Brenda Keller, CNP
Gastroenterology Associates of Northwest Ohio
A noticeable change in restaurant menus the past few years is the number of items labeled, “gluten free.” You may wonder, “What is gluten and why would I want to avoid it?” Gluten is a protein found in grains, such as barley, wheat and rye. It’s the protein that gives bread its chewy texture.
When someone with celiac disease eats foods containing gluten, the body reacts to the protein and causes damage to the villi of the small intestine. Villi are small, finger-like projections found along the wall of the small intestine. When the villi are injured, the small intestine cannot properly absorb nutrients from the food that is eaten, so the person may develop malnourishment. This can lead to loss of bone density as well as the development of certain types of cancer, such as lymphoma.
Who is at risk for celiac disease? Celiac disease occurs primarily in individuals who are Caucasian of northern European ancestry. The disease is also more common in people who have had other diseases like Down Syndrome, Type 1 diabetes, Turner syndrome, Addison’s disease or rheumatoid arthritis. Celiac disease tends to run in families. It’s a genetic disorder. For persons with a parent, child or sibling with celiac disease, there is a one in 10 chance of getting the disease.
Celiac disease is not the same thing as a food allergy. If you are allergic to wheat, you may have itchy or watery eyes or difficulty breathing if you eat foods containing wheat. If you have celiac disease and eat something containing gluten, you may experience intestinal problems like abdominal pain, diarrhea, gas, nausea, weight loss, osteopenia (loss of bone density) or an itchy, blistery rash (known as dermatitis herpetiformis).
Celiac disease can be determined by blood tests or by endoscopy. There are blood tests that look for certain antibodies and there is genetic testing to look for certain antigens. If the testing suggests that a person may have celiac disease, he or she will need an esophagogastroduodenoscopy or EGD. This is a test where a lighted flexible scope containing a video camera (an endoscope), is used to look at the villi in the small intestine (duodenum). With celiac disease, the villi are flattened or blunted, suggesting celiac disease. Biopsies from the area are taken and the pathologist examines the specimens to confirm the diagnosis. Biopsies from the duodenum are the only method for confirming the diagnosis.
If biopsies confirm celiac disease, the person will need to follow a strict gluten-free diet. This will include avoiding bread, cake, beer, pasta, cereals and other products containing gluten. After following a gluten-free diet for a few weeks, the person typically begins to feel better as the small intestine begins to heal. If there is a severe nutritional deficiency, the health care provider may recommend gluten-free vitamin and mineral supplements.
If you have any symptoms suggesting celiac disease, talk with your health care provider to see whether testing is indicated. If you are diagnosed with celiac disease, become a “label reader,” to avoid inadvertently ingesting gluten. If you are unsure about a specific food item, ask the cook what ingredients the item contains so you can avoid the uncomfortable symptoms that accompany celiac disease. To avoid the health risk, “hold the gluten!”