Wednesday, December 06, 2006

Hm, haven't really done much with this site lately....
Thought I'd at least post my Biology research paper here, for all those interested in Celiac Disease.

Celiac Disease
November 2006

"Among those kinds of food which the good housekeeper should scrupulously banish from her table, is that of hot leavened bread...I believe it more often lays the foundation of diseases of the stomach, than any other kind of nourishment used among us."
-Sarah Josepha Hale
The Good Housekeeper (1839)

Celiac disease, often referred to as gluten-sensitive enteropathy or celiac sprue, is a disorder of the small intestine caused by the ingestion of gluten. Celiac disease is an inherited autoimmune disorder that causes many physically and psychologically painful symptoms, and while scientists are becoming more adept at diagnosing the disorder, there are as of yet no known treatments or cures other than the complete and total dietary exclusion of gluten in any form.
Celiac disease is caused by gluten. Gluten is a protein found in wheat, barley, and rye. The immune system of a person with celiac disease will cause an inflammation when exposed to gliadin, a subfraction of the gluten protein (1), as well as with the equivalent prolamins found in rye and barley. When the immune system of a person with celiac disease senses gluten, which it has deemed foreign, it sends white blood cells to attack. This abnormal response leads to the flattening of the villi, which are the microscopic finger-like projections that line the walls of the small intestine. The villi are primarily responsible for the absorption of nutrients as they pass through the intestine. When the villi are damaged in any way, their ability to absorb these nutrients is severely limited. If the condition is not recognized and treated, this causes moderate to severe malnutrition in the patient. Continued exposure to gluten leads to complete villous atrophy.
Technically, everything we eat is considered foreign. But in infancy, as our immune system begins to mature, it learns to tolerate food so our bodies can absorb the nutrients in them. This is one reason breast milk is so beneficial. It contains a perfect balance of the nutrients we need, and because it comes from the mother, an immune reaction is less likely to occur. Our bodies become used to the nutrients we need, and eventually adjust as we take in a variety of solid foods. There is speculation about the link between a baby being breast fed and the development of celiac disease. Some scientists believe that the longer a child was breast fed, the later the symptoms of celiac disease may occur (6).
Celiac disease is a genetic disorder, and many theorize that the gene can be traced back to Western European ancestors. Many doctors recommend that a person diagnosed with celiac disease encourage their family members to undergo testing as well, because approximately 5%-15% of first degree relatives of a celiac affected person are likely to have the disease (2).
Studies have shown a direct link between celiac disease and other autoimmune disorders. There is a 3%–8% prevalence of celiac disease reported in patients with diabetes mellitus type 1. Similarly, approximately 40% of patients with celiac disease also have osteopenia or some type of bone loss (3).
Celiac disease is one of the most prevalent human genetic disorders. It is common in about 1% of the population worldwide, and affects approximately one out of every 133 people in the United States (2). Despite this, it is still misconceived as a "rare" disorder in the United States, and sadly most general practitioners are not familiar with and correctly informed about the disease. There is relatively little support for someone diagnosed with celiac disease. There are books and web sites dedicated to educating the newly diagnosed, but there are many inaccuracies (4).
Symptoms of celiac disease vary by age group. Symptoms also vary from person to person, making the disease more difficult to diagnose. The symptoms of celiac disease range from intestinal distress–bloating, gas, chronic diarrhea; to psychological ailments–depression, anxiety, a "head fog"; and often other disorders–osteoporosis, anemia, diabetes, lactose intolerance, lupus and infertility (2, 5). Another common symptom of celiac disease is dermatitis herpetiformis, which is a skin condition that causes painful itchy blisters to appear on the skin. Celiac disease is often aggravated, and thus more easily diagnosed, after a traumatic event such as surgery, pregnancy, viral infection, or even severe emotional stress.
Because celiac disease causes malnourishment, untreated celiac patients have a high risk of developing other diseases. Celiac disease has a high occurrence of mis-diagnosis, and this probably stems from the fact that one-half to two-thirds of celiac patients don’t have obvious gastrointestinal symptoms. The average time between the appearance of symptoms and proper diagnosis is currently 11 years.
