Celiac Disease- Autoimmune Disorder of Gluten Intolerance

Against the Grain

What if you ate and ate – but kept losing weight. Imagine suffering from abdominal bloating, muscle cramps, diarrhea, night blindness, brittle bones, fatigue and dehydration. Then picture doctors telling you it was all in your head. This is what my friend Nancy went through for years before finally learning that she had celiac disease.

Celiac is an inherited autoimmune disorder marked by severe gluten intolerance that damages the small intestine. Once thought to be rare, a landmark study in the Archives of Internal Medicine has found that celiac is actually quite common. In fact, one in 133 Americans suffer from this disorder – and many of them, like Nancy, are women.

Solving the Mystery

Nearly half of celiac patients suffer from gastrointestinal distress, including chronic or intermittent diarrhea, constipation, bloating and cramps. Strangely, however, the other half of those with celiac don’t have any gastrointestinal problems. Instead, they experience a wide range of seemingly unrelated symptoms including fatigue, weight-loss, asthma, migraines, depression and anemia. Unfortunately, it isn’t unusual for these folks to spend years going from doctor to doctor, trying to find out what’s behind their “mystery” condition.

The problem with this scenario is that unrecognized celiac symptoms can lead to compromised immunity and misdiagnoses. The most common misdiagnosis is irritable bowel syndrome (IBS) – up to 20 percent of those diagnosed with IBS actually have celiac.

Years of nutrient malabsorption can cause nutritional fallout and numerous immune-related side effects at any age. Fortunately, healing starts by simply cutting out dietary gluten – an easier prospect than ever before, thanks to a variety of new gluten-free products showing up in stores.

Get Tested

Since most doctors rarely think of celiac disease when confronted with symptoms, it’s up to you to bring it up. Tell your doctor that you want a blood test to check for antigliadin antibody (IgG and IgA), tissue transglutaminase (tTG IgA), and total serum IgA.

Because celiac disease is hereditary, if you do test positive, it’s important that other family members get tested too, since undiagnosed celiac triggers an autoimmune response that causes the body to attack itself and destroy normal tissue, especially the villi in the small intestine. Normally, these tiny, hair-like fingers absorb nutrients from food. But when the villi malfunction, the digestive system goes haywire. Long-term, damaged villi can lead to unhealthy weight-loss and serious malnutrition.

Go Gluten-Free

If you are diagnosed with celiac, the first – and most important – step is to rid your kitchen of any and all foods that contain gluten. This means obvious foods like bread, cookies, cake mixes, pasta, cereal and crackers, and not-so-obvious foods like soups, soy sauce, battered foods and even beer.

The initial celiac diet should be based on healthy, simple foods, like meat and poultry, fish, eggs, nuts, legumes, fruits, vegetables and rice. It’s a good idea to get a few gluten-free cookbooks to help expand your diet. You might even want to meet with a dietitian specializing in the disorder for dietary guidance.

The challenge of gluten-free living is magnified by gluten’s ubiquity. It’s the second most common ingredient in all the foods you eat. New food-labeling laws make gluten identification easier, but some products, including medications, may still contain grain derivatives. Red-flag words include starch, stabilizer, flavoring, hydrolyzed plant protein (unless it’s made from corn or soy), and emulsifier.

Becoming a label sleuth can help you avoid gluten. But even if the front of the package claims that a product is gluten-free, check the ingredient label to be sure. While it’s no piece of cake to cut gluten out of your life, once you do it you’ll never want to go back.

One Last Thing …

Even if your tests come back negative for celiac disease, it’s possible that you have an allergy to wheat or other foods. So the next logical step is to rule out food allergies with a simple blood test that can pinpoint problematic foods.  

If you truly do suffer from celiac, eliminating gluten from your diet can be the basis for healing. But, because damaged villi can lead to bacterial overgrowth, it is critical that you take probiotics to recolonize your intestine with good bacteria. Look for a probiotic supplement that contains several strains of live bacteria from various Lactobacillus, Acidophilus and especially Bifidobacteria species. Essential for intestinal health, these beneficial bugs are especially helpful for those with gluten issues.

This Just in …

When it comes to the myriad of risk factors for heart disease, most doctors focus primarily on LDL (bad) cholesterol. Meanwhile, triglycerides are often all but ignored.

Triglycerides are the body’s preferred form of energy storage and usually come from the foods we eat. The calories that aren’t immediately used by the tissues are converted to triglycerides and transported to fat cells to be stored. Hormones regulate the release of triglycerides from fat tissue so they meet the body’s needs for energy between meals. But high levels of plasma triglycerides damage the arteries and increase your risk of atherosclerosis. Left unchecked, they sometimes can result in acute pancreatitis, a life-threatening inflammatory condition.

National Cholesterol Education Program guidelines state that triglyceride levels should remain below 150 milligrams per deciliter. Levels between 200 and 500 are considered high, and any number over 500 is a cause of immediate concern. In those cases, most doctors opt for either statins or fibrates to try to lower the numbers.

But you don’t need to wait until your triglycerides skyrocket. If your triglyceride levels are upwardly mobile, adopt some smart lifestyle changes to rein them in. Exercise and weight-loss will give you the most satisfying decline in triglycerides.

Diet, of course, is also crucial. Avoid refined carbohydrates, saturated fats and hydrogenated oil. Swap these unhealthy foods for fresh vegetables, fruit and nuts. It’s also wise to consume omega-3 fatty acids by taking fish oil supplements and adding fish to your diet frequently.

Taking supplemental niacin can also help. If your triglyceride levels just won’t budge, ask you doctor about a prescription form of niacin called Niaspan that also gives your HDL levels a boost.

It’s also important to keep a lid on stress levels. According to a study of 35 women by researchers at Ohio State University, stress slows the body’s ability to clear triglycerides from the blood. And the longer these unhealthy fats circulate in your body, the more negative impact they have on your heart.

Here’s another bonus of taming your stress levels: A Duke University study of 94 men with heart disease found that those who learned relaxation techniques had fewer heart attacks, less cardiac surgery and lower medical costs than those who didn’t learn how to manage their stress. So do yourself and your heart a favor and try meditation or yoga to soothe away tension. No time? Find a quiet corner where you won’t be disturbed. Take a couple of deep breaths and let your body flop for a minute or two. Slowly come up into an erect position. Practicing this exercise each day has a cumulative effect on your stress levels and can prevent them from escalating.

References:

Fasano A, Berti I, Gerarduzzi T, et al. “Prevalence of Celiac Disease in At-Risk and Not-At-Risk Groups in the United States.” Archives of Internal Medicine. 2003;163:  286-292.

Lindfors K, Blomqvist T, Juuti-Uusitalo K, et al. “Live probiotic Bifidobacterium lactis bacteria inhibit the toxic effects induced by wheat gliadin in epithelial cell culture.” Clinical and Experimental Immunology. 2008;152:552-558.

Stoney CM, West SG, Hughes JW, et al. “Acute psychological stress reduces plasma triglyceride clearance.” Psychophysiology. 2002;39:80-85.

Warnholtz A, Wild P, Ostad MA, et al. “Effects of oral niacin on endothelial dysfunction in patients with coronary artery disease: Results of the randomized, double-blind, placebo-controlled INEF study.” Atherosclerosis. 2008 Aug 12. [Epub ahead of print]