Other names of this disease : cœliac disease (with œ ligature), gluten intolerance, celiac sprue, nontropical sprue, endemic sprue, gluten enteropathy or gluten-sensitive enteropathy.
Celiac disease is an autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy onward [1]. For people with celiac disease, a lifelong disorder of the digestive system, these foods aren't always the treats that most people think they are. They usually contain a type of protein called gluten, which causes problems for people with celiac disease. [2]
When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi—the tiny, fingerlike protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished, no matter how much food one eats. Celiac disease is both a disease of malabsorption—meaning nutrients are not absorbed properly—and an abnormal immune reaction to gluten [3]. Eventually, the decreased absorption of nutrients (malabsorption) that occurs with celiac disease can cause vitamin deficiencies that deprive your brain, peripheral nervous system, bones, liver and other organs of vital nourishment. This can lead to other illnesses and stunted growth in children. [4]
What is gluten ?
Gluten is a composite of the proteins gliadin and glutenin. These exist, conjoined with starch, in the endosperms of some grass-related grains, notably wheat, rye, and barley. Gliadin and glutenin comprise about 80% of the protein contained in wheat seed. Being insoluble in water, they can be purified by washing away the associated starch. Worldwide, gluten is an important source of nutritional protein, both in foods prepared directly from sources containing it, and as an additive to foods otherwise low in protein. [5]
When these proteins are present in the diet of someone with celiac disease, they become toxic and cause damage to the intestine. This damage leads to decreased absorption of essential nutrients and, if left untreated, can lead to nutrient deficiency and subsequent disease (i.e. iron deficiency anemia, decreased bone density, unintentional weight loss, folate and vitamin B12 deficiency). [6]
Gluten is found in most types of cereals and in many types of bread. Not all foods from the grain family, however, contain gluten. Examples of grains that do not have gluten include wild rice, corn, buckwheat, millet, amaranth, quinoa, teff, oats, soybeans, and sunflower seeds.
Gluten can be removed from wheat flour, producing wheat starch. All of the gluten in wheat flour, however, cannot be removed. Gluten helps make bread elastic, providing it with that chewy texture it has when eaten. For this reason, flour that has had most of its gluten removed, produces a sticky dough that feels much like chewing gum. Gluten provides many additional important qualities to bread. For example, gluten keeps the gases that are released during fermentation in the dough, so the bread is able to rise before it is baked. In addition, gluten firms up when it is cooked and, with the help of starch, helps ensure the bread maintains its proper shape.
Gluten also has an absorbent quality, which is why bread is capable of soaking up broth. Because of this feature, gluten is often used by those on a vegetarian diet as an imitation meat. On the downside, gluten is believed to be partly responsible for causing bread to become stale.
According to the Food and Drug Administration (FDA), if a certain amount of the gluten is removed, the food product can be labeled "gluten-free." (This is somewhat similar to food products that can be labeled as 0 Calories even though a serving contains 4 or less Calories) [7]. Standards for "gluten-free" labeling have been set up by the "Codex Alimentarius"; however, these regulations do not apply to "foods which in their normal form do not contain gluten". [1]
The legal definition of the phrase "gluten-free" varies from country to country. Current research suggests that for persons with celiac disease the maximum safe level of gluten in a finished product is probably less than 0.02% (200 parts per million) and possibly as little as 0.002% (20 parts per million).
Prevalence of Celiac Disease
Celiac disease is a serious health issue and challenge for food scientists, because celiac disease can only be treated by strict adherence to a gluten-free diet. The prevalence of celiac disease, an intolerance of gluten, has been reported to be as high as 1 in 200 of the world population [8 : Shih F.F., Daigle K.W., Truong V.; 2006].
The prevalence of clinically diagnosed disease (symptoms prompting diagnostic testing) is 0.05–0.27% in various studies. However, population studies from parts of Europe, India, South America, Australasia and the USA (using serology and biopsy) indicate that the prevalence may be between 0.33 and 1.06% in children (5.66% in one study of Sahrawi children) and 0.18–1.2% in adults. People of African, Japanese and Chinese descent are rarely diagnosed; this reflects a much lower prevalence of the genetic risk factors. Population studies also indicate that a large proportion of celiacs (coeliacs) remain undiagnosed; this is due to many clinicians being unfamiliar with the condition. [1, accessed Dec. 2009]
Principal Features of This Disorder
It's important to diagnose celiac disease early before it causes damage to the intestine. But because it's easy to confuse the symptoms with other intestinal disorders, such as irritable bowel syndrome or lactose intolerance, teens with celiac disease may not know they have it.
Symptoms of Celiac Disease may include one or more of the following : Recurring bloating; gas or abdominal pain, Chronic diarrhea or constipation or both, Unexplained weight loss or weight gain, Pale; foul-smelling stool, Unexplained anemia, Bone or joint pain, Behavior changes / depression / irritability, Vitamin K Deficiency, Fatigue; weakness or lack of energy, Delayed growth or onset of puberty, Failure to thrive (in infants), Missed menstrual periods, Infertility male and female, Spontaneous miscarriages, Canker sores inside the mouth, Tooth discoloration or loss of enamel.
Symptoms include chronic diarrhea, failure to thrive (in children), and fatigue, but these may be absent, and symptoms in other organ systems have been described. Someone with the disease may feel tired and could be irritable or depressed. Some have skin rashes and mouth sores. Teens with undiagnosed celiac disease may go through puberty late. Someone might not show any symptoms until going through an emotionally or physically stressful event, such as going away to college, illness, or an injury or pregnancy. [1,2]
Sometimes people with celiac disease may have no gastrointestinal symptoms at all. Celiac disease symptoms can also mimic those of other conditions, such as irritable bowel syndrome, gastric ulcers, Crohn's disease, parasite infections, anemia, skin disorders or a nervous condition. [9]
People at higher risk for celiac disease are those that have type 1 diabetes, autoimmune, thyroid disease, dermatitis, herpetiformis, Down syndrome, Turner syndrome, Williams syndrome, or have a relative with celiac disease. You may still have celiac disease even though you are not in a group at higher risk.
Causes
The disease has some genetic background, which means that it may run in families. Just like eye or hair color, people inherit the genes that make them more likely to get celiac disease from their parents and grandparents. If an immediate family member (such as a parent or a sibling) has celiac disease, there's about a 5% to 10% chance that you could have it, too. Celiac disease affects people of all heritages and backgrounds. [2]
A growing portion of diagnoses are being made in asymptomatic persons as a result of increased screening. Celiac disease is caused by a reaction to gliadin, a prolamin (gluten protein) found in wheat, and similar proteins found in the crops of the tribe Triticeae (which includes other cultivars such as barley and rye). Upon exposure to gliadin, and certain other prolamins, the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction. That leads to a truncating of the villi lining the small intestine (called villous atrophy). This interferes with the absorption of nutrients, because the intestinal villi are responsible for absorption. [1]
Treatment
The only known effective treatment is a lifelong gluten-free diet. While the disease is caused by a reaction to wheat proteins, it is not the same as wheat allergy.
If your nutritional deficiencies are severe, you may need to take vitamin and mineral supplements recommended by your doctor or dietitian to help correct these deficiencies. Complete healing and regrowth of the villi may take several months in younger people and as long as two to three years in older people.
If you notice or experience any of the signs or symptoms common to celiac disease, see your doctor. If someone in your family is known to have celiac disease, you may need to be tested.
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