Celiac disease

• Celiac disease, also called celiac sprue, is a digestive disorder that occurs when an individual's immune system overreacts to the protein gluten, or other proteins within gluten such as gliadin, found in grains including wheat, rye, barley, and to some degree, oats. When a patient with the disease eats food that contains gluten, the immune system's response damages the intestinal lining. This causes symptoms of abdominal pain and bloating after consuming gluten.
• Additionally, complications, including poor absorption, may occur if the patient continues to eat gluten-containing foods. When the intestinal lining is damaged, patients have difficulty absorbing nutrients.
• It has not been determined what triggers this reaction in celiac patients. However, celiac disease is associated with autoimmune disorders, such as lupus. Autoimmune disorders occur when the patient's immune system mistakenly identifies body cells as harmful invaders, such as bacteria. As a result, the immune cells in celiac patients attack the patient's intestinal cells.
• Researchers at the National Digestive Diseases Information Clearinghouse (NDDIC) estimate that one out of 133 people in the United States have the disease. Prevalence is even higher, one out of 22 people, among patients who have immediate family members (parent or sibling) who have the disease. This suggests that the disease may be inherited (passed down through families) in some cases.
• Individuals can develop the disease at any age, but it is most commonly diagnosed in patients who are eight to 12 months old or in patients ages 30-40.
• Although there is currently no cure for celiac disease, the condition can be managed with a gluten-free diet. In general, patients who strictly follow a gluten-free diet can expect to live normal, healthy lives. Symptoms will subside in several weeks and patients will be able to absorb food normally once they avoid eating gluten. A dietician or certified nutritionist may help a patient with celiac disease develop a healthy diet. Patients with celiac disease may also find gluten-free cookbooks to be a helpful resource. Many products, including rice flour and potato flour, can be used as substitutes for gluten.

• General: When a celiac patient eats gluten, or other protein components of gluten, such as gliadin, the body's immune system overreacts. Gluten is present in all types of wheat (including farina, graham flour, semolina, and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt, and triticale. The gluten is mistaken for a harmful invader, such as bacteria, and an attack is launched. Immune system cells flood to the stomach and intestine to destroy the gluten. However, among these immune cells are autoantibodies that attack the lining of the intestine by mistake. As a result, the intestinal lining becomes damaged.
• Gliadin is a protein component of gluten, found in wheat and several other cereal grains of the genus Triticum. Patients with celiac disease are sensitive to the α, β, and γ forms of gliadins. In response to gliadin, anti-gliadin IgA antibodies are produced, which are reportedly found in many patients with celiac disease.
• Inherited: Researchers believe that many cases of celiac disease are inherited (passed down through families). Researchers estimate that if someone in a patient's immediate family (parent or sibling) has celiac disease, the patient has a 5-15% chance of developing the disease as well.
• Trauma: It also appears that many cases of celiac disease develop after trauma, such as an infection, stress, physical injury, surgery, or pregnancy.
• Other disorders: Celiac disease is associated with autoimmune disorders. Autoimmune disorders occur when the immune system attacks the body by mistake. Autoantibodies in the blood bind to components of an individual's own cells, triggering other cells to attack the body. The most common autoimmune disorders associated with celiac disease are lupus erythematosus, type I diabetes, rheumatoid arthritis, thyroid disease, and microscopic colitis (disorder that causes inflammation of the colon).

• Blood tests: If celiac disease is suspected, blood tests will be performed to determine whether or not the patient has autoantibodies associated with the disease. Specific autoantibodies in the blood bind to the patient's own body cells. This triggers other cells to attack and destroy cells in the intestinal lining. If these autoantibodies are present in a patient's blood, a positive diagnosis is made.
• Blood tests may also be performed to determine whether or not the patient has antibodies to gluten. During this procedure, a sample of the patient's blood is combined with gluten to determine whether or not antibodies are present. If antibodies are present, it suggests the patient may have celiac disease.
• Biopsy: An intestinal biopsy may be performed to confirm a diagnosis, but it is not often required. This procedure is more invasive and expensive than a blood test. During the procedure, a thin, flexible tube called an endoscope is inserted through the patient's mouth and into the intestine. A small tissue sample is taken and analyzed under a microscope. If the intestinal tissue is damaged, a positive diagnosis is made.

