When It Comes To Celiac Disease, Listen To Your Gut

Maybe it’s time to think twice about those ongoing stomach pains. After years of pies, bagels and noble attempts at eating whole wheat bread instead of white, your aching stomach may be telling you something. And it’s not simply to eliminate refined white flour; it’s to forget those troublesome grains altogether.

The cause of the stomach twists-and-turns could be a serious condition called celiac disease, also known as celiac sprue, non-tropical sprue or gluten-sensitive enteropathy. Gluten, a type of protein found in wheat, barley and rye, can irritate the digestive tract, causing inflammation. With enough irritation, the delicate, fingerlike extensions in the intestinal wall, called villi, are impaired and unable to allow nutrients to be absorbed properly. The result is malabsorption and eventual malnutrition. If not treated, celiac also can lead to pancreatic enzyme deficiency, thyroid disease, neurological disorders and, in some cases, cancer.

Those of Irish decent are fortunate. The Irish were the last Northern Europeans to introduce grains into their diet, so they have the lowest risk of Europeans for developing celiac. If, however, you are of mixed origins, the chances of developing celiac are approximately 1 in 133 or 2.2 million Americans. Compare that with the fact that approximately 2 million people in the U.S. have Alzheimer’s, and it would appear that celiac is as prevalent as some of the other diseases we hear so much about in the news. So why doesn’t it get the same notoriety? It’s probably due to the fact that upwards of 90 percent of those 1 in 133 Americans may be undiagnosed, according to the University of Chicago Celiac Disease Program.

Symptoms may not always point toward the stomach, making celiac a tricky condition to identify. It varies with age and in intensity, often taking an average of 11 years to diagnose. For instance, irritability is one of the most common symptoms in children, while teenagers may develop a red itchy rash. Add to this a lengthy list of possibilities, such as irritable bowel syndrome, anemia, fatigue, infertility and joint pain, and it’s easy to understand why a gastroenterologist might not detect it right away.

The good news is that many cases are diagnosed by age 2, before nutritional deficiencies occur. But for those whose symptoms are less apparent — or even nonexistent — it takes much more detective work. Kentlands resident Christy Froehlich lived for 31 years without realizing she had celiac. ‘‘When I played soccer in high school, I would wake up in the middle of the night with terrible muscle cramps. Everyone told me that my potassium was probably low so I ate bunches of bananas. No one ever attributed those cramps to gluten sensitivity,” she recalls.

It was not until she became pregnant that the doctors figured it out.

‘‘I was pregnant with twins,” she explains, ‘‘but I wasn’t gaining any weight. The doctors had me eating every two hours from my eighth month on, but for the entire pregnancy, I only gained 28 pounds.”

Froehlich didn’t know she had celiac because of the condition’s ability to lie dormant until some type of significant physiological event triggers it to become active – such as stress, physical injury, infection, surgery or virus. In her case, it was pregnancy.

‘‘After I delivered the twins, I was absolutely gaunt,” she says. ‘‘The girls came out healthy because they absorbed everything they needed from me, but I wasn’t absorbing anything.”

The doctors ran a number of typical tests on Froehlich, but everything looked normal. Then a blood test and biopsy revealed her condition.

‘‘When the doctor first told me,” Froehlich says, ‘‘I cried because I was so relieved that I had an answer. After I saw a dietician, though, I cried again, but this time it was over all the foods I would never again be able to eat. It seemed overwhelming. I had no idea how far reaching the food list was, from soy sauce to modified food starch, which is in everything.”

Antibody testing is a first step in a positive diagnosis. When a gluten-sensitive person eats a bagel, the immune system responds by making high levels of antibodies to attack the offending matter. A physician will first test blood to measure the increase in two antibodies called anti-endomysium (EMA-IgA) and anti-tissue transglutaminase(tTG-IgA). If these tests are positive, the doctor will perform a biopsy and remove a small piece of tissue from the small intestine, examining it for any damage to the villi. The procedure is called an endoscopic biopsy, and it is the procedure that either positively or negatively confirms the presence of celiac disease.

Regardless of when and how celiac is diagnosed, all agree on how to treat it: Eliminate gluten. The treatment is entirely diet-related. A person with celiac should not eat grains, pasta, cereal and many processed foods. The challenge is looking out for hidden sources of gluten such as sauces, salad dressings and cooking sprays. Some nonfood items, like shampoos and lotions ,also contain gluten so reading labels is key in the management of celiac.

As a nutritionist, I recommend rebuilding and healing the digestive tract through a few key supplements. Probiotics, like acidophillus, which is the beneficial bacteria already found in the gut, will help improve digestion and nutrient assimilation. And glutamine helps repair the gastrointestinal lining, which, in turn, prevents environmental toxins from crossing the intestinal barrier into the bloodstream. Of course, working in conjunction with a doctor provides a safe and holistic approach to care.

Good news is on the horizon. A recent study done by the Archives of Disease in Childhood reports that breastfeeding at the time of solid food introduction significantly reduces the baby’s risk of celiac. Breast-fed infants in the study were 52 percent less likely to develop celiac. Researchers are not clear on why this works, but it’s encouraging for moms-to-be and provides them with an additional incentive to breastfeed their newborns. New moms who already have celiac will find this information encouraging since the disease is genetically predisposed. An infant has a one in 10 chance of also developing the disease.

Food labeling laws are changing too. In January, the FDA began its Food Allergen Labeling and Consumer Protection Act, which requires food manufacturers to identify common allergens food labels. The labels will take some of the guesswork out of determining safe foods for many allergy sufferers, including the gluten-intolerant. Locally, restaurants like Bonefish and grocery stores like Whole Foods and Trader Joe’s are addressing consumers’ specific needs by offering gluten-free menus and shopping lists. In the Gaithersburg area we are also lucky enough to have a new gluten free bakery, called Sweet Sin, run by Pastry Chef Renee D’Souza. Sweet Sin specializes in gluten free breads and desserts (www.glutenfreedesserts.com).

So as we head toward spring and picnics complete with sandwiches and cheese and crackers, remember to listen more closely to your stomach. If you find yourself frustrated with irritable bowel or any other celiac-like symptoms, it may be worth a trip to the doctor.

And skip the bagel on the way.