Going Against the Grain: Gluten Intolerance and Celiac Disease

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By Dr. Tim Moser, Denver House Calls- Denver
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Karen was feeling fatigued. “Join the club” was the response she received from her friends whenever she mentioned her unexplained fatigue.  Despite eating a healthy diet consisting of whole grains, fruits, and vegetables, and getting at least 7 hours of sleep per night, Karen was finding it more difficult to get through her day.  The morning work out at the gym was almost too much to bear.  In addition, vague abdominal pain was an almost daily occurrence.  Mild diarrhea was also present.

Karen finally had enough, and made an appointment to see her primary care doctor.  Screening blood tests were obtained, which showed iron deficiency anemia, as well as a deficiency in B complex vitamins.  An upper and lower endoscopy were performed to determine the source of blood loss.  A biopsy of the small intestine confirmed the diagnosis of sprue, also known as celiac disease or gluten intolerance.

Gluten intolerance is a very common condition that is seen more often in females, and can occur at any age.  Since the symptoms and signs may be subtle, many persons are unaware an allergy is present.  Typical ‘allergy’ reactions that can be seen with bee stings or pollen are usually absent with gluten intolerance.

The miracle of the small intestine

To absorb the nutrients and calories consumed, a complex process is needed.  This starts with chewing food, which breaks it down into smaller pieces that offer more surface area for digestive enzymes to work.  As food passes from the stomach into the small intestine, these digestive enzymes are released by the pancreas to break down food into the very elementary particles and substances that can easily be absorbed.

An average person’s small intestine measures about 20 feet in length. Although this is quite a distance for the food to travel, additional help is needed to increase the surface area for nutrient absorption.  The small intestine is lined with microscopic, finger-like projections called villi and micro villi, which increase the surface area about a trillion times (not quite, but you get the picture).

Mess with the villi, and serious problems arise absorbing needed nutrients.

How gluten affects the colon

Gluten is a perfectly good substance found in all sorts of grains, to include wheat, barley, and rye.  There may be some gluten in oats, also.  In those persons sensitive to gluten, a condition called celiac disease develops.  Those essential microvilli in the small intestine may decide gluten is not such a grand thing after all.  In response, the microvilli shrink and practically disappear from the intestinal lining.  The result is a tremendous loss in the ability to absorb what the body needs.  This can result in a variety of health problems, to include vitamin or mineral deficiencies, anemia, abdominal pain, bloating, weight loss, fatigue and abnormal stools.

Diagnosing the problem

Probably the best way to diagnose gluten intolerance or celiac disease is a biopsy of the small intestine.  The small intestine is easily accessed by performing an upper endoscopy, where a lighted tube is passed down the throat and into the stomach, while the patient is under sedation.  A very small piece of the intestinal lining is removed using a small pincher device.  Bleeding is very minimal, totaling a few drops in most cases.

The sample is then sent to a Pathologist for examination under a microscope.  If the characteristic changes are seen, then the diagnosis is made.

A blood test is an alternative method for diagnosing celiac disease.  Specifically, a test looking for anti-tissue transglutaminase antibodies is used.  This test is very accurate if the patient is currently eating gluten in the diet.  If a gluten-free diet is followed for as little as several weeks, the test will be negative, even though a sensitivity to gluten exists.  This is known as a false negative test result.

Treatment

The cornerstone of treatment for sprue is diet restrictions, avoiding all exposure to gluten.  This is harder than it sounds, for gluten may be a hidden ingredient in a variety of foods and beverages.  There is no medication that can cure gluten allergy.  Once sensitivity or allergy to gluten develops, it remains for life.  With proper changes in the diet, the associated health problems with celiac disease can improve or resolve, leading to a more normal life.

Want more information about celiac disease and gluten sensitivity?

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001280/

http://www.mayoclinic.com/health/celiac-disease/DS00319