Celiac Disease: Symptoms, Diagnosis, and Diet

When you have celiac disease, bread is not your friend.

Celiac Disease (also known as non-tropical sprue and gluten sensitive enteropathy) is a condition where a person is unable to digest foods containing gluten (the protein portion of wheat, spelt, kamut, oats, rye, and barley). In time, this reaction destroys the villi of the small intestine. Celiac disease (CD) is genetic, but it can be managed by following a gluten-free diet.

A gluten-free diet is quite a lifestyle adjustment.  We are surrounded by bread, crackers, pasta, pizza and cookies. Though a gluten-free diet may seem daunting to newbies, once you put a few strategies in place, it gets easier.  Plus, your intestines will thank you!

Symptoms

Symptoms include:

• nutrient malabsorption
• diarrhea
• weight loss
• lactose intolerance
• abdominal pain
• anemia
• steatorrhea (fatty stools that float)
• joint pain
• muscle cramps
• fatigue
• depression
• fibromyalgia
• arthritis
• schizophrenia
• dermatitis herpetiformis
• stunted growth (in children)

Untreated celiac disease patients can end up diagnosed with:

• cancer (intestinal lymphoma)
• bone disease (osteoporosis)
• vitamin A,D,E,K,deficiencies
• neurological problems.

Difficulties in Diagnosing Celiac

According Dr. Alessio Fasano, famed Celiac researcher and director of University of Maryland School of Medicine Center for Celiac Research:

“The projected number of people in the United State with celiac disease could be as high as 3 million, yet only a small fraction of these cases has been correctly diagnosed and treated”.

According to Joseph Murray, MD, a Mayo clinic CD specialist and gastroenterologist, anemia is the most common finding used to diagnose celiac disease. To complicate matters even further, doctors often attribute the symptoms of diarrhea, abdominal pain, dermatitis, fatigue, joint pain to other diseases.

About 50% of patients with celiac disease are lactose intolerant because their bodies are unable to manufacture the enzyme lactase, which breaks down lactose. So, every time a CD patient drinks milk or eats dairy products, he/she will get diarrhea, gas and bloating.

According to Mary Schluckerbier, executive director of The Celiac Sprue Association USA,

“Doctors have been taught in medical schools that celiac sprue is extremely rare, so it’s not high on the list of culprits when presented with a patient with symptoms that mimic other diseases thought to be more common.”

Celiac disease often confused with irritable bowel syndrome, which can involve abdominal pain, diarrhea, gas and bloating. Published research from Department of Clinical and Experimental Medicine, Federico University of Naples, Italy identified “a significant correlation between celiac disease and chronic fatigue syndrome. In celiac, fatigue is a common finding, which ameliorates with the gluten-free diet.”

Testing for Celiac Disease

The following tests are used to confirm celiac disease:

1. Blood test for IgG and IgA antibodies (reacting to gliadin)

2. Immunoglobulin A anti-transglutaminase antibodies; if elevated,

3. EMA (antiendomusial antibodies) test should follow; if EMA comes back positive,

4. An intestinal biopsy is recommended to confirm small intestine villi damage.

5. Also, a lactose breath test (to confirm lactose intolerance) and ELISA blood test ( to identify food allergy/sensitivity) are useful diagnostic tools for celiac patients.

6. ELISA blood test screens for antibodies to gluten plus other food substances. Both celiac patients and gluten intolerance patients test positive for gluten antibodies but the difference is that celiac patients have small intestine damage, and gluten intolerance patients display no damage to small intestine.

7. Parasites can be a hidden cause of celiac disease. Comprehensive Digestive Stool Analysis (CDSA) evaluates stool for presence of parasites, pathogenic bacteria, and yeast. CDSA test is available through Genova Diagnostics.

8. Most patients with celiac disease have vitamin (A, D, E, K), mineral deficiencies (magnesium, iron), fat malabsorption and anemia. The lab assessment of the above nutrients should be done in order for proper supplementation.

Medical Treatment

In addition to a prescribing a gluten-free diet, doctors should remember that the majority of celiacs are lactose intolerant. So, dairy products must also be avoided. By removing grains and dairy from the diet, celiacs stop irritating the gut and allow the intestine to heal.

Avoid Gluten-Containing Grains

These include:

• wheat
• barley
• rye
• spelt
• kamut
• triticale ( a cross between wheat and rye).

