of oats per day may be acceptable for individuals with Celiac disease. Other dietary recommendations for persons with this condition include the avoidance of dairy-containing products. [12, 13]

Individuals must be very diligent about excluding gluten and gliadin-containing products from there diet. This often turns them into “food sleuths,” because many of the processed foods that are available in today’s markets contain traces of some gluten grains, which can cause adverse reactions.

Study has indicated that nearly 30% of individuals on the gluten free diet will see an improvement in the first week, and 50% in the first month. The cure rate is 90% when individuals are consistent with a gluten free diet over a calendar year. [14] Although these statistics are promising, around 90% of individuals will have to continue the gluten free diet for life in order to avoid a relapse.

Supplements helpful for Celiac Sprue Disease

Iron The most common deficiency in children is iron. Supplementation with iron has shown to increase blood hemoglobin levels and correct iron deficiency anemia. It also has been shown to improve overall mental and psychomotor function. Long-term iron supplementation is critical even if the child is adhering to the gluten free diet. Concurrent supplementation with Vitamins B12 and folic acid is recommended to improve the overall function of red blood cells. [15] Iron deficiency is also common in adults with celiac disease. Recommended dosages for adults with this condition is 300 milligrams per day of ferrous sulfate.[16]

Folic acid In adults, folic acid is the most common deficiency. Folic acid should be given at a dose of 5-10 mg/day. [17] Folic acid is necessary to correct a macrocytic anemia, which occurs when red blood cells are too big or enlarged.

Calcium Calcium is often taken to correct a deficiency in an individual who may have gone undiagnosed for some time. Because of the effects of celiac disease on the small intestine, calcium is poorly absorbed. A deficiency of calcium from the diet can lead to excessive calcium being pulled from the bones, thereby dramatically decreasing one’s bone-mineral density. This can lead to the onset of other bone-related conditions, such as osteoporosis and fractures. Studies show that supplementing with calcium gluconate may help correct blood levels and prevent further damage to the bones.[18]

Vitamin B12 Initially Vitamin B12 was not thought to be deficient in individuals with celiac disease. Recent studies have, however, show that individuals with untreated celiac disease will be deficient in Vitamin B12. This particular nutrient deficiency will often correct itself, once a gluten free diet is implemented. Individuals with Vitamin B12 suffer from lethargy, have paresthesias, and may also have a macrocytic anemia. The dietary supplementation of B12 has been shown to improve these deficiency symptoms. [19]

References

[1] Yarnell, Eric. 2000. Naturopathic Gastroenterology. Pages 212-219. Naturopathic Medical Press, Sisters Oregon.

[2] Beers,Mark H and Berkow,Robert. 1999. The Merck Manual . 17th ed. 299-300. Merck Laboratories Publishing. Whitehouse Station NJ.

[3] Murray, JA, et al. Effect of gluten free diet on gastrointestinal symptoms in celiac disease. Am J Clin Nutr. 2004 April; 79(4):669-673.

[4] Pizzorno, Joseph. Murray, Michael. Joiner-Bey, Herb. 2002. The Clinician’s Handbook of Natural Medicine. Pp99-103. Churchill Livingstone, New York.

[5] Yarnell, Eric. 2000. Naturopathic Gastroenterology. Pages 212-219. Naturopathic Medical Press, Sisters Oregon.

[6] Shah, Mayberry, Williams et al. Epidemiological survey of celiac disease and inflammatory bowel disease in first degree relatives of celiac patients. Q J Med 1990; 74:283-288.

[7] Cronin, CC et al. High prevalence of celiac disease among patients with insulin dependent (type I) diabetes mellitus. Am J Gastroenterol. 1997; 92:2210-2212.

[8] Yarnell, Eric. 2000. Naturopathic Gastroenterology. pp 212-219. Naturopathic Medical Press, Sisters Oregon.

[9] Jennings, J and Howdle, P. New developments in celiac disease. Curr Opin Gastroenterol. 2003;19(2):118-129.

[10] Beers,Mark H and Berkow,Robert. 1999. The Merck Manual . 17th ed. 299-300. Merck Laboratories Publishing. Whitehouse Station NJ.

[11] Young, LS and Thomas, DJ. Celiac sprue treatment in primary care. Nurse Pract. 2004 Jul; 29(7):42-45.

[12] Peraaho, M et al. Oats can diversify a gluten free diet in celiac disease and dermatitis herpetiformis. J Am Diet Assoc. 2004 Jul; 104(7):1148-1150.

[13] Yarnell, Eric. 2000. Naturopathic Gastroenterology. pp 212-219. Naturopathic Medical Press, Sisters Oregon.

[14] Krause, MV and Mahan, KL. Food, Nutrition, and Diet Therapy. Philadelphia: WB Saunders, 1984.

[15] Patwari, K et al. Iron Supplementation in children with Celiac disease. Indian J Pediatr. 2003 Dec; 70(12):955-958.

[16] Beers,Mark H and Berkow,Robert. 1999. The Merck Manual . 17th ed. 299-300. Merck Laboratories Publishing. Whitehouse Station NJ.

[17] Beers,Mark H and Berkow,Robert. 1999. The Merck Manual . 17th ed. 299-300. Merck Laboratories Publishing. Whitehouse Station NJ.

[18] Abdulkarim, AS. Celiac Disease. Curr Treat Options Gastroenterol. 2002 Feb; 5(1):27-38.

[19] Dahele, A and Ghosh, S. Vitamin B12 deficiency in untreated Celiac disease. Am J Gastroenterol. 2001 Mar; 96(3): 745-750.