It can appear at different ages and has many faces. We combine it with diarrhea and flatulence, but it can only manifest itself as anemia, chronic fatigue and even depression. It is the heterogeneity of the clinical picture that causes celiac disease to be diagnosed much too late. It happens that even after 10 years …
The “gluten free” trap
In recent years, the gluten-free diet has gained worldwide popularity. Apparently it allows you to lose weight, apparently improves the complexion, apparently her fan is Madonna. Much “supposedly”, and how much truth in it? It turns out that a gluten-free diet can be a trap for many people, but let’s start from the beginning, which is gluten that has become the modern “whipping boy” …
Gluten is nothing but protein found in grains such as wheat, rye and barley. A gluten-free diet is used in the three diseases of celiac disease, gluten allergy and non-celiac gluten hypersensitivity (NCGS). This is where the guidelines end, and switching to the fashionable “gluten free” just in case is not advisable for several reasons. First of all, so far there are not enough studies to confirm the positive health effects of a gluten-free diet used without indications. Secondly, it is a diet that is not only expensive, but also complicated, and gluten-free food is often highly processed and full of “additives”: thickeners, emulsifiers and conditioners. Third: by eliminating grains such as wheat, barley or rye from your diet, you are giving up micronutrients, vitamins and fiber, which is necessary for the proper functioning of the intestines.
There is something else – if you are switching to a gluten-free diet due to disturbing symptoms: chronic abdominal pain, diarrhea, flatulence, you can delay the diagnosis of celiac disease, one of the most common chronic diseases of the digestive system.
Following the introduction of a gluten-free diet, the concentration of antibodies in the blood serum decreases, and as the concentration of antibodies decreases, the mucosa of the small intestine gradually regenerates. In children, the phenomenon described here occurs very quickly – even within a month, while in adults it can last up to a year. This can lead to false negative serological and histological results. Incorrect diagnostics may lead to the fact that a person will not be treated or will be treated in the wrong way – explains Dr. Emilia Majsiak, MD, PhD.
Too rarely, too late
What exactly is celiac disease? It is a genetic autoimmune disease characterized by lifelong gluten intolerance. Contrary to common myths, it does not only affect children – it can appear at any age, and is most often detected in people aged 30-50. Statistics show that at least 1 percent suffer from it. population, but as Emilia Majsiak, MD, PhD emphasizes, there may be many more patients. – It is assumed that there are 1 undiagnosed people per 7 diagnosed person. Also, the average waiting time for diagnosis is too long – 13 years according to a study by the University of Oxford! So we are talking about a serious disease that leads to numerous complications, and is detected too rarely and too late.
The main reason for late diagnosis is the heterogeneity of the clinical picture of the disease. According to the applicable criteria, four clinical forms of celiac disease are distinguished: classic, characterized by malabsorption symptoms such as: diarrhea, fatty stools, weight loss and growth disorders, non-classical, subclinical and potential. The common feature of all of them is the presence of specific antibodies in the blood serum. Histopathological changes in the intestinal mucosa are also typical of celiac disease, with the exception of the potential form in which they do not occur.
Symptoms of celiac disease can be very diverse and may affect many organs or systems, and even, as in the case of anemia, symptoms may appear alone for up to several years. While the exact mechanism of the disease is yet to be understood, we do know that gluten is a harmful factor in celiac disease, which leads to the loss of the villi in the small intestine, which are responsible for the absorption of nutrients from food. The effect of impaired absorption is a deficiency of nutrients and malnutrition of the body. Depending on the duration of the disease and what nutrients the patient’s body lacks, we can talk about various symptoms of malnutrition. For example, a deficiency of vitamin B1 (thiamine) can cause fatigue, muscle weakness and decreased concentration, low calcium concentration contributes to defects in tooth enamel, development of rickets and osteoporosis, while iron deficiency may cause anemia – adds Emilia Majsiak, MD, PhD.
Say: I check!
You ask yourself: are you allergic to gluten or do you have celiac disease? Don’t guess! For proper diagnosis and treatment, it is necessary to consult your own concerns with a doctor. After collecting a clinical history, the gastroenterologist will order blood serological tests typical of celiac disease.
If celiac disease is suspected, diagnosis begins with the concentration of antibodies in the patient’s blood serum. In this case, anti-tTG IgA antibodies (tissue transglutaminase IgA) are measured. It is currently the celiac disease marker with the best sensitivity and specificity for celiac disease. However, in order to meet our expectations regarding the detection of celiac disease, we need to be sure that the patient produces IgA antibodies, therefore, when performing anti-tTG IgA antibodies, the total concentration of IgA antibodies is always determined. If the patient is diagnosed with IgA deficiency, then anti-tTG and / or anti-DGP (deaminated gliadin peptide) should be determined in the IgG class. Performing blood serological tests is the right step before switching to a gluten-free diet – if we stop consuming gluten, the body stops producing characteristic antibodies, and the test results will be unreliable. In such a situation, in order to diagnose celiac disease, the gastroenterologist will have to reintroduce gluten into the patient’s diet for a minimum of 6-8 weeks – the expert explains.
When diagnosed with celiac disease, it is necessary to switch to a strict gluten-free diet permanently. Which in practice means saying goodbye to common wheat and its varieties, such as spelled or kamut, as well as barley or rye, as well as to products with their addition. A small group of people with celiac disease are also intolerant to oats. People with celiac disease who tolerate it, however, can only consume it if it comes from certified crops because it is often heavily contaminated with other grains containing gluten. The clinical condition of most patients improves even after 2 weeks after introducing a gluten-free diet. yh