Celiac Disease, What does it mean?

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Celiac disease is an autoimmune disorder that affects approximately 1 in 100 people all over the world [3,5]. It is an inflammatory condition of the bowel trigged by gluten consumption [1]. In particular, gluten acts as an antigen and triggers an immune reaction in which the antibodies are directed against the small gut (auto-antibodies).

Due to the autoimmune response the surface of the intestine becomes inflamed. Villi (that are digitiform structures for the nutrient absorption) are severely compromised with a negative impact on the nutrient absorption [5]. In particular villi decrease in number, with less absorptive area and enzyme activity[2].

Celiac disease can develop at any stage of life [8] even though the most common onset is during early childhood (8-12 months) or during later adulthood (40-60 years old).

Women are more likely to suffer from this condition than men (prevalence 2 - 3 times higher).

This disorder is particularly critical when present in children because if it is not treated immediately, it can cause hindrance in their growth [7].

What is Gluten?

Gluten is a general term for proteins found in rye, wheat and barley [6]. Also some hybrids such as kamut and triticale are also sources of gluten [1]. It is therefore present in a lot of products such as pasta, cereals, bread and baked products etc. Gluten does not contain high nutritional values, but it is important because it helps the food to maintain its shape and structure [8].

Sometimes, people suffering from celiac disease can have problems consuming oat as well. Oats in fact, can be contaminated with gluten during the manufacturing process.

Furthermore some people can be sensitive to a protein (called AVENIN) found in oats that is very similar to gluten [7]. For this reason people diagnosed with celiac disease are recommended to eat small amounts of oats (only if it is tolerated).

People suffering from this condition should pay attention to unsuspecting products, such as meat and cold cuts because sometimes gluten is added to these products during processing.

Moreover gluten can also be added as a thickener, filler or carrier for flavours in different products, especially soups, sauces and ready meals [6].

People suffering from this condition must also pay attention to product labels. Two main captions are permitted by the legislation: gluten free and very low gluten [9].

  • Gluten free products: are those products that contain <20 mg/kg of gluten. This classification includes products that are naturally free from gluten, non-contaminated oats and substitute products. Some gluten free products can also be indicated with the crossed grain symbol.
  • Very low gluten products: are those products containing <100 mg/kg of gluten. This classification includes specialist substitute products.

What are the symptoms?

The symptoms of this disorder can range from mild to severe and can come and go. The principal symptoms are [7]:

Dermatitis herpetiformis is the dermatological manifestation of celiac disease [2]. This appears as itchy lesions and rashes especially on the knees, legs, trunk, neck and elbows. It isn’t common and happens in approximately 1/ 5 people with celiac disease. Usually it is treated with a gluten free diet. To accelerate the healing of rashes and lesions a medication can also be prescribed.

What causes celiac disease?

Unfortunately what causes this condition is still unknown; however genetic and environmental factors play an important role [7]. Primarily people who have first degree relatives with this celiac disease are more likely (10% risk) to also have this condition.

Additionally people who, during childhood, suffered from digestive system infections and started to eat food containing gluten before 3 months old seem to have a higher risk of suffering from this disease [7]. From recent research it appears also that it is important to breast feed a baby when he/she consumes gluten for the first times.

Different health conditions can also increase the chance of suffering from celiac disease such as:

  • Type 1 diabetes,
  • Ulceratives colites
  • Neurological disorders

Diagnosis and cure

This disease is diagnosed through:

  • Blood tests (searching for specific antibodies).
  • A duodenal biopsy to confirm the diagnosis (gold standard) [6]

Unfortunately there is not a specific treatment for this condition. The only effective cure is a strictly gluten free diet [5].

On the basis that this is a lifelong condition a person should continue a gluten free diet. In fact a re-exposure to gluten can reactivate the disease and the symptoms [3].

The symptoms should improve in about 4-5 days of a gluten free diet adherence [2].

It is very important to treat celiac disease. If not treated different complications can arise [8] such as:

  • Very severe damage to the villi. In the most serious cases, a complete atrophy can
  • also occur.
  • Development of more serious autoimmune diseases such as type two diabetes,
  • multiple sclerosis, etc.
  • Osteoporosis
  • Miscarriages during pregnancy.
  • Low birth weight babies.
  • Vitamin and mineral deficiencies (iron deficiency anaemia, vitamin B12 and
  • folate deficiency anaemia)
  • Neurological manifestations.
  • Various forms of cancer.

People suffering from this disease can also suffer from different nutrient deficiencies due to the damage in the small intestine and due to the insufficient nutrient absorption.

Often people who are recently diagnosed with this condition have a poor micronutrient status especially for iron, calcium, magnesium, zinc, folate, niacin, riboflavin, vitamin B 12 and vitamin D. Additionally they can also have the incorrect intake of fibre, protein and calories.

The majority of people do not need any supplementation once gluten is removed from the diet. A gluten free diet in fact allows and individual to recover from the symptoms as well as from absorptive issues.

Adults with this disease are advised to increase their calcium intake to optimize their bone health and decrease the risk of suffering from problems with their bones in the future [6]. A daily intake of 1000 mg of calcium is recommended for these adults. Moreover, for men > 55 years and post-menopausal women 1200 mg daily is recommended [4].

What are gluten free foods?

Grains and starches that can be used freely are [2]:

  • Amaranth
  • Quinoa
  • Beans
  • Rice
  • Sorghum
  • Soy
  • Tapioca
  • Rice
  • Corn
  • Potatoes

Furthermore currently on the market there are a lot of gluten free products such as pasta, bread, cakes, and biscuits specifically created for people suffering from this disease.

These products can also be eaten safely:

  • Most dairy products.
  • Fruit and vegetables.
  • Meat and fish.

A Mediterranean diet seems to be beneficial for people suffering from this disorder. Consuming fruits, vegetables, nuts and oil as source of fat is recommended. Moreover, lycopene, quercetin and tyrosol may control the pro-inflammatory genes involved in this condition.

In particular, lycopene is a carotenoid found in red fruits and vegetables such as tomatoes, pink grapefruit and water melon. Quercetin is a flavonol found in apples, citrus fruit, tea, broccoli and red onions [2].

Lastly, people suffering from this condition could find the help of a dietician helpful or to joining one of the several celiac associations operating around the world.

This is the link for the UK celiac association: https://www.coeliac.org.uk/about-us/who-we-are

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  1. Bascuñán, K. A., Vespa, M. C., & Araya, M. (2016). Celiac disease: understanding the gluten-free diet. European Journal of Nutrition, 1-11.
  2. Escott-Stump, S. (2015). Nutrition and diagnosis-related care. Wolters Kluwer.
  3. Foschia, M., Horstmann, S., Arendt, E. K., & Zannini, E. (2016). Nutritional therapy–Facing the gap between coeliac disease and gluten-free food. International Journal of Food Microbiology.
  4. Geissler, C., & Powers, H. (2010). Human nutrition. Elsevier Health Sciences.
  5. Kurada, S., Yadav, A., & Leffler, D. A. (2016). Current and Novel Therapeutic Strategies in Celiac Disease. Expert Review of Clinical Pharmacology, (just-accepted).
  6. Webster-Gandy, J., Madden, A., & Holdsworth, M. (Eds.). (2011). Oxford handbook of nutrition and dietetics. OUP Oxford.
  7. http://www.nhs.uk/conditions/Coeliac-disease/Pages/Introduction.aspx
  8. https://celiac.org/celiac-disease/what-is-celiac-disease/
  9. http://labellingtraining.food.gov.uk/module11/overview_2.html

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