USA Today ran a 16 page insert on celiac disease this month in honor of
Celiac Awareness Month. It contains contributions from all the big names
in the field including Alessio Fasano and Peter Greene. Read / download
Here is a blog by Shelly Case, RD - North America's Gluten-Free Nutrition Expert
May is Celiac Awareness Month so it’s a great time to share many facts about the disease and its treatment - the gluten-free diet.
Celiac disease (CD) is an inherited autoimmune disease that affects 1:100 people. The disease can develop at any age including the elderly. It is twice as common as Crohn’s, ulcerative colitis and cystic fibrosis combined.
Consumption of gluten, found in the grains wheat, rye and barley, damages the tiny finger-like projections called “villi” that line the small intestinal tract. As a result, nutrients from foods, especially iron, calcium, vitamin D and folate, cannot be absorbed through the villi and into the bloodstream. A variety of nutritional deficiencies can occur over time. Gluten not only affects the gastrointestinal system but many other organ systems in the body. This can lead to a wide range of symptoms that vary from one person to another. Some individuals may only present with a few symptoms or have none at all, while others can have numerous symptoms.
Symptoms can include nausea, bloating, gas, abdominal pain, diarrhea or constipation (or both), lactose intolerance, weight loss (note-CD can also occur in obese individuals), mouth ulcers, extreme fatigue, irritability, bone and joint pain, easy bruising of the skin, swelling of the ankles and hands, menstrual irregularities, elevated liver enzymes, migraine headaches, depression and ataxia (balance and coordination difficulties). Children may also have delayed growth, dental enamel defects and concentration and learning difficulties.
Another presentation of CD is a skin condition called dermatitis herpetiformis (DH). It is characterized by an intense burning, itchy rash that is symmetrically distributed. Areas affected can include the elbows, knees, back of the neck and scalp, upper back and buttocks. Initially, groups of small blisters are formed that soon erupt into small erosions. Most people with DH will also have varying degree of small intestinal villous atrophy, although many will have no bowel complaints. For more information about DH check out this link.
Read the rest of the article....
Newsletter on celiac disease from the National Institutes of Health
The phrase "gluten intolerant" is a rather nebulous term which is why I
try to avoid using it. I prefer to use 'gluten sensitivity'. The
sub-groups of gluten sensitivity are: gluten sensitive enteropathy
(otherwise known as celiac disease); non-celiac gluten sensitivity;
neuropathic gluten sensitivity, etc.
Gluten sensitivity is the term recommended by the world renowned celiac
researcher, Dr. Michael N. Marsh. The terminology I advocate is
congruent with Dr. Marsh's assertions and it provides some clarity, as
it often identifies specific sites of damage induced by gluten,
distinguishes between some subgroups, and allows even the novice to
accurately interpret some discussions of these topics.
The varying opinions on your biopsies may have been driven by just how
familiar or unfamiliar these physicians were with the Marsh system for
categorizing intestinal damage, which was developed by the same Dr.
Michael Marsh mentioned above. The Marsh system is gradually being
adopted throughout most of the industrialized world, as older
pathologists and gastroenterologists advance their understanding, and
the younger ones usually learn about the Marsh system during their
Of course, the terminology I recommend also makes it very clear that
there are a number of types of gluten-induced damage to various body
systems. Dr. Rodney Ford, on the other hand, has offered the term
'gluten syndrome' to incorporate the various groups of gluten
sensitivities into one group. I also subscribe to that choice of
terminology. Careful word choices in this regard are, I think, critical
to understanding the broader field of gluten sensitivity, and that
celiac disease is just one sub-set of a rather large and growing
continuum of illnesses that require a life-long gluten free diet.
Celiac disease has long been considered the most serious of this
spectrum and other gluten sensitivities were considered "lesser"
ailments. However, Anderson et al recently published findings that
suggest that non-celiac gluten sensitivity may more frequently lead to
serious illness or death than celiac disease (1). If confirmed by
further research, we may need to revise our opinions regarding where
celiac disease falls on the gluten sensitive spectrum.
I hope my comments serve to clarify this issue.
Ron Hoggan, Ed. D.
1. Anderson LA, McMillan SA, Watson RG, Monaghan P, Gavin AT, Fox C,
Murray LJ. Malignancy and mortality in a population-based cohort of
patients with coeliac disease or "gluten sensitivity". World J
Gastroenterol. 2007 Jan 7;13(1):146-51.