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CELIAC
DISEASE-HIDDEN & DANGEROUS
Celiac
disease Is a genetically-based autoimmune disorder in which specific peptides
from wheat, rye, barley, spelt, kamut, and triticale [collectively
called gluten] trigger progressive destruction of the villi of the small
intestines. Gluten consumption can
result in deficiencies of certain vitamins and minerals.
DERMATITIS
HERPETIFORMIS is an expression of celiac disease characterized by a blistering,
intensely itchy skin rash, found most frequently on the elbows, knees, buttocks
and upper back. Patients with DH often present with mild or no gastrointestinal
symptoms, but villous atrophy occurs in the majority of cases.
Celiac
disease is now recognized as one of the most common inherited diseases;
therefore first and to a lesser extent second-degree relatives are at a higher
risk of having unrecognized celiac disease.
SYMPTOMS
The
symptoms of Celiac Disease can occur at any age and the number and severity of
symptoms associated with untreated celiac disease vary greatly from person to
person. In many cases the disease is silent and is discovered only by blood
screening. The presence of obesity or constipation does not exclude the
diagnosis of celiac disease.
The following symptoms may occur singly or in combination:
-anemia-iron,
folate/vitamin B12 deficiency
-recurrent canker sores
-deficiency
of Vitamins A, D, E, K -easy bruising
-abdominal
pain, bloating/cramping/gas -bone/joint pain
-recurring/persistent
diarrhea
-edema of
feet & hands
-constipation -menstrual irregularities
-extreme
weakness and fatigue
-infertility in men and & women
-weight
loss
-indigestion
& nausea
-lactose
intolerance -migraines
-dermatitis
herpetiformis
-depression
-elevated
liver enzymes
-recurrent miscarriages
-peripheral
neuropathy, ataxia, epilepsy with occipital calcifications
Additional symptoms in children:
-vomiting -delayed puberty -dental enamel abnormalities
-irritability
and behavioral changes
-delayed growth -short stature
CELIAC DISEASE FREQUENTLY OCCURS IN COMBINATION WITH OTHER CONDITIONS,such as
-type 1 diabetes mellitus
-osteoporosis -Downs
Syndrome
-lymphoma -Turner Syndrome
-Other
autoimmune diseases-e.g. autoimmune hepatitis or thyroid disease.
Screening for Celiac Disease should
be considered if there
is a family history of celiac disease or if there are symptoms of celiac
disease with any of the above diseases. There is a 10-15% chance of having
celiac disease if it is in your family
DIAGNOSIS
The
similarity of the symptoms with those of other diseases often leads to
misdiagnoses such as irritable bowel syndrome, lactose intolerance, chronic
fatigue syndrome and diverticulosis, resulting in even further delays. Blood
tests-According to Celiac News 2010,
the IgA-based tissue transglutaminase antibody (TTG)is a highly sensitive and
specific teat and is currently the recommended screening test for celiac
disease. Both the IgA and IgG are now considered redundant. False negative
results can occur with these tests. False positive results can occur but are
rare.
An intestinal biopsy,
while an individual is on a gluten-containing
diet, is required to establish the
diagnosis.
A GLUTEN-FREE DIET SHOULD NOT BE
STARTED BEFORE A BLOOD TEST AND BIOPSY HAVE BEEN COMPLETED, since it can
interfere with making an accurate diagnosis.
TREATMENT
The
ONLY TREATMENT for celiac disease, including those patients with DH, is a STRICT GLUTEN FREE DIET FOR LIFE. This
enables the gut to recover and can reduce the risk of developing many of the
complications of untreated celiac disease.
The services of a qualified dietician and regular follow-ups with a
physician are recommended. Join the CANADIAN CELIAC ASSOCIATION and their local chapter for valuable
practical information and ongoing support:http://www.celiac.ca
The
safety of oats in celiac disease has been extensively investigated. Clinical
studies have shown that small amounts of pure,
uncontaminated oats are safe for most adults and children. Most
commercially available oats are contaminated with wheat, rye, or barley;
however pure, uncontaminated oats are now being
produced in Canada.
Being diagnosed with celiac disease
today is not as bad as it was a few years ago. Foods today are delicious and
are varied and abundant. With the help of the experts at your local health food
store, you can live a normal and happy life with great-tasting foods. It’s also
a great place to pick up information about celiac disease and mouth watering recipes.
HIDDEN GLUTENS
It is assumed that, patients
with celiac disease, once diagnosed, can eliminate glutens from their diet safely by reading all the labels. For
the most part, this is true; however there are some disguised glutens to be
aware of.
MODIFIED STARCH: if it is corn, tapioca, or
potato starch, it is safe.However we as a consumer do not know if the
manufacturer has used wheat starch. Therefore, it is wise to avoid anything
made with modified starch.
