Celiac 1

Colorado Technical University

Celiac, the Underdiagnosed Killer

By

Cindy Sherman; student id#

Professor Barb Power

Submitted in Partial Fulfillment of the Requirements for

INTD 111 CSC

Creating Academic and Professional Success

Colorado Springs, Colorado

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Celiac, the Underdiagnosed Killer

Celiac Disease (CD) is an underdiagnosed silent killer. It is a form of gluten intolerance

and is widely misunderstood. This potentially debilitating condition can manifest in

digestively disruptive ways, or it can be the source problem for a host of other

seemingly unrelated health challenges where no digestive symptoms are present.

Untreated CD can be a gateway to gallbladder and liver problems, rheumatoid arthritis,

pancreatic insufficiency, cancer of the small bowel, esophagus, or pancreas, and other

autoimmune disorders. (Dr Scot Lewy (n.d.) Gallbladder Problems Common In Celiac

Disease May Be Missed By Doctors Because Of Normal Tests.) Although CD can be

difficult to diagnose, if found early enough, it can be treated easily. The greatest

challenges are in getting educated about all the less obvious locations gluten may be

lurking, and of course the inconvenient, frustrating reduction of foods a celiac diseased

person can consume. A gluten free diet (aka GFD) for the rest of one’s life is vital for

improved health and longevity. Even trace exposures on a semi-regular basis can have

a devastating effect on both one’s quality of life and life span if they are celiac or gluten

intolerant.

Celiac is a type of gluten intolerance. When a person with CD consumes food

with gluten, even a trace amount, there is a cascade of autoimmune responses that

take place in the digestive tract that a normal person does not experience. It is

important to understand information about other forms of gluten intolerance and wheat

allergies. They are not CD, however, they may exist alongside CD, and complete relief
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may require addressing both conditions. Although CD’s hallmark effect is a damaged

small intestine, it should be viewed as a whole body condition. This is because when

the small intestine cannot absorb nutrients properly, leaky gut syndrome and

malabsorption result causing the entire body to suffer. Other conditions can then

develop over time without apparent symptoms and be deadly.

CD is a condition in which if gluten is consumed, the body launches an attack in

the small intestine aimed at the gluten. The attack is severe enough to also destroy the

mucosal lining in the small intestine including the villi that line the small intestine and are

pictured below. These villi serve to increase surface area and provide a variety of

purposes. One purpose is to assist in nutritional absorption and another is to protect

and strain out undigested particles or toxins. When they are destroyed or even

diminished in functioning a person’s health is at risk. Destroyed or diminished villi in the

small intestine is what determines if someone is CD or not, as long as it occurs from the

consumption of gluten. (“About Celiac Disease,” n.d.)

Gluten is a composite of the two proteins gliadin and glutenin. They are the well

known proteins in wheat, rye, barley and all grains derived from these grains. The word

gluten translates to “glue” in Latin. This glue-like protein does not fully breakdown in the

gut. It is the sticky substance in dough that gives it elasticity.

Many CD enthusiasts suggest that those with any gluten intolerance conditions

consider avoiding oats as well. Oats don’t inherently contain gluten, but many sources

of oats now test positive for gluten due to crop and factory cross contamination. One

does not need to have symptoms to be in danger of serious damage from secondary

diseases. Therefore, even trace amounts of gluten from cross contamination of grains,
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trace amounts from the wheat in soy sauce and teriyaki sauce, or even from a shared

grill should be monitored and avoided.

Below is a diagram that shows normal villi that line the small intestine. (Conor G.

Loftus M.D., Joseph A. Murray M.D., 2010, “CELIAC DISEASE”)

The following picture is an actual photo of the difference in villi in a healthy

person, and one who has had extreme damage from being celiac and consuming
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gluten. (R. JOHN PRESUTTI, DO, JOHN R. CANGEMI, MD, HARVEY D. CASSIDY,

MD, and DAVID A. HILL, DO. (12/15/2007) Celiac Disease, Fam Physician. Figure 3.)

“Endoscopic and biopsy findings in patients with and without celiac disease. (A) High-

definition endoscopic photo of normal small intestine. The villi are clearly visible with no

evidence of atrophy or scalloping of the folds. (B) Biopsy specimen of normal small

intestine (hematoxylineosin; original magnification, × 100). (C) Pill-Cam image of small

intestine in a patient with celiac disease, showing scalloping of the mucosal folds

(arrows) characteristic of a malabsorption pattern. There is also evidence of villous

atrophy compared with normal. (D) Biopsy specimen of small intestine in a patient with

celiac disease (hematoxylineosin; original magnification, × 100). Note the loss of villous

architecture. “
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One of the challenges with proper diagnosis is that while there are some people

who have classic symptoms of celiac, some may have none at all, and some of the

symptoms may mimic other conditions. These conditions include microscopic colitis,

pancreatic insufficiency, inflammatory bowel disease, ulcerative jejunoiletis, collagenous

sprue, and T-cell lymphoma. (R. JOHN PRESUTTI, DO, JOHN R. CANGEMI, MD,

HARVEY D. CASSIDY, MD, and DAVID A. HILL, DO. (12/15/2007) Celiac Disease Fam

Physician. Section Follow Up, para 2.)

Unfortunately whether you have symptoms or not, if you do not adhere to a

gluten free diet, you are at risk for a host of other conditions. Here are some of the
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classic symptoms listed by the National Digestive Disease Information Clearinghouse

(NDDIC) What are the symptoms of celiac disease? (n.d.)