Avoid Products Which Potentially Contain Gluten

Although the following grains are gluten-free, individuals with severe gluten sensitivity must avoid them due to possible contamination during processing:

• oats
• buckwheat
• millet
• amaranth
• quinoa

The following foods, products, and drinks also contain gluten: bran, farina, orzo, couscous, bulgur, matzo, semolina, seitan, udon, wheat germ, hydrolyzed wheat protein, malt vinegar (made from barley),malt/malt flavoring (made from barley), malted milk, communion wafers, croutons, breading, gravy, dextrin, non-dairy creamers, processed cheeses, dry roasted nuts, imitation seafood, caramel coloring, some condiments, dips, MSG, emulsifiers, stabilizers, modified food starch, baking powder, salad dressings, hydrolyzed vegetable protein, soy sauce, commercial soups, bouillon cubes, chocolate, ice cream, instant coffee, packaged rice mixes, ketchup, seasoning mixes, hot dogs, luncheon meats, chewing gum, and ovaltine.

Avoid grain derived alcohol: beer, vodka, ale, gin, whiskey. Avoid medications and dietary supplements that may contain gluten fillers. Read the ingredients list, and if not sure, ask the pharmacist.

Prevent Gluten Contamination at Home

When cooking at home, avoid cross contamination between gluten and non-gluten products by using separate cutting boards, bowls, toasters, and toaster oven.

People with refractory celiac disease may not respond to gluten-free diet; therefore, steroid medications and anti-inflammatory drugs are recommended by doctors to remedy severe cases of celiac disease.

KnowYourGut Protocol for Celiac Disease Healing

1. First identify and remove the possible cause of the disease.

Parasite and candida involvement should be ruled out. Perform stool culture for ova and parasites to identify possible bacteria/parasite infestation. Food allergies/sensitivities (especially gluten, dairy) may cause intestinal irritation resulting in diarrhea. To allow the gut to heal completely, at the beginning of the treatment, all grains except rice should be avoided as well as lactose-containing foods.

2. Reduce colon inflammation and heal colon mucosa by consuming therapeutic foods /supplements.

According to scientific studies in Norway and UK, the “Elemental Diet is a therapeutic option that can provide long-term clinical improvement of this difficult condition”, refractory celiac disease. To promote faster colon healing, 2 weeks of the elemental diet is highly recommended before resuming a normal diet. After 2 weeks on the elemental diet, start adding 1 food at a time.

Remember to keep a food diary to record gut reactions to each food eaten. Celiac disease process impairs the absorption of nutrients by small intestine; therefore, a liquid or powdered hypoallergenic multivitamin/multimineral supplement is a necessary addition for gluten sensitive individuals.

To promote faster intestinal healing and to support your immune system the following nutraceuticals must be taken: iron, magnesium, calcium, Vitamins (A,B,C,D,K, E) and folic acid. For best absorption, take supplements with meals. The diet should contain lots of green veggies, cauliflower, brussel sprouts (high in vitamin K), tomatoes (high in lutein), different berries (blueberries , raspberries, strawberries, blackberreries – all high in vitamin C).  Raspberries contain almost as much vitamin C as oranges.

Consume seeds daily ( pumpkin, sunflower seeds and sesame seeds – high in zinc, vitamin E and minerals), wild caught fatty fish and whole organic eggs (high in vitamin A and protein). Salmon is high in vitamin D. Permitted grains on celiac’s diet include: brown and wild rice (high in vitamin E, B6 and B3 ), legumes such as black-eye peas, kidney beans,lima beans, mung beans, and garbanzo beans (high in folic acid).

3. Normalize intestinal flora.

Introduce probiotics (good bacteria) to remedy dysbiosis and to restore the gut flora. I prefer to use Natren’s products. Good intestinal flora must be present for normal vitamin K production. Vitamin K is usually deficient in individuals with celiac disease.

4. Improve digestion and absorption of foods.

I really like pancreatic enzyme supplementation to aid food absorption. Each pancreatic enzyme capsule should contain:

• lipase (17,500 USP Units) – aids in breaking down lipids (fats).
• protease (110,000 USP Units) – aids in breaking down proteins.
• amylase (120,000 USP Units) – aids in breaking down amylase (starch).

For best results, one to two pancreatic enzyme capsules should be taken with each meal. Celiacs should beware of possible interactions of pancreatic enzymes with Orlistat, prescription medication used to treat obesity. Orlistat blocks the activity of enzyme lipase.

5. Eliminate diet and lifestyle risk factors, which can trigger flare-up.

Examples include: gluten containing foods, artificial sweeteners, dairy, lack of sleep, emotional stress, etc.