Celiac Disease in America: A Term Paper


I recently discovered that I only needed one more college course to complete an associates degree at the community college I attended when I lived in Omaha. The course was called Information Systems and was available as an online course. It covered writing a term paper, bibliography, creating an Excel spreadsheet with graph, and a PowerPoint presentation. So for the last several months I have been working on homework! Last week I zipped all of the requirements up and emailed them to my professor. And now I wait.

For my topic I chose to write on celiac disease. For this long-past-due blog (hey, I’ve been busy!) I’m going to share that paper. It is a quick overview of celiac disease. I can’t tell you if this paper is good (yet) because I’m still waiting for my grade!! Cross your fingers for me!

Celiac Disease in America

“Three million Americans across all races, ages, and genders suffer from celiac disease” (NFCA). Celiac disease is an autoimmune disorder in which the gluten (a protein) in wheat, barley and rye that is ingested causes the body to attack the gluten and in the process it also attacks the small intestine. This causes the small intestine to be unable to absorb the nutrients the body needs to function. This paper will present the signs, symptoms, testing for, and solutions to celiac disease.

Gluten is a protein found in wheat, barley, and rye. It is what makes bread dough elastic, pizza crust chewy, and cake light and fluffy. Over the past 50 years or so our diets have changed. Our intake of gluten has increased. We have cereal and toast for breakfast, sandwiches for lunch, and pasta for dinner. In between we eat cakes made from a box or cookies purchased at a bakery.

Combine the increase in consumption with the theory that the wheat that we use today has been so genetically modified to have such an abnormally large amount of gluten that our bodies cannot easily digest it (Davis). These factors may be creating the increase in people being diagnosed with celiac disease. “At least 2 studies of stored serum revealed that as few as 50 years ago celiac disease occurred in only .02% of the population. Now it is about 1%” (Smith).

With any food allergy the best possible solution is to avoid it. At first eliminating gluten may sound simple. It is only found in wheat, rye and barley. But if you have celiac disease you must eliminate ALL forms of wheat. That includes: bulgur, couscous, faro, graham, kamut, malt, malt vinegar, matzo meal, orzo, panko, spelt, wheat germ and wheat starch among others! It also means avoiding all forms of white flour since white flour is derived from wheat.

But it doesn’t stop there. There are also many hidden sources of gluten. Gluten can be an ingredient in such products as chap stick, lipstick, deli meats, hydrolyzed protein, imitation seafood, licorice, medications, salad dressings, soy sauce, beer, toothpaste, and vitamins. It can also be in the “natural flavors” often found on an ingredient list.

Those with celiac disease have a genetic intolerance to gluten where “the body sees gluten as a…toxin and attacks it. In doing so it accidentally attacks the villi, and those villi get blunted and shortened, sometimes to the extreme of becoming completely flat” (Korn). Celiac disease is different from gluten sensitivity, “a reaction to the gluten in wheat but not achieving the severity of celiac disease…the most common definition [of gluten sensitivity] is that of showing symptoms of sensitivity to wheat gluten, such as acid reflux, abdominal pain, cramps, and diarrhea, that disappear with elimination of wheat” (Davis). There are more people with non-celiac gluten sensitivity than with celiac disease. People with non-celiac gluten sensitivity have similar symptoms as those with celiac but they don’t have the autoimmune response.

There are at least 130 different symptoms that have been associated with celiac disease and almost every tissue in the body can be affected (Frangou). Some of the most common gastrointestinal symptoms of celiac disease include:

Abdominal pain/distention Acid reflux Bloating Constipation
Diarrhea Gas/flatulence Greasy, foul smelling stools Nausea
Vomiting Weight loss/gain Delayed onset of puberty Delayed growth in children

(Korn)

But for many people with celiac those symptoms are only part of the picture. There are also non-gastrointestinal symptoms that may clue you in to whether you have celiac. These include:

Fatigue/weakness/anemia Headaches Joint/bone pain Inability to concentrate
Respiratory problems Canker sores Eczema/psoriasis Rosacea
Acne Early onset osteoporosis Hair loss Hypoglycemia
Muscle cramps Nose bleeds Night blindness Swelling/inflammation
Bruising easily Lactose intolerance Ataxia (balance) Vitamin/mineral deficiencies

(Korn)

To compound the issue for those with celiac, according to the National Foundation for Celiac Awareness (NFCA) “Celiac disease can lead to a number of other disorders including infertility, reduced bone density, neurological disorders, some cancers, and other autoimmune diseases” (NFCA).

