Introduction To Celiac Disease
Dermatitis Herpetiformis, Wheat Allergy, Gluten
Intolerant Enteropathy, Celiac Sprue Disease
- What is celiac disease?
- Celiac disease, also called celiac sprue, and officially
known as "gluten intolerant enteropathy" is a
genetic autoimmune disorder. "Genetic" means
that a gene carries the trait, and the trait can be
passed down from one family member to another.
"Autoimmune" describes the way that the disease
does damage; "auto" here means "to
oneself" so it's saying that the immune system of a
celiac mistakenly does damage to the celiac rather than
to the supposed invader. What happens is that the immune
system believes that a portion of the food eaten needs to
be attacked, and as a side-effect of the attack, the
lining of the small intestine gets damaged. It appears as
though the gene for celiac disease may ride on the same
gene as diabetes, and like diabetes, you can carry the
gene but not have the disease. It takes some
"triggering event" to start up the process
(little is known about this mechanism, but suspected
"events" include physical or emotional stress,
pregnancy, over-exposure to wheat, other diseases, and
even antibiotics); and, of course, the celiac must be
exposed to wheat in the first place.
- What is dermatitis herpetiformis?
- Dermatitis herpetiformis (DH) is another form of celiac
disease. Anyone who has DH is a celiac. In this form of
the disease, lesions that look like a herpes sore
("formis" means "in the form of" and
"herpeti" refers to the similarity to herpes)
appear on the skin, usually in very symmetrical ways: on
both hands, both arms, head, elbows, knees, buttocks,
etc. They are often extremely itchy. (Please note that
the name of this disease is a misnomer -- it really has
nothing to do with herpes.)
- How is a "wheat allergy" different from
- A common garden-variety "wheat allergy" happens
when your body sees wheat as an invader and attacks it --
not your body. Symptoms of wheat allergy could be eczema
(different from dermatitis herpetiformis), sneezing,
increased acne, or if you have a very serious allergy to
wheat, you might have an anaphylactic reaction in which
your throat would swell up to the point where you could
no longer breath. These are not symptoms typical of
celiac disease. The main effect of celiac disease is
damage to the small intestine; if you have symptoms that
are caused by damage to the small intestine (e.g.
flattened villi as seen in a biopsy, or any form of
malnutrition that is caused by the damaged villi) then
what you have is not a wheat allergy, but celiac disease.
In my years dealing with wheat-free diets, I have seen
very few people with a simple "wheat allergy"
and lots with celiac disease, so I suspect celiac disease
is more common than wheat allergies. If you have problems
with wheat, you should visit with a gastroenterologist
and get tested for celiac disease.
- Is there a cure for celiac disease or dermatitis
- At this time there is no cure, and no hope for one any
time soon. Once the disease has been triggered there is
no way to turn it back off, though in the far future
there might be hope for gene therapies or other
mechanisms which could work; none of these are likely in
the near future. However, while there is no actual cure,
a gluten-free diet solves most of the problems associated
with the disease.
- What is a gluten-free diet?
- "Gluten-free" is another slight misnomer, since
it's probable that "gluten" isn't the problem,
and it certainly isn't the whole problem, however this
term has come to represent the celiac diet and so we
define what we eat -- or what we don't eat -- by this
term. The gluten-free diet just means strict avoidance of
wheat, rye, barley (and, currently, oats), even in tiny amounts.
This is more easily said than done, but once one becomes
familiar with the diet it becomes fairly routine. Please
visit A Gluten-Free Living Primer
for more information on the ins and outs of the diet.
- What are the symptoms of celiac disease?
- Celiac disease is known as "The Great Mimic"
because patients who ultimately end up diagnosed with the
disease come to the doctor's office with such a wide
variety of symptoms that it can be very hard to diagnose.
