Celiac Disease
About Celiac
The most serious of all food reactions is Celiac Disease, an autoimmune destruction of cells lining the gastrointestinal tract that results from consuming the gluten-containing grains: wheat, barley, rye, triticale, spelt, kamut, and (though this is less clear) oats. The chemical fraction of the protein gluten that causes the immune system to attack the gut is also a protein, called gliadin.
Celiac Disease has gone by other names in the past: Celiac sprue, non-tropical sprue, gluten enteropathy – but until recently, it was rarely diagnosed (by medical doctors: naturopathic physicians, who have always been in the forefront of recognizing the connection between food and health, and the role of allergic or other reactions to foods in undermining health, have recognized Celiac for decades.) Celiac Disease is incurable – the destruction to the digestive tract that occurs as a result of consuming gluten is irreversible; and a person with celiac cannot, as far as is known, lose their autoimmunity to gluten. This is not to say, however, that most people with celiac can’t overcome their symptoms and live normal (though gluten-free) lives. I have seen many patients who, after their diagnosis of Celiac Disease, were told by their doctors that nothing could be done for the ongoing suffering that continued long after discontinuing gluten. However, after undertaking a naturopathic program that addressed nutritional insufficiencies and the overall health of the gastrointestinal tract, as well as examining the role of other dietary factors in health, these patients felt like they had made a complete recovery (as long as they continued to avoid gluten!)
Food Allergies, GAD, and Celiac
Reactions to foods, whether they are called allergies, intolerances, or sensitivities, can cause a nearly unimaginably wide range of illnesses, from recurrent infections to chronic fatigue syndrome to migraines to gastrointestinal ailments, and this list could be nearly unlimited. However, with other types of food reactions, there is not such a direct correlation between a single food-type and a disease (which is why medical doctors tend not to recognize food sensitivities, because the relationship to illness is unpredictable.) Celiac Disease, on the other hand, has a defined pathology; a defined autoimmune reaction; a defined offending substance; and a defined genetic distribution.
Many people who react to wheat or gluten or to other grains do not have Celiac Disease
. There is a relatively new medical terminology, “Gluten-Associated Disease” or GAD, that describes a spectrum of illnesses and syndromes that result from the consumption of gluten, and which can be cured or ameliorated with the elimination of gluten, but which have none of the laboratory or pathological findings of Celiac Disease. Some patients with GAD may appear more symptomatic and more debilitated than those with frank Celiac Disease
.
Celiac Symptoms
The most common symptoms of Celiac Disease are those of the gastrointestinal tract. They include: cramping, gas, distention and bloating; chronic diarrhea and/or constipation; fatty stools (light-colored, floating); anemia due to a nutritional deficiency of folate, Vitamin B6 or B12, or iron (or all of the above); and weight loss in spite of normal or increased appetite.
Other possible symptoms include: dental enamel defects; osteopenia and osteoporosis; bone or joint pain; fatigue, weakness and lack of energy; infertility, both male and female; depression; aphthous ulcers (commonly called canker sores). It should be noted that these are very general symptoms and have many possible causes. Many of these symptoms can be caused by food allergies that are not as destructive as Celiac Disease.
One of the most common manifestations of Celiac Disease, Dermatitis Herpetiformis, is characterized by blistering, intensely itchy skin. The rash has a symmetrical distribution and is most frequently found on the face, elbows, knees and buttocks. DH patients can have gastrointestinal damage without other perceptible symptoms.
Celiac Diagnosis
Blood tests that can indicate Celiac Disease are tests of antibodies, including Anti-Gliadin (AGA) IgA, (AGA) IgG, Anti-Endomysial (EMA) IgA, Anti-tissue transglutaminase (tTG) and total serum IgA. Of these, TTG is currently the most specific (least likely to be positive in someone who does not have Celiac.) Anti-Gliadin antibodies indicate a reaction to gluten, but are often positive in people who do not have Celiac Disease. Standard medical procedure is for patients with a positive antibody test and an IgA deficiency to undergo a biopsy of their small intestine to confirm the diagnosis and assess the degree of mucosal damage. Most medical doctors and gastroenterologists consider the biopsy to be the “acid test” for celiac. Blood Tests for Celiac Disease are only useful when the patient has been consuming gluten; after prolonged avoidance of gluten, the tests revert to normal.
Dermatitis Herpetiformis can be diagnosed by a biopsy of a skin lesion. More than 85% of DH patients have reactivity to gluten. Everyone with DH needs to follow a gluten-free diet.
Naturopathy for Celiac
For people who have Celiac Disease, there is no alternative to the avoidance of gluten.
A gluten-free diet must be maintained for life, or further irreversible destruction of the gastrointestinal tract takes place. The role of naturopathic medicine in celiac is diagnosis, if necessary, and then to address nutrient insufficiencies and the overall health of the digestive tract (while destroyed tissue cannot be restored, the balance and function of the digestive tract as a whole can be restored with naturopathic measures.) This page about gastrointestinal health contains some background on this topic. There is also some information on our approach to nutrition here and here.
Helpful Links
These websites may provide useful resources and information to celiac patients:
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/index.htm
Please explore the rest of this website, to learn more about the general philosophy and practice of naturopathic medicine. Of course, I am happy to meet with you to discuss your particular situation, and to explore with you how I can help you feel your best.