Wanna stay healthy? Just follow these simple guidelines!

So you or someone you know has been diagnosed with Celiac Disease. I’m sure you’re wondering just how this disease is treated? I’m going to explain just that.

The simplest and most efficient way to have a vast improvement in a patient’s symptoms is to follow a strict gluten-free diet. A patient’s health care provider will typically refer their patients to a specialized dietitian or nutritionist. These people will teach their patients how to successfully avoid gluten while still maintaining a healthy and nutritious diet. These instructions include learning how to read and identify ingredients that contain gluten in food and product labels, how to make healthy choices about what type of food to eat, and how to design specialized meal plans.

People with Celiac Disease can still eat a well-balanced diet with a variety of foods. They can use potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour. They can also buy gluten-free bread, pasta, and other products from stores, or order products from special food companies. Meanwhile, meat, fish, rice, fruits, and vegetables without additives or seasoning do not contain gluten, so people with Celiac Disease can still eat these foods.

Most people with Celiac Disease can safely eat small amounts of oats as well, as long as the oats are not contaminated with wheat gluten during processing.

People with Celiac Disease should always read food labels carefully, especially canned, frozen, and processed food labels, for ingredients that contain gluten. They should also avoid ingredients such as hydrolyzed vegetable protein, also called lecithin or soy lecithin. In addition, they should ask restaurant servers and chefs about ingredients, food preparation and whether a gluten-free menu is available. The following image illustrates some recommendations for a gluten-free diet.

For most people, following a gluten-free diet will stop their symptoms, heal their existing intestinal damage, and prevent any further damage from occurring. Symptoms may improve within days to weeks of starting the diet. Complete healing of the small intestine can take several years in adults, and 3-6 months in children. Once the intestine heals, the villi will start absorbing nutrients from food into the bloodstream normally again.

In some cases, people will continue to have difficulty absorbing nutrients despite following a strict gluten-free diet. People with this condition, called Refractory Celiac Disease, have severely damaged intestines that cannot heal. Because their intestines don’t absorb enough nutrients they may need to receive nutrients via IV. Research is still being done on medications that will treat Refractory Celiac Disease. (NDDIC, 2015)

So there you have it. The only effective way to treat Celiac Disease is by not eating foods that contain gluten. Upon starting a gluten-free diet a patient’s intestines will heal over time. In my next blog post I will be taking a look at several different websites that can provide useful information to those with Celiac Disease. See you then!

Works Cited

NDDIC. (2015, June 25). Celiac Disease. Retrieved from The National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/celiac-disease/Pages/facts

Celiac Symptoms and Signs

So what are some signs and symptoms of Celiac Disease? Well, a person may experience digestive signs and symptoms as well as symptoms in other parts of the body. Digestive signs and symptoms are more common in children and can include the following:

• abdominal bloating
• chronic diarrhea
• constipation
• gas
• pale, foul-smelling, or fatty stool
• stomach pain
• nausea
• vomiting

Being unable to absorb nutrients during the years when nutrition is critical to a child's normal growth and development can lead to other health problems, such as

• the failure to thrive in infants
• slowed growth and short stature
• weight loss
• irritability or change in mood
• delayed puberty
• dental enamel defects of permanent teeth

Adults are less likely to have digestive signs and symptoms and may instead have one or more of the following:

• anemia
• bone or joint pain
• canker sores inside the mouth
• depression or anxiety
• dermatitis herpetiformis, an itchy, blistering skin rash
• fatigue, or feeling tired
• infertility or recurrent miscarriage
• missed menstrual periods
• seizures
• tingling numbness in the hands and feet
• weak and brittle bones, or osteoporosis
• headaches

Intestinal inflammation can cause other symptoms, such as:

• feeling tired for long periods of time
• abdominal pain and bloating
• ulcers
• blockages in the intestine

Celiac disease can produce an autoimmune reaction, or a self-directed immune reaction, in which a person's immune system attacks healthy cells in the body. This reaction can spread outside of the gastrointestinal tract to affect other areas of the body, including the following:

• spleen
• skin
• nervous system
• bones
• joints

Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases and conditions. Celiac disease can be confused with the following:

• irritable bowel syndrome (IBS)
• iron-deficiency anemia caused by menstrual blood loss
• lactose intolerance
• inflammatory bowel disease
• diverticulitis
• intestinal infections
• chronic fatigue syndrome

As a result, celiac disease has long been underdiagnosed or misdiagnosed. As health care providers become more aware of the many varied symptoms of the disease and reliable blood tests become more available, diagnosis rates are increasing, particularly for adults.

Signs and symptoms of celiac disease vary from person to person because of numerous factors, including:

• the length of time a person was breastfed as an infant; some studies have shown that the longer an infant was breastfed, the later the symptoms of celiac disease appear
• the age a person started eating gluten
• the amount of gluten a person eats
• age—symptoms can vary between young children and adults
• the degree of damage to the small intestine

Some people with celiac disease have no signs or symptoms; however, they can still develop complications of the disease over time. Long-term complications include:

• malnutrition
• liver diseases
• intestinal cancer
• lymphoma

(NDDIC, 2015)

As you can see, the symptoms and signs of Celiac Disease can be varied and depend on several different factors. I you or somebody you know is experiencing any of the symptoms I would highly recommend scheduling an appointment with your health care provider. In my next post I will be discussing the treatment guidelines of Celiac Disease. I’ll see you then!

