| | | | Other Names | | | Celiac, Celiacs, Coeliac, Coeliacs, Gluten-Free, Gluten Intolerance,
Gluten Sensitive, Gluten Sensitivity, Gluten Sensitivities, Gluten
Allergy, Gluten Allergies.
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| | | Also known as: Celiac Sprue, Non-Tropical Sprue
Celiac disease
(also called gluten enteropathy) is an intestinal disorder that results
from an abnormal immunological reaction to gluten, a protein found in
wheat, barley, rye, and to a lesser extent, oats. In addition to damaging
the lining of the small intestine, celiac disease can sometimes affect
other parts of the body, such as the pancreas (increasing the risk of
diabetes), the thyroid gland (increasing the risk of thyroid disease), and
the nervous system (increasing the risk of peripheral neuropathies and
other neurological disorders). Occasionally, such damage occurs only in
one or more of these parts of the body in the absence of damage to the
intestines.
What are the symptoms of celiac disease? Celiac disease
may not cause symptoms in some people. However, others may have a history
of frequent diarrhea; pale, foul-smelling, bulky stools; abdominal pain,
gas, and bloating; weight loss; fatigue; canker sores; muscle cramps;
delayed growth or short stature; bone and joint pain; seizures; painful
skin rash; or infertility. Microscopic examination of the small-intestinal
lining reveals severe damage, especially in the jejunum (the central
portion of the small intestines). People with untreated celiac disease may
eventually experience malaise and weight loss and have an increased risk
of developing anemia, osteoporosis, osteomalacia, and certain types of
cancer. In addition to physical symptoms, some people may experience
emotional disturbances, including feelings of anxiety and
depression.
Conventional treatment options: The conventional
treatment is strict adherence to a gluten-free diet although doctors are
increasingly questioning the need for all celiac patients to avoid oats.
People with severe damage to the absorptive surface of their intestines
may also be prescribed intravenous nutritional supplements.
Immunosuppressive and anti-inflammatory medications, such as
glucocorticoids (e.g., prednisone) and 6-mercaptopurine, are sometimes
used as components of conventional treatment.
Dietary changes that
may be helpful: All doctors agree that consumption of the
gluten-containing grains wheat, barley, and rye must be avoided in all
celiac patients. Less consensus exists regarding the advisability of
eating or restricting oats and oat products. While oats contain a
substance similar to gluten, modern research suggests that eating moderate
amounts of oats does not cause problems for most people with celiac
disease.1 In one of these reports, approximately 95% of people with celiac
disease tolerated 50 grams (almost two ounces) of oats per day for up to
12 months.2
Strict avoidance of wheat, barley, and rye, and of
foods containing ingredients derived from these grains, usually results in
an improvement in gastrointestinal symptoms within a few weeks, although
in some cases the improvement may take many months. Tests of absorptive
function usually improve after a few months on a gluten-free
diet.3
Many people with celiac disease become symptom-free when
following gluten-free diets. Others, however, continue to experience
symptoms, often resulting from the presence of trace amounts of gluten
either permitted in some gluten-free diets or consumed by mistake. Such
mistakes are easy to make because many processed foods contain small
amounts of gluten. For people with residual symptoms, a diet that truly
eliminates all gluten, followed by open and double-blind challenges,
resulted in symptomatic improvement in 77% of those studied.4 A careful
dietary analysis should ensure that all trace amounts of gluten are
removed from the diet. If this fails to relieve symptoms after three
months, then other food intolerances should be ruled out using an
elimination diet.
Avoiding gluten may also reduce cancer risk. In
one trial, 210 people with celiac disease were observed for 11 years.