Another reason for mis-diagnosis is that until recently celiac disease was believed to be a childhood disorder. However, it is now widely recognized that celiac disease may present itself at any age, and several surveys have identified that the peak age of onset is in the fifties and sixties (3).
In a person with celiac disease, gluten produces an excess of anti-tissue transglutaminase (tTG-IgA) and antiendomysium (EmA-IgA) antibodies. These unique antibodies are detectible through a blood test, and allow for diagnosis. However, the blood test is often inaccurate, and scientists are trying to come up with another more reliable test. After the blood test is performed, a biopsy of the small intestines is obtained, which will show any damage caused by celiac disease (2). The biopsy is usually more conclusive and reliable.
Celiac disease is a lifelong illness. Unfortunately, the only treatment for celiac disease is completely excluding gluten-containing foods from the diet. This sounds simple, but in practice it can be very difficult. Licorice, gravy, processed meats, chicken nuggets, and of course any type of flour tortilla or bread product cannot be eaten. Gluten is an important part of a variety of consumables, including vitamins, medication, hygiene items, and even envelope glue. In many situations it is also a struggle to keep gluten-free foods and gluten-containing foods separate in the kitchen. Even a tiny amount of gluten can trigger an immune system attack on the intestines, causing distress and delaying healing.
Healing is an important step for an individual who is diagnosed with celiac disease. If the patient is able to completely exclude gluten from their diet, the intestines will normally heal in six months to a year. If a gluten-free diet is strictly followed in this time period, most symptoms will have improved dramatically or disappeared completely. If the patient continues to ingest gluten in any form, the healing process is delayed and the symptoms will return.
Currently scientists and doctors are working to create several options for the treatment of celiac disease. One is the creation of a genetically modified wheat. Scientists have put a great deal of time and effort into this idea, but unfortunately they have found that taking out the elements of the wheat molecule that are harmful to those with celiac disease would also affect its elasticity and durability. Another option undergoing research at this time is a bacterial supplement that has the ability to neutralize the immune system, allowing gluten to be passed through the body safely. Scientists have also considered a possible vaccine for those with celiac disease. The vaccine would almost certainly involve the toxic peptide itself, or a slight variation of it, which would completely desensitize a person with celiac disease to the A-gladidin sequence.
Celiac disease is a common, yet highly under-diagnosed disease with a broad spectrum of symptoms. It is a genetic disorder that causes the immune system to attack glutenous proteins, found in grains such as wheat, rye and barley, in the small intestine. It causes severe damage to the villi of the small intestine, preventing absorption of all nutrients, which then leads to malnutrition, and can cause additional complications, such as osteoporosis and anemia. Celiac disease is diagnosed by a blood test and a small bowel biopsy that detect the damage within the intestine. Though several alternatives are under development, the only treatment currently available is the complete elimination of all gluten in the diet.

1. Beaudette, Therese, (1991), Adverse Reactions to Food, The American Dietetic Association
2. Harvard Women’s Health Watch, July 2006, Celiac Disease: When the Body Goes
Against the Grain, pg 4-5
3. Zipser, Robert D., Farid, Mary, Baisch, Donald, Patel, Bhairavi & Patel, Devika (2005)Physician Awareness of Celiac Disease. Journal of General Internal Medicine 20 (7),
pg. 644-646.
4.The British Dietetic Association, 2004, J Hum Nutr Dietet, 17, pg 547-559
5. Hagman, Bette, (1996), The Gluten Free Gourmet Cooks Fast and Healthy, Henry Holt and Company, New York, pg ix-x.
6. Baron-Faust, Rita, and Buyon, Jill P. (2003), The Autoimmune Connection, Contemporary Books Publishing, pg. 226-228


benny said...

yum !!! My niece has celiac disease, I may pass these along...her family has a hard time feeding her things she can eat without making her feel left out all the time.

MankyCat said...

I just found your blog and am starting from the beginning forward. I look forward to seeing what you have experienced through the years. Btw, so far, that peppermint bark looks delish!