Tag: celiac disease

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Gluten Free Diet

Golden Gate Bridge, San Francisco. (Dr. Noorali Bharwani)
Golden Gate Bridge, San Francisco. (Dr. Noorali Bharwani)

Celiac disease is a serious autoimmune condition that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine.

Celiac disease and non-celiac gluten allergy should not be taken lightly.

Celiac disease is a common lifelong intestinal disorder and runs in families. A first-degree relative with celiac disease has a 10-fold increased risk of acquiring the condition.

It affects about one in 100 people. A person can be critically ill to being completely well.

The risk is increased among people with autoimmune thyroid disease (three to five per cent), type one diabetes mellitus (five to 10 per cent) and Down syndrome (5.5 per cent).

Patients with celiac disease can present with a variety of symptoms. The classical symptoms include chronic diarrhea, abdominal pain, malabsorption and weight loss.

When gluten is ingested, it causes immunologically toxic reaction in the lining of the small intestine. The toxic reaction damages the lining of the intestine thus interfering with the absorption of nutrients and leading to diarrhea and malnutrition.

How to diagnose celiac disease?

The most widely available test is the tissue transglutaminase IgA antibody test, which has an estimated 95 per cent accuracy rate. If antibody testing is negative and celiac disease is suspected, the IgA level should be measured. All adults with an abnormal screening result should undergo a small-bowel biopsy to confirm the diagnosis of celiac disease.

Celiac Disease Foundation website says first-degree relatives of people with celiac disease – parents, siblings and children should be screened.

What is non-celiac gluten sensitivity?

The term non-celiac gluten sensitivity is used to describe the clinical state of individuals who develop symptoms when they consume gluten-containing foods and feel better on a gluten-free diet but do not have celiac disease.

Research estimates that 18 million Americans have non-celiac gluten sensitivity. That’s six times the number of Americans who have celiac disease. More research is needed to understand this problem.

Besides being sensitive to gluten often these individuals experience headaches, rashes and fatigue. These individuals have no inflammation or damage to the intestinal lining as in celiac disease.

Treatment is lifelong adherence to a gluten-free diet. The follow-up is most often provided on an annual basis, and includes reinforcement of the need to adhere to a gluten-free diet, dietary review, physical examination, laboratory tests and a recommendation to join a patient support and advocacy group.

Prognosis

The long-term prognosis for celiac disease is good as long as people with celiac disease follow a gluten-free diet.

Eating out is not always easy. Sometimes, no matter how prepared and informed you are, there is not a satisfying gluten-free choice. There are two strategies to address this. The first is to eat at home prior to dining out so that your hunger is under control and you are less tempted to make unsafe menu choices. The second is to bring gluten-free foods with you such as bread, crackers or even pasta, which you can ask the chef to cook in a clean pot.

Life is not easy for people with celiac disease or non-celiac gluten allergy. Patience and perseverance with dietary choices is the key to good health.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Making sense of celiac disease, gluten allergy and non-celiac gluten sensitivity.

Crown Fountain in Millennium Park, Chicago, Illinois. (Dr. Noorali Bharwani)
Crown Fountain in Millennium Park, Chicago, Illinois. (Dr. Noorali Bharwani)

Celiac disease is a lifelong autoimmune intestinal disorder that runs in families.

The symptoms of celiac disease are triggered by gluten (a protein found in wheat, rye, barley and triticale) in people who are genetically susceptible. Triticale is a hybrid of wheat and rye first bred in laboratories during the late 19th century and can be associated with other immune diseases.

What is non-celiac gluten allergy?

It is a condition with symptoms of celiac disease but the diagnosis cannot be confirmed.

It has taken only 13 years or so to move celiac disease from obscurity into the popular spotlight worldwide. What is more interesting is the spectrum of illnesses associated with ingestion of gluten. Such as allergy to wheat, autoimmune celiac disease, and immune-mediated gluten sensitivity. Sounds complicated? Well, you are not alone.

