Responding To The Reader
Celiac disease
Dr. Paul Beck responds to a reader’s question about new research and information on celiac disease.
About this feature
AHFMR frequently receives letters requesting information about Heritage research or about various medical conditions. "Responding to the reader" is a Research News feature intended to provide up-to-date information related to readers' questions, with the help of experts in the Alberta research community. AHFMR cannot provide medical advice, however; please consult your family physician about your specific health concerns.
Celiac disease (CD) is caused by an immunological reaction to gluten, a protein found in wheat and grains related to it, including rye, barley, triticale, spelt, and kamut. This immune reaction results in inflammation or injury (or both) of the small intestine leading to poor absorption of nutrients and, often, diarrhea, abdominal pain, as well as numerous other health problems if it isn’t treated.
To find out more about new developments in research into celiac disease and its diagnosis and control, we talked with Dr. Paul Beck, an AHFMR Scientist in the University of Calgary’s Department of Medicine, and the recipient of several teaching and research awards.
Dr. Beck explains that the treatment for celiac disease is straightforward—patients must eat a gluten-free diet for the rest of their lives. As little as 25 to 50 milligrams of gluten (there are approximately 4,800 milligrams of gluten in one slice of whole wheat bread) can cause inflammation and induce symptoms. Although carefully watching what you eat all the time may be frustrating, the good news is that more and more gluten-free foods and beverages are showing up on grocery-store shelves. And the Canadian Celiac Association and its local chapters offer tips, resources, and recipes for embarking on a gluten-free lifestyle—and enjoying it.
“While it may be somewhat restrictive, a gluten-free diet isn’t all hardship,” says Dr. Beck. “What’s wrong with a dinner of lobster or steak on a bed of rice with a side of vegetables?” Instead of deprivation, people with celiac disease may find their treatment to be a bit of a gourmet experience. To those who find a gluten-free diet expensive, Dr. Beck points out that celiac patients can get a tax break on their grocery bills to help offset costs.
According to Dr. Beck, though, the foremost benefit of a gluten-free diet lies in significantly lowering the risk of life-threatening diseases associated with the disorder.
Classic symptoms of celiac disease in adults may include diarrhea, nutrient deficiency, non-specific abdominal pain, bloating, flatulence, and fatigue. However, Dr. Beck advises that CD can be a subtle disease, often presenting in nearly undetectable ways that make it hard to diagnose. “When a patient’s symptoms are confounding, suspect celiac disease,” he recommends.
New blood tests (EMA and tTG) prove very accurate for Marsh 3-level celiac patients—those who show intestinal inflammation and injury resulting in flattening or blunting of the villi (tiny, finger-like structures that absorb nutrients in the intestine). Yet blood tests for Marsh 1- and 2-level patients (those with less severe intestinal inflammation or injury) often come back with “false negatives”, leaving about 30% of patients undiagnosed. However, the gold standard for detecting celiac disease is still a biopsy of the duodenum (the first section of the small intestine). This five- to ten-minute procedure, performed with an endoscope (a long tube with a camera on the end), is relatively straightforward, and has a very low complication rate.
Celiac disease has a strong genetic component: Most common in people of European descent, it is generally rare in those of Asian or African descent, although it appears to be common in some isolated areas in Africa. First-degree (parents, children, siblings) and second-degree (grandparents, grandchildren, nephews, nieces, cousins) relatives of patients with celiac disease are at markedly higher risk, as are those with type 1 diabetes; auto-immune diseases of, for example, the thyroid or liver; Sjögren’s syndrome or other connective-tissue diseases; Down syndrome or Turner’s syndrome; and such lesser-known genetic disorders as selective Immunoglobulin A deficiency.
Dr. Beck offers some final food for thought: “CD is a disorder that can be dealt with—if you change your diet, you’ll get better.” It’s that simple. To best succeed at the gluten-free lifestyle, Dr. Beck recommends that patients shift their expectations and understand that it may take anywhere from two weeks to a year to experience the full benefits of a gluten-free diet.