Published: 03/21/2013 - Updated: 02/21/2020
Celiac disease or gluten intolerance is an intestinal disease (Enteopatía), in which the small intestine is damaged by the consuming certain proteins (prolamins) which are present in grains (wheat, oats*, barley and rye). This intolerance causes atrophy of the intestinal mucosa, which prevents the nutrient absorption.
This is because the intestinal mucosa is not smooth, but rather, contains a series of folds in the shape of fingers grouped along the entire intestinal tract (villi) that significantly increase the intestine’s capacity. Exposing the intestinal mucosa to gliadin*** in the celiac individuals destroys the hairs along with their digestive enzymes. This results in a “flat” mucous, consequently reducing surface absorption.
Barley and rye contain prolamins similar to gliadin; hordein and SECALINE, which also produce intestinal lesions in Celiac patients.
There are four types of Celiac disease
*Classic: Includes enteropathy cases (intestinal lesion) gluten sensitivity with clinical symptoms, typical or not, in which a biopsy shows intestinal disruption. Often manifests in genetically predisposed individuals.
* Potential: includes individuals that are genetically predisposed, but those who do not have any data for diagnosis.
* Silent: gluten-sensitive enteropathy cases that are asymptomatic. Although they are genetically predisposed individuals,the intestinal biopsy appears altered.
* Latent : genetically predisposed individuals who consume gluten and have a normal intestinal biopsy, but who were previously diagnosed with Celiac disease via biopsy. These lesions were then healed or later tested negative for Celic disease, but later manifested a typical disruptions.
Celiac disorder is genetic disorder and is found in the genes encoding HLA molecules of chromosome 6. It is believed that patients have close to 5% to 10% chance of developing the disease.
Celiac disease tends to manifest itself mainly in children, affecting 1 in every 300 children. It can, however, also present in adulthood; 7 out of 10 patients were women. It can occur at any age but it most often manifests in children between 9 and 36 months, or during weaning. However, it can also occur for the first time in adulthood (20 – 40 years).
In order to develop the disease the individual not only has to be genetically predisposed, but they also have to consume wheat, oats, or rye. In addition to these two factors there has to be a trigger factor or something to start the immune system’s reaction. These environmental factors that make individuals genetically similar produce different gluten reactions. Once the diseases damages the bowels, it can take months to manifest, or even years.
There are several illnesses associated with this condition:
* Herpetiformis Dermatitis
* Type I Diabetes
* Isolated IgA Deficiency
* Thrombocytopenic Purpura autoimmune disorder
* Autoimmune Anemia
* Down Syndrome
* Epilepsy with intracranial calcifications
* Neurological Disorders
* Gynecological disorders
Those that have a higher percentage of association with celiac disease are:
Dermatitis herpetiformis: Characterized by symmetrical skin lesions that are very itchy.
Insulin Dependent Diabetes: Presents as progressive destruction of pancreatic beta cells that are responsible for producing insulin.
* Recent studies suggest that this grain may be consumed by celiacs, but this must be confirmed.
** Gluten contains two components, one soluble and another insoluble. The toxic component is the soluble portion, known as gliadin.
Celiac disease and Symptoms
For the moment, there is no substitute for a biopsy to determine whether or not to follow a gluten-free diet. Once diagnosed with celiac disease, you should begin a gluten free diet that will continue forever.
Doctors say that the disease itself can not be prevented, but the strict exclusion of gluten prevents its manifestation and progression.
To diagnose this disease you must have an appropriate analysis, which would require a biopsy for histological symptom confirmation.
This disease usually manifests in children 2 to 5 years of age, causing diarrhea , vomiting and changes in character. Celiac’s can often become irritable, tired, and can exerience loss of appetite. Celiac children grow below their potential and sometimes completely stop growing, which may be the only symptom of Celiac spruedisease, if they do not get diarrhea.
The lack of absorption from the intestines that causes diarrhea. Fat is usually the most difficult nutrient to absorb. This usually causes Celiac individuals’s stool to contain large amounts of fat absorbed by the intestine, causing abundant fecal material that is grayish-yellow and very smelly.
When patients develop this disease they frequently look tired and indifferent, ocassionally become shy. They could also develop weak muscle mass and anemia, resulting from iron and vitamin deficiency. Loss in bone calcium was also observed, and a general retardation of growth of bones. The abdomen usually looks swollem while the buttocks look flat. In some cases, individuals may develop skin lesions, mouth sores, vomiting and diarrhea without steatorrhea, which is fat in the stool.
Celiac disease seriously impairs children’s digestion, resulting in weight loss. Growth stops after a few months. Eating a gluten-free diet, however, can recover weight and re-start growth. The body needs 2 to 3 months to reach optimum nutrition levels and to resume growth.
It is strange that the disease could present symptoms during adolescence, and even cases that were diagnosed during childhood could stop producing symptoms even without following a gluten-free diet. However these individuals could experience relapses in adulthood. Most adult cases show that they had symptoms of the disease in childhood. The most common symptoms are diarrhea, weight loss and fatigue.
Most common symptoms:
* Abdominal pain
* Low growth rates
* Poor absorption of nutrients
* Prominent abdomen and Flat buttocks
In the majority of adults:
* Fatigue and general weakness
* Weight loss
Rarely (but increasingly frequent ):
* Nausea, inflammation, constipation and occassional diarrhea
* Muscle cramps, neuropathological symptoms
* Problems with blood clotting
* Joint pain, pathological fractures or osteoporosis
* Sterility in women
An intestinal biopsy is undoubtedly necessary to confirm a diagnosis. It also allows for a comparative study of the evolution of the disease. Samples of intestinal mucosa are analyzed to identify or exclude any typical lesion in the villi in celiacs; this is essential for good self-care. The sample should be handled as little as possible and be examined immediately after being taken. If damage to the mucosa is determine, the magnitude is then graded from 1 to 4, 4 being the most atrophy.
