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October is National Celiac Disease Awareness Month

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Margo Kerrigan, M.P.H., Area Director
Indian Health Service California Area Office

Celiac disease is an autoimmune digestive condition. It is triggered by eating foods containing gluten, which is found in bread, pasta, cookies, and many other foods containing wheat, barley, or rye. Celiac disease is an autoimmune disease, meaning that it causes the body to produce antibodies that attack its own organs. When someone with Celiac disease eats food containing gluten, it causes an autoimmune reaction that damages their small intestine, and makes it difficult or impossible for them to absorb nutrients from their food. Over time, this can cause vitamin deficiencies that can affect other parts of the body, including the brain, bones, liver, and other systems, and lead to other illnesses. In children, it can lead to stunted growth. Celiac disease affects men and women in equal numbers.

While Celiac disease was once thought to be extremely rare, researchers now estimate that it affects 1 of every 133 people in the United States. Approximately 120,000 people have been diagnosed with Celiac disease in the United States, though it is estimated that there are likely 3 million Americans living with the disease. Celiac disease tends to run in families, but it is possible for an individual to have it even if no close family members have been diagnosed with the disease. On average, it takes 11 years from the initial onset of symptoms for patients to be diagnosed, likely because the symptoms of the disease can mimic other conditions, including Irritable Bowel Syndrome (IBS), gastric ulcers, Crohn's Disease, parasite infections, anemia, or even skin disorders.

Symptoms of Celiac disease

There are many signs of Celiac disease, but the symptoms vary among individuals. Some people have no symptoms and others have only mild symptoms. Still others have a very severe reaction to any foods containing gluten. The most common symptoms of Celiac disease affect the digestive tract and include:

Flatulence (gas)
Abdominal bloating
Abdominal pain

However, about one in three people with Celiac disease may have no gastrointestinal symptoms at all.

Some less obvious symptoms of Celiac disease include:

Irritability or depression
Alopecia (hair loss)
Headaches and Migraines
Joint pain
Infertility or recurrent miscarriages
Muscle cramps or weakness
Skin rash
Mouth sores
Dental and bone disorders (such as osteoporosis)
Tingling in the legs and feet (neuropathy)
Weakness and fatigue
Stunted growth in children
Weight loss
Frequent or easy bruising
Fluid retention

The symptoms of Celiac disease also tend to be different depending on age. Infants with Celiac disease usually have diarrhea, fatty stools, abdominal cramps and distension, irritability, and failure to thrive and grow. These symptoms typically start after introduction of cereals into their diets. Children with Celiac disease typically have diarrhea, fatty stools, flatulence (gas), short stature, and weight loss. Some children will experience spontaneous remissions (reduced or no symptoms) in adolescence, but the symptoms will usually reappear later in adulthood.

Adults with Celiac disease may have diarrhea, fatty stools, weight loss and flatulence; however, many either have no symptoms or only vague abdominal discomfort, bloating, abdominal distension and excess gas. Some patients with Celiac disease are mistakenly diagnosed with Irritable Bowel Syndrome since the symptoms are so similar.

People with Celiac disease tend to have other autoimmune diseases as well. An estimated 10% of patients with Celiac disease also have dermatitis herpetiformis, a skin disease that produces an itchy rash on the extremities, buttocks, neck, trunk, and scalp. People with Celiac are also more likely to have painful mouth ulcers, autoimmune thyroid disease (Hashimoto's Disease), Rheumatoid Arthritis, and Systemic Lupus. Celiac disease also increases the risk of developing all gastrointestinal cancers. It is also estimated that approximately 10 percent of individuals with Type I Diabetes and 16 percent of individuals with Down Syndrome have Celiac disease.

Celiac disease cannot be cured. However, it can be managed by strictly following a gluten-free diet, which means avoiding all foods containing wheat, barley, or rye. A consultation with a skilled dietician is helpful in identifying what foods are safe to eat. A dietician can also help identify and correct nutritional deficiencies that may have developed due to the disease.

When you should see a doctor

If you experience any of the signs or symptoms of Celiac disease, see your doctor. If someone in your family is known to have Celiac disease, let your doctor know. First degree relatives (parent, child, or sibling) of someone with Celiac have a 1 in 22 chance of having the disease themselves. A blood test can detect the presence of antibodies. If the tests are positive, the provider usually orders an upper endoscopy (a procedure in which a lighted, flexible tube is inserted into the upper gastrointestinal tract) to take a sample of tissue from the first section of the small intestine.

Genetic testing is also available; the DQ2 and DQ8 genes are associated with Celiac disease. However, while only individuals with these genes can develop Celiac disease, not everyone with them will develop Celiac disease. One in three people carry one of these genes, so the presence of them does not mean that you have or will develop Celiac. However, it can rule out Celiac disease in individuals with similar symptoms.

Should I try a gluten-free diet?

If you suspect you have Celiac disease, see your doctor before trying a gluten-free diet. The blood tests to determine the presence of antibodies may not be accurate if you have not been eating foods containing gluten.

Patients diagnosed with Celiac disease must follow a gluten-free diet in order to control symptoms and prevent damage to their intestinal tract and other organs.

However, other people may also benefit from a gluten-free diet, including patients diagnosed with wheat or gluten sensitivities. These patients may exhibit symptoms of Celiac disease, including the blood antibodies, but do not have the damage to the small intestine found in Celiac disease. A gluten-free diet has also shown to improve the symptoms of other autoimmune diseases, such as autoimmune thyroid disease (Hashimoto's), type-1 diabetes, Rheumatoid Arthritis, Systemic Lupus, and Multiple Sclerosis.

Fortunately there are many prepared food products that are now gluten-free. These are usually labeled with a "g" symbol on the packaging. A dietician can also suggest recipes that do not use gluten. For people trying to follow a gluten-free diet, it is also important to remember that there are many hidden sources of gluten in prepared foods such as salad dressings and potato chips, and in even some drinks, including herbal teas and beer.

For more information:

Celiac.com website: http://www.celiac.com Exit Disclaimer – You Are Leaving www.ihs.gov

Mayo Clinic Celiac website: http://www.mayoclinic.com/health/celiac-disease/DS00319 Exit Disclaimer – You Are Leaving www.ihs.gov

Web MD Celiac website: http://www.webmd.com/digestive-disorders/celiac-disease/celiac-disease Exit Disclaimer – You Are Leaving www.ihs.gov

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