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MD Corner

Q&A on Celiac Disease

with Melinda Dennis, RD LDN, The Celiac Center at BIDMC

Celiac disease is one of the most common chronic health disorders in the United States, causing stomach pain and affecting the eating habits of some 3 million Americans. But it often goes undiagnosed. Click here to learn more about this digestive disorder and a gluten-free diet from BIDMC Registered Dietician Melinda Dennis.

Q: What is celiac disease and how do I know if I have it?

A: Celiac disease is a small intestinal digestive disorder that is characterized by inflammation, villous atrophy (damage to the lining of the small intestine) and abnormal absorption of vitamins and nutrients. It is triggered by the ingestion of wheat gluten or related proteins from rye and barley in susceptible individuals.

Celiac disease is closely associated with symptoms such as abdominal pain, bloating, gas, constipation, diarrhea, weight loss and fatigue. However, some people have no symptoms at all and others have symptoms outside of the gut, such as a skin rash.

Celiac disease is diagnosed with a blood test to check for antibodies found in patients with the condition. If the test is positive, the patient will need to undergo an upper endoscopy and a biopsy of the duodenum, the first, shortest and widest part of the small intestine to determine if there has been any damage.

Q: Is celiac disease hereditary?

A: Celiac disease is closely associated with the genes HLA DQ2 and/or DQ8. However, having these genes does not necessarily mean that a person has celiac disease. Some 40-50 percent of the normal population also carry these genes.
Celiac disease is triggered by gluten in genetically predisposed individuals. Between 7 and 10 percent of immediate family members of someone with celiac disease also have the disorder.

People who are genetically predisposed to celiac disease may develop symptoms following a period of acute or chronic stress, trauma, physical injury, or pregnancy. A person is also more likely to develop celiac disease if they were exposed to glutens before they were 3 months old.

Q: Are there risks if celiac disease goes untreated?

A: Untreated celiac disease can lead to nutritional deficiencies (vitamin D, B-12 and folate), iron deficiency anemia, autoimmune diseases, neurological disorders and osteoporosis (calcium deficiency). In rare instances, untreated celiac disease can result in pancreatitis, the formation of ulcers along the small intestine and even cancer. (Enteropathy associated T-cell Lymphoma).

Q: Are there any new treatments for celiac disease on the horizon?

A: Research into the development of potential new treatments for celiac disease is moving at a rapid pace and we are optimistic that these efforts will come to fruition in the coming years. The Celiac Center at Beth Israel Deaconess Medical Center continues to be a leading center in evaluating the safety and effectiveness of potential novel treatments.

Researchers are always in need of individuals to participate in this cutting edge research. If you have celiac disease and are interested in taking part in a research study, contact the Celiac Center at celiac@bidmc.harvard.edu.

Q: My doctor put me on a gluten-free diet, but it's complicated. What's the best way to tell if food has gluten in it?

A: Eating a gluten-free diet doesn't have to be stressful. Don't focus on what you can't eat. Instead, focus on the foods you can eat. Fruits and vegetables (without additives or sauces) are naturally gluten free. Consume lean proteins, such as fish and chicken and limit red meat.

Many people find they don't eat enough fiber on a gluten-free diet, so fill up on legumes like chickpeas, lentils and kidney beans. Also, be sure to stock up on gluten-free whole grains such as amaranth, millet and quinoa. These grains are high in complex carbohydrates, iron, calcium, B vitamins and minerals. Also, make sure you get adequate amounts of calcium and vitamin D.

Wine and most distilled liquors are safe to drink, provided no additional flavorings have been added. Beer, which is made from wheat or barley, should be avoided.
Most importantly, read the nutrition labels on processed foods and stay away from anything that contains wheat, barley, rye, triticale, spelt and contaminated oats.

Visit with a registered dietitian to learn more about avoiding hidden gluten and balancing your gluten free diet.

Q: Is it possible I'm not getting all the nutrients I need because I'm cutting so many foods out of my diet? Should I take vitamin supplements?

A: Under the direction of a healthcare provider, depending on age and gender, most people choose a daily multivitamin with minerals, such as magnesium and zinc, which provides no more than 100 percent of the recommended daily allowance for each nutrient. Check the label for 'gluten free' as some vitamin coatings may contain gluten.

It is also important to note that some medications have gluten-containing fillers or coatings. To find out if your medications contain gluten, visit www.glutenfreedrugs.com. This website gives helpful information about how to identify gluten in your medications, as well as a list of gluten free drugs. It is always best to contact the manufacturer directly.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.