Individuals with celiac disease must follow a strict gluten-free diet. Gluten is a protein found in wheat, barley and rye. In celiac disease, or gluten intolerance, dietary gluten causes an inflammatory response that damages the small intestine. Nutrient-absorbing cilia in the small bowel are destroyed, causing digestive and other health problems. The only treatment for celiac disease is lifelong adherence to a gluten-free diet, which allows the intestinal cilia to heal.
Going Gluten-Free
A tiny amount of gluten can damage the intestine of a person with celiac disease, even if symptoms are not immediately apparent. There is no gluten in cow's milk, but a milk protein called casein caused effects similar to gluten for half of subjects with celiac disease in a small study conducted by Swedish researchers. The findings were published in the March 2007 issue of "Clinical and Experimental Immunology." Celiacs sensitive to casein may be able to reintroduce dairy products after several months on a gluten-free diet.
Foods such as potatoes, rice, meats, beans, nuts, fruits, vegetables and grains such as corn, oats, amaranth, quinoa, teff and buckwheat are gluten-free when prepared with uncontaminated utensils. Cross-contamination can be a problem in restaurants, along with hidden ingredients in processed foods such as thickener, fillers, preservatives, modified food starch, stabilizers or deep-frying oil. Wheat is an ingredient in most battered foods and commercial soups. Many medications, cosmetics and children's modeling dough contain wheat.
Food labels are required to list wheat as an allergen, and specialized gluten-free products are available in many supermarkets. A separate toaster should be used to prepare gluten-free bread.
Celiac Prevalence and Diagnosis
The National Digestive Diseases Information Clearinghouse reports that approximately 1 in 133 Americans have celiac disease. Intolerance to gluten is genetic, and the rate may be as high as 1 in 22 for close relatives. Diagnosis may be delayed or prove difficult because symptoms can range from few to severe, and they often mimic those of other disorders, such as chronic fatigue syndrome or irritable bowel syndrome.
Children are more likely to have digestive discomforts, including diarrhea, stomach pain and weight loss. Dermatitis herpeteformis, an intensely itchy blistering rash, affects mostly men with celiac disease. Blood tests may be positive for antibodies, and a biopsy of the small bowel may reveal a flat mucosa, but false negative results are common, particularly in patients following a gluten-free diet.
Prevention and Related Health Problems
Researchers in Spain looking into dietary strategies for at-risk infants report that long-term breastfeeding has been shown to reduce the risk of developing celiac disease. The review, published in "The Proceedings of the Nutrition Society" in August 2010, suggests that genetic risk and gluten introduction may not be the only factors involved in gluten sensitivity.
Babies with celiac disease may be irritable; children are likely to be smaller than normal, and permanent teeth may have dental enamel defects. Gluten intolerance is associated with other genetic disorders, such as Down syndrome, and autoimmune disorders such as Type 1 diabetes, rheumatoid arthritis and autoimmune thyroid disease. Untreated celiac disease may lead to osteoporosis, anemia, depression, seizures, infertility and intestinal lymphoma, a type of cancer.
