Celiac disease is a digestive disease
Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten, which is found in wheat, rye, barley, and possibly oats. When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Specifically, tiny fingerlike protrusions, called villi, on the lining of the small intestine are lost. Nutrients from food are absorbed into the bloodstream through these villi. Without villi, a person becomes malnourished-
Because the body's own immune system cause s the damage, celiac disease is considered an autoimmune disorder. However, it is also classified as a disease of malabsorption because nutrients are not absorbed. Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy.
Celiac disease is a genetic disease, meaning that it runs in families. Sometimes the disease is triggered--or becomes active for the first time--after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.
What Are the Symptoms?
Celiac disease affects people differently. Some people develop symptoms as children, others as adults. One factor thought to play a role in when and how celiac appears is whether and how long a person was breastfed--the longer one was breastfed, the later symptoms of cel iac disease appear, and the more atypical the symptoms. Other factors include the age at which one began eating foods containing gluten and how much gluten is eaten.
Symptoms may or may not occur in the digestive system. For example, one person might have diarrhea and abdominal pain, while another person has irritability or depression. In fact, irritability is one of the most common symptoms in children.
Symptoms of celiac disease may include one or more of the following:
- recurring abdominal bloating and pain
- chronic diarrhea
- weight loss
- pale, foul-smelling stool
- unexplained anemia (low count of red blood cells)
- gas
- bone pain
- behavior changes
- muscle cramps
- fatigue
- delayed growth
- failure to thrive in infants
- pain in the joints
- seizures
- tingling numbness in the legs (from nerve damage)
- pale sores inside the mouth, called aphthus ulcers
- painful skin rash, called dermatitis herpetiformis
- tooth discoloration or loss of enamel
- missed menstrual periods (often because of excessive weight loss)
Anemia, delayed growth, and weight loss are signs of malnutrition-
Some people with celiac disease may not have symptoms. The undamaged part of their small intestine is able to absorb enough nutrients to prevent symptoms. However, people without symptoms are still at risk for the complications of celiac disease.
How Is Celiac Disease Diagnosed?
Diagnosing celiac disease can be difficult because some of its symptoms are similar to those of other diseases, including irritable bowel syndrome, Crohn's disease, ulcerative colitis, diverticulosis, intestinal infections, chronic fatigue syndrome, and depression.
Recently, researchers discovered that people with celiac disease have higher than normal levels of certain antibodies in their blood. Antibodies are produced by the immune system in resp onse to substances that the body perceives to be threatening. To diagnose celiac disease, physicians test blood to measure levels of antibodies to gluten. These antibodies are antigliadin, anti-endomysium, and antireticulin.
If the tests and symptoms suggest celiac disease, the physician may remove a tiny piece of tissue from the small intestine to check for damage to the villi. This is done in a procedure called a biopsy: the physician eases a long, thin tube called an endoscope through the mouth and stomach into the small intestine, and then takes a sample of tissue using instruments passed through the endoscope. Biopsy of the small intestine is the best way to diagnose celiac disease.
Screening
Screening for celiac disease involves testi ng asymptomatic people for the antibodies to gluten. Americans are not routinely screened for celiac disease. However, because celiac disease is hereditary, family members--particular
What Is the Treatment?
The only treatment for celiac disease is to follow a gluten-free diet--that is, to avoid all foods that contain gluten. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within days of starting the diet, and the small intestine is usually complet ely healed--meaning the villi are intact and working--in 3 to 6 months. (It may take up to 2 years for older adults.)
The gluten-free diet is a lifetime requirement. Eating any gluten, no matter how small an amount, can damage the intestine. This is true for anyone with the disease, including people who do not have noticeable symptoms. Depending on a person's age at diagnosis, some problems, such as delayed growth and tooth discoloration, may not improve.
A small percentage of people with celiac disease do not improve on the gluten-free diet. These people often have severely damaged intestines that cannot heal even after they eliminate gluten from their diets. Because their intestines are not absorbing enough nutrients, they may need to receive intravenous nutrition supplements. Drug treatments are being evaluated for unresponsive celiac disease. These patients may need to be evaluated for complications of the disease.
If a person responds to the gluten-free diet, the physician will know for certain that the diagnosis of celiac disease is correct.
A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, barley, and possibly oats--in other words, most grain, pasta, cereal, and many processed foods. Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods, including bread and pasta. For example, instead of wheat flour, people can use potato, rice, soy, or bean flour. Or, they can buy gluten-fre e bread, pasta, and other products from special food companies.
