Frequently Asked Questions About Celiac Disease

Frequently Asked Questions About Celiac Disease

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How much gluten is in a normal diet, and how much damage does it cause to the intestine?

       To give you an idea, one slice of wheat bread has 4.8 grams of gluten, and one serving of pasta has 6.4 grams of gluten. These are just components of the gluten-containing diet, which usually includes about 40-60 grams of gluten per day. As small as 0.1 gram of gluten can cause damage to the lining of the small intestine in an individual with celiac disease. This means that 1/48th of a slice of bread can damage the lining. So, even a little bit of gluten can be dangerous to the individual with celiac disease. It's important to completely eliminate gluten from your diet, once you've been diagnosed with celiac disease by a physician (Celiac.com). 

If gluten-containing products touch my skin, can that be dangerous as well?

       This is unlikely. Gluten is only dangerous to the gut of an individual with celiac disease, so if it does not directly contact the gut, it is unlikely to cause damage. Only people who have had an anaphylactic reaction to gluten before should avoid any topical contact with the substance, although this is extremely rare (Celiac.com).

How accurate are the blood tests for celiac disease?

       The blood tests are very accurate, so long as the individual is on a gluten-containing diet at the time of testing. The gluten autoantibodies will only be detected by the blood test when the person has consumed gluten recently (Massgeneral.org). 

Is celiac disease an allergy?

      No. Celiac disease is an autoimmune disorder that is triggered by the consumption of gluten. It is not an allergy to wheat or to gluten. An allergy is when an individual's immune system overreacts to a substance and produces symptoms as a result. An autoimmune disorder is much more severe, because in this case, the body's immune system malfunctions and reacts incorrectly to its own bodily tissues. This is what happens in the case of celiac disease, when the body produces immunoglobulins that attack it's own small intestine lining's villi (About.com). 

Can you grow out of celiac disease?

     No. Celiac disease is a condition that follows the individual for the rest of his or her life. This is why it is important to adapt to a gluten-free diet and lifestyle, to protect one's small intestine's longevity and health. If an individual were to stray from his or her gluten-free diet later on in life, the body would react to the consumption with the same negative autoimmune reaction as before the diagnosis (Coeliac.com).

The following is a link to a Dr. Oz video about Celiac Disease that may answer some other potential questions you may have regarding celiac disease: Dr. Oz: Celiac Disease. 

Resources:

Celiac Disease & Gluten-free Diet Information at Celiac.com. (n.d.). . Retrieved June 12, 2014, from http://www.celiac.com/

Massachusetts General Hospital Home. (n.d.). . Retrieved June 12, 2014, from http://www.massgeneral.org/ 

Celiac Disease - Gluten-Free Diet. (n.d.). About.com Celiac Disease & Gluten Sensitivity. Retrieved June 12, 2014, from http://celiacdisease.about.com

Home - Coeliac UK. (n.d.). Home - Coeliac UK. Retrieved June 12, 2014, from https://www.coeliac.org.uk

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Talking to Your Family About Celiac Disease

Talking to Family about Celiac Disease

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       After being diagnosed with celiac disease, it's easy to feel alone in the matter. All of a sudden, you have to give up so many foods that you've always loved, while everyone else gets to go on with their lives eating all the bread and pasta their hearts desire. However, you are not alone. Your family members play a crucial role in your condition. First of all, you can tell them how to help you manage your gluten intolerance. Second of all, your first- and second-degree family members actually have a significant chance of having celiac disease, as well, and it is important that you encourage them to get tested, and pay attention to any symptoms. 

      It's important to explain celiac disease to your family members, so that they can help you make healthy choices for yourself. Tell them something like, "Being gluten-free is somewhat like a food allergy -- I cannot eat food containing gluten, or I will get sick." Explain to them that gluten-containing foods are bread, spaghetti, and even some beer, among countless other foods that contain gluten. Make sure you explain to them that sometimes, gluten-containing ingredients can "sneak" into food items that seem safe, on the surface. Tell your friends and family about how foods can be contaminated with gluten, and they can help you have a more watchful eye on what you eat! Explain to them that if something containing gluten even touches your food, that you can become sick, so you have to be extremely careful. Explaining your condition in this thorough and helpful way to a friend or family member can help them to help you manage it effectively (Celiac Central). 

Process of determining a celiac disease diagnosis.