Those who followed a gluten-free diet had an incidence of cancer similar
to that in the general population. However, those eating only a
gluten-reduced diet or consuming a normal diet had an increased risk of
developing cancer (mainly lymphomas and cancers of the mouth, pharynx, and
esophagus).5
Children with untreated celiac disease have been
reported to have abnormally low bone mineral density. However, after
approximately one year on a gluten-free diet, bone mineral density
increased rapidly and approximated the level seen in healthy children.6
Long-term adherence to a gluten-free diet ensures normal bone density and
is an important preventive measure in young people with celiac
disease.7
Adults with celiac disease also have significantly lower
bone mineral density than do healthy adults. After consumption of a
gluten-free diet for one year, bone mineral density of the hip and lumbar
spine has been reported to increase by an average of more than
15%.8
Infertility, which is common among people with celiac
disease, has been reportedly reversed in both men and women after
commencement of a gluten-free diet.9
Some people with celiac
disease may be intolerant to other foods, in addition to gluten. Foods
that have been reported to trigger symptoms include cows'milk10 and soy.11
12 13
Lifestyle changes that may be helpful: In one study, children
who were breast-fed for less than 30 days were four times more likely to
develop celiac disease, compared with children who were breast-fed for
more than 30 days.14 Although this study does not prove that
breast-feeding prevents the development of celiac disease, it is
consistent with other research showing that breast-feeding promotes a
healthier gastrointestinal tract than does
formula-feeding.15
Nutritional supplements that may be helpful: The
malabsorption that occurs in celiac disease can lead to multiple
nutritional deficiencies. The most common nutritional problems in people
with celiac disease include deficiencies of essential fatty acids, iron,
vitamin D, vitamin K, calcium, magnesium, and folic acid.16 Zinc
malabsorption also occurs frequently in celiac disease17 and may result in
zinc deficiency, even in people who are otherwise in remission.18 People
with newly diagnosed celiac disease should be assessed for nutritional
deficiencies by a doctor. Celiac patients who have not yet completely
recovered should supplement with a high-potency multivitamin-mineral. Some
patients may require even higher amounts of some of these vitamins and
minerals-an issue that should be discussed with their healthcare
practitioner. Evidence of a nutrient deficiency in a celiac patient is a
clear indication for supplementation with that nutrient.
After
commencement of a gluten-free diet, overall nutritional status gradually
improves. However, deficiencies of some nutrients may persist, even in
people who are strictly avoiding gluten. For example, magnesium deficiency
was found in 8 of 23 adults with celiac disease who had been following a
gluten-free diet and were symptom-free. When these adults were
supplemented with magnesium for two years, their bone mineral density
increased significantly.19
In another study, six people with
diet-treated celiac disease had abnormal dark-adaptation tests (indicative
of "night blindness"), even though some were taking a multivitamin that
contained vitamin A. Some of these people showed an improvement in dark
adaptation after receiving larger amounts of vitamin A, either orally or
by injection.20 People with celiac disease should discuss the possibility
of vitamin A deficiency with a healthcare practitioner before taking
vitamin A supplements.
Malabsorption-induced depletion of vitamin D
can lead to osteomalacia (defective bone mineralization) in people with
celiac disease.21 Although supplementation with vitamin D appears to
increase bone density, the excess risk of bone fracture may not be
entirely eliminated.
It is possible that subtle deficiencies of
other nutrients may exist in people with celiac disease who are on a
gluten-free diet and are in remission. People who are not strictly
avoiding gluten are likely to have more severe deficiencies. Because of
the complexity of this condition and the multiple nutritional factors
involved, people with celiac disease should be under the care of a doctor.
Some doctors may recommend use of nutritional supplements, including a
high-potency multivitamin-mineral supplement, to reduce the risk of future
deficiencies. No controlled trials have investigated the value of
supplements in the minority of celiac disease patients who do not go into
remission in response to a gluten-free diet.22
In one trial, 11
people with celiac disease suffered from persistent depression despite
being on a gluten-free diet for more than two years. However, after
supplementation with vitamin B6 (80 mg per day) for six months, the
depression disappeared.23
People with celiac disease often do not
produce adequate digestive secretions from the pancreas, including lipase
enzymes24 In a double-blind trial, children with celiac disease who
received a pancreatic enzyme supplement along with a gluten-free diet
gained significantly more weight in the first month than those treated
with only a gluten-free diet.25 However, this benefit disappeared in the
second month, suggesting enzyme supplements may only be useful at the
beginning of dietary treatment.
Are there any side effects or
interactions? Refer to the individual supplement for information about any
side effects or interactions.
References:
1.
Srinivassan U, Leonard N, Jones E, et al. Absence of oats toxicity in
adult coeliac disease. BMJ 1996;313:1300-1.
2. Jantauinen EK,
Pikkarainen PH, Kemppainen TA, et al. A comparison of diets with and
without oats in adults with celiac disease. N Engl J Med
1995;333:1033-7.
3. Greenberger JN, Isselbacher KJ. Disorders of
absorption. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds.
Harrison's Principles of Internal Medicine, 14th ed. New York:
McGraw-Hill, 1998, chapter 285.
