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Celiac Disease: All About Gluten Allergy

Celiac disease, is a chronic disease of the intestine triggered by the consumption of gluten, a mixture of proteins contained in some cereals (wheat, barley, rye …).The disease is mainly manifested by digestive symptoms (diarrhea, pain, bloating …).

In people with celiac disease, ingestion of gluten causes an  abnormal immune response  in the small intestine, which creates inflammation and damages the intestinal wall. More specifically, it is the intestinal villi that are destroyed. These are small wave-shaped structures that make up the “folds” of the intestine and allow the absorption of most of the nutrients, vitamins and minerals (see diagram above).

If the inflammation persists, the damaged intestine becomes unable to absorb certain nutrients, vitamins and minerals. This can lead to malnutrition despite normal nutrition.

Other symptoms of varying intensity may occur, such as fatigue , depression and joint pain . Over time, more serious health problems may appear.

However, people can recover health by eliminating gluten from their diet .

Differences with gluten intolerance

Although the term “gluten intolerance” is often used, celiac disease is not really a food intolerance since an immune reaction is involved.

The abnormal reaction of the immune system also turns against the body by attacking the lining of the small intestine. Celiac disease is therefore an autoimmune disease induced by ingestion of gluten.

In recent years, non-celiac gluten sensitivity (NCMS) has emerged in scientific studies. It manifests itself in symptoms similar to those of celiac disease and irritable bowel syndrome when consuming foods containing gluten. An estimated 3-6% prevalence of the population is poorly defined due to the frequency of self-diagnosis without medical advice.

Gluten

Gluten, Latin glue  (glue), is an elastic and viscous protein mass which is in the grains of several cereals, including wheat, barley and rye. Thus, gluten is found in many foods (bread, biscuits, pasta …). Giving breads and other baked goods a soft texture, gluten allows the ingredients to bond well together and is often used in sauces, prepared dishes, etc.

In the case of wheat , the immune reaction is directed against gliadin (a protein fraction present in wheat gluten). For barley , it is hordein, and for rye , secalin.

Celiac disease, an inherited disease 

Celiac disease has a hereditary component  . When a close family member is affected, the probability of being infected is about 20%. Researchers now know the main genes involved, called HLA genes type DQ2 and DQ8. It is known that 95% of patients express the HLA DQ2 genotype, and almost all others the DQ8. But we find the DQ2 in 30 to 40% of the general population. It therefore appears that genetic predisposition is a necessary but not sufficient condition to trigger the disease. As in many other cases, genetic predisposition must combine with factors to trigger the disease.

These other elements that come into play have not yet been precisely identified. It seems that  environmental factors  (intestinal infections, trauma, and stress caused by surgery or pregnancy …) can sometimes be responsible for triggering the disease.

There would be greater  intestinal permeability  in people predisposed to this disease. This would allow some of the  gluten  to enter the lining of the small intestine, triggering an immune response.

Possible complications of  Celiac Disease

If the gluten-free diet is not adopted, celiac disease, in its most serious forms, can have several health consequences. The most common complications are related to the poor absorption of nutrients in the intestine:

  • Malnutrition, due to the malabsorption of nutrients in the intestine. Malnutrition causes fatigue, weight loss, muscle weakness and many deficiencies.
  • Lactose intolerance . Due to damage to the intestinal wall, lactose intolerance may occur. Usually, it disappears some time after adopting a gluten-free diet.
  • Anemia . Due to the poor absorption of iron, the body’s iron stores are depleted, causing anemia.
  • Osteoporosis . The poor absorption of calcium and vitamin D results in a loss of bone density that can lead to osteoporosis.
  • Kidney stones . There is a relatively low risk of kidney stones that is caused by abnormal absorption of oxalates.