Gluten is measure in parts per million (ppm). “There aren’t any consistent standards for determining what is gluten free” (Korn). A food with a ppm of less than 10 is considered certified gluten free and allowed to put the gluten free label on their foods. For most people this ppm<10 is acceptable. There are a few, however, who may still react to this minute amount of gluten. (After this paper was written the FDA ruled that <20 ppm would be the standard for a manufacturer to meet in order to label their products as “gluten free”. (FDA))

Awareness of celiac disease is on the rise. As more people learn the potential of ill effects of gluten they are starting to change their diets. One in every three adults (30% of adults) “claimed to cut down or avoid gluten completely in January 2013” (NPD Group).

Another sign that celiac awareness is on the rise is the increase in gluten free foods produced by the food industry. “As awareness increased during the past decade and a half so, too, has the gluten free food industry” (Frangou). Gluten free products now represent the second fastest growing segment of the U.S. food industry (Frangou). Many restaurants are also offering gluten free alternatives, but many times a person must ask for a gluten free menu. Even then the restaurant may not have a full understanding of cross contamination of foods (i.e. using the same toaster for bread with gluten and bread without gluten).

Even with the long list of symptoms many people are going undiagnosed. “The vast majority of patients with celiac disease remain undiagnosed. One report suggests that only 10%-15% of celiac disease cases in the United States are diagnosed” (FDA).

Testing for gluten sensitivity/celiac disease can be tricky. A blood sample may be taken to check for several types of antibodies that may be elevated indicating the immune system has responded to gluten in the past. However these tests can be unreliable if the person has not been eating gluten for some time! A biopsy of the small intestine is also a test that may be ordered. In this case snippets of the small intestine are removed and the villi are examined to see if they are healthy. But, again, the villi may not show signs of impairment.

There is no cure for celiac disease. The only option a person with celiac has is to remove all gluten from their diet. “The keystone treatment of celiac disease patients is a life-long elimination diet in which food products containing gluten are avoided” (Korn).

The cases of celiac disease are on the rise. There are currently advancements being made in awareness and testing. Even the potential of a vaccine is on the rise (Stuart). If you, or someone you know has some of the symptoms listed above you may have celiac disease. It is important to know if you have it before years of malnutrition make irreparable damage to your body. “Untreated, it can destroy digestive tract tissue and can lead to anemia, osteoporosis, infertility, neurological dysfunction, or even cancer. Currently, the only solution is to avoid gluten altogether” (Stuart).

Works Cited

Davis, William. Wheat Belly Cookbook. New York: Rodale, 2013. Print.

FDA. “Health Hazard Assessment for Gluten Exposure in Individuals with Celiac Disease: Determination of Tolerable Daily Intake Levels and leves of Concern for Gluten.” 2011. fda.gov. Web. 30 June 2013. <www.fda.gov/downloads/food/foodscienceresearch/UCM264152.pdf>.

—. What is Gluten Free? FDA Has the Answer. 5 August 2013. Online. 13 August 2013.

Frangou, Christina. “Gluten Sensitivity Baffles Celiac Disease Specialist.” Gastroenterology and Endoscopy News (2010): 1, 25, 28-29. Print.

Korn, Danna. Living Gluten Free for Dummies. Hoboken: Wiley Publishing, Inc, 2006. Print.

NDDIC. National Digestive Diseases Information Clearinghouse (NDDIC). September 2008. Web. 15 July 2013.

NFCA. Celiac Facts. n.d. Web. 30 June 2013.

—. What is Celiac Disease? n.d. 15 July 2013.

NPD Group. NPD Group. 6 March 2013. Web. 30 June 2013.

Smith, Monica. “Researchers Probe New Genetic Links to Celiac Diseae That May Improve Diagnosis and Treatment.” Gastroenterology and Endoscopy News (2010): 33. Print.

Stuart, Alix. Making Bread Safe for Celiacs. 11 March 2013. Web. 30 June 2013.

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