OPTIMIZE YOUR HEALTH
Living With Celiac Disease

What Does Celiac Disease Have to Do With Me? The Importance of Identifying Subclinical Celiac Disease
By Sue Kim-Saechao, RN, MSN, CRNP, and Jannet Huang, MD, FRCPC, FACE, ABHM

Celiac disease is more common than many people realize. Even individuals without gastrointestinal complaints can be affected by celiac disease. Establishing the diagnosis of subclinical celiac disease is of potential importance for four reasons: the danger of malignancy, the presence of unsuspected nutritional deficiencies, the association with low-birth weight infants in affected mothers, and the occurrence of autoimmune disorders.

Celiac disease, also known as gluten intolerance, is an inherited autoimmune disorder affecting 1 in 133 Americans. It is an inflammatory condition in which our immune system attacks the small intestine when gluten is consumed. Unfortunately, gluten is used in many food products so treatment can be challenging (for more info, please read Nutrition News). Most people have no signs or symptoms for years and the disease is suddenly “activated” for an unknown reason, whereas for others, symptoms can start as young as age 2. Symptoms can range from bloating, irritable bowel symptoms, constipation, diarrhea, weight loss, and malnutrition, to no gastrointestinal symptoms at all. Whether gastrointestinal symptoms are present or not, all affected by celiac disease can manifest the nutritional consequences of malabsorption, such as iron/folate/Vitamin D deficiency, chronic fatigue, chronic pain, and unexplained fractures.

The risk of malignancy, specifically non-Hodgkin’s lymphoma and other gastrointestinal tract malignancies is modestly increased in patients with celiac disease. Interestingly, risk of cancers of the breast and possibly lung appears to be reduced.

No single test can confidently establish the diagnosis of celiac disease in every individual. All testing should be performed while patients are on a gluten-containing diet. As a general rule, testing should begin with screening blood tests such as endomysial antibodies, tissue transglutaminase antibodies and anti-gliadin antibodies. Patients with a positive IgA endomysial or transglutaminase antibody tests should undergo a small bowel biopsy. Exceptions are those who have biopsy-proven dermatitis herpetiformis in whom the diagnosis can be established without a small bowel biopsy. HLA typing for DQ2 and DQ8 may be useful in individuals with equivocal small bowel biopsy findings since celiac disease is unlikely if neither is present. The diagnosis of celiac disease is confirmed when symptoms resolve subsequently on a gluten-free diet.

Who Should Be Tested

Testing for celiac disease should be considered in the following groups of patients:

• Those with gastrointestinal symptoms including chronic diarrhea, malabsorption, weight loss, and abdominal distension.

• Individuals without other explanations for signs and symptoms such as persistent elevation in liver enzymes, short stature, delayed puberty, iron-deficiency anemia, recurrent fetal loss, and infertility.

• Symptomatic individuals at high risk for celiac disease including patients with type 1 diabetes mellitus or other autoimmune endocrine disorders (such as Hashimoto’s thyroiditis and adrenal insufficiency), first- and second-degree relatives of individuals with celiac disease, patients with Turner, Down, or Williams syndromes.

• There are other conditions in which testing may also be considered such as patients with irritable bowel syndrome, persistent apthous stomatitis, autoimmune diseases (lupus, rheumatoid arthritis), primary biliary cirrhosis, peripheral neuropathy, cerebellar ataxia, Sjogren's syndrome, recurrent migraine, and dental enamel hypoplasia.

Fortunately, in celiac disease, removal of gluten from the diet brings about quick relief of symptoms, intestinal healing, and resolution of symptoms, usually within weeks to months.

Our goal at The Center for Optimal Health is to provide a holistic, comprehensive approach so we can accurately diagnosis, treat, and prevent illnesses for the best quality of life possible.

Resources:

• The Celiac Disease Foundation
• The Celiac Sprue Association
• The Celiac Disease and Gluten-free Diet Support Page
• The Gluten Free Pantry (offers a variety of gluten-free products)

—October 2007

Back to October Wellness e-Letter