Research estimates that 18 million Americans have non-celiac gluten sensitivity. That’s six times the amount of Americans who have celiac disease. Researchers are just beginning to explore non-celiac gluten sensitivity.

These individuals seem to be sensitive to gluten often also experience headaches, rashes and fatigue. It is possible that it may in fact be other proteins or sugar in wheat (other than gluten) that may be triggering the reaction. There is no inflammation or damage to the intestinal lining as in celiac disease. More research is needed to understand this problem.

Things to remember about celiac disease are:

A first-degree relative with celiac disease has a 10-fold increased risk of acquiring the condition. It affects one in 133 North Americans.

The risk is increased among people with autoimmune thyroid disease (three to five per cent), type one diabetes mellitus (five to 10 per cent) and Down syndrome (5.5 per cent).

The disease can develop at any age.

Symptoms can be abdominal pain, diarrhea, weight loss and malnutrition.

The most widely available test is the tissue transglutaminase IgA antibody test, which has an estimated 95 per cent accuracy rate. If antibody testing is negative and celiac disease is suspected, the IgA level should be measured.

All adults with an abnormal screening result should undergo a small-bowel biopsy to confirm the diagnosis of celiac disease.

Celiac disease should be considered as a diagnostic possibility in any patient with unexplained iron deficiency anemia, especially if there has been a poor response to oral iron supplementation.

Treatment is lifelong adherence to a gluten-free diet. Examples of gluten-free naturally occurring grains are – oats, buckwheat, millet, rice and quinoa. Gluten-free diet reduces the risk of complications such as osteoporosis and intestinal lymphoma.

Remember, celiac disease is a condition that is fully treatable with dietary modification alone. There are few diseases in medicine that can make this claim.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Making Sense of Celiac Disease and Non-Celiac Gluten Allergy is Not Easy

Gordon Wright waiting for birds to fly by so he can take pictures in Police Point Park on a beautiful spring afternoon in Medicine Hat. (Dr. Noorali Bharwani)
Gordon Wright waiting for birds to fly by so he can take pictures in Police Point Park on a beautiful spring afternoon in Medicine Hat. (Dr. Noorali Bharwani)

“Celiac disease is common and is associated with other immune diseases,” says an article in the Canadian Medical Association Journal (CMAJ January 8, 2013).

The symptoms of celiac disease are triggered by gluten (a protein found in wheat, rye, barley and triticale) in people who are genetically susceptible. Triticale is a hybrid of wheat and rye first bred in laboratories during the late 19th century.

Ten things to remember about celiac disease as summarized from the CMAJ article:

  1. A first-degree relative with celiac disease has a 10-fold increased risk of acquiring the condition. It affects one in 133 North Americans.
  2. The risk is increased among people with autoimmune thyroid disease (three to five per cent), type one diabetes mellitus (five to 10 per cent) and Down syndrome (5.5 per cent).
  3. Gluten perpetuates the destruction of villi in the small intestine. Intestinal villi are small, finger-like projections that help in digestion.
  4. The disease can develop at any age.
  5. Clinical symptoms can be diverse from abdominal pain to diarrhea, weight loss and malnutrition.
  6. Screening for celiac disease is recommended for people who have associated symptoms, an associated condition or a family history of celiac disease.
  7. The most widely available test is the tissue transglutaminase IgA antibody test, which has an estimated 95 per cent accuracy rate. If antibody testing is negative and celiac disease is suspected, the IgA level should be measured.
  8. All adults with an abnormal screening result should undergo a small-bowel biopsy to confirm the diagnosis of celiac disease.
  9. Because of an increasing awareness of celiac disease, people may choose to adopt a gluten-free diet before diagnostic testing. That is not the right way to manage the problem. Further diagnostic testing should be performed following a medically supervised gluten challenge of at least four weeks, with sufficient gluten to produce symptoms.
  10. Treatment is lifelong adherence to a gluten-free diet. Examples of gluten-free grains are oats, buckwheat, millet, rice and quinoa. Gluten-free diet reduces the risk of complications such as osteoporosis and intestinal lymphoma.

