September 23, 2020
September 13th was National Celiac Day, so I devoted the entire hour of “Your Radio Doctor” to talking about celiac disease and the gluten-free (GF) diet.
There is so much confusion around this topic. First, what is gluten? It’s a protein found in wheat, barley and rye. So, if you have celiac disease and you eat food which contains gluten, it causes an inflammatory reaction which can damage the lining of your small intestine.
Why is that important? Because your small intestine is your “sponge.” It’s the part of the gastrointestinal (GI) tract where you absorb all the good nutrition to stay healthy and alive! Damage can lead to malabsorption or difficulty absorbing important nutrients.
Classic symptoms include diarrhea, bloating, foul smelling or floating stools, and weight loss. However, about 50% of patients don’t have any GI symptoms.
Instead, they may develop symptoms resulting from decreased levels of nutrients, which are not being absorbed properly. For instance, if you don’t absorb enough iron, it can lead to anemia (low blood count), which then causes stress on your heart and other organs. Decreases in calcium and vitamin D can lead to osteoporosis and an increased risk of broken bones. Low vitamin B 12 levels can cause headaches or ataxia (lack of muscle coordination), and celiac is the third leading cause of peripheral neuropathy (loss of sensation in your hands and feet). It may appear as dermatitis herpetiformis, a rash with small blister-like lesions most often found on the elbows.
Marianne Ritchie, MDUntreated celiac can also manifest as a delay in puberty, early menopause,
infertility and even miscarriages. Male infertility can result from
abnormal sperm motility and abnormal male hormone levels.
There is a blood test for antibodies (proteins) that are elevated in patients with celiac. Most patients with untreated celiac will have abnormal blood tests. The gold standard for confirming the diagnosis is a biopsy from the small intestine (duodenum) during an upper GI endoscopy. Note, if you are on a GF diet, the intestinal lining can begin to heal and your blood tests and biopsies may “appear” as normal. You should eat at least 2 slices of bread daily for 2 WEEKS or longer before testing. Gluten has to be in your system for the blood tests and biopsies to be diagnostic.
There is also a gene test for celiac. About 30% of Americans carry a positive gene, but only 1% have the actual disease. Another 8% have a gluten sensitivity. These patients have GI symptoms, but the gluten doesn’t damage their intestine. They should also follow a GF diet.
Treatment? A diet that is 100% free of gluten, and that’s not easy. Especially since gluten is in so many foods you wouldn’t expect like additives in soups, gravies, salad dressings, and soy sauce. Maybe you’re eating GF bread but gluten is in the butter-flavored spread.
Did you know it’s found in beer and in some flavored alcohols? It’s also in some medications, denture creams, and even some lipsticks.
Visit a registered dietician to learn all the nuances about the GF diet. One issue is cross contamination, especially in restaurant settings. If you order fried eggs and they’re cooked on the same grill as French toast, you could have a reaction. GF pizza cooked on the same pan or cut with the same slicer as regular pizza will do the same. At home, don’t rinse your GF pasta in the same strainer as regular pasta.
Patients will ask, can I have a little bread? A small piece of cake on my
birthday?
Unfortunately, no. As little as 1/100 of a piece of bread can cause damage.
If you know you have a life-threatening allergy to shrimp, would you eat
just one little shrimp?
To know whether a GF diet is working, your doctor can periodically check blood tests for antibodies. We also check yearly blood tests for levels of iron, calcium, folate, vitamins, and other nutrients to watch for recurrent malabsorption.
Make sure you don’t go GF without advice from your doctor and a dietician. It can lead to deficiencies in folate, certain vitamins and fiber and may not be the right plan for you. Eat naturally GF foods with fiber like brown rice, corn, sweet potatoes, beans, quinoa, and fresh fruits and vegetables.
Celiac disease is an autoimmune disorder, so no surprise, it may be linked to other autoimmune diseases like Type I diabetes, thyroid disease, inflammatory bowel disease (Ulcerative Colitis or Crohn’s Disease), Lupus, or inflammation of the liver.
Get your child tested if he/she has slow growth, diarrhea for weeks, brown/yellow teeth with grooves or pits, a delay in puberty, or a family member with celiac.
It is very important to be tested for celiac disease if you have a positive family history.
Your risk for celiac is increased by 10% if you have a first degree relative (parent, sibling)
with the disease. Untreated celiac can increase your risk for lymphoma and other GI cancers.
So, friends, pay attention when you get a “gut feeling,”
Visit Beyondceliac.org and Glutenfreedrugs.com for additional resources and information.
Tune in at 10 a.m. every Sunday morning to “Your Radio Doctor” on WPHT, talk radio station 1210 AM or listen on Radio.com. All shows are posted on yourradiodoctor.com.
