Celiac Disease (CD)

Definition | Symptoms | Diagnosis | Treatment | Related Diseases & Conditions | Lactose Intolerance | Frequently Asked Questions

Definition

Although statistics are not readily available, it is estimated that 1 in 133 persons in Canada are affected by celiac disease.

A wide range of symptoms may be present. Symptoms may appear together or singularly in children or adults. In general, the symptoms of untreated celiac disease indicate the presence of malabsorption due to the damaged small intestine.

Gluten is a protein found in wheat, rye, triticale, barley. In the case of wheat, gliadin has been isolated as the toxic fraction. It is the gluten in the flour that helps bread and other baked goods bind and prevents crumbling. This feature has made gluten widely used in the production of many processed and packaged foods.

At present there is no cure, but celiac disease is readily treated by following the gluten-free diet.

Recent studies have shown that pure uncontaminated oats may be used in the gluten-free diet with care. Please see the Professional Advisory Board statement re oats.

Symptoms

Common symptoms are anemia, chronic diarrhea, weight loss, fatigue, cramps and bloating, irritability.

Although some or all of these symptoms occur in celiac disease, some can also occur in many other diseases more common than celiac disease.

In other cases, sufferers from gluten-intolerance develop an intense burning and itching rash called dermatitis herpetiformis. The intestinal symptoms of celiac disease may or may not appear in dermatitis herpetiformis.

Diagnosis

a) Screening

Until recently physicians had to rely on clinical signs to suggest the diagnosis and to select which patients should have further investigation to prove the diagnosis. Since these signs may be vague or of varying severity this may be difficult. Now simple blood screening tests are becoming available to help this process.

b) Biopsy

A definitive diagnosis can only be made by a small bowel biopsy. The biopsy is performed by a specialist in the gastrointestinal field. The biopsy must be done before treatment is started.

Recommendations by International Celiac Societies and Associations regarding diagnosis of celiac disease as researched by Dr. Mohsin Rashid, Professional Advisory Board of CCA.

Treatment

Celiac disease as yet has no known cure, but can usually be effectively treated and controlled. The treatment of celiac disease is strict adherence to a GLUTEN FREE DIET FOR LIFE. This requires knowledgeable dietetic counselling and frequent "up-dates" as commercial food contents change.

Celiacs must be alert to hidden sources of gluten such as HVP/HPP (hydrolyzed vegetable/plant protein); malt; spelt; kamut; and certain drug products.

Today's processed and packaged foods have many hidden sources of gluten which can be unintentionally ingested. Particular care should be taken in the selection of soups, luncheon meats and sausages.

The person with celiac disease MUST READ THE LIST OF INGREDIENTS ON ALL LABELS, EVERY TIME.

There is a great variation in sensitivity to gluten among those with celiac disease, and although one may have no obvious symptoms, damage to the intestinal lining may still occur.

Related Diseases and Conditions

• Type 1 diabetes
• sarcoidosis
• Sjogren's syndrome
• Grave's disease
• myasthenia gravis

These diseases are all autoimmune disorders which appear to have a higher incidence among people with celiac disease than in the general population. Treatment for CD will not cure these conditions.

Other Conditions: A number of other conditions have been reported that may occur because of untreated CD, and can be expected to improve when treated with a gluten-free diet.

• Osteoporosis is a frequent complication of CD due to malabsorption prior to diagnosis. Adherence to a gluten-free diet can lead to significant bone remineralization. The two major determining factors in developing osteoporosis are maturation of peak bone mass and subsequent bone loss. Thus in order to achieve optimal bone mass, early detection of CD is essential.
• Depression is another well-documented presentation of untreated or undiagnosed CD. Psychological improvement is usually noted after placement on a gluten-free diet and vitamin B6 treatments. Ane mia, deficiency of iron, folic acid and/or Vitamin B12 is another common symptom of CD, and can be expected to improve on a gluten-free diet.

Lactose Intolerance

What is it? | Causes | Dietary Recommendations

This material on lactose intolerance is used with permission from Gluten-Free Diet, A Comprehensive Resource Guide by Shelley Case, B.Sc., RD - ISBN 1-894022-79-3

What is Lactose Intolerance?

Milk and milk products contain a natural sugar called lactose. People who are lactose intolerant or, more precisely, who are lactose maldigesters, lack enough of the enzyme lactase needed to completely digest the lactose into its simple sugars, glucose and galactose. Symptoms of lactose intolerance may include some or all of the following: abdominal cramping, bloating, gas, nausea, headache and diarrhea. Symptoms may occur 15 - 30 minutes after digestion of lactose or as long as several hours later.

Causes of Lactose Intolerance

Primary lactase deficiency: The level of lactase enzyme activity in some people may gradually fall with age to the point where they no longer tolerate as much as they used to. This type of intolerance affects as many as 70% of the world's population. It is more prevalent in Asians, Africans, Hispanics and North American aboriginals.