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      Additionally, it is important to recognize, and to help your family members recognize, that not only are you diagnosed with celiac disease, but they are also at risk, because they are a close relative to you, and celiac disease tends to run in families. 1 in 22 first-degree family members (such as a parent, brother, sister, or child), and 1 in 39 second-degree family members (such as an aunt, uncle, niece, nephew, granddaughter or grandson) are at risk for celiac disease (Celiac Central). A simple genetic test, called a H.L.A. DQ2/DQ8 test, can be given to see if an individual possesses the genes necessary to have celiac disease. If positive for these genes, the individual should look into a blood test to further see if the individual is affected. It is important to encourage family members to get tested for celiac disease, so that if they do have it, they can stop eating gluten immediately as to not cause further damage to their small intestine (NY Times). 

Resources:

National Foundation for Celiac Disease Awareness. (n.d.). Talking to Your Friends. Retrieved June 5, 2014, from http://www.celiaccentral.org/kids/talking-to-friends/

Genetic Testing for Celiac Disease. (n.d.). Consults Genetic Testing for Celiac Disease Comments. Retrieved June 5, 2014, from http://consults.blogs.nytimes.com/2010/01/13/genetic-testing-for-celiac-disease/?_php=true&_type=blogs&_r=0

Screening and Diagnosis of Celiac Disease

Screening and Diagnosis of Celiac Disease

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Screening

       The first step of the screening process for celiac disease is a genetic test. This can be a blood, saliva, or cheek swab test, that looks to see if the genes necessary for celiac disease to develop are present in the individual's body. Individual's with first-degree relatives who had the disease have been shown to be likely to develop it as well, so this test is a good starting point (University of Chicago Celiac Disease Center). 

        The next step in the screening process is a blood test. This simple blood test is called a tTG-IgA test, short for Tissue Transglutaminase Antibodies, and it will most likely be positive if you have celiac disease. However, it is crucial that you are on a gluten-containing diet at the time of the test, because otherwise, the test will be inaccurate. There is a chance that your test results may reflect a false positive if you have autoimmune diseases such as chronic liver disease, type 1 diabetes, rheumatoid arthritis, and heart failure (Celiac Disease Foundation). 

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        Other antibody tests include an EMA test (IgA Endomysial antibody test), which is still effective, but not as sensitive as the tTG-IgA test, because 5-10% of people who have celiac disease will have a negative result on this test. A total serum IgA test can be used to check for an IgA deficiency, which is a condition that is relatively harmless that is associated with celiac disease. Finally, a deaminated gliadin peptide test can be given to test people for celiac disease who have an IgA deficiency (Celiac Disease Foundation).

Diagnosis

        An intestinal biopsy can be performed to test for celiac disease, in order to confirm the diagnosis suggested by the blood test. An endoscope is used in this process, which is a long skinny tube inserted through the mouth, all the way down to the intestines of the patient. The doctor will take a sample of the small intestine's lining, and observe to see if damage to the villi (projections on in the inner surface of the lining, responsible for nutrient absorption) has occurred (National Digestive Diseases Information Clearinghouse). 

        The biopsy procedure is usually an outpatient one. Sedatives and local anesthetics are used, and the process takes about 30 minutes total (Celiac Disease Foundation). The patient will be assigned a Marsh classification which will explain the severity of the intestinal damage. Stage 0 is when the internal mucosa of the lining of the small intestine is normal, and celiac disease is extremely unlikely. This stage is also called the "pre-infiltrative stage". Stage 1 is when the surface cells of the inside of the small intestine are being infiltrated by lymphocytes (a white blood cell that is part of the body's immune system). Stage 3 shows a larger amount of lymphocytes, and a lining of the small intestine that is shrinking and flattening out. Stage 4 is when the the villi on the inside of the small intestine are completely flattened out, rendering them relatively ineffective (About.com). 

Resources

Screening - Celiac Disease Foundation. (n.d.). Celiac Disease Foundation. Retrieved June 3, 2014, from http://celiac.org/celiac-disease/diagnosing-celiac-disease/screening/http://celiac.org/celiac-disease/diagnosing-celiac-disease/screening/

National Digestive Diseases Information Clearinghouse (NDDIC). (n.d.). Celiac Disease. Retrieved June 3, 2014, from http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/#diagnosis

Celiac Disease Screening – Univeristy of Chicago Celiac Disease Center. (n.d.). . Retrieved June 3, 2014, from http://www.cureceliacdisease.org/living-with-celiac/guide/screening

Celiac Disease Marsh Stage - Celiac Disease Marsh Score. (n.d.). About.com Celiac Disease & Gluten Sensitivity. Retrieved June 3, 2014, from http://celiacdisease.about.com/od/diagnosingceliacdisease/ss/MarshScore.htm

        

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