Have you noticed the aisle in the grocery store dedicated to "gluten-free" foods? Food labels are also highlighting gluten content. Why the rise in gluten awareness? Food manufacturers and marketers are finally responding to a segment of the population that has celiac disease.
Also known as gluten intolerance, celiac sprue, nontropical sprue and glutensensitive enteropathy, celiac disease occurs in people who have a susceptibility to gluten. It"s a digestive condition triggered by the protein gluten, which is found in bread, pasta, cookies, pizza crust and other foods containing wheat, barley or rye.
"Celiac disease is a very serious, genetically-based autoimmune disease," says Tricia Thompson, M.S., R.D., and author of The Gluten-Free Nutrition Guide (McGraw-Hill, 2008). "When gluten is eaten by a person with celiac disease, it triggers an immune system response that damages the lining of the small intestine. Our small intestine has finger-like projections called villi, and these villi help our bodies absorb nutrients from food. In someone with celiac disease, these villi become shortened, and nutrients cannot be properly absorbed."
Without villi, the inner surface of the small intestine becomes less like a plush carpet and more like a tile floor, and your body is unable to absorb nutrients necessary for health and growth. Instead, nutrients such as fat, protein, vitamins and minerals are eliminated with your stool.
SIGNS AND SYMPTOMS
According to the Mayo Clinic, there are no "typical" signs and symptoms of celiac disease. However, most people with the disease have general complaints, such as intermittent diarrhea, abdominal pain and bloating.
Sometimes people with celiac disease may have no gastrointestinal symptoms at all. The disease can be difficult to diagnose because the 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.
Celiac disease may also present itself in less obvious ways, including:
- Irritability or depression
- Stomach upset
- Joint pain
- Muscle cramps
- Skin rash
- Mouth sores
- Dental and bone disorders (such as osteoporosis)
- Tingling in the legs and feet (neuropathy)
It was the nontypical symptoms that tipped off Laurel Bragg"s nutritionist to the possibility of gluten intolerance. "I was working with a nutritionist to lose weight," says the 36-year-old financial advisor. "I mentioned how tired I was all the time — thinking it was just part of a thyroid condition I"d been battling for years. I also told her about my allergies and skin rashes, which I assumed were due to stress. She suggested we do some blood work to check for higher-than normal antibodies that show up in people with gluten intolerance. Sure enough, they were off the charts."
Bragg switched to a gluten-free diet, and within a week the horrible rash she had had on her neck since childhood went away. Her allergies and asthma improved dramatically too. "Then the next week I slipped a bit on the diet, and within four hours the rash was back," recalls Bragg. "I"ve been gluten-free since September of 2007 and have lost 115 pounds, have so much more energy, and my asthma is under control. Before eating gluten-free, I was sick all the time, so much so that my co-workers noticed the change too because for once I was well! Needless to say, my doctor is thrilled and so am I."
CAUSES OF CELIAC DISEASE
The exact cause of celiac disease is unknown, but it's often inherited. If someone in your immediate family has it, there"s a 5- to 15-percent chance of your having it as well.
It was that familial connection that finally tipped off Dawn Snow, C.P.P., and corporate photographer at USAA. "I think I"ve been gluten intolerant my whole life. I was lethargic, constantly ill and had to deal with gastrointestinal issues all the time," says Snow. "I switched to a gluten-free diet about 15 years ago after my mother was diagnosed with celiac disease."
It wasn"t until after she was diagnosed that she remembered an episode of her life many years earlier. "I had been dieting and struggling to lose those last 10 pounds to reach my goal. I gave up bread and experienced "lightness," an increase in energy and that final loss of weight," Snow recalls. "We suspect my grandmother suffered from celiac disease, and my daughter also exhibits some symptoms. We think my brother has it too, but he"s in denial."
Heredity doesn"t account for the estimated one in 133 people in the United States (Archives of Internal Medicine, Feb. 2003) who have celiac disease, many of whom remain undiagnosed. For reasons that aren't clear, the disease sometimes emerges after some form of trauma, such as an infection, a physical injury, the stress of pregnancy, severe stress or surgery.
Although celiac disease can affect anyone, it tends to be more common in people who have:
- Type 1 diabetes
- Autoimmune thyroid disease
- Down syndrome
- Microscopic colitis, particularly collagenous colitis
People with celiac disease carry higher than normal levels of certain antibodies (anti-gliadin, anti-endomysium and anti-tissue transglutaminase). Antibodies are specialized proteins that are part of your immune system that work to eliminate foreign substances in your body. In people with celiac disease, the immune systems may be recognizing gluten as a foreign substance and producing elevated levels of antibodies to get rid of it.
A blood test can now detect high levels of these antibodies and is used to initially detect people who are most likely to have the disease and who may need further testing. To confirm the diagnosis, your doctor may need to microscopically examine a small portion of intestinal tissue to check for damage to the villi. To do this, your doctor inserts a thin, flexible tube (endoscope) through your mouth, esophagus and stomach into your small intestine and takes a sample of intestinal tissue.
WARNING: A trial of a gluten-free diet also can confirm a diagnosis, but it's important that you not start such a diet before seeking a medical evaluation. Doing so may change the results of blood tests and biopsies so that they appear to be normal.
Unfortunately, celiac disease has no cure. The good news is it can be effectively managed by changing your diet.
Once gluten is removed from your diet, inflammation in your small intestine will begin to subside, usually within several weeks, though you may start to feel better in just a few days. 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.
Although Bragg misses the ease of not having to think so hard about what she can eat, she is fully committed to living gluten-free. "The alternative is just too awful. The last time I relapsed, my body literally fell apart. It was just a little rash, I felt grossly ill, my body ached all over, my skin broke out, and I got severe rashes," she recalls. She"s chosen to cook more at home, and she"s scouted out all the local restaurants with gluten-free menu options to make going out to lunch with co-workers a no-brainer.
"I have little things that make life easier, more normal, such as using Bragg"s Amino Acids to replace soy or teriyaki and Pasta Joy gluten-free pasta when I"m cooking, or having pizza at the Little Aussie Bakery, where everything is gluten-free," says Bragg. Her special treat is a meal at one of Jason Dady"s restaurants (The Lodge, Bin 555 and Tre Trattoria). "They make everything fresh and are happy to accommodate people who are gluten-free. The food is delicious!" she says.
Snow is also a fan of the Little Aussie Bakery (she says their chocolate cake is to die for), and says following a gluten-free diet isn"t as hard as it used to be because there are so many new products and recipes. "I used to miss pancakes and crackers but have found joy in the world again after discovering Pamela"s Pantry products and Nut-thins," she says. "After adjusting to the basic shift of diet, my life became easier, "less embarrassing" (we all know what I am talking about.) I experienced an increase in energy that you wouldn't believe. And the overall knowledge I've gained from reading labels has caused me to be more aware of where my food comes from. I've used this process to become more "green."
For more information on celiac disease, please visit www.alamoceliac.org.