Celiac disease – symptoms, types, diet [WE EXPLAIN]

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Celiac disease is an intolerance to gluten – a protein present in the seeds of wheat, rye, barley and oats. If celiac patients couldn’t eat just bread and cookies, things would be simpler. The problem is that gluten is also an additive to pies, sausages, yoghurts, ice cream, candies, sauces, powdered creamers, and some medications.

The first detailed description of celiac disease was made in 1888 by Samuel Gee. He considered this disease to be a chronic indigestion, which most often occurs in children between the ages of 1 and 5, and he considered avoiding starch in food as a method of treatment.

During World War II, Dutch and English doctors observed that sick children who did not eat grain products (due to a lack of bread and flour) experienced spontaneous clinical improvement. This is how the hypothesis that the cereal protein called gluten is a factor that triggers the symptoms of celiac disease was created.

Although celiac disease is commonly considered a childhood disease, many cases are also diagnosed in adults, and even in the elderly.

Celiac disease – what is it?

Celiac disease (gluten intolerance) is it celiac diseasereferred to as gluten-dependent enteropathy of the small intestine. It is known as autoimmune disease of genetic origin. It is characterized by lifelong intolerance to gluten, a spare protein contained in cereals (wheat, rye, barley, oats). Gluten, which is toxic to the body, leads to the disappearance of small intestine villi, projections of the mucosa, which increase the surface of the intestine and are responsible for the absorption of nutrients. As a result, food absorption is impaired, which leads to various clinical symptoms.

Thanks to the progress of research and clinical observations, we know that celiac disease is not only a disease of the intestines, but of the entire systemcaused by a genetically abnormal immune response of the body to ingested gluten. Celiac disease is therefore the result of a combination of genetic, immunological (related to the activity of the immune system) and environmental factors.

The disease can manifest itself at any age! Celiac disease may appear both in a young child immediately after introducing gluten to the diet, but also in adolescents during adolescence, in pregnant women, in adults after experiencing strong emotional stress, after a strong infection or surgery. So far, the group most often diagnosed with celiac disease is the group of people aged 30-50. However, this does not change the fact that people aged 80 or 3 are also diagnosed with celiac disease. It is estimated that women get sick twice as often as men.

Who gets celiac disease?

The inhabitants of countries where cereals are the staple food product are also more prone to gluten intolerance. Screening of blood donors in Europe and the USA has shown that asymptomatic celiac disease affects 1 to 3 cases per 100 inhabitants. It is estimated that about 1 percent. of the population suffer from celiac disease, and there are between 7 and 10 undiagnosed cases in Europe for every patient diagnosed with the disease. It follows that nearly 400 people suffer from celiac disease in Poland. people, but only 3-5% know about it! This epidemiological situation is often compared to an iceberg, the apex of which are diagnosed cases, and a much larger part of it corresponds to undiagnosed celiac disease.

The disease is more common in patients with type I diabetes, certain autoimmune diseases and genetically determined syndromes, such as Down syndrome. Its risk is also greater in relatives of patients diagnosed with celiac disease. The influence of genetics on the development of the disease is evidenced by the fact that in three-quarters of cases, celiac disease affects both identical twins (i.e. genetically identical), and the disease usually occurs in people who have specific histocompatibility antigens closely related to the functioning of the immune system.

Several types of celiac disease, different symptoms

The classic form of celiac disease with gastrointestinal symptoms occurs in young children, pregnant women and the elderly. Celiac disease in adults is mainly an oligosymptomatic form in which it comes to the fore extraintestinal symptoms. It happens, therefore, that even 10 years elapse from the first symptoms to diagnosis. There is also a mute form of the disease, without clinical symptoms, but with the presence of characteristic antibodies and atrophy of intestinal villi, and the so-called latent form, also without symptoms, with typical antibodies, normal mucosa and risk of discomfort caused by a gluten-containing diet.

Celiac disease develops gradually or attacks suddenly. Among the factors that may accelerate its disclosure are mentioned acute gastroenteritis, gastrointestinal surgery, travel-related diarrhea to low-hygiene countries, and even pregnancy. The symptoms of celiac disease in adults are very diverse – so far about 200 of them have been described. chronic diarrhea or (much less frequently) constipation, abdominal pain, flatulence, weight loss, vomiting, recurrent mouth erosions and liver dysfunction.

However, there are more frequent cases when initially nothing indicates a disease of the digestive system. Celiac disease it causes skin symptoms quite often and may suggest Dühring’s disease – cutaneous form of celiac disease. Gluten intolerance also causes symptoms on the part of the genitourinary system (delayed sexual maturation), the nervous system (depression, balance disorders, headaches, epilepsy), pallor, fatigue, muscle weakness, short stature, tooth enamel defects or clotting disorders manifested easily bruising and nosebleeds. Therefore, it is not a disease that only pediatricians or gastroenterologists (specialists in digestive system diseases) encounter, especially as its picture may change depending on the patient’s age.