Other complications, which are not related to intestinal damage, can occur in cases of intolerance to gluten, without the link is always well understood:

  • Neuropathy (nerve damage). Gluten intolerance is sometimes associated with nerve damage, most often causing numbness in the limbs or even pain. Migraines, epileptic seizures or other neurological disorders are sometimes observed.
  • Infertility . Infertility is more common among people with gluten intolerance. The risk would be increased by about 12%. The miscarriages are also more frequent.
  • Arthritis . Inflammation of the joints, which causes pain, occurs in some people with the disease.
  • Herpetiform dermatitis . It is a skin condition that is associated with gluten intolerance in 15% to 25% of cases. It is characterized by itching, a burning sensation and the appearance of red blisters, especially on the elbows, knees and buttocks.
  • Some types of cancer . The disease is associated with an increased risk of intestinal lymphoma, bowel cancer and other types of cancer in the long term.

How many people are affected by celiac disease?

Prevalence data fluctuate a great deal, as the diagnosis of gluten intolerance is not straightforward. Experts and patient associations believe that many people are unknowingly infected, and that the disease is more common than people think.

The frequency of the disease depends on the regions of the world and ethnic origin. Caucasians (Europe, whites in North America, Australia) are the most affected, the oscillating prevalence between 1 in 100 and 1 in 300 or. The disease seems rarer in people of Asian or African descent.

A long and difficult diagnosis of Celiac Disease

The diagnosis is often difficult and time-consuming (12 years on average in Canada), because of the wide variety of symptoms and the fact that they are not at all specific to this disease. The doctor must first eliminate the possibility that it is a more common digestive problem (eg, irritable bowel syndrome, food intolerance or inflammatory bowel disease).

The more specific diagnosis is usually done in 3 steps.

  • The first is a blood test that can detect the level of certain antibodies (anti-endomysium or anti-tissue transglutaminase). Their presence in high amounts indicates that the body reacts abnormally to gluten. This test provides information on who is most likely to have the disease, particularly in families at risk.
  • tissue sample (biopsy) is then taken from the small intestine. A thin flexible tube (an endoscope) is inserted through the mouth to the small intestine. In cases of intolerance to gluten, the villi of the intestine are no longer visible, since they have been totally or partially destroyed by the immune system.
  • The effect of the gluten-free diet confirms or invalidates the diagnosis.
Warning.  It is advisable to consult a doctor before starting a gluten-free diet . Otherwise, the diagnosis can be more difficult to ask. It is therefore necessary to have consumed gluten in the months preceding the blood tests because otherwise, the results can be distorted.

SGNC is diagnosed by eliminating the existence of celiac disease and wheat allergy. Blood taken, intestinal biopsies are often necessary.

The symptoms of celiac disease

The symptoms and their intensityvary a lot from person to person. In some people diagnosed with this disease, no symptoms are noticeable. This is called silent celiac disease .

In general, digestive problems are the most common, but sometimes they are absent. Here are some of the possible symptoms.

Celiac disease in children

  • Chronic diarrhea sometimes alternating with constipation.
  • Recurrent abdominal pain.
  • Vomitings.
  • Stunting or small size
  • A delay of puberty.
  • Anemia.
  • A lack of appetite.
  • Mood changes and irritability.
  • Tiredness.
  • Abnormalities of dental enamel.

Celiac disease in adults

  • Chronic diarrhea or constipation
  • Abdominal pain, gas and bloating.
  • A loss of weight.
  • Fatigue and irritability.
  • A pallor, in case of anemia.
  • Depressive state
  • Bone and joint pain
  • Muscle cramps
  • Infertility or lack of menstruation
  • Numbness or neuropathic pain in the limbs.
  • Rashes.
  • Canker sores or ulcers in the mouth.

Who is most affected by celiac disease?

Celiac disease can occur at any age. It can appear in  young children  from the age of 6 months, after the introduction of cereals in their diet, as it can be declared in  adulthood . The  women  are 2 to 3 times more affected than men.

