An estimated 1 in 133 people, about 2.4 million people or less than 1% of the population, in the U.S. suffer from Celiac disease, so thankfully it is not as widespread a problem as IBS, mentioned in my last blog post.
Celiac disease is an autoimmune disorder, with both a genetic predisposition and other triggers involved. It can affect both children and adults and has a highly varied presentation. In people with this disorder when they eat certain types of proteins, more specifically those containing glutens, their body’s immune system overreacts to the glutens damaging the lining of the small intestine. In turn this interferes with the body’s ability to absorb essential nutrients, vitamins and minerals from their food.
This can cause bloating, gassiness, abdominal pain and variable bowel movements – but it can also be so mild that it is many years before the failure to absorb iron, for example, manifests itself as generalized fatigue. There are possible other symptoms – and it is the fact that these symptoms can be so diverse that has precipitated an unwarranted fear of eating-gluten containing foods (more below).
An autoimmune disorder develops when your immune system, which defends your body against disease, gets confused. Wow – what a mess! The body’s own protective mechanism attacks itself, by mistake. As a result, autoimmune diseases result in attacks of previously healthy cells in a variety of tissues and organs.
In the case of Celiac disease this can result in changes in function of the small intestine. If unrecognized – because the symptoms can be vague and therefore are often left untreated – this results in damage to the brush-like lining of the small intestine designed to maximize the surface area available to absorb essential nutrients.
Because of the genetic underpinnings of Celiac disease, you are more susceptible if you have a family member with a similar diagnosis.
The most common way a gastroenterologist screens for Celiac disease in a person is by means of a simple blood test that tests for certain antibodies the body produces. It is important that the tests be done at a time when the person has not been avoiding gluten. In fact, gluten-free products must be avoided and gluten-containing foods deliberately consumed for at least 1 – 2 weeks or more before having this blood test in order to produce an accurate diagnosis.
A diagnosis can usually be confirmed by undergoing an endoscopic procedure – an outpatient procedure performed by a gastroenterologist like me. It is quick to do and results in little to no discomfort to the patient. Multiple biopsies are taken of the small intestine, and then analyzed by a pathologist to see if any damage consistent with Celiac disease exists.
The key trigger for the immune reaction in genetically predisposed people with Celiac disease are certain proteins comprising of gluten; found in the seeds of cereal grains such as wheat, barley and rye. The proteins of maize and rice are sometimes referred to as glutens but their proteins differ from true gluten and therefore are not at risk for those with Celiac disease.
Currently no pharmaceutical cure exists for Celiac disease and so treatment focuses on relieving symptoms through diet. In fact the broad relationship between diet and Celiac disease has been known for years. As the diagnostic techniques and the gluten-eating triggers are now well established for those suffering Celiac disease, treatment consists of following a gluten-free diet and avoiding gluten-containing products.
As we all know, gluten-free fad diets have soared in popularity throughout the world; the demand and availability of gluten-free processed foods has dramatically increased to an extent that far outpaces the real needs of those truly suffering Celiac disease. As a practicing gastroenterologist this poses more questions than answers.
Did the perceived demand drive increased availability or has the market pitched the needs for gluten-free products in such a way that fear has driven the desire to purchase? Why do people who don’t have Celiac disease possibly get some benefit from being gluten-free?
Further, many people do not realize that in the U.S. the market for processed gluten-free foods went largely unregulated until late 2013, at which time the FDA – U.S. Federal Food & Drug Administration – tightened the requirements for claiming gluten-free status for processed foods.
Much has been written about the dangers of consuming gluten both in and outside the context of Celiac disease. On a positive front, this has led to increased consumer awareness. But on the negative front, this has provided the opportunity for marketers to exploit people’s misinformed and often undiagnosed fears – especially among the 1 in 4 Americans that suffer IBS. Is today’s rumbling in the bowels a precursor for a Celiac diagnosis tomorrow? And therefore, should gluten be avoided at all costs?
And adding insult to injury, why is there a premium to be paid for be “gluten-free” when all that food processors are doing is excluding an ingredient or two?.
Although initial research has in the past suggested some people may have a non-celiac gluten sensitivity, (NCGS), a condition that includes both neurological and intestinal symptoms which improve after switching to a gluten-free diet, subsequent research has revealed that gluten is not the real culprit. While people’s symptoms may improve somewhat, the gluten is being eaten within foods containing other more significant ingredients. It is these other ingredients that are bad for digestion, for IBS sufferers in particular, but it is not the gluten per se.
In my upcoming blog posts I will cover what good gut health looks like for The Good, and what to avoid for the Bad and the Ugly, including the factors for improving your digestive health and wellness whether you suffer from Celiac, NCGS, IBS or none of the above and simply wish to maintain a healthy gut.
Remember, you are what you eat!