Coeliac Disease

DESCRIPTION

 
Also called non-tropical sprue, gluten-sensitive enteropathy or celiac sprue, celiac disease is an allergic response to gluten (a protein found primarily in wheat, barley and rye grains) and its smaller derivative, gliadin, which damages the small intestine resulting in diarrhoea, weight loss and multiple vitamin and mineral deficiencies. Symptoms typically appear either during the first 3 years of life when cereals are introduced into the diet, or during the third decade of life. In adults, symptoms may develop gradually over months or even years.

FREQUENT SIGNS AND SYMPTOMS

• Weight loss or slowed weight gain in an infant following the introduction of cereal to the diet
• Bulky, pale, frothy, foul-smelling, greasy stools with increased fecal fat
• Swollen and/or painful abdomen
• General undernourished appearance
• Anemia or vitamin deficiency, with fatigue, paleness, skin rash, or bone pain
• Poor appetite, vague tiredness, breathlessness
• Mouth ulcers
• Swollen legs, mildly bowed legs in children
• Increased blood levels of antibodies for alpha-gliadin: blood tests for anti-alpha-gliadin antibodies have a diagnostic sensitivity for celiac disease of 100%
• Diagnosis confirmed by biopsy of the small intestine: usually unnecessary due to the sensitivity of the blood test for anti-alpha-gliadin antibodies
• Schizophrenia: partially digested wheat gluten has demonstrated opiate-like activity, which may explain the association between wheat consumption and schizophrenia that has been substantiated in  epidemiological, clinical and experimental studies
• Lactose intolerance: celiac disease often leads to lactose deficiency, causing lactose intolerance and increased intestinal permeability, and frequently resulting in multiple food allergies
• Associated conditions: thyroid abnormalities, insulindependent diabetes mellitus, psychiatric disturbances (including schizophrenia), and hives have also been linked to gluten intolerance. Celiac patients also have an increased risk for malignant cancers that may be due to decreased absorption of vitamins and minerals, particularly vitamin A and carotenoids, or to a gliadin-activated suppression of immune function. Alpha-gliadin has demonstrated suppressive effects on immune function in celiac patients but has no effect on the immune function of healthy controls or patients with Crohn’s disease.

CAUSES

• Genetic factors: people with specific genetic markers known as HLA-B8 and DRw3 that appear on the surface of cells (like the genetic markers of blood type) are significantly more likely to have celiac disease than persons without these markers. The HLA-B8 marker is found in 85–90% of celiac patients versus 20–25% of normal subjects. The frequency of HLA-B8 is low in Asia, an area in which farming has a much longer history than in northern and central Europe and the northwest Indian subcontinent, where HLA-B8
  incidence is much higher and wheat cultivation, which began around 1000 BC, is a relatively recent development. Celiac disease is virtually unknown in Asia, but is estimated to occur in 1 : 300 people in southwest Ireland, and in 1 : 2,500 people in the US, a much more genetically diverse population.
• Gluten: the major protein component of wheat, gluten, is composed of gliadins and glutenins. Only the gliadin portion has been demonstrated to activate celiac disease. Among the different cereal grains, which are all members of the family Gramineae, the more closely a grain is related to wheat, the greater its ability to activate celiac disease. Rice and corn, the grains the farthest removed from wheat, do not appear to activate celiac disease.
• Protein digestion abnormality: gliadin that has been completely broken down by digestion does not activate celiac disease in susceptible individuals. This suggests that celiac disease may arise from a deficiency either of enzymes that break down gliadin or of some other factor involved in protein digestion. ¦ Immune system abnormality: the damage to the intestinal tract seen in celiac disease is not due to some toxic property of gliadin, but results when the immune system, in the process of trying to neutralize gliadin, destroys surrounding intestinal tissue.
• Early introduction of cow’s milk: cow’s milk contains a number of highly allergenic proteins. A major portion of the immune system – the gut-associated lymphoid tissue (GALT) – clusters around the intestines. Particularly during the first 4–6 months of life, when the intestinal system is not yet fully developed,  allergenic protein can leak across the intestinal wall, triggering an immune response from the GALT and the development of food allergies.

