Celiac Disease and Gluten Free Diet

Celiac Disease is caused by an immune response directed to the small intestine due to the immune complexes deposited in the mucosa after ingestion of foods containing gluten. The endothelium (or the inner most lining of the small intestine) is then damaged along with the intestinal folds that increase the absorptive surface, and the villi that are responsible for absorbing nutrients.

Foods containing gluten are abbreviated as BROW, to better put to memory. This stands for barley, rye, oats and wheat. Some gluten-containing dishes and foods that you’d want to avoid are donuts, dumplings, crackers, cookies, biscuits, bread, hamburger buns, Graham crackers, ice cream cones, waffles, pancakes, pasta, and pizza crust-basically almost everything that taste good.

Upon visual inspection of the upper small intestine (where the affectation is most concentrated) of someone with the disease, it appears shiny, cobble-stoned and thin. The shininess and cobble-stoned appearance could be due to the inflammation done by the immune response and the thinness is caused by the destruction of the intestinal folds found in the mucosa.

The pathophysiology of this disease explains the malabsorption of nutrients causing the train of signs and symptoms, and if not treated, secondary diseases and complications. Firstly, due to the damage done to the absorptive and secretory bodies in the mucosa, the secretion of intestinal hormones such as secretin and cholecystokinin-pancreozymin is drastically reduced. The pancreas and gallbladder are then affected, also decreasing their secretion of enzymes and bile to help digest the nutrients, especially fats.

Without the secretory capabilities of these organs, further digestion, not done by the stomach is impeded. Added to the lack of absorptive means of the small intestine, the resulting stool (which is evacuated frequently) is bulky, foul-smelling, floats in the water and pale in color. This kind of stool is called steatorrhea, and its characteristics can be attributed to the unabsorbed nutrients, generally the fats.

The frequent trips to the restroom result to significant loss of fluids and electrolytes like sodium, potassium and chloride. This causes muscle weakness, among others. Other electrolytes lost like phosphorus, magnesium and calcium are misused mainly due to the compensation of the body. Their absence may cause seizure and involuntary twitching of the muscles. Furthermore, bone and teeth weakness may occur due to the resulting bone reabsorption of phosphorus and calcium.

If this is not treated and progress into a full-blown disease, secondary conditions may ensue. Hyperoxaluria (aka oxalosis) may result due to the absorption of oxalate in the body which does not normally occur if calcium is readily available.

Fat-soluble vitamins, iron, folic-acid (Vit. B9) and cyanocobalamin (Vit. B12) may become deficient. These may manifest as cheilosis (breaking of the lips), easy bruising, smooth red tongue, fatigue, and anemia.

A gluten-free diet is the only accepted treatment for celiac disease and dermatitis herpetiformis which is a related condition that may co-exist with the disease. This diet excludes barley, rye, oats, wheat, cereals and triticale even as a food additive, flavoring, thickening or stabilizing agent.

Foods such as ice cream and ketchup sometimes use gluten as a stabilizer so it’s best to avoid them. Some over-the-counter and prescription drugs including vitamins also use gluten as an ingredient, so better watch out. Beauty products such as lipstick, lip balm and lip gloss should also be checked because some of these products also use gluten.

Some of the accepted substitutes are rice, tapioca derived from cassava, corn, potatoes, amaranth, arrowroot, montina, millet, lupin, quinoa, sorghum, sweet potato, teff, taro, yam, and chia seed. Beans, nut flour and soybeans can be added to include protein to the diet.