DEXTRIN: can be made from corn, rice, tapioca, or wheat. Avoid
dextrin unless the label clearly indicates from what source its from.
CARAMEL COLOUR: can be made
from dextrose(corn sugar), lactose(milk sugar), molasses, invert sugar, or
sucrose(beet or cane sugar).These are all safe, but it could be made from malt
syrup or starch hydrolysates which may contain wheat.
FLAVOURINGS, EXTRACTS &
TINCTURES: Many of these contain grain alcohols.
TRITICALE: a grain found in
some cereals and flour mixtures. This is a cross between wheat and rye and
contains gluten.
SIRIMI: an imitation seaweed
containing starch. Be sure to find out where the starch comes from.
CANDY: although companies are
required to list all ingredients in their products, they are not required to
list anything under 1%. This can lead to problems with celiacs as many candies
found may be dusted with wheat flour to prevent sticking.
PRESCRIPTION DRUGS: many
prescription and over the counter drugs contain gluten as a filler.Be sure your
doctor is aware of this. The best way is to talk to your pharmacist
SOYA SAUCE: Don't be fooled
by its name. Most contain wheat. Choose BRAGG'S
ICING SUGAR: Many commercial
brands contain wheat starch. REDPATH & LANTIC are gluten free.
PEANUT BUTTER: Many brands contain icing sugar. Unfortunately.
The companies do not list what starch is used. Choose a brand without icing
sugar or make your own at a Health Store that has their own Peanut Butter
Machine. Dry Roasted Peanuts are used with no additives. Great tasting and
better for your Health.
BAKING POWDER: Some brands
contain wheat starch. Choose a brand made from cornstarch. There are Gluten
Free Brands on the market. Rule of thumb with some is to use 50% more if the
recipe calls for regular Baking Powder.
Feb/Mar 2010 Issue
Iron deficiency is the most common nutritional deficiency in the world. The World Health Organization estimates that up to 700 million people suffer from lack of this important mineral. Could you be one of them?
If you have celiac disease, you are at risk. (A common manifestation of celiac disease is iron-deficiency anemia.) Vegetarians are also at risk. (People on a strict vegetarian diet have a difficult time maintaining healthy iron levels because vegetable sources of iron are more difficult to absorb than animal sources.) Heavy menstrual periods, pregnancy, any kind of internal bleeding (like ulcers) and certain kidney conditions can also set you up for iron deficiency. Lack of vitamin K can indirectly contribute because it can lead to poor blood clotting, which causes increased bleeding and iron loss.
With its profound impact on energy and even mood, iron has a major influence in determining your quality of life. If your body lacks iron, it has too-few red blood cells and the blood cells it does have are pale and small. Depletion symptoms range from pale skin, light nail beds, brittle nails and rapid heart rate to lack of stamina, depression, cognitive confusion and overall fatigue. In cases of severe deficiency, people develop intense cravings, called pica, driving adults to crunch on ice cubes, for example, and children to eat non-food items like chalk, dirt or paint chips.
A simple blood test checks for iron deficiency, usually diagnosed as anemia. However, if you’ve been iron depleted for a long time (often the case for people with undiagnosed celiac disease), you may be suffering from very low iron levels that won’t be detected by the usual blood test. In this scenario, doctors can assess iron levels with a more sensitive blood test, called serum ferritin. Celiac patients should specifically ask for this test if they continue to have low-iron symptoms after a blood test rules out anemia.
The foods richest in iron are meat, specifically beef, dark chicken and turkey, and lamb. Molasses is a good vegetable source (one tablespoon contains more iron than a 3-ounce steak), as are teff, amaranth, pumpkin seeds, raisins and prune juice. Absorption is enhanced by eating these items along with foods that contain vitamin C, like citrus juice.
Studies reveal that many celiacs are still iron deficient up to a decade after going gluten free. If you have celiac disease, ask your health care practitioner to monitor your ferritin level. Aim for a serum ferritin of at least 45. (Many labs use 10 as a bottom range but people often continue to have symptoms at this level.) If tests reveal your numbers are low, include more iron-rich foods in your diet. You may also want to talk with your doctor about taking an iron supplement.
Supplements are often required to reverse long-standing deficiency, especially in at-risk populations. Many iron supplements contain ferrous sulfate, which can cause stomach pain, nausea and constipation, particularly if taken on an empty stomach. Look for iron bys-glycinate, which is better tolerated. In severe cases of deficiency, iron can be administered at your doctor’s office via a series of injections or IV. LW
Christine Doherty, ND, is a licensed naturopathic doctor who specializes in food allergies and celiac disease. She lives in the Boston area.
Note that iron excess increases the risk of heart disease and organ damage. Most people, particularly men and post-menopausal women, should not take iron supplements unless prescribed by their doctor. Consult your health care practitioner before taking supplements.