  • People who have a close relative with celiac disease are more likely to have the disease.
  • The disease appears to be more common in people with autoimmune disease, such as lupus, type 1 diabetes, rheumatoid arthritis and  Hashimoto’s thyroiditis . It is also more common in people with trisomy 21 (Down syndrome).

Risk factors

The main risk  factors are genetic factors  (presence of HLA DQ2 and DQ8 genes). On the other hand, it seems that the   baby’s eating habits could influence the appearance of the disease. See the Prevention section.

The prevention of celiac disease

Can we prevent?
Due to lack of knowledge about the causes of gluten intolerance, there are no ways to prevent it.

Current research

Based on epidemiological data  which comes mainly from a period of recrudescence of gluten intolerance in Sweden in the early 1980s, researchers believe that parents can minimize the risk of their child being disease by adopting simple measures of nutrition:

  • Practice breastfeeding.
  • Continue breastfeeding while introducing foods containing gluten.
  • Introduce cereals at the recommended age (not before the age of 3 months or after 7 months).

Research published in 2014, however, provides a different perspective. In a randomized trial of 944 infants with a celiac parent, they received gluten versus placebo between the ages of 16 and 24 weeks. There was no significant difference in the proportion of children who developed Celiac Disease at age 3 (5.9% vs. 4.5%).

In another clinical trial in 823 infants still with at least one parent with celiac disease, the introduction of cereals at 6 months vs 12 months had no effect on the incidence of the disease at 5 years of age (16% ). Breastfeeding also seemed ineffective.

Therefore, the precise moment when cereals are introduced into the diet does not seem to have any notable influence: follow the usual recommendations. As for breastfeeding, its benefits are so important, for other reasons that it must still be strongly recommended.

How to treat celiac disease?

Important . If you think you have celiac disease, you should consult a doctor before starting a gluten-free diet. Many diseases have symptoms that can be confused with those of gluten intolerance. And the adoption of this diet without medical advice can make the diagnosis more difficult to establish.

There is no definitive cure for celiac disease. The only treatment possible is the gluten-free diet for life. The lifelong adoption of a gluten-free diet usually makes it possible to completely eliminate symptoms, treat deficiencies and prevent possible complications.

In the vast majority of cases, the tissues of the intestinal wall return to normal on a gluten-free diet. The skin symptoms (dermatitis herpetiformis) also disappear when the diet is started. This healing usually takes place in a few weeks, but can take 2 to 3 years. It is exceptional that the symptoms persist despite several months of gluten-free diet.

How to follow a gluten-free diet?

The gluten-free diet must eliminate from the diet all gluten-containing cereals, by-products of these cereals and products made from these by-products. To follow a gluten-free diet, many commonly eaten foods must be  banned . But gluten is not only found in most  cereals and their flours . He also hides in a crowd of prepared foods. Since a tiny amount of gluten can damage the gut and cause the symptoms to reappear, great vigilance is needed.

Here are some basic elements of a gluten-free diet . This information does not replace the advice of the physician and the nutritionist. These health professionals will also be able to assess the additional nutritional requirements, if any, for vitamins and minerals. Foundations and associations dedicated to gluten intolerance (celiac disease) are other very valuable sources of information (see Sites of Interest). See also our special Gluten Intolerance Diet .

The cost of gluten-free products is high. In Canada, people with gluten intolerance sufferers can get a tax credit for medical expenses.

What are the foods to ban during a diet without glutent?

  • Grain Products Containing Gluten  : Wheat, Bulgur (Crushed Durum), Barley, Rye, Spelled (a variety of Wheat), Kamut (a Wheat Variety) and Triticale (a Hybrid) rye and wheat). Most baked goods, pastries, pasta in any form, biscuits, breakfast cereals, crackers contain gluten
  • Many prepared foods  : Surprisingly, you can find gluten in fruit yogurts, ice cream, hot chocolate mixes, bouillon cubes, cheese sauces, low-fat cottage cheeses, sour cream, meats canned sausages, tomato sauces, soups, peanut butter, etc. In these foods, cereal gluten serves as a binder. It is hidden under several names in the ingredient lists. To watch for: malt, starch (wheat, barley, rye, etc.), hydrolysed vegetable protein and textured vegetable protein. Note that seitan is a food essentially made of wheat gluten.
  • Beers (except those labeled gluten-free).
  • Certain medicines and vitamins, whose coating may contain gluten (starch). Choose hypoallergenic vitamins, no wheat and no yeast.

