Gut Reaction

Thursday, September 1, 2011

Figuring out a gluten-free diet can be challenging, but it's far from impossible. Illustration by Stephen Sauer.

More Info

St. Joseph Hospital, Nashua

Southern N.H. Medical Center, Nashua

The Sante Center for Natural Healing, Hampton

The many challenges of Celiac disease.

Those of us who can eat just about anything without fear of gastrointestinal distress should consider ourselves lucky. We casually grab what we want off grocery store shelves, order pizza with insouciance, and toss down an assortment of breads and pasta with nary a concern about what we're ingesting, aside from fretting over waistline and artery clogging consequences, perhaps.

People with Celiac disease don't have it so easy. Although living with Celiac disease today is not as challenging as it once was, it still requires constant vigilance, as those with the disease try to live their life while avoiding gluten - a protein found in wheat, barley and rye - like the plague. This means Celiac patients must cast a suspicious eye over the ingredient list of many grain-based foods, such as bread, pizza crust, cereals, pastries and pasta, as well as other, less-likely foods and products in which gluten is used as an additive, including some vitamins and lip balms.

It sounds like a type of allergy, but it's not. "It's not an allergic reaction," says Richard C. Dai, MD, a gastroenterologist at St. Joseph Hospital and Southern New Hampshire Medical Center in Nashua. "It is an autoimmune disease, where your body cannot digest a certain type of food and also develops a reaction to it." Celiac disease is like a chemical reaction, Dai says, in which gluten triggers a toxic-like effect that damages the small intestine and prevents proper absorption of food nutrients. For someone with Celiac disease, Dai says, eating gluten is akin to ingesting poison, as far as the gastro-intestinal system is concerned.

Celiac disease can develop at any time during a person's life, and, unfortunately, is pretty much out of our control because it is genetically driven, Dai says. It is easy to diagnose, he says, using a simple blood test. But variable Celiac disease symptoms sometimes mislead doctors and, to complicate matters, another disease entity has recently been discovered whose symptoms mimic those typical of Celiac disease and even abate when the patient shuns gluten. More research on that will be forthcoming, Dai says.

Some Celiac patients experience a mild form of the disease and remain symptom-free, although they still can be affected by health trouble associated with Celiac disease, while others have more severe symptoms. Common signs of Celiac disease include abdominal pain and digestive problems like bloating and diarrhea, but the disease can also manifest itself in many other ways, from fatigue and depression to byproducts of malnourishment, such as iron deficiency, weakened bones and growth delays in children.

Generally, a physician who suspects Celiac disease in a patient will order a blood test and possibly a small bowel biopsy, and might repeat each later to confirm the diagnosis and check to see that the small intestine is returning to normal, Dai says. Most Celiac disease patients heal, as their small intestine returns to proper working order and their symptoms dissipate.

But patient cooperation is crucial to proper diagnosis, Dai says. Some patients read about Celiac disease and attempt to cure themselves by going on a gluten-free diet, he says. Then, after six months or so, they visit a doctor, seeking a diagnosis. "But by that time, it's too late," Dai says. "It's very frustrating for doctors that patients do that because what happens is, their blood test will come back as normal. Their small bowel biopsy will be normal. There's nothing I can do. And meanwhile, you're always wondering, do they really have Celiac disease or do they have some other problem?"

Take the bad with the good

To the untrained eye, Celiac disease might seem more prevalent than it once was, now that we see "gluten-free" labels everywhere. In fact, one in 133 people in the United States will develop it, according to the Celiac Disease Foundation, but what appears to be a climbing incident rate can be chalked up to increased awareness and testing, Dai says. "[The disease] has always been there. When I was a younger physician, we rarely saw one case of Celiac disease in one or two years." Now, because of research and enhanced testing and screening, Dai diagnoses the disease about once every three or four months, he says. Fortunately, raised awareness of Celiac disease has prompted corporate America to produce more Celiac-friendly goods, leading to an abundance of products clearly marked "gluten-free." That's welcome news to Celiac disease sufferers, since there is no cure, per se, for the disease; the only Rx is to avoid gluten.

But as they adjust their eating habits, Celiac patients can expect perhaps one unwelcome change in their body. As you might expect of people who are chronically malnourished, Celiac disease patients usually have a hearty appetite. "They're always hungry, but don't gain weight," Dai says. "They're lucky that way - they eat anything they like, but they remain skinny." Once Celiac disease is addressed and gluten is banned from their diet, however, Celiac disease patients become more like the rest of us. "I always warn my patients, 'Once I correct your problem, you're going to complain to me that you're gaining weight,'" he says.

So much for having your cake and eating it, too. NH

Bon appétit

Celiac disease, triggered in some people by gluten consumption, can require diligent label reading and new dietary habits. Constantly banishing gluten from your plate may not be as easy as pie, but it also does not mean that you have to forgo all of your culinary favorites; many gluten-free varieties of foods are available now, and fruits and veggies can and should ideally still be a mainstay of your diet, says Carolann Kummins, CCHT, founder and executive director of The Sante Center for Natural Healing in Hampton.

Perhaps you'd like to skip the cooking and make raw vegetables and fruits, especially, luminaries of your everyday menu. Doing so would allow you to take advantage of their special energy and benefits, Kummins says. A life force remains in fruits and veggies that are not cooked, she says, helping to protect our body on a cellular level. Consuming the right raw foods and thoroughly cleansing the colon, as well as taking a pass on all things gluten, will help restore wellness to Celiac disease sufferers, she says, and if raw foods are too difficult to digest, patients can enjoy them in juice or soup form.

Indeed, "ultimately, not eating gluten is the big key" to dealing with Celiac disease, says Mark Su, M.D,.S medical director of The Sante Center and a family medicine physician on the North Shore of Massachusetts. "But people who want to take it a step further and improve their gastrointestinal health" should upgrade their overall diet, he says, and consider other options that could enhance GI health.