Celiac Disease: Get the Goods on Gluten
The term ‘gluten-free’ has become very popular among food manufacturers and marketers within the past few years, with everything under the sun not containing wheat marketed as such. These products have become intensely trendy, with many people restricting themselves to the famed gluten-free diet, and paying a premium price for it. But what does gluten-free really mean, who benefits from this type of diet, and how do you truly know if you are gluten intolerant?
What is gluten-intolerance?
Gluten-intolerance is otherwise known as Celiac disease, nontropical sprue and glutensensitive enteropathy. Despite its recent popularity, celiac disease is not a new condition. Descriptions of chronic malabsorption have dated as far back as the second century AD, but the disease wasn’t fully characterized until the Second World War. It was noted by Dutch pediatrician Willem K Dicke that chronic diarrhea seemed to resolve in certain patients during shortages of bread and cereals, and subsequently returned upon resolution of the war when these products were readily available again.
What causes Celiac disease?
Gluten-intolerance is precipitated by an interaction between genetic and environmental factors, namely exposure to gluten. Gluten is a protein found in wheat, barley and rye. The reaction is in fact not towards gluten specifically, but to a particular component of the protein called gliadin. Gliadin is freed from gluten in the small intestine by an enzyme found in the gut wall (tissue transaminase), and then transported across the gut wall where it activates immune cells in genetically predisposed people. It is actually the immune response that causes damage to the inner lining of the small intestine, leading to issues with nutrient absorption.
What are the symptoms of Celiac disease?
Celiac disease can become apparent at any age. There is a wide range of symptoms associated with celiac disease, from very minor or no manifestations to life-threatening malabsorption. Classically, people experience diarrhoea and weight loss, but can also have severe anemia, neurologic sequelae (such as tingling in the hands or feet), and weakened bones. These issues occur as a result of a vitamin and nutrient deficiency, mainly in iron and vitamins B12, C and D, which are all absorbed in the first part of the small bowel (the duodenum). In infants with celiac disease, the main symptom is typically failure to thrive, in which the baby fails to grow at an appropriate rate or begins to lose weight.
How is it diagnosed?
While it may seem enticing to assume bloating or diarrhoea after eating is a sure-fire sign that one is gluten-intolerant, these symptoms may be related to many other conditions. If celiac disease is suspected, blood work can be performed to look for certain immune-based components, or antibodies, specifically found within gluten-intolerant individuals. This mainly includes tissue transglutaminase antibodies, which is positive in 98% of people with Celiac disease. If this is positive, your family physician may refer you for a gastroscopy to obtain a tissue biopsy of the small intestine, which may show increased numbers of particular immune cells (known as lymphocytes), a flattened appearance to the inner lining of the intestine, and other microscopic changes. The gold standard of diagnosis is resolution of these intestinal changes after initiation of a gluten-free diet.
How is Celiac disease treated?
Currently, the only way to prevent the unwanted symptoms associated with gluten-intolerance is to avoid foods containing gluten, including wheat, barley, rye and oats.