RISK INCREASES WITH

• Not having been breast-fed as an infant
• Early introduction of cereal grains and/or cow’s milk into the diet
• Northern and central European or northwest Indian ancestry
• Family history of celiac disease
• Lactose intolerance
• Other allergies

PREVENTIVE MEASURES

• Breast-feeding for a minimum of 6 months.
• Delay introduction of cow’s milk and high-gluten cereal grains (wheat, barley, rye) into the diet of high risk individuals for at least the first year of life.
• Once these potentially problematic foods have been introduced, rotate foods in the child’s diet so that high gluten cereal grains and cow’s milk are consumed no more frequently than every fourth day.

Expected outcomes

Significant improvement will usually be apparent within a few days or weeks. Thirty percent of celiac patients respond within 3 days; another 50% within 1 month, and 10% after 2 months. Ten percent, however, only respond after 24–36 months of gluten avoidance. Milk and milk products should also be eliminated until intestinal structure and function return to normal.
If improvement does not occur after following a gluten-free diet for 2 months, consider the following:

• Diagnosis may be incorrect.
• Gliadin may still be being consumed from hidden sources in the diet. Gliadin is found in some brands of soy sauce, modified food starch, ice cream, soup, beer, wine, vodka, whiskey, malt, and other foods.
• Complications of celiac disease, such as an underlying nutrient deficiency, may prevent healing. Zinc deficiency in particular will prevent healing as zinc is a necessary cofactor for growth and repair.

TREATMENT

Diet

• Follow a gluten-free diet. Eliminate any wheat, rye, barley, triticale, or oats. Buckwheat and millet are often excluded as well. Although buckwheat is not in the grass family, and millet is more closely related to rice and corn, both do contain proteins similar to alpha-gliadin.
• Eliminate milk and milk products until intestinal structure and function return to normal.
• Rotate other foods to minimize the potential for developing allergies.

Resources for gluten-free recipes and further education

The Coeliac Society,
Carmichael House,
4 North Brunswick St.,
Dublin 7
Telephone: 00-353-1-872 1471.
Email: info(at)coeliac.ie

Coeliac UK
PO Box 220
High Wycombe
Bucks HP11 2HY, UK

Digestive Disorders Foundation
3 St Andrew’s Place
London NW1, UK

American Celiac Society
45 Gifford Avenue
Jersey City, NJ 07304

American Digestive Disease Society
7720 Wisconsin Avenue
Bethesda, MD 20014

Gluten Intolerance Group of North America
5110 10th Avenue SW, Suite A
Seattle, WA98166-1820

Websites

• The Coeliac Society http://www.coeliac.ie
• Coeliac UK: http://www.coeliac.co.uk/
• Digestive Disorders Foundation: http://www.digestivedisorders.org.uk/
• Gluten Intolerance Group of North America: http://www.gluten.net/
• American Autoimmune Related Diseases Association,Inc.: http://www.aarda.org/
• Celiac Sprue Association/United States of America, Inc.: http://www.csaceliacs.org/

Nutritional supplements

• A high-potency multiple vitamin and mineral supplement: this should include folic acid, vitamin B12, and B6. (Folic acid supplementation should always be accompanied by vitamin B12 supplementation to prevent folic acid from masking a vitamin B12 deficiency.) In addition to treating any underlying deficiency, a daily multiple providing all of the known vitamins and minerals provides the cofactors for growth and repair. Celiac disease will often not clear up if there is an underlying nutrient (e.g., zinc) deficiency.
• Pancreatic enzymes: a deficiency of pancreatic enzymes is found in 8–30% of celiac patients. A double-blind study found that pancreatic enzyme supplementation enhanced the clinical benefits of a gluten-free diet during the first 30 days but did not provide greater benefit than placebo after 60 days:

ICIM Medics Approach

If you feel that this article relates to you and you suspect that Coeliac may be present, then please make an appointment for your Coeliac Assessment.

The results from the assessment can be used by one of our Natural Medical Practitioners who will help you with your individualised treatment plan. This may include dietary, nutritional and/or botanical advice.

This article is not meant to be used for treatment but for information purposes only. If you feel that this approach is appropriate for you please contact ICIM Medics on 045 844 819 or www.icim.ie e-mail : info@icim.ie  Both appointments can be arranged for you.

Tags: celiac sprue, Coeliac Disease, gluten-sensitive enteropathy, non-tropical sprue