CELIAC DISEASE OR GLUTEN INTOLERANCE?…
We are accustomed to the idea that celiac disease is a modern disorder, which affects hypochondriacs, stars of show business, and individuals who are focused on themselves and their health almost too much. Many even believe that this is not a real disease, but rather a whim. Let’s see what celiac disease is, how it differs from gluten intolerance and what the state of science at this point is.
MUSSELS AND BANANA … WHERE IS THE LINK?
In the 19th century, Samuel Gee, an English pediatrician, observed manifestations of celiac disease in children. Kids showed symptoms of developmental deficiency, weight loss, diarrhea, and anemia. “If the patient can be cured at all, it must be by means of diet”. Gee concluded that a mussel-rich diet cures the disease in young patients. The children who consumed a “pint of the best Dutch mussels every thrived wonderfully,” but the symptoms returned when the mussel season ended. As we understand it now, in this way, he documents the results of the gluten-free diet (complete elimination of gluten-containing products from the diet) and the relapse after repeated administration of gluten.
In 62 years a Dutch pediatrician Willem Dicke will first identify and describe the interconnection of gluten and the disease.
Meanwhile, in the 20s of the 20th century, bananas replaced the mussels when, in 1924, American pediatrician Sidney Haas presented his banana diet, which successfully treated children with celiac disease. Even after 40 years, when it became unequivocally clear what exactly caused the reaction, which annually took the lives of small Americans, Haas did not adopt the new approach. He continued arguing that it was bananas and their special nutrient composition that, combined with the exception of cereals, treats the disease.
1952 can be called the year of birth of the gluten-free diet. Willem Karel Dicke noted that in the last years of World War II when there was no access to bread in Holland, the death rate from celiac disease dropped to 0 cases per year, and the symptoms were significantly less pronounced. After the war, symptoms, and deaths resumed. This encouraged Dick and his colleagues to investigate the contribution of gluten to the development of the disease and the great mystery over which scientists had puzzled over the centuries (the first mention dates back to the 1st century AD), was revealed.
DIAGNOSIS AND TREATMENT
Despite the fact that we have found a way to combat celiac disease — the complete and unconditional exclusion of gluten in any, even trace amounts, the question of diagnosis is still open.
Nowadays celiac disease can be compared to an iceberg: the number of undiagnosed cases is much higher than diagnosed. According to statistics, about 70–80% of cases worldwide are left without a diagnosis.
It used to be that celiac disease is an extremely rare disease. However, we now understand that we have about 1 case per 100 people. Typical celiac disease, with severe symptoms, is really rare. The disease is mostly represented in latent and atypical forms of the disease. Women suffer from the celiac disease on average one and a half to two times more often than men.
CELIAC DISEASE, GLUTEN INTOLERANCE, WHEAT ALLERGY. IT’S ALL THE SAME, RIGHT?
Wrong. These are completely different disorders, and they are treated differently.
Celiac disease (CD) is a genetically determined, autoimmune disease that manifests itself when consuming gluten-containing products. In order to get a reaction, a person must have a genetic predisposition, consume gluten and the disease must be activated.
Gluten intolerance (Non-Celiac Gluten Sensitivity (NCGS)). The mechanisms of action are still not well understood, but we can definitely say that this is not an allergic or autoimmune reaction. There are currently no tests and biomarkers for the detection of gluten intolerance.
Wheat allergy is an immune response to one or more of the hundreds of wheat proteins. It is not an autoimmune reaction, it can be diagnosed with specific IG blood and skin prick tests.
WHAT DO WE NEED TO KNOW ABOUT CELIAC DISEASE?
When people with celiac disease consume gluten (a complex of proteins found in wheat, rye, and barley), their immune system attacks their own cells in the small intestine. These attacks cause damage to the villi, small cylindrical protrusions that line the small intestine and promote nutrient absorption. When the villi are damaged, nutrients can’t be properly absorbed, leading to a number of disorders.
ALL IN THE FAMILY
Celiac disease is hereditary, meaning that it runs in families. If your first-degree relative (parent, child, brother or sister) suffers from celiac disease, your risk also increases and is 1 in 10. There are genes that are responsible for the likelihood of developing this disease. Having passed the genetic analysis, you can find out your risk.
WHAT ARE THE SYMPTOMS OF CELIAC DISEASE?
According to the World Gastroenterology Organization, celiac disease can be divided into two types: classical and non-classical.
With classic celiac disease, patients have signs and symptoms of malabsorption, including diarrhea, steatorrhea (pale, foul odor, oily stools), as well as weight loss or retarded growth in children.
In atypical celiac disease, patients may have mild gastrointestinal symptoms without obvious signs of malabsorption or may appear to have unrelated symptoms. They may suffer from abdominal distention and pain and / or other symptoms, such as iron deficiency anemia, chronic fatigue, chronic migraine, peripheral neuropathy (tingling, numbness or pain in the hands or feet), unexplained chronic hypertransaminasemia (elevated levels of certain liver enzymes), reduction of bone marrow masses and bone fractures, as well as vitamin deficiencies (B9 and B12), late menarche / early menopause and unexplained infertility, tooth enamel defects, depression and anxiety, Duhring’s disease (itchy skin rash), etc.
In the latent form, the disease is asymptomatic, but patients still suffer from villous atrophy and concomitant malabsorption: the absorption of nutrients is disturbed, the patient does not receive a number of essential vitamins and microelements, especially iron, calcium, and folate. This condition is especially dangerous for pregnant women and women who are planning a pregnancy, as well as children who are in an active stage of development.
NOW, WHAT AM I SUPPOSED TO DO WITH THIS INFORMATION?
1. Exclude gluten and forget about pizza… just kidding. Do not panic. If you don’t have celiac disease, there is no reason to worry. Gluten-containing products, especially whole grains, are an absolutely safe and high-quality source of complex carbohydrates, group B vitamins, and fiber. Gluten itself is not toxic, and the autoimmune reaction of patients with celiac disease is what leads to negative consequences.
2. If you suspect that you may have celiac disease, it is most reasonable to consult with a specialist. Your physician will offer you a panel of tests, such as serology testing, that looks for antibodies in your blood, a genetic test for specific human leukocyte antigens, and an endoscopy if the results of two previous tests are positive. It is possible that the symptoms are caused by other disorders that are mandatory to be treated.
3. Tell your family and friends about celiac disease. Many Americans live with the celiac disease and suffer from its consequences and do not even realize it. Informed means armed!
4. Find out whether genetics favors you :) Download your raw data and find out your genetic predisposition to the disease. If you do not have any variants of the genes responsible for the development of the disease, you should not worry at all, but if you have a genetic predisposition, you can do further research and be more mindful about your health and food choices.
Resources:
Celiac Disease Foundation
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD)
University of Chicago Celiac Disease Center
Catassi C; G. Fanciulli; A. R. D’Appello et al. Antiendomysium versus Antigliadin Antibodies in Screening the General Population for Coeliac Disease. Am. J. Gastroenterol. 2000; 95: 7: 732–736
Sapone et al.: Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Medicine 2011 9:23.
