This article reviews the relationship between celiac disease and gluten intolerance (an allergy to grains containing gluten such as wheat allergy). (New in 2009 - For much more complete information, check out Dr. Wangen's book "Healthier Without Wheat".)
What Is Celiac Disease?
Celiac disease is a hereditary allergy to gluten that results in damage to the small intestine. Common symptoms include loose stools, fatigue, weight loss and generally poor health. However, symptoms can vary widely and include constipation, weight gain, and a skin condition called dermatitis herpetiformis.
Gluten is a protein found in wheat, barley, and rye. Gluten is responsible for the springiness and stretchiness of bread. Without it, bread turns out heavy and dense.
How Is Celiac Disease Diagnosed?
Celiac disease is diagnosed by measuring damage to the small intestine. This damage can be measured via two blood tests, anti-endomysial antibodies and tissue transglutaminase.
This damage may be assessed via blood tests for antigliadin and tissue transglutaminase antibodies.
How Common Is Celiac Disease?
The occurrence of celiac disease is much higher than previously thought. A recent study put the prevalence at 1 in every 133 people, making it one the most common genetic diseases known. Once diagnosed, 1 in 22 first degree relatives, and 1 in 39 second degree relatives, is also diagnosed positive.
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How Is Celiac Disease Different from a Gluten Intolerance?
Although celiac disease is a gluten allergy, it is only one form of gluten allergy. Many react to gluten and may have elevated serum antigliadin antibodies, but they do not have damage to the small intestine. These people have a negative biopsy of the small intestine, as well as negative antiendomysial antibody and tissue transglutaminase tests.
How Common Are Gluten Allergies?
Although no studies have been done on the prevalence of gluten intolerance, the prevalence of gluten allergies is certainly higher than that of celiac disease alone. Return to Top
What Is the Treatment for Celiac Disease and Gluten Intolerance?
The treatment is identical for both celiac disease and gluten intolerance and involves removing all sources of gluten from the diet. This means that a person with a gluten allergy should not eat bread products, pastas, or processed food of any kind that contains wheat, rye, or barley in any form.
Individuals require special dietary counseling. Fortunately, many alternative sources for gluten free breads, pastas and other foods now exist and are easier than ever to find.
What Are the Results of Avoiding Gluten?
If you are allergic to gluten, then the result of removing gluten from your diet is generally a reversal of your health problems. Symptoms very often resolve, some faster than others, and you gain a new definition of optimal health.
Even celiac disease is reversed, usually resulting in complete recovery of the damage to the small intestine.
What if Someone with a Gluten Allergy Chooses Not to Avoid Gluten?
Of course, they continue to suffer the symptoms that their gluten allergy is causing. However, the long term consequences are much more severe.
People with celiac disease are known to be at higher risk for many conditions, including cancer of the digestive tract, thyroid problems, anemia, osteoporosis, and many autoimmune conditions.
If you or someone you know suffers from any of the symptoms listed above, be sure to be screened for food allergies via blood testing.
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Case Studies of the Month
Case #1: 27 year old male with loose stools, gas, Irritable Bowel Syndrome, inability to gain weight, acne on back, poor endurance, and hypoglycemic/needing to eat every 2-3 hours. Patient was very athletic and in most respects would be considered extremely healthy. Allergy testing demonstrated a severe allergy to gluten. Removal of gluten from his diet resulted in complete resolution of his Irritable Bowel within 2 days. Over time acne cleared, endurance improved dramatically, and he is no longer hypoglycemic.
Case #3: 24 year old female with a long history of sinus infections including two sinus surgeries, asthma, diarrhea, headaches, chronic fatigue, and dizziness. Food allergy testing was positive for allergies to gluten, dairy, and eggs. This patient also tested positive for hypothyroidism and iron deficient anemia. Removal of these foods from the diet and treatment of hypothyroidism and anemia has resulted in significant improvement in energy and the resolution of diarrhea and dizziness. Sinus infections have been greatly reduced, as have headaches, and her health continues to improve with time.
Case #3: 30 year old female with infertility, gas, bloating, acne, headaches, and insomnia. This patient has been attempting to get pregnant for 1 1/2 years. Her menstrual cycle was consistently abnormally long at 35 days. All female hormone and standard fertility related tests were negative. Food allergy testing was positive for gluten (a known cause of infertility), dairy, corn, and garlic. After removal of the food allergens, this patients next menstrual cycle returned to a normal 28 days. Pregnancy next?!
Case #4: 3 year old with frequent upper respiratory infections and a history of reflux as a baby. Patient allergic to gluten and dairy and is doing significantly better off these foods. Mother also positive for gluten allergy.
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Do Oats Contain Gluten?
Oats do not have gluten in them, but they may have gluten on them. If that sounds confusing then please let me explain.
For years oats have been mistakenly considered to contain gluten. Many people with a gluten allergy discovered that eating oats could result in the same symptoms known to be caused by eating wheat, barley or rye. However, recent research has shed some light on this problem and given everyone with a gluten allergy a reason to rejoice.
Oats do not contain gluten. However, because oats are a major agricultural product they are handled by the same mills, processing plants, and grain elevators that handle wheat, barley and rye. This results in enough contamination of the oats that they can readily trigger a gluten allergy when ingested.
The good news is that there are companies now providing non-contaminated oats. These can often be found in your local health food store or online at one of the many gluten free food retailers.
Bring on the oatmeal cookies!
Flying Apron Bakery
Flying Apron Organic Bakery, located in the University District at the corner of 50th and Brooklyn, is a welcome addition to the gluten free community.
Flying Apron specializes in tasty wheat free and gluten free desserts. A majority of their offerings are also vegan, meaning they’re free of dairy and eggs.
During a recent visit I enjoyed quinoa bread and several surprisingly nutritious sweets. The desserts look almost wickedly sweet, but when you bite into one you will be pleasantly surprised by the balance between whole grains and natural organic sweeteners that results in a food worthy of a category all its own.
For anyone needing a gluten free wedding cake, Flying Apron is happy to cater to your needs.
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Do You Really Need a Biopsy
to Diagnose Celiac Disease?
Celiac disease is traditionally diagnosed with a positive biopsy of the small intestine. The biopsy will demonstrate damage to the intestine known as villous atrophy. Villi are small finger-like extensions of the lining of the intestine that are visible only under the microscope.
People with celiac disease and other conditions will show a marked reduction in their villi, almost as if the villi have been worn off. Damage to the villi causes a dramatic reduction in the surface area of the small intestine, resulting in both the poor digestion and absorption of many nutrients.
Biopsies are done in a hospital on an outpatient basis, but require strong medication due to the invasiveness of the procedure. An endoscopy is performed, which involves a tube being placed into the mouth, down the esophagus, and past the stomach. A tissue sample can then be taken from the small intestine.
Although the small intestine is extremely important to our health, in most cases the value of the biopsy in diagnosing celiac disease is highly questionable. About 98% of people with a gluten allergy or celiac disease can be diagnosed as being allergic to gluten with a blood tests alone. There is no added benefit from performing the biopsy. The results of the biopsy do not change the form of treatment nor the outcome for the patient. Only if the blood tests are negative can a biopsy potentially provide useful additional information.Return to Top
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Dr. Stephen Wangen
1229 Madison. St., Suite 1220 · Seattle WA 98104 · 206-264-1111
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