Celiac Disease or Sprue

By Clo Mudrik

Celiac disease - Sprue

• Sprue; Nontropical sprue; Gluten intolerance; Gluten-sensitive enteropathy

• Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy

• The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.

Causes, incidence, and risk factors

• The exact cause of celiac disease is unknown. • The lining of the intestines contains areas called villi, which help absorb nutrients. When

people with celiac disease eat foods or use products that contain gluten, their immune system reacts by damaging these villi.

• This damage affects the ability to absorb nutrients properly. A person becomes malnourished, no matter how much food he or she eats.

• The disease can develop at any point in life, from infancy to late adulthood.• People who have a family member with celiac disease are at greater risk for developing the

disease. The disorder is most common in Caucasians and persons of European ancestry. Women are affected more often than men.

People with celiac disease are more likely to have:

• Autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and Sjogren syndrome

• Addison's disease• Down syndrome• Intestinal cancer• Intestinal lymphoma• Lactose intolerance• Thyroid disease• Type 1 diabetes

Symptoms( the symptoms can be different from person to person. This is part of the reason

why the diagnosis is not always made right away!)

Gastrointestinal Symptoms:

• Abdominal pain, bloating, gas, or indigestion

• Constipation

• Decreased appetite (may also be increased or unchanged)

• Diarrhoea, either constant or off and on

• Lactose intolerance (common when the person is diagnosed, usually goes away after treatment)

• Nausea and vomiting

• Stools that float, are foul smelling, bloody, or “fatty”

• Unexplained weight loss (although people can be overweight or of normal weight)

Because the intestines do not absorb many important vitamins, minerals, and other parts of food, the following symptoms may start over time:

• Bruising easily• Depression or anxiety• Fatigue• Growth delay in children• Hair loss• Itchy skin (dermatitis herpetiformis)• Missed menstrual periods• Mouth ulcers• Muscle cramps and joint pain• Nosebleeds• Seizures• Tingling or numbness in the hands or feet• Unexplained short height

Children with celiac disease may have:

• Defects in the tooth enamel and changes in tooth color

• Delayed puberty• Diarrhea, constipation, fatty or foul-smelling

stools, nausea, or vomiting• Irritable and fussy behavior• Poor weight gain• Slowed growth and shorter than normal height

for their age

Signs and tests

• Albumin(may be low)• Alkaline phosphatase (high level may be a sign

of bone loss)• Clotting factor abnormalities• Cholesterol(may be low) • Complete blood count (CBC- test for anemia)• Liver enzymes (transaminases)• Prothrombin time

Treatment

• Gluten Free Diet!• Look for support groups!• Lots of Information at internet!

Complicationsdelaying diagnosis or not following the diet puts you at risk for

related conditions such as:

• Autoimmune disorders• Bone disease (osteoporosis, kyphoscoliosis,

fractures)• Certain types of intestinal cancer• Low blood count (anemia)• Low blood sugar (hypoglycemia)• Infertility or repeated miscarriage• Liver disease

Prevention

• Because the exact cause is unknown, there is no known way to prevent the development of celiac disease

• However, being aware of the risk factors (such as having a family member with the disorder) may increase your chances of early diagnosis, treatment, and a long, healthy life.

Allowed Foods• Amaranth• Arrowroot• Buckwheat• Cassava• Corn• Flax• Indian rice grass• Job’s tears• legumes• Millet• Nuts• Potatoes• Quinoa• Rice• sago• Seeds• Sorghum• Soy• Tapioca• Wild rice• Yucca• Foods To Avoid• Wheat• einkorn,• emmer,• spelt, • kamut• Wheat starch,• wheat bran, • wheat germ, • cracked wheat, • hydrolysed wheat protein• Barley• Rye• Triticale (a cross between wheat and rye)

• Other Wheat Products• Bromated flour• Durum flour• Enriched flour• Farina• Graham flour• Phosphate flour• Plain flour• Self-rising flour• Semolina• White flour• Processed Foods that May Contain Wheat, Barley, or Rye*• Bouillon cubes• Brown rice• Syrup• Candy• Chips/potato chips• Cold cuts, hot dogs, salami, sausage• wafers• French fries• Gravy• imitation fish• matzo• rice mixes• sauces seasoned tortilla chips• self-basting turkey• soups• soy sauce• vegetables in sauce• * Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer.

Other Wheat Products• Bromated flour• Durum flour• Enriched flour• Farina• Graham flour• Phosphate flour• Plain flour• Self-rising flour• Semolina• White flour• Processed Foods that May Contain Wheat, Barley, or Rye*• Bouillon cubes• Brown rice• Syrup• Candy• Chips/potato chips• Cold cuts, hot dogs, salami, sausage• wafers• French fries• Gravy• imitation fish• matzo• rice mixes• sauces seasoned tortilla chips• self-basting turkey• soups• soy sauce• vegetables in sauce

Points to remember: • People with celiac disease cannot tolerate gluten, a protein in wheat, rye, and

barley.• Untreated celiac disease damages the small intestine and interferes with nutrient

absorption.• Without treatment, people with celiac disease can develop complications such as

osteoporosis, anemia, and cancer.• A person with celiac disease may or may not have symptoms.• Diagnosis involves blood tests and, in most cases, a biopsy of the small intestine.• Since celiac disease is hereditary, family members of a person with celiac disease

may wish to be tested.• Celiac disease is treated by eliminating all gluten from the diet. The gluten-free

diet is a lifetime requirement.• A dietitian can teach a person with celiac disease about food selection, label

reading, and other strategies to help manage the disease.