4. Faulkner-Hogg KB, Selby WS,
Loblay RH. Dietary analysis in symptomatic patients with coeliac disease
on a gluten-free diet: the role of trace amounts of gluten and non-gluten
food intolerances. Scand J Gastroenterol 1999;34:784-9.
5. Holmes
GKT, Prior P, Lane MR, et al. Malignancy in coeliac disease-effect of a
gluten free diet. Gut 1989;30:333-8.
6. Mora S, Barera G, Ricotti
A, et al. Reversal of low bone density with a gluten-free diet in children
and adolescents with celiac disease. Am J Clin Nutr
1998;67:477-81.
7. Mora S, Barera G, Beccio S, et al. Bone density
and bone metabolism are normal after long-term gluten-free diet in young
celiac patients. Am J Gastroenterol 1999;94:398-403.
8. McFarlane
XA, Bhalla AK, Robertson DAF. Effect of a gluten free diet on osteopenia
in adults with newly diagnosed coeliac disease. Gut
1996;39:180-4.
9. Baker PG, Read AE. Reversible infertility in male
coeliac patients. BMJ 1975;2:316-7.
10. Sewell P, Cooke WT, Cox EV,
Meynell MJ. Milk intolerance in gastrointestinal disorders. Lancet
1963;2:1132-5.
11. Haeney MR, Goodwin BJF, Barratt MEJ, et al. Soya
protein antibodies in man: their occurrence and possible relevance in
coeliac disease. J Clin Pathol 1982;35:319-22.
12. Mike N, Haeney
M, Asquith P. Soya protein hypersensitivity in coeliac disease: evidence
for cell mediated immunity. Gut 1983;24:A990.
13. Ament ME, Rubin
CE. Soy protein-another cause of the flat intestinal lesion.
Gastroenterology 1972;62:227-34.
14. Auricchio S, Follo D, de Ritis
G, et al. Does breast feeding protect against the development of clinical
symptoms of celiac disease in children? J Pediatr Gastroenterol Nutr
1983;2:428-33.
15. Udall JN, Colony P, Fritze L, et al. Development
of gastrointestinal mucosal barrier. II. The effect of natural versus
artificial feeding on intestinal permeability to macromolecules. Pediatr
Res 1981;15:245-9.
16. Connon JJ. Celiac disease. In: Shils ME,
Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed.
Philadelphia: Lea & Febiger, 1994, 1062.
17. Crofton RW, Glover SC,
Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis
herpetiformis: a test of small intestinal function. Am J Clin Nutr
1983;38:706-12.
18. Solomons NW, Rosenberg IH, Sandstead HH. Zinc
nutrition in celiac sprue. Am J Clin Nutr 1976;29:371-5.
19. Rude
RK, Olerich M. Magnesium deficiency: possible role in osteoporosis
associated with gluten-sensitive enteropathy. Osteoporos Int
1996;6:453-61.
20. Russell RM, Smith VC, Multak R, et al.
Dark-adaptation testing for diagnosis of subclinical vitamin-A deficiency
and evaluation of therapy. Lancet 1973;2:1161-4.
21. Basha B, Rao
S, Han ZH, Parfitt, AM. Osteomalacia due to vitamin D depletion: neglected
consequence of intestinal malabsorption. Am J Med
2000;108(4):296-300.
22. O'Mahony S, Howdle PD, Losowsky MS. Review
article: management of patients with non-responsive coeliac disease.
Aliment Pharmacol Ther 1996;10:671-80 [review].
23. Hallert C,
Astrom J, Walan A. Reversal of psychopathology in adult celiac disease
with the aid of pyridoxine (vitamin B6). Scand J Gastroenterol
1983;18:299-304.
24. Patel RS, Johlin FC Jr, Murray JA. Celiac
disease and recurrent pancreatitis. Gastrointest Endosc
1999;50:823-7.
25. Carroccio A, Iacono G, Montalto G, et al.
Pancreatic enzyme therapy in childhood celiac disease. A double-blind
prospective randomized study. Dig Dis Sci 1995;40:2555-60.
Source:
NOW Foods
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Please Note: This Traditional Use information is provided as a courtesy only. The products indicated above may be listed in error. This information is based on Traditional and Folklore Medicine which uses natural materials to support health. This information has not been evaluated or approved by the FDA and is not based on scientific evidence from any source. These statements have not been evaluated by the Food and Drug Administration (FDA). These products are intended to support general well being and are not intended to treat, diagnose, mitigate, prevent, or cure any condition or disease. If conditions persist, please seek advice from your medical doctor.
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