By Andy Bailey, M.D.
If one were to hitch a ride in an intestinal capsule, he would first travel down the esophagus into the stomach. After spending maybe an hour or two there, he would then enter the small intestine. In the small intestine, nutrients are absorbed into the blood stream. Our intraintestinal traveler would see fields upon fields of finger-like projections called villi. These villi dramatically increase the surface area of the small intestine, giving the body a tremendous ability to absorb nutrients, vitamins, and minerals from what we eat.
What if our traveler looked out and instead saw a flattened surface, as if all the finger-like projections had fallen off? The small intestine would have a very difficult time absorbing nutrients from the diet. Unfortunately, most of the nutrients would pass on, along with our capsule traveler, to points south without doing the body any good.
Celiac disease is a disease in which the villi of the small intestine are severely damaged and take on such a flattened appearance. Much of the patient’s nutrition is not absorbed at all. The expected result is diarrhea and weight loss. Sometimes the symptoms are much more subtle. The patient might just have a condition related to poor absorption of a particular nutrient, such as iron-deficiency anemia or osteoporosis. Sometimes the patient develops even more subtle symptoms related to vitamin deficiency, such as fatigue or depression.
What causes all this mischief? Individuals with celiac disease inherit a defect in which a dietary substance called gluten triggers an inflammatory reaction against the intestinal villi. Not all individuals with the inherited defect develop celiac disease, and many patients do not develop the condition until late in life. Exactly what triggers the condition in susceptible individuals is still the focus of intense research.
Where do we find gluten? Unfortunately for the celiac patient, one does not have to look far at all. Gluten is found in wheat, rye, and barley. These products are found almost everywhere. Rice and oats are safe, although patients with celiac disease are so sensitive to gluten that even the small amount of gluten that might contaminate oats can trigger the disease.
So you think you might have celiac disease? After all, the symptoms described above are common. Why not just eliminate wheat from your diet and see what happens? As tempting as this may sound, I do not recommend it. First, gluten is so common that it takes a concerted effort to avoid the substance. Second, we now have blood tests that are very accurate in screening for the diagnosis. Any physician can order an endomyseal IgA antibody, or a tissue transglutaminase IgA, along with serum IgA levels. If these tests are normal, you are not going to have the disease. Third, the diagnosis of celiac disease is lifelong; we cannot cure or outgrow the disease yet.
What if the blood tests are positive? These days we would perform an endoscopy and obtain biopsies of the small intestine. This is a safe and straightforward procedure, technically easier than a colonoscopy to perform.
Once the diagnosis of celiac disease is established, nutritional counseling is crucial. The patient must stay on a gluten-free diet or face certain relapse and even worsening of the condition. Even small amounts of gluten can trigger a relapse. Fortunately, many local grocery and health food stores now either have a section dedicated to the gluten-free diet, or individuals who can assist the patient in maintaining the proper diet. Organizations such as the Celiac Disease Foundation (www.celiac.org)
can be very helpful as well.
Within weeks or months of adhering to the proper diet, the intestinal villi grow back and the patient’s ability to absorb nutrients returns to normal. Nevertheless, nutritional deficiencies may remain, so it is very important to make sure that the patient is getting an adequate intake of calcium, vitamin D, iron, and the B vitamins. The wonderful restorative powers of the human body do the rest. It is satisfying to the patient and physician alike to have the patient report at their three-month office visit that they have gained ten pounds and have not felt so well in years!
Read Food Ingredient Labels. Potential Harmful Ingredients Include:
• Brown Rice Syrup (frequently made from barley)
• Caramel color (infrequently made from barley)
• Dextrin (usually corn, but may be derived from wheat)
• Flour or cereal products (containing wheat)
• Malt or malt flavoring (usually made from barley. Okay if made from corn)
• Malt vinegar
• Modified food starch (from unspecified or forbidden source)
• Soy sauce or soy sauce solids (many soy sauces contain wheat)
Andrew Bailey, M.D., is a graduate of Davidson College and Vanderbilt University School of Medicine. He did his postgraduate training at Brooke Army Medical Center in San Antonio, Texas and is board-certified in both Internal Medicine and Gastroenterology. He practices in Louisville since 1990.