Traditional thinking about celiac disease is that it is an illness that is characterized by an autoimmune attack on the small intestine triggered by eating gliadin, a prolamine protein of gluten found in wheat and grains of the triticiae family such as rye and barley, along with spelt and kamut. The enzyme “tissue transglutaminase modifies the protein, and the immune system cross-reacts with the small bowel tissue, causing an inflammatory reaction.” (9)
This leads to a flattening of the villi in the small intestine which creates severe malabsorption and even starvation in some affected individuals. The classic symptoms of celiac disease are severe nutrient deficiencies, failure to thrive, digestive disturbances, bowel irregularities, and malnourishment.
Most of the time, these individuals will react immediately to gluten exposure. Many can’t even walk into a bakery as exposure to flour in the air can stimulate a reaction.
Historically, celiac disease is only thought to be principally a disease of the small intestine. A clinically positive reading on a blood test of transglutaminase antibodies, which can cause bowel destruction, endomysial antibodies, or anti-gliadin or deaminated gliadin antibodies, is a diagnosis of celiac disease. These tests will only show positive for celiac if there is significant damage to the intestines.
It is commonly known that only a small percentage of those with celiac disease suffer damage to the intestines. This means that many people who are tested for celiac will be negative for a diagnosis of celiac disease. Unfortunately for many people who should avoid eating gluten, they are told that they could continue to eat gluten grains. Statistically, a person who has celiac and continues to eat gluten has a 6-fold risk of mortality over those who live a gluten-free life.
Many people suffer with celiac for years before being diagnosed. It takes an average of ten to twelve years to diagnose. Even then, many who have celiac do not get diagnosed until the symptoms become very severe. The symptoms are often diagnosed as irritable bowel syndrome or gastritis, when celiac is actually the underlying issue.
Statistics on Celiac
It is estimated that 1 in 133 people have celiac and that 97 percent go undiagnosed. (3)
60 percent of children and 41 percent of adults diagnosed with celiac had no symptoms
In people with first-degree relatives who have celiac, there is a 1 in 22 chance of having celiac disease
In people with second-degree relatives with celiac, there is a 1 in 39 chance of having celiac disease
Two-thirds of those with celiac don’t have intestinal symptoms.
59 percent are misdiagnosed with irritable bowel syndrome.
“That gluten sensitivity is regarded as principally a disease of the small bowel is ahistorical misconception.”
“Our studies show that gluten sensitivity plays an important part in neurological illness. Gluten sensitivity can be primarily, and at times, exclusively a neurological disease.” (4)
“Inflammation caused by gluten reactions are not confined to the gut as gliadin antibodies are found systemically.” (4)
“The clinical presentation of this condition can range from the typical syndrome of malabsorption to symptoms and conditions that can affect any organ system.
“CD “out of the intestine” is even more frequent than CD “within the intestine.” (4)
A significant number of those with thyroid disease have celiac and vice versa (300-400 percent more likely). It is the second most prevalent autoimmune disorder after Type 1 diabetes associated with celiac disease.
Heart disease is 60 percent more common in those with celiac.
Celiac Disease vs. Gluten Sensitivity
The philosophy that celiac is only relegated to the intestines is still part of the medical lexicon even to this day. What is now known from research over the past twenty years or so is that celiac disease can affect not only the gut, but all other organ systems. Two-thirds of those with celiac disease do not have intestinal symptoms nor have intestinal damage. In fact, there are now considered to be two primary types of gluten intolerance: celiac disease and non-celiac
Celiac disease is still considered to be an autoimmune process, but being gluten sensitive means that there is a sensitivity to not only gluten, but also to the different fractions of the wheat molecule such as wheat germ, gliadin, and gluteomorphin. Even though celiac disease is often called gluten sensitivity or gluten intolerance, having non-celiac gluten sensitivity may be more problematic in that a person is sensitive to many of the wheat fractions, as well as gluten. It is also possible that one can have both celiac disease and non-celiac gluten sensitivity.
Symptoms of non-celiac gluten sensitivity are well documented to trigger a diverse set of symptoms that may affect multiple organ systems. Issues associated with gluten sensitivity and celiac disease include:
- All neurological disorders
- Mood issues: anxiety, depression
- Failure to thrive
- Heart Disease
- Iron anemia
- Inflammatory bowel diseases
There are several tests that need to be run if any symptoms are perplexing and may be related to gluten sensitivity. The Transglutaminase IgA blood test and the HLADQ gene tests should be run. Better yet, run the Wheat Proteome Sensitivity and Autoimmunity (Array 3) Panel from Cyrex Labs. This test measures the IgA and IgG reactions to the wheat fractions and different sets of transglutaminase enzymes. Each set relates to different areas of the body and if positive,
signal an indication of celiac along with gluten sensitivity.
The treatment is total elimination of gluten grains for life. For those with celiac disease, after eliminating gluten from the diet, even one small exposure will trigger a serious immune system response and manifest in obvious symptoms. For those with gluten sensitivity the same is true, as one exposure may still trigger an immune system response and may also manifest in obvious symptoms. For example, if migraines are stopped by eliminating gluten then eating a piece of bread may trigger another migraine. Failure to eliminate the gluten grains will result in long-term health consequences. Autoimmunity is a common finding in those with celiac and gluten sensitivity.