The full-blown (overt, classic) form of celiac disease is most common in children, pregnant women and the elderly. Despite the fact that it is quite easy to diagnose, it is very often confused with food allergy, stress reaction or irritable bowel syndrome. It occurs less frequently than the mute form (in about 10% of all patients).

Symptoms of gluten intolerance in this form of celiac disease:

1. abdominal pain and bloating,
2. fatty or watery diarrhea
3. weight loss, weight loss,
4. developmental disorders in children,
5. short stature,
6. change of disposition,
7. depression,
8. deficiency symptoms (e.g. persistent anemia) resulting from the malabsorption syndrome.

In oligosymptomatic celiac disease (mild or even asymptomatic), the lesions concern only the mucosa of the small intestine and are usually not accompanied by symptoms typical of the overt form. This form of celiac disease the most common.

The main symptoms are:

1. aphthas and ulcerative stomatitis (very characteristic),
2. underdevelopment of tooth enamel,
3. constant fatigue,
4. unexplained iron deficiency anemia,
5. elevated cholesterol,
6. neurological disorders (peripheral neuropathy, ataxia, epilepsy),
7. persistent headaches,
8. depression,
9. early osteoporosis, bone and joint pain,
10. skin problems,
11. habitual miscarriages, fertility problems,
12. concomitant autoimmune diseases.

The latent (latent) form of celiac disease occurs when characteristic antibodies are found in the blood of people with a normal bowel image. These people can be expected to disappear villi in the future and fully develop the disease.

Get tested for celiac disease without leaving your home. Choose a mail-order test for gluten intolerance from Medonet Market’s offer and send the sample for laboratory analysis.

Celiac disease and gluten consumption

What happens when a gluten intolerant person eats a grain product? Gluten fragment resistant to the action of hydrochloric acid and digestive enzymes of the gastrointestinal tract penetrates the wall of the small intestine. Under the influence of enzymatic transformations, it transforms into a form that it stimulates the cells of the immune system to release inflammatory factors. Chronic inflammation of the mucosa of the small intestine leads, in turn, to damage and atrophy of the intestinal villi through which the digested nutrients enter the circulation.

The result is impaired absorption of proteins, fats, sugars, vitamins and minerals into the bloodstream. The immune system’s response is not limited to the gut wall alone. The course of the disease also produces antibodies, the presence of which in the blood makes it easier to diagnose celiac disease. Symptoms after eating gluten in patients are mainly the stimulation of the immune system, which produces antibodies and is responsible for inflammation in the body. As a consequence, there is a weakening of the small intestine and the appearance of symptoms mainly on the part of the digestive system, incl intestinal villi inflammation. You may get a very severe headache, even migraine, after eating a product containing gluten.

Celiac disease – diagnosis

The primary care physician should refer the patient to a gastroenterologist (in the case of a child, to a pediatric gastroenterologist).

There is no one commonly available diagnostic test that would clearly confirm or rule out gluten intolerance. The key research in the diagnosis of celiac disease is the determination of typical for this disease antibodies. In turn, endoscopy of the upper gastrointestinal tract enables the evaluation of the duodenum, which is the initial segment of the small intestine. Here, celiac disease may be indicated by the flattening or atrophy of the mucosa folds, its uneven surface or the translucency of the blood vessels. The great advantage of endoscopic examination is the possibility of collecting several biopsies (biopsy) from different sites for microscopic examination, which gives an answer to the question of whether there is villi atrophy.

When is a biopsy not performed?

A biopsy is not only performed for the diagnosis of celiac disease in children, but only if the following conditions are also met:

1. the child has symptoms that suggest celiac disease,
2. the study showed a high level of IgA antibodies to tissue transglutaminase (10 times above the upper limit of normal)
3. another blood sample from your baby has EMA antibodies
4. the patient has the HLA-DQ2 and / or HLA-DQ8 haplotype

with symptoms suggestive of celiac disease, high levels of anti-TG2 antibodies [> 10 x upper limit of normal (ULN)] and the presence of EMA in another blood sample. Additionally, the diagnosis of celiac disease can be enhanced by identifying a patient with the HLA-DQ2 or HLA-DQ8 haplotype.

Additional tests may show anemia, an increase in the number of platelets and certain liver enzymes, and a decrease in serum electrolytes or proteins. Further diagnosis reveals, in some cases, a reduction in the concentration of iron and some vitamins, and in bone mineral density.

