Gluten~related disease damaging but treatable
By the Faculty of Harvard Medical School
Q:
One of my co-workers recently had
diarrhea and an itchy rash that wouldn't go away.
Her doctor finally sent her to a dermatologist, who
diagnosed a digestive disorder called celiac sprue.
I've never heard of this condition. What can you
tell me about it?
The damaging effects of gluten
A:
People with celiac disease, also called
celiac sprue, cannot normally digest a protein
called gluten. This sticky protein is found in
grains such as wheat, barley and rye. It's also used
in many processed foods, including bottled sauces
and condiments, and in some vitamins and
medications.
For people with this condition, eating gluten
can damage the lining of the small intestine, .
In celiac sprue, a protein called gluten, found in many foods, triggers the body's immune system to
attack villi in the small intestine. Villi are hair-like projections that pull nutrients out of the food you
causing abdominal pain and bloating, gas,
eat (left Inset). If the villi are damaged (right Inset), your body cannot absorb the nutrients it needs.
diarrhea and constipation. Because the injured
intestine can't absorb vital nutrients, untreated
2009 Harvard University. Illustration by Scott Leighton. from 4 Weeks to Heallhy Digel:ilion.
celiac disease can lead to iron-deficiency
anemia, osteoporosis and other problems. It also ups the risk for certain cancers.
Celiac disease was once thought to be rare, but experts now estimate that about 1 in 133 Americans -- 2 million in all -have
the disorder. It's more common among people of European ancestry, and it's slightly more prevalent in women.
Celiac disease is often misdiagnosed because its classic symptoms resemble those of other common ailments, such as
Irritable Bowel Syndrome. Another challenge is that half to two-thirds of celiac patients don't have gastrointestinal
complaints; instead, they show signs of anemia, weight loss or gain, swollen feet and legs, an itchy rash or fatigue.
These difficulties help explain why people can have symptoms for years before their doctors finally diagnose celiac disease.
Many people assume that the disease is diagnosed as soon as a child .starts eating foods that contain gluten, but that's not the case.
Celiac disease can develop at any time in life, including old age. The average age at diagnosis is 46; about 20 percent of cases are
diagnosed after age 60.
The body's immune system produces antibodies to attack foreign invaders. But in people with celiac disease or other autoimmune
disorders, the body mistakenly attacks itself. Thanks to recent scientific advances, doctors can now diagnose celiac disease with
blood tests for two particular antibodies. If you test positive for these antibodies, your doctor will probably perform a biopsy of
your small intestine. During this test, a thin tube is put down your throat and advanced into the intestine. A small piece of tissue is
then removed. Doctors can check the tissue for damage to confirm the diagnosis. Knowing for certain is critical because the
treatment -- following a gluten-free diet for a lifetime -- can be challenging and costly.
Doctors strongly discourage people from trying a gluten-free diet on their own before receiving a final diagnosis. That's
because the antibody tests are accurate only if you are eating foods that contain gluten.
The good news is that the only treatment for celiac disease a gluten-free diet -- starts to work within days. And within about
three to six months, the small intestine usually heals completely. Although giving up bread, pasta and other foods can be tough,
many people who have adapted to a gluten-free diet say that it does not prevent them from socializing or traveling. Gluten-free
foods are available by mail order and on the Internet, and gluten-free items are becoming more common in restaurants and
supermarkets.
The Food and Drug Administration requires that foods containing allergens such as wheat must list that information on their
labels. This doesn't mean that people with celiac disease are home free, because even wheat-free products can still cause trouble.
For example, oats don't contain gluten, but contamination with wheat can occur during milling and processing.
People with celiac disease need to check labels carefully for hidden gluten in prepared foods, such as cured pork products, selfbasting turkeys, imitation meats and seafood, and the thickeners found in gravy and some spaghetti sauces. Gluten may also be
hidden in dates and candies that are dusted with flour to prevent sticking. The recently published book "4 Weeks
to Healthy Digestion" by Harvard Medical School professor Norton Greenberger provides an extensive list of foods and
ingredients to avoid. A dietitian can also help with food selection and disease management.
Foods and beverages aren't the whole story. Medications (both prescription and over,-the-counter) as well as vitamins, minerals
and other supplements are often packed in a starch base that may contain gluten. A pharmacist can suggest gluten free
alternatives. Gluten is also found in some personal-care products, such as lipstick, toothpaste and mouthwash, and in the glues on
envelopes and stamps.
For more information, contact the Celiac Disease Foundation at 818-990-2354 or at www.celiac.org or the National Institute of
Diabetes and Digestive and Kidney Disorders at 301-496-4000 or at www.niddk.nih.gov ..
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Copyright 2009 the President and Fellows of Harvard College. Developed by Harvard Health Publications
(www.health.harvard.edu).
Distributed by UFS. Submit questions to harvard_adviser@hms.harvard.edu.