Celiac disease, also called celiac sprue, nontropical sprue, or gluten sensitive enteropathy, is caused by an inability to properly digest foods containing the gliadin fraction of gluten, which causes damage to the lining of the small intestine. People with celiac disease do not absorb nutrients well, and they are likely to become malnourished.

Gluten is found in many grains including wheat, rye, barley, millet, and probably spelt. Most people with celiac disease can eat oats if they are in remission. Some people experience some gas when they first introduce oats, but their stool formation is better and they feel better.

In a recent study of nineteen people with celiac disease, all but one improved when about two ounces (onehalf cup dry) of oats were added to their daily diet. In a further study, several others with celiac were found to worsen with the addition of oats to their diet. So, once again, biochemical individuality plays an important role.

With the addition of oats, most celiac sufferers feel better, have better nutritional status, are more satisfied with their diet, and have higher overall fiber and higher nutrient intake. Children with celiac disease often do poorly with oats, but then are able to eat them normally as adults.

Celiac disease is chronic and is genetic. In 90 to 95 percent of cases, it is associated with the HLA-DQ2 gene, and in 5 to 10 percent of cases with the HLA-DQ8 gene. It may affect several family members and occurs about twice as often in women as in men and mainly affects people of northwestern European ancestry.

It rarely occurs among people of African, Jewish, Mediterranean, or Asian descent. A person who was breast-fed will find a delay in development of the disease, and research shows that the longer the baby was breast-fed, the greater the benefit.

While celiac disease was previously thought to be rare, new studies indicate that many people without obvious symptoms have subclinical celiac disease. According to analysis of IgG and IgA blood testing, an estimated 1 person in 250 to 300 may have celiac disease.

Celiac disease often goes undiagnosed and can be mistaken for irritable bowel syndrome or other problems because many physicians are unfamiliar with the disease. About 20 to 30 percent of those with celiac have classic symptoms of the disease. The rest may have other symptoms or be asymptomatic.

Elimination of wheat, rye, barley, spelt, and possibly oats from the diet can eliminate many diverse symptoms. Symptoms are characterized by recurring attacks of diarrhea or constipation, abdominal cramping, bloating, gas, weakness, anemia, and steatorrhea (gray or tan fatty stools).

Less typical symptoms are weight loss, arthritis, irritability, depression, fatigue, brain fog, bone pain, schizophrenia, fibromyalgia, bone pain, muscle cramps, tingling numbness in the legs, mouth sores, a skin rash (dermatitis herpetiformis), tooth discoloration, missed menstrual periods and miscarriage, neurological symptoms, and epilepsy.

In children, the most common symptom is irritability. Infants may have failure to thrive. Celiac disease is usually recognized early in childhood but may disappear in adolescence and reappear later in adulthood. Anemia is common in those with celiac disease.

A recent pediatric study showed that half of the children tested were anemic, and a small percentage of children with anemia really had undiagnosed celiac disease.

Untreated celiac disease can lead to long-term complications that include lymphoma and adenocarcinoma, osteoporosis, miscarriage, and congenital birth defects such as neural tube defect, being shorter than you would have been otherwise, and seizure disorders.

Other long-term consequences of celiac disease can be diminished calcium reserves and poor fat-soluble vitamin status, including vitamins A, D, E, and K. About half of all people with celiac disease are also lactose intolerant at the time of their diagnosis.

Lactase, the enzyme required to split lactose, is manufactured at the tips of the villi. Because these villi are damaged in people with untreated celiac disease, their bodies can’t manufacture the lactase. Once people have gone onto a gluten-free diet and the intestinal lining is repaired, some will be able to tolerate dairy products.

Remember that about 20 percent of Americans are lactose intolerant, so many people with controlled celiac disease will still be affected by dairy products. Traditionally, diagnosis of celiac disease was made by excluding other possibilities and then performing an intestinal biopsy.

New tests, such as the anti-endomysial antibodies, anti-gliadin antibodies, and the tissue transglutaminase antibodies tests more easily diagnose celiac disease. The anti-endomysial antibodies test appears to be the most accurate. It would be best to do at least two of these tests to have confirmation, because none of them is 100 percent conclusive.