Obtaining the intestinal biopsy can be unpleasant and always involves some sort of minimal risk. We therefore developed a number of blood tests to determine if patients were most likely to be Celiac, and they would then be subjected to a biopsy. These tests determine the level of antibodies against gliadin and the level of antibodies to the intestinal mucosa that were damaged. These antibodies are present in celiacs that consume gluten,whereas the level of these antibodies drops when beginning a gluten-free diet.
Not every stress on the analysis of antibodies in blood point directly to the presence or absence of celiac disease. This is because the absence of said antibodies does not guarantee that hte patient is not Celiac; just the opposite, some patients that have these antibodies are not Celiac.
For the moment, there is no substitute for a biopsy to determine whether or not one should follow a gluten-free. Once diagnosed with celiac disease, you should begin a gluten-free diet that will continue forever.
Do not start a gluten-free diet without having been diagnosed with this disease (with a biopsy showing intestinal gluten-intolerance).
One common error, and one that only postpones Celiac diagnosis, is to prescribe a diet based on the suspicion of intolerance to this protein, or to test positive for specific antibodies without having made an intestinal biopsy to confirm this.
Up to 5 eggs a week are allowed to faciliate digestion: scrambled eggs or omelettes can be made with a little oil, or a poached egg with water or grilled.
In regards to transitory lactose intolerance, you can try how tollearnt you are to yogurt and cheese, and if you continue to have problems, use lactose-free products that are available in the market.
Standards for a gluten-free diet
* Follow a varied and balanced diet to prevent nutritional deficiencies.
* The diet should be strictly followed, as the ingestion of small amounts of gluten can cause lesions that are not always accompanied by symptoms.
* Increase consumption of natural foods that do not contain gluten, gluten free grains: rice, corn, millet and sorghum, vegetables, fruits,milk and dairy products, meats, fish and eggs).
* Reserve consumption of manufactured products labeled “gluten free” for specific cases or situations.
* Reject any product that contains: starch, modified starch (H-4381 to M-4395), starch grains, thickeners (no source indicated), gluten, flour, protein , and vegetable protein meal.
* Obtain products that are made or packaged that appear in the last edition of the gluten-free foods list, which is updated periodically by the Federation of celiac (FACE).
* Read food labels and avoid those that list “questionable ingredients” that can not be verified as gluten-free by the manufacturer, if the ingredients are not described on the label, contact the manufacturer for complete information on the ingredients.
* As a general rule, you should eliminate all products manufactured in bulk and those that are artisinally produced .
* Avoid frying foods in oils where gluten-free pre-fried products have gluten.
* Use caution with corn flour, rice, etc.. that are for sale in bakeries or supermarkets, without certifying the absence of gluten. They may be contaminated if the mill has ground other grains.
* If in doubt, do not consume a product.
Dairy: milk and yogurt, whole or skim (be careful to read labels to ensure the absence of gluten).
Cheeses: all cheeses are allowed, but, like yogurt, you must be careful to read the labels or the international symbol to identify food allowed for celiacs.
Eggs: can be eaten without problems.
Meat: red and white poultry or fish, without any drawbacks.
Vegetables: All are allowed
Fruits: All are allowed.
Grains: you may use corn flour, rice, soybeans, potatoes and cassava.
Bread and biscuits: rice cakes, bread, rice or corn.
Sweets: homemade jams and jellies. In the case of trade, read the ingredients or test the international symbol of food permitted for celiacs.
oils and fats: butter, olive oil and seeds.
Sugar: no problem
Drinks: water, fresh juices, soft drinks and soda.
Condiments: aromatic, spicy and salty (powdered and packaged).
Infusions: tea, chamomile, etc..
Products not allowed
Bread and flour made from wheat, barley, rye, oats.
buns, cakes, pies and other bakery products.
biscuits, cakes and bakery products.
Italian Pasta (spaghetti, macaroni, noodles, etc.). Semolina and wheat.
Malted milkshake and beverages
Distilled fermented beverages from grain: beer, whiskey, water, barley, some liquor …
Products that are manufactured with any of the aforementioned products in any form: starch, modified starch, starch, flour and protein.
During recent years, the CFE has conducted numerous investigations with analytical gluten detection in products that list wheat starch in their ingredients. In most cases the results are usually positive.
Manufacturers claim that wheat starch, from an industrial point of view, technologically is virtually impossible to secure a wheat starch with gliadin levels below 100 ppm (approximately 200 ppm of gluten).
Therefore, it seems clear that the wheat starch is a potentially dangerous ingredient that should not be used in the special manufacturing of products labeled “gluten free” for celiacs.
Make healthy lifestyle habits, daily sleeping hours at least, practice exercise and avoid stress, contribute positively to maintaining a healthy state.
Join Celiac associations in each community that has lists of brands of processed food (eg ham, tomato sauce, various sausages, etc..) that can be safely consumed because they are gluten-free.
Go to meetings for people with the same problem; it helps to share experiences and provides insights.
Avoid frying foods in oils, gluten-free where they were fried products with gluten, as this will contaminate the.
Use caution in bars and restaurants, omelettes could contain yeast, chips can be made in fryers that are also used for frying or Empanadilla croquetas. Before you ask the waiter, inquire as to whether their cooking can meet your demands.
Whenever you leave the house, always take gluten-free crackers, or some other gluten-free product; you never know when you’ll get hungry. If you don’t have anything to eat, you could always have an order of french fries, but avoid using flavoring.
You can buy gluten-free products in specialized shops.
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