The final diagnosis of celiac disease is possible with the simultaneous presence of symptoms indicative of this disease (or its suspicion in the case of people in risk groups), the presence of typical antibodies, atrophy of intestinal villi, exclusion of other diseases and improvement of patients’ condition after eliminating gluten from the diet.

Gluten intolerance and celiac disease test – you can order a home cassette test from Medonet Market. The test result can be read after just 15 minutes.

Celiac disease – diet

Celiac disease is a lifelong disease – it cannot be cured. This does not mean, however, that we are powerless against it.

In a gluten-free diet, it is strictly forbidden to consume products containing wheat, rye, barley and – in Polish conditions – oat, as well as triticale and spelled and any products with their addition. You can reach for hemp flour available on Medonet Market.

It is necessary to fill in the missing ones vitamins and mineralsbut essential is a diet that excludes all grain products from wheat, rye, barley, and oats. Such a diet is called gluten-free.

It includes both naturally gluten-free foods and foods with a gluten content of less than 20 mg per 1000 g of product. They are marked with the symbol of the crossed ear.

Naturally gluten-free products include corn, rice, buckwheat, millet, soybeans, potato flour, as well as nuts, fish, eggs, sugar, honey, coffee beans, tea and alcoholic beverages except for beer and malt whiskey. Industrial gluten-free products include gluten-free wheat starch and gluten-free flour.

At Medonet Market you can buy Pro Natura Natural Brown Rice, which is available in 400 g packs and is suitable for people with celiac disease. You will also find Pro Natura organic corn starch there.

Due to the deficiency of the enzyme digesting lactose (milk sugar), which often coexists with celiac disease, sometimes it is also required to temporarily exclude milk and dairy products from the diet, although they are gluten-free in their pure form.

In most people, after following a gluten-free diet, symptoms usually disappear within 2 weeks, and microscopic changes in the small intestine within 6-8 weeks. In rare cases, strong drugs that suppress the immune system are required.

Celiac disease – problems with shopping

Compared to other gastrointestinal diseases, treating celiac disease seems fairly simple. However, these are appearances, which the patients and their families know very well.

Establishing a diagnosis does not always go hand in hand with educating patients about dietary recommendations. Often, within a radius of several dozen kilometers from their place of residence, there is no dietary clinic that would help to create a proper menu. In addition, industrial gluten-free products are usually only available in large cities, and their price is higher than traditional products. It is also important to pay attention to the way food is stored at home, because neglect in this regard may lead to gluten contamination of a gluten-free product.

We should also remember that gluten is a frequent addition present, among others, in pates, sausages, yoghurts, ice cream, candies, crisps, sauces, baking powder or powdered cream. Some medications (e.g. painkillers or allergies) may also contain gluten, so it is important to read food labels and medication information leaflets carefully.

Celiac disease – dangerous complications

Both the lack of treatment and inaccurate adherence to dietary recommendations lead to complications. Among them, the greatest risk is the development of malignant neoplasms, e.g. of the throat, esophagus, small intestine. The primary tumor may also appear outside the gastrointestinal tract, e.g. in the thyroid gland, liver, lymph nodes. Other possible complications include ulcerative enteritis, osteoporosis, infertility, recurrent miscarriages, premature birth, and early menopause. Interestingly, people with celiac disease are probably less likely to develop breast cancer.

The important thing is that it comes with celiac disease other comorbid conditions may arise. They are mainly related to the undiagnosed form of asymptomatic celiac disease. These can be conditions:

1. nervous system: depression, neurosis, dementia, dementia, myopathies, balance and speech disorders, gluten ataxia, peripheral neuropathy, epilepsy, nystagmus,
2. the hematopoietic system: iron deficiency anemiavitamin K deficiency (thrombocytosis) vasculitis
3. skeletal system: early osteoporosisfairly short stature, rheumatoid arthritis, failure to reach peak bone mass
4. lung diseases: sarcoidosis, asthma,
5. kidney and liver diseases: glomerulonephritis, fatty liver, cirrhosis, chronic hepatitis,
6. endocrine diseases: type I diabetes, fertility disorders, miscarriage tendency, Hashimoto’s disease, pancreatic diseases, Addison’s disease.
7. high cholesterol
8. aphthous stomatitis.

Better prospects for people with celiac disease

Fortunately for patients, work continues on new methods of treating celiac disease, for example by adding to products containing gluten bacterial enzymes that digest this protein and weaken its destructive effect on the intestinal mucosa. Another direction of research is the development of gluten-free cereal varieties through genetic engineering.

Read more about the gluten-free diet in Celiac Nutrition!

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