Celiac disease affects the small intestine, one of the major components of the digestive system. The intestine itself is over twenty feet long, starts at the stomach and ends at the beginning of the large intestine, also called the colon. The small intestine is divided into three sections, the duodenum, the jejunum and the ileum. Each section performs a different role in the digestive process.
- The first section, the duodenum is connected to the stomach, the first section that the food is emptied into. It absorbs calcium, magnesium, iron, fat soluble vitamins A and D and glucose.
- The second section of the small intestine is the jejunum. It absorbs: fat, sucrose, lactose, glucose, proteins, amino acids, fat soluble Vitamins A and D and water soluble vitamins like folic acid.
- The last section before the large colon begins is the ileum. It absorbs: proteins, amino acids, water soluble vitamins like folic acid and Vitamin B 12
After food is emptied from the stomach, it is treated with bile which has been secreted by the liver. After the food has been digested and absorbed as much as possible from the small intestine, it is sent to the colon for further processing and for elimination from the body in the form of waste product.
In celiac disease, there is a problem with the reaction of the small intestine to certain proteins in wheat, rye, barley and in some cases, oats. The protein that is the problem - gluten, causes an allergic reaction that not only causes inflammation but can destroy the lining of the small intestine. Because of this destruction, the body cannot absorb the dietary nutrients that it needs which will lead to deficiencies.
Celiac disease is common in countries in Europe, especially Ireland, Italy, Sweden and Austria. In Finland, celiac disease may be as common as one in every 100 persons, in Northern Ireland, the number may be one in every 300. In the United States, the rough estimate of the disease is one in every 3000 people.
What is Gluten?
Gluten is a group of proteins that is found in wheat and other grains. Proteins are long chains of amino acids that can number in the hundreds. During the digestive process, the body breaks down these chains into single amino acids and smaller chains. However, one of these, gliadin is not broken down the same way as the others and leads to the problems in the small intestines lining. Other foods may contain similar proteins but may not cause reactions to the majority of people. Still other foods may only cause reactions that are fairly weak or may only cause a reaction in those who are very severely affected by celiac disease.
Signs and Symptoms of Celiac Disease
Not all people with celiac disease have it to the same degree. Symptoms can range from non-existent to severe. Most symptoms that arise do so because of malabsorption while others may be due to malnutrition. Fat is the most commonly affected nutrient in celiac disease. Symptoms of fat malabsorption includes: diarrhea, malodorous flatulence, abdominal bloating, and increased amounts of fat in the stool. The stools tend to be fairly large in size, foul smelling, greasy and light in color. They also tend to float in the toilet bowl. It is possible that you will see oil droplets on the top of the water.
Lactose may also be affected by celiac disease because the body is unable to split lactose into its two smaller sugar forms, glucose and galactose. In those who have celiac disease and are also lactose intolerant, symptoms may be greatly increased and more severe. These include: diarrhea, excessive gas, abdominal pain and distention.
When celiac disease causes malnutrition and vitamin or mineral deficiencies it can lead to weight loss, fluid retention, anemia, osteoporosis, easy bruising, nerve damage, infertility and muscle weakness. The disease is typically found in children or infants, however in adults the disease is often misdiagnosed first and then later discovered to be present. For instance, in many cases, the disease is occasionally misdiagnosed as irritable bowel syndrome.
Other Problems
Celiac disease may cause a number of other problems including: an itchy rash that affects the arms, legs, buttocks, neck, trunk and scalp. Medically it is called dermatitis herpetiformis and affects about 10% of those who have celiac disease. Other conditions: painful mouth ulcers, insulin dependent diabetes (Type I), autoimmune thyroid disease, rheumatoid arthritis and systemic lupus.
Celiac disease and other intestinal inflammation causing diseases may lead to cancer in some people, including abdominal, liver and colorectal cancers and some lymphomas, making it very important to diagnose celiac disease before the damage becomes severe.
Diagnosis
Because there are a number of other diseases that can present with symptoms that are similar to celiac disease, it is important that the diagnosis be made in a definitive way. A biopsy of the small intestine is considered to be the most accurate method of testing for the disease; this can be done by passing a scope down the throat and into the duodenum under light sedation. Several samples are obtained and then analyzed.
While the test is considered to be the best, it is not without drawbacks. There are some additional allergies that could look like celiac disease as well as some temporary conditions that can skew the results of the biopsy, most notably cow milk and soy protein allergies. There are blood tests that can be done for celiac disease, however most people are still required to have the biopsy for confirmation.
The gluten Free Diet
After the diagnosis is made, the patient will be put on a lifelong gluten free diet which can be difficult and time consuming to follow and nearly impossible to handle in certain social settings. There are those who choose to follow this diet on their own, whether or not they have celiac disease or not, however it is not for everybody and even those who have to do so may find themselves overwhelmed. It is hard to find gluten free foods when eating out, for instance. There are foods in the average grocery store but they tend to be more expensive than others.
Because so much of the nutrients that are needed in the diet are not being absorbed by the body, it is important to consider supplementation. However, this can often be hard to do because of the inability to digest the ingredients in the supplement.