• Nutritional deficiencies: When a patient with celiac disease consumes gluten, the immune cells attack enzymes in the intestine that are needed for digestion and absorption of nutrients. Therefore, nutritional deficiencies are a complication of untreated celiac disease. Children may experience stunted growth if they are not receiving enough nourishment.
• Patients who continue to eat gluten despite their condition may develop anemia (low levels of iron in the blood) because they are unable to absorb iron, folic acid, or vitamin B12.
• Patients who continue to eat gluten often have low levels of vitamin K and D because they are normally absorbed in the intestine. Vitamin K is needed for the production of blood clotting factors. Patients with vitamin K deficiency have an increased risk of bleeding. Patients with vitamin D deficiency may have low levels of calcium in the blood, which may lead to bone disorders such as osteoporosis (hollow, brittle bones).
• If left untreated, poor nutrition can potentially be fatal.
• Other disorders: Celiac disease is associated with autoimmune disorders. The most common autoimmune disorders associated with the disease are lupus erythematosus, type I diabetes, rheumatoid arthritis, thyroid disease, and microscopic colitis (inflammation of the colon). The prognosis for patients with co-existing autoimmune disorders depends on the specific disorder. Most autoimmune disorders are chronic. However, many disorders can be managed with treatment such as immunosuppressants and anti-inflammatories.

• General: Although there is currently no cure for celiac disease, the condition can be managed with diet. Symptoms will subside within several weeks and patients will be able to absorb food normally once they avoid eating gluten. However, it may take several months in children and two to three years in elderly patients for the intestine to fully recover.
• Support: Healthcare providers may recommend a dietitian or nutritionist who can help a patient plan an appropriate gluten-free diet. These professionals can also help patients determine whether or not supplementation with vitamins and minerals is necessary.
• Gluten-free diet: Patients should avoid all foods that contain gluten. This includes any type of wheat (including farina, graham flour, semolina, and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt, and triticale. Therefore, foods such as bread, cereal, crackers, pasta, cookies, cake, pie, gravy, and sauce should be avoided unless they are labeled as gluten-free.
• Many less obvious foods contain gluten. For instance, grains that contain gluten are often used in food additives, such as modified food starch and malt flavoring. Also, some medications, herbal supplements, and vitamins may contain gluten as a binding agent. Lipstick and postage stamps may contain gluten.
• Studies have shown that a gluten-free diet may improve iron deficiency (anemia), malnutrition, anxiety, and depression. Some reports exist of mood swings or depression after adopting a gluten free diet, purportedly due to issues relating to dietary adherence. However, the overwhelming body of scientific evidence concludes that a gluten-free diet will reduce these symptoms.
• How to avoid gluten: Patients should carefully read the labels of their foods. To help patients identify foods like gluten, the U.S. Congress passed the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA). The law, which went into effect January 1, 2006, requires food manufacturers to clearly state on their packages whether the food is made with any ingredients that contain products derived from milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, or soybeans. This act also requires the FDA to develop and finalize rules for the use of the term "gluten-free" on product labels by August 2008.
• Food products can become cross-contaminated with gluten if they come into contact with gluten. For instance, a knife that was used to cut bread should be washed thoroughly with soap and water before it is used to cut food for a patient with celiac disease. Cross contamination may also occur if bread and vegetables were cut on the same cutting board.
• Hidden gluten can be found in some unlikely foods, such as cold cuts, soups, hard candies, soy sauce, and many low or non-fat products (such as licorice and jelly beans). Gluten may also come in forms such as vegetable proteins and starch, modified food starch (when derived from wheat instead of corn), maltodextrin, malt flavoring, and glucose syrup. Many common ingredients contain wheat or barley derivatives.
• Patients with celiac disease should always ask about the ingredients in food when dining at a restaurant or someone else's home.
• Patients should consult their healthcare providers and pharmacists before taking any drugs, herbs, or supplements because they may contain gluten.
• Read the labels of cosmetics because some beauty products, such as lipstick, may contain gluten.
• Use self-adhesive postage stamps because stamps that require moistening may be contaminated with gluten.
• Foods that are safe to eat: Today, patients can choose from a wide variety of gluten-free products at grocery stores. There are gluten-free substitutes for many foods and beverages, including cookies and beer. If gluten-free foods are not readily available at the local supermarket, they can be purchased online.
• Patients can eat fresh meats, fish, and poultry that are not breaded or marinated. Most dairy products are safe to eat, as well as fruits, vegetables, rice, potatoes, and gluten-free flours that are made from rice, soy, potato, or corn.
• Although amaranth, buckwheat, and quinoa are gluten-free when they are grown, they may become contaminated with other grains during harvesting and/or processing. Even though oats may not be harmful for most patients with celiac disease, they are often contaminated with wheat. Therefore, oats should be avoided as a precautionary measure.
• Cooking: Patients with celiac disease do not necessarily have to give up their favorite foods because they cannot eat gluten. Substitutes for wheat flour can be used for many recipes. For instance, if a recipe calls for one teaspoon of wheat flour, patients can use 1.5 teaspoon of potato starch, cornstarch, rice flour, or arrowroot starch instead. One cup of wheat flour may be substituted with one cup of fine cornmeal, 3/4 cup of coarse cornmeal, 3/4 cup of rice flour, or 5/8 cup of potato flour. Gluten-free cookbooks are widely available to help patients maintain their quality of life with respect to food.

Note
: There is currently a lack of available scientific evidence on the use of integrative therapies for the treatment or prevention of celiac disease. The therapies listed below should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.