Whether people with celiac disease should avoid oats is controversial because some people have been able to eat oats without having a reaction. Scientists are doing studies to find out whether people with celiac disease can tolerate oats. Until the studies are complete, people with celiac disease should follow their physician or dietitian's advice about eating oats.
Plain meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat as much of these foods as they like. Examples of foods that are safe to eat and those that are not are provided below.
The gluten-free diet is complicated. It requires a completely new appro ach to eating that affects a person's entire life. People with celiac disease have to be extremely careful about what they buy for lunch at school or work, eat at cocktail parties, or grab from the refrigerator for a midnight snack. Eating out can be a challenge as the person with celiac disease learns to scrutinize the menu for foods with gluten and question the waiter or chef about possible hidden sources of gluten. Hidden sources of gluten include additives, preservatives, and stabilizers found in processed food, medicines, and mouthwash. If ingredients are not itemized, you may want to check with the manufacturer of the product. With practice, screening for gluten becomes second nature.
A dietitian, a health care professional who specializes in food and nutrition, can help people learn about their new diet. Also, support groups are particularly helpful for newly diagnosed people and their families as they learn to adjust to a new way of life.
The Gluten Free Diet: Some Examples
Following are examples of foods that are allowed and those that should be avoided when eating gluten-free. Please note that this is not a complete list. People are encouraged to discuss gluten-free food choices with a physician or dietitian who specializes in celiac disease. Also, it is important to read all food ingredient lists carefully to make sure that the food does not contain gluten.
Food Categories | Foods Recommended | Foods To Omit | Tips |
| Breads, cereals, rice, and pasta: 6-11 servings each day | |||
| Serving size = 1 slice bread, 1 cup ready-to-eat cereal, ½ cup cooked cereal, rice, or pasta; ½ bun, bagel, or English muffin | • Breads or bread products made from corn, rice, soy, arrowroot corn or potato starch, pea, potato or whole-bean flour, tapioca, sago, rice bran, cornmeal, buckwheat, millet, flax, teff, sorghum, amaranth, and quinoa | • Breads and baked products containing wheat, rye, triticale, barley, oats, wheat germ or bran, graham, gluten or durum flour, wheat starch, oat bran, bulgur, farina, wheat-based semolina, spelt, kamut | Use corn, rice, soy, arrowroot, tapioca, and potato flours or a mixture instead of wheat flours in recipes. |
Food Categories | Foods Recommended | Foods To Omit | Tips |
| Vegetables: 3-5 servings each day | |||
| Serving size = 1 cup raw leafy, ½ cup cooked or chopped, ¾ cup juice | • All plain, fresh, frozen, or canned vegetables made with allowed ingredients | • Any creamed or breaded vegetables (unless allowed ingredients are used), canned baked beans | Buy plain, frozen, or canned vegetables and season with herbs, spices, or sauces made with allowed ingredients. |
Food Categories | Foods Recommended | Foods To Omit | Tips |
| Fruits: 2-4 servings each day | |||
| Serving size = 1 medium size, ½ cup canned, ¾ cup juice, ¼ cup dried | • All fruits and fruit juices | • Some commercial fruit pie fillings and dried fruit | |
Food Categories | Foods Recommended | Foods To Omit | Tips |
| Milk, yogurt, and cheese: 2-3 servings each day | |||
| Serving size = 1 cup milk or yogurt, 1½ oz natural cheese, 2 oz processed cheese | • All milk and milk products except those made with gluten additives | • Malted milk | Contact the food manufacturer for produ c t information if the ingredient is not listed on the label. |
Food Categories | Foods Recommended | Foods To Omit | Tips |
| Meats, poultry, fish, dry beans and peas, eggs, and nuts: | |||
| Serving size = 2-3 oz cooked; count 1 egg, ½ cup cooked beans, 2 tbsp peanut butter, or 1/3 cup nuts as 1 oz of meat | • All meat, poultry, fish, and shellfish; eggs | • Any prepared with wheat, rye, oats, barley, gluten stabilizers, or fillers including some frankfurters, cold cuts, sandwich spreads, sausages, and canned meats | When dining out, select meat, poultry, or fish made without breading, gravies, or sauces. |
Food Categories | Foods Recommended | Foods To Omit | Tips |
| Fats, snacks, sweets, condiments, and beverages | |||
| | • Butter, margarine, salad dressings, sauces, soups, and desserts made with allowed ingredients | • Commercial salad dressings, prepared soups, condiments, sauces and seasonings prepared with ingredients listed above | Store all gluten-free products in your refrigerator or freezer because they do not contain preservatives. |
source : 2001, the American Dietetic Association - patience diet.
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