Is there an illness called non-celiac gluten sensitivity?

Yes. You have symptoms of celiac disease but it cannot be confirmed. Then you may have non-celiac gluten sensitivity.

An article by Sapone et al. (BMC Medicine 2012) titled, “Spectrum of gluten-related disorders: consensus on new nomenclature and classification,” says in only 10 years, key milestones have moved celiac disease from obscurity into the popular spotlight worldwide.

What has generated more interest is the spectrum of illnesses associated with ingestion of gluten. These are: 1. Allergy to wheat 2. Autoimmune celiac disease, dermatitis herpetiformis and gluten ataxia 3. Possible immune-mediated gluten sensitivity.

Research estimates that 18 million Americans have non-celiac gluten sensitivity. That’s six times the amount of Americans who have celiac disease. Researchers are just beginning to explore non-celiac gluten sensitivity.

These individuals seem to be sensitive to gluten often also experience headaches, rashes and fatigue. It is possible that it may in fact be other proteins or sugar in wheat (other than gluten) that may be triggering the reaction. There is no inflammation or damage to the intestinal lining as in celiac disease. More research is needed to understand this problem. Did I hear you say, “If only things in life would be simple and straight forward?”

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Patients with Celiac Disease Should Have Regular Follow-up

Celiac disease (CD) is a lifelong autoimmune intestinal disorder and runs in families. First degree relatives of individuals with CD may or may not manifest symptoms of the disease. It affects people to varying degrees, from being critically ill to being completely well.

Gluten is the common name for the offending proteins in specific cereal grains that are harmful to persons with CD. When gluten is ingested, it causes immunologically toxic reaction in the lining of the small intestine. The small intestine is lined by villi which help absorb the nutrients from the food we eat. The toxic reaction damages these villi thus interfering with the absorption of nutrients and leading to diarrhea and malnutrition.

Symptoms of celiac sprue in children appear when cereal is introduced in their diet, anywhere between the ages of four to 24 months. They present with diarrhea, impaired growth and abdominal distension. Vomiting, anemia and swelling of the body tissues with fluid occur due to malnutrition.

Celiac sprue can develop in adults as new cases. About 20 per cent of the patients may be diagnosed after the age of 60. Otherwise, most adults with celiac disease will have history of the disease going back to childhood.

What is the long term effect of celiac disease if it remains untreated?

Chronic diarrhea will result in fluid and electrolyte imbalance. Development of cancer of the small bowel is a possibility. Poor absorption of food nutrients will result in malnutrition and poor immune system. Iron-deficiency anemia is now the most common clinical presentation in adults with celiac sprue. Osteoporosis is another likely complication of celiac disease.

Approximately, 50 per cent of adult patients do not have clinically significant diarrhea. So, making a diagnosis and provide follow-up is not always easy.

Why regular follow-up is important?

An article in the Canadian Journal of Gastroenterology (August 8, 2010) says that long term follow-up of patients with celiac disease is important for monitoring three things: their clinical status, dietary compliance and complications.

Most guidelines recommended a scheduled annual review and regular measurements of body mass index, dietary review with a nutritionist and serial tissue transglutaminase antibody testing. Some recommend annual hemoglobin, ferritin and folate checks. One guideline recommended annual hemoglobin, electrolyte, calcium, albumin, ferritin, folate, fat-soluble vitamin, liver function test, parathyroid hormone and bone density measurements (approximately $400 per patient).

What is the science behind these guidelines?

Unfortunately, there are no evidence based guidelines to suggest exactly what needs to be done in follow-up to change the outcome of the disease or prevent complications from the disease itself.

The survey done by the authors of the article say that most gastroenterologists in Canada provide routine long-term follow-up to their patients with celiac disease. Those who do not, delegate this role to the patient’s family doctor.

The follow-up is most often provided on an annual basis, and includes reinforcement of the need to adhere to a gluten-free diet, dietary review, physical examination, laboratory tests and a recommendation to join a patient support and advocacy group, says the article.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!