“Digestive symptoms are more common in infants and young children and may include

• abdominal bloating and pain

• chronic diarrhea

• vomiting

• constipation

• pale, foul-smelling, or fatty stool

• weight loss

Irritability is another common symptom in children. Malabsorption of nutrients

during the years when nutrition is critical to a child’s normal growth and development

can result in other problems such as failure to thrive in infants, delayed growth and short

stature, delayed puberty, and dental enamel defects of the permanent teeth.

Adults are less likely to have digestive symptoms and may instead have one or

more of the following:

• unexplained iron-deficiency anemia

• fatigue

• bone or joint pain

• arthritis

• bone loss or osteoporosis

• depression or anxiety

• tingling numbness in the hands and feet

• seizures
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• missed menstrual periods

• infertility or recurrent miscarriage

• canker sores inside the mouth

• an itchy skin rash called dermatitis herpetiformis

People with celiac disease may have no symptoms but can still develop

complications of the disease over time. Long-term complications include malnutrition—

which can lead to anemia, osteoporosis, and miscarriage, among other problems—liver

diseases, and cancers of the intestine.”

Currently, there are three common tests for diagnosing celiac, however, the tests

are not always accurate, and not all medical professionals are proficient at

understanding the results of the tests. The three tests as shown by the National

Digestive Disease Information Clearinghouse (NDDIC) How is celiac disease

diagnosed? (n.d.) are: 1) A blood test to show high levels of anti-tissue

transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). A person

with CD may test negative with this test. If CD is implicated in other ways, the person

should have additional tests, and have an intestinal biopsy. A person who intends to

have these blood test must continue to consume gluten containing foods so that the

antibodies the test intends to find will show up if they have CD. 2) An Intestinal Biopsy

is done if symptoms and blood work appear to confirm CD. It is important to have this

biopsy include at least 4 different areas of the intestine because of the varying degree

and locations in the small intestine that may have been affected. 3) A test for Dermatitis

Herpetiformis (DH) is the third common possible way to diagnose celiac. DH is an itchy

blistery skin condition, consequently a skin biopsy is used to confirm this form of CD. It
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is interesting to note that most people with DH have no digestive symptoms, yet they

may still have damage to the small intestine.

Many people have had great success in following a diet called “the specific

carbohydrate diet” (SCD) for at least the first year after diagnosis. The diet is suggested

for people with a variety of digestive orders, not just CD. It was created to support and

expedite the healing of the gut during that first year following diagnosis. This is because

many innocent foods a person with CD eats might still be problematic just after their

diagnosis. Eliminating the antagonist may not be enough at first. CD and other

digestive orders are inflammatory conditions. The SCD is void of all foods with gluten,

and only includes foods that either diminish inflammation or are at least neutral. The

Specific Carbohydrate Diet was developed by the Canadian biochemist Elaine

Gottschall who published the book “Breaking the Vicious Cycle.”

Additional resources for learning about CD what foods to avoid, and other

miscellaneous information about this condition include:

1) www.celiac.com This is one of the most popular sites about CD. There are four main

doctors who write many of their articles.

2) http://www.scdrecipe.com/ This site has a search engine that allows you to enter in a

food or ingredient in a search engine to see if it is considered “legal” or “illegal”

according to the specific carbohydrate diet’s list of acceptable and not acceptable foods.

If it is not legal, articles will be listed explaining why, and if it is legal, recipes will be

displayed that contain that food or ingredient.

3) http://nowheatnodairynoproblem.com/ This site is a great source of information and

gluten free recipes. The creator, Lauren Hoover, was a pastry chef who discovered that
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she had celiac. She created this site and the recipes with the intention providing gluten

and dairy free foods that are delicious and have textures characteristic of the traditional

dishes celiacs can no longer have.

4) http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed has numerous articles about CD.

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References:

Conor G. Loftus M.D., Joseph A. Murray M.D. (2010) CELIAC DISEASE, Division of

Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.)

retrieved 6/10/10 from http://www.acg.gi.org/patients/gihealth/celiac.asp

About Celiac Disease (n.d.) retrieved 06/10/2010 from http://www.csgmv.org/whatis.htm

R. JOHN PRESUTTI, DO, JOHN R. CANGEMI, MD, HARVEY D. CASSIDY, MD, and

DAVID A. HILL, DO. (12/15/2007) Celiac Disease Fam Physician, Mayo Clinic,

Jacksonville, Florida Am. 2007 Dec 15;76(12):1795-1802.) Retrieved 6/10/2010 from

http://www.aafp.org/afp/2007/1215/p1795.html

What are the symptoms of celiac disease? and How is celiac disease diagnosed? (n.d.)

This publication was reviewed by Ciaran Kelly, M.D., Beth Israel Deaconess

Medical Center; Mitchell Cohen, M.D., Cincinnati, Children’s Hospital Medical Center;

Walter Reed Army Medical Center; National Foundation for Celiac Awareness; Celiac

Disease Foundation; Celiac Sprue Association/USA, Inc.; and Centers for Disease

Control and Prevention staff. The gluten-free diet chart was reviewed by Alice Bast and

Nancy Dickens, National Foundation for Celiac Awareness; Cynthia Kupper, R.D., C.D.,

Gluten Intolerance Group; and Elaine Monarch, Celiac Disease Foundation. Retrieved

06/10/2010 from http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/

Dr Scot Lewy (n.d.) Gallbladder Problems Common In Celiac Disease May Be Missed

By Doctors Because Of Normal Tests Retrieved 06/10/2010

http://ezinearticles.com/?Gallbladder-Problems-Common-In-Celiac-Disease-May-Be-

Missed-By-Doctors-Because-Of-Normal-Tests&id=229284