Works Cited

NDDIC. (2015, June 25). Celiac Disease. Retrieved from The National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/celiac-disease/Pages/facts.aspx#diagnosed

Doctor's Notes:

So how is somebody diagnosed with Celiac Disease? Well, a health care provider can diagnose Celiac Disease with the following examinations:

• a medical and family history
• a physical exam
• blood tests
• an intestinal biopsy

Firstly, examining a patient’s medical and family history can assist a health care provider in diagnosing Celiac Disease by checking if the patient is already genetically predisposed to contract the disease. Celiac Disease is more common in patients who have a first degree relative who also has the disease.

Next, a physical exam can help diagnose Celiac Disease as a health care provider can see if a patient has any common symptoms. As an example; a health care provider may check for malnutrition or rashes, tap on a patient’s abdomen to check for bloating or pain, and use a stethoscope to listen to the sounds within the abdomen.

Blood tests taken at a health care provider’s office, or a commercial facility, can show the presence of certain antibodies that are common in Celiac Disease. If the results are negative but the health care provider still suspects Celiac Disease they may have a patient retake the blood tests. It is important that a patient eats a diet that includes gluten before the blood test is taken, or else the results may be a false negative.

Finally, if a blood test suggests that a patient has Celiac Disease a health care provider will perform an intestinal biopsy of the patient's small intestine to confirm the diagnosis. A biopsy is a procedure that involves taking a piece of tissue for examination with a microscope. A health care provider performs the biopsy in an outpatient center or in a hospital. They will give the patient light sedation and a local anesthetic. Some patients may receive general anesthesia.

During the biopsy, a health care provider will remove tiny pieces of tissue from the patient's small intestine using an endoscope (a small, flexible camera with a light). The health care provider will carefully feed the endoscope down the patient's esophagus and into their stomach and small intestine. A small camera mounted on the endoscope will transmit a video image to a monitor, allowing close examination of the intestinal lining. The health care provider then takes the samples using tiny tools that he or she passes through the endoscope. A pathologist will then examine the tissue in a lab. The test can show if there is damage to the villi within the small intestine. (NDDIC, 2015)

So there you have it. With these tests a health care provider can assess whether or not you or someone else has Celiac Disease. In my next post I’ll be analyzing the signs and symptoms of this disease. I’ll see you then!

Works Cited

NDDIC. (2015, June 25). Celiac Disease. Retrieved from The National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/celiac-disease/Pages/facts.aspx#diagnosed

How did this happen?

                                               JupiterImages (photograph); Jen Christiansen (photoillustration)

In this post I'm going to talk about the etiology and the pathophysiology of Celiac Disease. Etiology is the cause, or set of causes, of a disease or condition. Pathophysiology is the convergence of pathology and physiology. The former describes conditions observed during a disease state, while the latter is the biological discipline that describes mechanisms and processes operating within an organism. Pathophysiology seeks to explain the physiological processes or mechanisms whereby a condition develops and progresses. 

First off, the etiology of Celiac Disease. The sad fact of the matter is that the precise cause of Celiac Disease is not known. However correlation has been shown between people with many different factors. One of these is if an infant under three months of age is exposed to gluten. Another strong correlation is if an immediate family member also has Celiac Disease. Next, a major life event, pregnancy, surgery, or emotional stress in people who are genetically predisposed will have a greater risk of developing Celiac Disease. In addition, those individuals with type 1 diabetes, thyroid disease, or other autoimmune diseases will have a greater chance of also obtaining Celiac Disease. Finally, if a person has a genetic disorder such as Down syndrome or Turner syndrome, they as well may have a higher risk of Celiac Disease developing.

The pathophysiology of Celiac Disease is that it's a multi-factorial and a multi-system disorder involving a genetic predisposition, environmental exposure of the small bowel mucosa to gluten, and an immunologic response to gluten.

Genetically, the majority (>90%) of people with Celiac Disease possess the HLA DQ2 haplotype, and 5% to 10% possess the DQ8 haplotype, conferring a negative predictive value greater than 98%. These haplotypes are encoded within the HLA class II region of the major histocompatibility complex on chromosome 6p. However, about 40% of the general population carries these haplotypes without having the disease, which makes their presence necessary but not sufficient for its development.

Environmentally there was a serendipitous observation that children with Celiac Disease improved during World War II when cereals used to make bread were scarce, and they relapsed after the war when the supply of these cereals was reinstituted. Risk for developing Celiac Disease is increased with the introduction of gluten in the diet of infants before the age of 4 months. Grains that activate the disease contain proteins that can form gluten (prolamins: glutenins and gliadins) and include wheat, barley, and rye. Grains that do not activate the disease include rice, corn, sorghum, and millet. Oats contain a very small proportion of prolamins and should be avoided initially.

Finally, with regards to immunology, exposure of the upper small bowel mucosa to gluten in susceptible people precipitates an immune mediated reaction that involves both the innate and the adaptive immune responses. Tissue trans-glutaminase, an enzyme present in the lamina propria of the small bowel, deamidates glutamine residues in gluten to form glutamic acid. Glutamic acid is a negatively charged molecule that is recognized by the antigen-precipitating cells that express the HLA DQ2/DQ8 receptors for T lymphocytes. T lymphocytes become activated and they begin to divide rapidly and secrete several immunomodulators such as immunoglobulins, cytokines, interferons, tumor necrosis factor, and interleukin 15 and 17 that cause damage to the enterocytes and result in villous atrophy.

I hope that by reading this you'll have come to understand a bit more about how it was possible for you or your loved one to develop Celiac Disease. In my next blog post I'll explain a bit more about how Celiac Disease is diagnosed. See you there!