What this means is that there is no typical set of
symptoms. There is a "classic" set of symptoms
(diarrhea, thinness, malnutrition, pot belly) that is
associated with the disease, but "classic" is
not the same as "typical." People with celiac
disease who are not following the gluten-free diet may
have just one symptom (maybe just anemia, or feeling run
down, or behavioral problems) or they may have several.
That said, here is a list of possible symptoms:
SHORT TERM SYMPTOMS
- steatorrhea (fatty stools that float rather than
- abdominal pain
- excessive gas
- fuzzy-mindedness after gluten ingestion
- burning sensations in the throat
- querulousness, irritability
- inability to concentrate
- pale, malodorous, bulky stools
- frequent, foamy diarrhea
- itchy rash (in dermatitis herpetiformis)
LONG TERM SYMPTOMS
- any problem associated with vitamin deficiencies
+ iron deficiency (anemia)
+ chronic fatigue
+ weight loss
+ bone pain
+ easily fractured bones
+ abnormal or impaired skin sensation (paresthesia),
including burning, prickling, itching or tingling
- white flecks on the fingernails
- failure to thrive (in infants and children)
- wasted buttocks
- pot belly with or without painful bloating
- persistent itchy rash (in dermatitis herpetiformis)
- What are the effects of celiac disease?
- Celiacs who are not following a gluten-free diet will,
first of all, suffer from damage to the lining of their
small intestines (specifically, to the "villi"
-- the little hair-like growth that helps process food in
the small intestine). This damage slows and even prevents
the digestion of of food, which can lead to malnutrition
(anemia, osteoporosis, vitamin deficiencies, and more).
Over the long term, the constant damage to the small
intestine can cause enough wear to lead to intestinal
cancers. In the short run, many annoying symptoms can
also make life downright uncomfortable. (See also
"Short Term Symptoms" and "Long Term
Symptoms" above.) Following a gluten-free diet
reduces the risk of cancer down to that of the general
population, and will improve digestion enough to sustain
the body normally, as well as getting rid of the usual
- What tests can be done to diagnose celiac
- The "gold standard" test for celiac disease
involves three biopsies (one before going on a
gluten-free diet, showing damage to the villi; one during
a gluten-free diet, showing healed villi; one after going
back to eating gluten, again showing damage), but many
knowledgeable physicians now accept one biopsy, an
antibody blood test, and improvement of symptoms while on
a gluten-free diet (the biopsy showing damage to the
villi prior to a gluten-free diet; the antibody test
showing elevated antibodies to gluten while still eating
a gluten-filled diet). A less formal diagnostic process
would just involve the blood tests, and improvement on a
gluten-free diet. It should be noted that the blood tests
look for elevated IgA antibodies as an immune response to
gluten, but a fair percentage of people with celiac
disease are IgA deficient, and so their tests would give
a false negative. There is another test now being
Transglutaminase Testing or tTG) which looks at IgG
antibodies, instead of IgA antibodies, that is proving
very reliable for diagnosing celiac disease.
- How long have we known about celiac disease?
- Although the disease itself has been around for quite
some time -- it gets the name of "sprue" from
the similarity of symptoms to "tropical sprue"
which is an older known disease -- the cause of the
disease was not recognized until the middle of this
century, when war-time limited supplies of wheat to local
populations, and a physician noticed after the war, that
several of his "sprue" patients who had
improved during the war, were now ill again. It was not
long before he realized that wheat was the culprit. From
that point, continued investigation added rye, barley,
and oats to the list of grains that made celiac sprue
patients sick. Still, for quite a while it was thought of
as a childhood disease that would be outgrown, so it was
not that long ago that the medical community recognized
that adults suffered from the disease as well (see the
question above on symptoms for more details). Until very
recently, it was thought of as a "rare" disease
in the United States, and most medical practitioners are
still unaware of the growing evidence that celiac disease
is actually quite common.
Copyright ©1999 Linda Blanchard All Rights
Reserved Worldwide. Date Added: November 14, 1999, 1998. Last
Update: November 14, 1999.