D

Fair negative scientific evidence

• zinc
  : In a very small study, oral zinc supplements did not seem to improve the clinical condition of patients with unresponsive celiac disease.
• Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.
• Traditional or theoretical uses, which lack sufficient evidence
  :
• Carob
  : Carob (Ceratonia siliqua) is a leguminous evergreen tree of the family Leguminosae (pulse family). Although carob has traditionally been used as a replacement for gluten, there is currently a lack of human studies on the safety and efficacy of the use of carob for celiac disease.
• Avoid if allergic/hypersensitive to carob (Ceratonia siliqua), its constituents, or any plants in the Fabaceae family, including tamarind. Avoid with metabolic disorders, with a chromium, cobalt, copper, iron, or zinc disorder or deficiency, kidney disorders, or acute diarrhea. Avoid in underweight infants. Use cautiously in patients with anemia, known allergy to peanuts and other nuts, complications with powdered bulk forming laxative drinks, diabetes, or hyperlipidemia (high cholesterol). Use cautiously if taking oral herbs or drugs. Use cautiously in hypouricemic patients. Avoid if pregnant or breastfeeding.
• Pantothenic acid (vitamin B5)
  : Pantothenic acid (vitamin B5) is essential to all life and is a component of coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Traditionally, pantothenic acid (vitamin B5) has been used to treat celiac disease, but scientific studies have not been conducted to evaluate the safety and efficacy of this treatment. Human scientific studies are needed before a firm conclusion can be made.
• Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
• Quinoa
  : Quinoa has been cultivated in the Andes Incas for thousands of years. Quinoa has been used as a substitute for wheat, especially by those on a gluten-free diet due to celiac disease or other conditions. However, human research is lacking.
• Avoid if allergic or hypersensitive to quinoa (Chenopodium quinoa), its constituents, or members of the Amaranthaceae family. Use unwashed quinoa cautiously because it is naturally coated with saponins. Avoid if pregnant or breastfeeding.
• Spleen extract
  : Spleen extract primarily comes from the spleens of cows or pigs. Although spleen extract has been used to treat celiac disease, scientific studies have not been conducted to evaluate the safety and efficacy of this treatment.
• Avoid if allergic or hypersensitive to spleen extract or its components, including tuftsin. Use cautiously if taking analgesics, anticoagulants/antiplatelet agents, bestatin, chemotherapy drugs, or psychotropic drugs. Use cautiously with bleeding disorders with Hodgkin's disease, leukemia, or systemic lupus erythematosus. Use cautiously in children and in patients with weakened immune systems. Avoid if taking immunosuppressants. Avoid spleen extract from countries where bovine spongiform encephalitis (BSE or "mad cow disease") has been reported. Avoid if pregnant or breastfeeding.
• Vitamin K
  : Vitamin K is found in green leafy vegetables like spinach, broccoli, asparagus, watercress, cabbage, cauliflower, green peas, beans, olives, canola, soybeans, meat, cereals, and dairy products. Although vitamin K deficiency is rare, patients who have celiac disease have an increased risk of developing this condition. Therefore, vitamin K has been suggested as possible treatment for patients with celiac disease. However, there are currently no human studies available on the safety and efficacy of this treatment.
• Avoid if allergic or hypersensitive to vitamin K. Injection into the muscle or vein should only be done by a healthcare professional. Many serious side effects have occurred after injection. Menadiol (type of vitamin K that is not available in the United States) should be avoided with glucose-6-phosphate dehydrogenase deficiency. Avoid if pregnant. The American Academy of Pediatrics recommends giving a single vitamin K1 injection into the muscle to all newborns to prevent vitamin K deficiency bleeding (VKDB). However, large amounts of vitamin K may cause serious side effects or death. Vitamin K is generally considered safe for breastfeeding mothers.

• Currently, there is no known method to prevent celiac disease.
• Patients who have celiac disease can prevent symptoms from returning by adhering to a gluten-free diet. A certified dietitian can help patients plan appropriate and healthy gluten-free diets.
• Patients should carefully read the labels of all food products. Food manufacturers in the United States are required to clearly state whether their products contain wheat.
• If children have celiac disease, their baby-sitters, teachers, and other caretakers should be informed of their conditions.
• Patients with celiac disease should always ask about ingredients in the food when dining at a restaurant or someone else's home.
• Patients should consult their healthcare providers and pharmacists before taking any drugs, herbs, or supplements because they may contain gluten.
• Read the labels of cosmetics because some beauty products, such as lipstick, may contain gluten.
• Use self-adhesive postage stamps because stamps that require moistening may be contaminated with gluten.
• Food products can become cross-contaminated with gluten if they come into contact with gluten. For instance, a knife that was used to cut bread should be washed thoroughly with soap and water before it is used to cut food for a patient with celiac disease. Cross contamination may also occur if bread and vegetables were cut on the same cutting board.