A rectal gluten challenge test is available that determines gluten sensitivity. It appears that there are several types of gluten sensitivity: celiac disease, tropical sprue (caused by an infection or toxin and treated with antibiotics), and gluten sensitivity (caused by leaky gut syndrome).

While symptoms may be similar for these problems, the treatments vary considerably. People with celiac disease must avoid gluten-containing foods for life. People with tropical sprue are generally treated with antibiotics and over time are able to use gluten-containing grains without further problems.

People with wheat and/or gluten sensitivity often find that after avoidance of those foods for four to six months and a nutritional program that supports healing and friendly flora, they can then begin eating grain products without further problems. People with celiac disease tend to have other autoimmune diseases as well, including:

• Dermatitis herpetiformis
• Thyroid disease
• Systemic lupus erythematosus
• Type 1 diabetes
• Liver disease
• Collagen vascular disease
• Rheumatoid arthritis
• Sjögren’s syndrome

Fortunately, there is a cure: avoid grains that contain gluten. This stops the irritation to the gut and allows it to heal. Many people find quick relief in three to four days, although complete healing of the intestines will take longer. Nutritional therapies may help you heal faster.

If you don’t feel better in four to six weeks, you need to investigate other possibilities. Because of the malnourishment that celiac can cause, supplementation of nutrients is often necessary. It’s not easy to completely change your diet to avoid all glutencontaining foods.

Americans depend on a wheat-based diet and many other foods that have gluten-containing grains. In addition to obvious sources of gluten, many products have hidden sources. Salad dressings, some hot dogs, ice cream, bouillon cubes, chocolate, and foods containing hydrolyzed vegetable protein may contain gluten.

Fortunately, because of the many people who are intolerant of gluten, more gluten-free products are being introduced into the marketplace. Excellent breads, pastas, crackers, pancake mixes, cereals, and cookies are now available. A new home test kit may soon be on the market that can help you determine which foods contain gluten.

Functional Laboratory

• Testing Anti-endomysial, anti-gliadin, and tissue transglutaminase antibodies testing. This is a specific way to screen for celiac disease. Anti-endomysial antibodies are the most specific. If one of these tests is negative, do one of the others to make sure.

• Food allergy/sensitivity screening. Test for wheat, oats, rye, barley, gluten, and gliadin; IgE and IgG antibody testing are all required. Gluten antibodies are positive in people with celiac disease and gluten intolerance. IgA levels are also higher in people with celiac disease, but a negative test does not always rule it out. Additional food sensitivities are likely.

• Intestinal permeability screening. Test for leaky gut syndrome or intestinal hyperpermeability.

• Iron status or nutrient status. Celiac disease causes malabsorption of nutrients. Many people with celiac disease have iron deficiency anemia; low vitamin A, D, E, and K; poor fat absorption; and other mineral deficiencies. Several labs have tests that help determine which nutrients need supplementation.

• Comprehensive digestive stool analysis with parasitology. This test can be used to determine if there is an unidentified underlying cause of the celiac disease.

• Rule out lactose intolerance. The lactose breath test determines lactose intolerance. Elimination of dairy products from your diet also helps determine if dairy products are contributing to your problem.

Healing Options

• Make dietary changes. Avoid all gluten-containing grains and products that contain them, even in small amounts. Gluten-containing grains include wheat, rye, barley, millet, and spelt. It is essential to read all labels carefully and become an expert at reading between the lines. Switch to rice, quinoa, wild rice, and oats.

• Try digestive enzymes. Either pancreatic or vegetable enzymes can be used to enhance digestive function. Take 1 to 2 with each meal. Specific amylase enzymes can be of particular benefit.

• Supplement with acidophilus and bifidobacteria. Probiotic flora enhance digestive function.

• Try gut-healing nutrients. Glutamine, gamma oryzanol, and N-acetyl-D-glucosamine are all healing to the intestinal lining. While no specific testing has been done on therapeutic use of these nutrients in people with celiac disease, clinical experience with celiac and other diarrheal illnesses indicates their usefulness.

• Take a multivitamin with minerals. Zinc; selenium; folic acid; iron; and vitamins A, B6, D, E, and K have all been shown to be deficient in people with celiac disease. Get a good quality multivitamin with minerals. Look for a supplement that is hypoallergenic and contains no grains or dairy.