Note
– Alcoholic beverages made from malt (or derived from wheat, barley or rye) such as gin, vodka, whiskey and scotch are potentially harmful. Although distillation seems to largely eliminate gluten, doctors recommend avoiding these drinks as a precaution.
– Be careful with some lipsticks, which may contain traces of gluten.

Some prepared foods are labeled gluten-free , with a logo representing a wheat eared barrel. According to the standards of the Food and Agriculture Organization (FAO), these foods must not contain more than 200 parts per million (ppm) of gluten protein fractions 7 . It is found mainly in grocery stores of natural products, but also in supermarkets.

Be wary of cross contamination

In the kitchen, special care must be taken not to contaminate gluten-free foods. Contamination can occur when gluten-free products are prepared in unwashed dishes that have come into contact with foods containing gluten. Also beware of exchanging utensils with people who do not follow the gluten-free diet. The toaster, for example, should be for the exclusive use of the person following a gluten-free diet.

Unfortunately, cereals that do not contain gluten are contaminated during the production, processing or packaging process. So for more safety, it is recommended to focus on products labeled gluten-free.

The particular case of oats

Regular oat cereal does not contain gluten. On the other hand, there is a high risk of cross-contamination since oats are very often grown, transported or milled in the same environments as cereals or food products containing gluten.

The Quebec Foundation for Celiac Disease (FQMC) suggests that uncontaminated / gluten-free oats are introduced only after the normalization of anti-transglutaminase antibodies. This normalization takes between 6 months to 2 years after the beginning of a strict diet without gluten.

Gluten-free products: not all good for health

It is important, when embarking on a gluten-free diet, to adequately replace foods that have been excluded from our diet. The impact of these restrictions on the intake of protein, vitamins, minerals and other nutrients can be negative. We must see how to replace the essential nutrients contained in traditionally eaten gluten foods. For example, bread and cereals are often fortified with iron and vitamin B (especially B9 / folic acid) while gluten-free breads and cereals are not. Gluten-free products are often low in fiber and protein and high in sugars and additives. Be careful to choose your replacement products.

Gluten-free diet: focus on fresh foods

The diet of a person with gluten intolerance involves a lot of fresh food, the least processed possible.

  • Fruits and vegetables.
  • Meat, fish and poultry, not breaded or marinated.
  • Legumes and tofu.
  • Some cereals: rice, millet and quinoa.
  • Potato
  • Some flours: rice, corn, potatoes, chickpeas, soybeans.
  • Most dairy products can be eaten, but people who tolerate them badly will benefit from eliminating them from their diet for a few months.

Support Groups

To break the isolation, get support and nutritional advice, the patients’ associations are of great help. The Support Groups section groups a few.

pharmaceuticals

In rare cases (less than 5%), the gluten-free diet is insufficient to control symptoms. We are talking about refractory celiac disease . The doctor can then offer medications to prevent possible complications of the disease. It is most often corticosteroids (anti-inflammatory steroids, such as prednisone or hydrocortisone). These can sometimes be used in addition to the gluten-free diet to speed up remission in severe cases.

Rashes can sometimes require taking dapsone, an antibacterial drug.

A few tips

  • Chewing food well before swallowing improves the absorption of nutrients.
  • Bacteria found in yogurt (gluten-free) could help the intestinal flora to reform.
  • Call the restaurant before going there to inquire about the possibility of having gluten-free dishes.
  • Cook food ahead of time for lunches.
  • Inform relatives about ingredients that cannot be eaten. And why not give them some gluten-free recipes?

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