When Gluten is a Problem
By Brent Lemberg, MD
Celiac disease has become an
increasingly common diagnosis lately. In the United States nearly two million
people have it and we suspect many more remain undiagnosed. Celiac disease is an
inflammatory condition of the small intestine caused when the body’s immune
system reacts to gluten, which is a protein found in the grains wheat, rye,
barley, and oats.
This immune reaction injures the
tiny villi on the interior walls of the small intestine. The villi are shaped
like fingers and their job during the digestive process is to extract vitamins,
minerals, calories, and fat from the food we eat. However, in people with
celiac disease the tops of the villi are damaged and eventually die off, leaving
the villi short and flat. As a result they are not able to do their job very
well, which can cause difficult symptoms.
Who gets celiac disease?
Celiac disease is a genetic
condition: if your mother, father, sister, or brother has celiac disease, there
is a 7-10 percent chance you have it, too. It affects both children and adults
and is most common in people of northern European ancestry. The symptoms are
often most severe in the teenage years.
What are the symptoms of celiac
Some people experience very mild
symptoms while others suffer from symptoms that are quite severe. Symptoms
include bloating and gas, chronic diarrhea, weight loss, and fatigue. In
children, celiac disease can result in growth retardation issues and small
stature due to the inability of the small intestine to absorb nutrients.
Unfortunately the symptoms of celiac disease are so common to other disorders
that finding the proper diagnosis can take a while. Some mild cases of celiac
disease go on for many years and are not diagnosed until the symptoms grow much
How is celiac disease diagnosed?
The first step in diagnosis is a
blood test to check for antibodies that are produced during the body’s immune
system reaction to the presence of gluten. If the blood test results are
positive, the second step is a small bowel biopsy. This is recommended because
blood tests have a 5 percent rate of false positive. A gastroenterologist
performs the biopsy using an endoscope, which is a narrow, flexible tube that
can be used to collect tiny pieces of tissue from the inside of the small
How is celiac disease treated?
Treatment involves adapting your
diet to avoid wheat, barley, rye, and oats, which can be tricky for teenagers
who consume lots of pasta, pizza, bread, and bagels. Thankfully it is much
easier nowadays to adhere to a gluten-free diet because since 2006
manufacturers have been required to label food that contains gluten. However,
products such as lipstick, multivitamins, and candies also contain gluten so
there are many ways to ingest it without realizing it.
Getting involved with a good
dietitian is very helpful. We refer many celiac disease patients to the
dietitians at the Cayuga Center for Healthy Living (6o7-252-3590). They can
tell you what to eat, what to avoid, and which restaurants serve gluten-free
food. Many celiac disease patients have been struggling with their symptoms for
so long they have forgotten what it is like to feel good. Within a week or two
of eating a gluten-free diet they experience significant improvement.
Lemberg is board certified in gastroenterology and serves on the medical staff
of Cayuga Medical Center. He practices with Gastroenterology Associates of
Ithaca and can be reached at (607) 272-5011.