Secondary lactase deficiency: This is usually a temporary condition in which the level of lactase has fallen as a result of injury to the gastrointestinal tract in conditions such as Celiac Disease, inflammatory bowel disease, surgery, infections and with the use of certain drugs.

Dietary Recommendations for Lactose Intolerance

Different people will tolerate various levels of lactose in their diet. Those people with secondary lactase deficiency such as Celiac disease may need to eliminate lactose temporarily until the small intestine heals. Most people can digest small amount of lactose. In addition,  many people can become less lactose intolerant over time by gradually introducing milk products into their diet. Other factors can affect tolerance besides the total lactose content of foods.

The following tips can help improve tolerance:

Milk

• Drink small amount of milk throughout the day, 1/4 - 1/2 cup (60 - 125 mL); avoid drinking large amounts at once. Enjoy milk with meals or snacks; avoid drinking it on an empty stomach.Try heating the milk; it may be easier to tolerate.The higher the fat content in the milk, the slower it is digested; since whole milk is higher in fat, you may tolerate it better than 2% and 2% better than 1% or skim milk.
• Cultured buttermilk and acidophilus milk are usually tolerated to the same degree as plain milk.

Yogurt

• Yogurt is usually well tolerated. Although yogurt contains a lot of lactose, the lactase enzymes in the active cultures digest this lactose. Look for brands that contain "active" or "live" cultures as they are tolerated more easily.

Cheese

• Aged, natural cheeses such as Cheddar, Edam, mozzarella contain very little lactose. Most of it is removed with the whey; the small amount remaining is broken down during the aging process. Fresh cheeses, such as creamed cottage cheese, ricotta and quark contain varying amount of lactose.Dry-curd cottage cheese contains less lactose than creamed cottage cheese. Processed cheese has a lactose content similar to that of natural, aged cheese. Processed cheese food and processed cheese spread may have dairy products other than cheese added to them, therefore their lactose content may be higher.
• Light/lite cheese products may be very high in lactose.

Special Products

Several products have been specially developed to help in the management of lactose maldigestion.

• Lacteeze Milk is a lactose-reduced milk available in skim, 1% and 2% in the dairy case of grocery stores. It is also available in 1 litre Ultra High Temperature (UHT) shelf-stable packages (it must be refrigerated after opening). The lactase enzyme has been added to the milk and 99% of the naturally occurring lactose has been converted to simple, easily digested sugars. Lacteeze milk is slightly sweeter than regular milk but it has the same nutritional value and can be used in cooking and baking. 
• Lactaid Milk is another brand of lactose-reduced milk available in skim and 2% (in Canada) and fat-free, low fat (1%), reduced fat (2%), whole and calcium-fortified (in USA) in the dairy case of grocery stores. It also comes in a 2% 1 litre UHT shelf-stable package (in Canada).
• Lactaid Drops* contain enzymes that can be added to liquid dairy products making them more easily digestible. Approximately 70 - 99% of the lactose is broken down based on the number of drops used (5 - 10 drops). They are available in most drug stores.
• Lacteeze Enzyme Drops*also contain enzymes that break down the lactose in dairy products and are available in drug stores.
• Lacteeze 4000 Tablets* contain extra-strength natural enzymes that are taken just before meals or snacks that contain lactose. The tablets are available from most drug stores.
• Lacteeze Children's Tablets* are available in strawberry flavour.
• Lactaid Tablets* is another brand of lactase enzymes available in Regular (Original) and Extra-Strength tablets and Ultra-Strength Caplets or Chewable Tablets (vanilla flavour).
• Lacteeze Swiss-Style Yogurts have 90% of the lactose converted into digestible glucose and galactose (regular yogurts are about 40% lactose-reduced). Lacteeze yogurt is available in a 6 oz. (175 g) container and comes in five fruit flavours. One serving, 6 oz. (175 g), contains 2.6 g of fat.
• Lacteese Ice Cream is available in 1 quart (1 L) containers and comes in seven flavours. A 1/2 cup (125 mL) serving contains 6.7 g fat.
• Soy Beverages are available in various flavours and many are gluten-free. However, not all are enriched/fortified with calcium and Vitamin D.

* The nutritional value of the dairy product is not changed when you use enzyme drops or tablets.

This material about Lactose Intolerance is used with permission from Gluten-Free Diet, A Comprehensive Resource Guide by Shelley Case, B.Sc., RD - ISBN 1-894022-79-3

Frequently Asked Questions

Who are celiacs?

Celiac disease can surface at any age. Until recently, it was recognized mainly in children. The rate at which adults are being diagnosed is increasing, particularly those in the 40-50 year old range, due to greater awareness and improved diagnosis skills. New medical studies indicate that the disease may be much more common than previously recognized.

Is it hereditary?

While it is still unknown whether celiac disease is passed on by a dominant or recessive gene it has been established that genetic factors are involved. About 10% of the relatives of persons with celiac disease may also have the condition.

Is there a cure?

Not yet. However, research efforts continue. But celiac disease can be controlled. Strict adherence to the GLUTEN-FREE DIET is essential for good health.