Celiac Disease, More than Intolerance to Gluten and Wheat - Research Paper Example

? Celiac Disease, More than Intolerance to Gluten and/or Wheat Celiac Disease, More than Intolerance to Gluten and/or Wheat Celiac disease is an autoimmune disease and a person suffering from it has to follow a strict dietary plan and lifestyle to prevent the symptoms and related complications. My interest in Celiac disease is not solely academic; it is also personal to a great extent. I previously had cancer in 2004 but was successful in emerging as survivor. But, I started experiencing some symptoms quite similar to my previous malignancy like fatigue, cramps and bloating. Obviously, my fears were directed towards the recurrence of the cancer. However, when the doctor diagnosed me in July 2010 of celiac disease I came to understand that it was an autoimmune disease with similar signs and symptoms. As an athlete I go through vigorous routines and exercises and also very athletically designed diet plans. Since this autoimmune disease is a reaction to gluten found in specific food items like wheat I knew instantly I would have to bring some drastic changes. Controlling my food cravings and changing my regular eating patterns was not easy. It indeed needed a lot of patience and complete knowledge about gluten-containing substances and cross contamination. At times it was extremely nerve-wrecking. In celiac disease the small intestine is the major organ that is affected. It is both a malabsorptive disease and an autoimmune disease as it is caused by an immune reaction against gluten. Gluten is a protein which is present in specific food items like wheat, barley, rye and to some traces are also found in oat. Apart from food items, gluten has also been detected in some vitamins, lip balms or medicines. Synonyms of the disease include gluten enteropathy, celiac sprue and non-tropical sprue. Gluten is basically a group of proteins that are found in the wheat. A particular type of protein in gluten is gliadin which is considered responsible for the immunological reaction. Normally these long chain gliadins are broken down by the digestive enzymes into smaller chains or single-unit amino acid. However, in celiac disease digestive enzymes fail to do so and the intact longer chains have a damaging action on the digestive system. Evidence suggests celiac disease to be both genetic and inherited. It is inherited by first-degree relatives and it has been observed that 30% fraternal twins and 70% of the identical twins are diagnosed positive of celiac disease. On the other hand, some genes are detected in celiac disease patients that are not found in the healthy individuals. It can also occur without any genetic background after surgery, child birth, pregnancy or severe viral infections. Spanish scientists have also concluded through experiments that the gut microflora is also responsible for the inflammatory reaction apart from the gliadin action (Jamron 2008; National Digestive Diseases Information Clearinghouse 2008; Marks n.d.). As it has been discussed earlier, that celiac disease is an autoimmune disorder hence it results in a reaction where the body’s protective systems attack itself resulting in an inflammatory reaction. The normal small intestine contains small finger-like projections called villi that play a vital role in absorption of nutrients. When the causative factor gluten reacts with the villi they swell up as a response to its toxic action. Gradually with continuous exposure to gluten, the villi flatten and the total surface area of the small intestine is reduced. This impairs the absorptive capacity and results in malabsorptive signs and symptoms. Usually the duodenum and jejunum is a victim of the immune reaction more than the ileum. Patients with greater part of intestine affected show more severe symptoms (National Digestive Diseases Information Clearinghouse 2008 ; Marks n.d.). Absorption of any of the three major nutrients can be affected i.e. carbohydrates, fats, proteins, however fat malabsorption is significantly observed in the majority of patients. Such patients present with foul smelling gas, steatorrhea and bloating. Fatty stools are characterized by greasy, tan grey appearance, foul smell and oil droplets seen on the water surface. In celiac disease the lactase enzymes responsible for digestion of lactose-chief component of milk- is also destroyed. This results in lactose malabsorption presenting as excessive flatulence, bloating and diarrhea. Vitamin and mineral malabsorption affects multiple body organs and systems and results in anemia, fluid retention, osteoporosis, easy bruising, muscle weakness, weight loss and infertility. Neurological manifestations are experienced at one time or another by 8 to 10 percent of the celiac disease patients that include peripheral neuropathies, ataxia, epileptic seizures, migraines and dementia. It is important to mention here that the symptoms differ according to age of the person, with digestive symptoms more common in the infants and young children. (Marks n.d. ; Green et al 2010). People presenting with celiac disease are usually positive for human leukocyte antigen (HLA) types; HLADQ8 and HLADQ2 which reacts against the body T cells after binding to the causative glutens. The patients also show positive serum results for specific antibodies like tissue transglutamase (tTG) which is an autoantibody and suggests the autoimmune character of the disease. (Schuppan et al 2005) During the immune reaction, the immune system also attacks other healthy parts of the body. In such cases, celiac disease might be associated with Addison’s disease, autoimmune thyroid disease, autoimmune liver disease, type 1 diabetes and Sjogren’s disease. Rheumatoid arthritis and systemic lupus can also be associated with celiac disease. Patients also present with mouth ulcers called aphthous stomatitis which is recurrent and painful in nature. Dermatitis herpetiformis is a skin disorder which is present in about every 10% of celiac disease patients. It presents as rash on legs, arms, buttocks and scalp. It is characterized by its severe itchy and blistering nature (National Digestive Diseases Information Clearinghouse 2008; Marks n.d.). The history of the celiac disease can be traced back to twelve and eight thousand years ago when people started to cultivate plants as a food source. This domestication of plants started in the eastern Mediterranean and Middle East where mankind started to cultivate wheat and barley near their homes which appeared to be a quick and cheap source of food. From this change in food resources that revolved around domestic animals and foods rather than hunting came the origin of gluten and the associated disease. The earliest mentioning of celiac disease was made by Samuel Gee in 1888 and termed it as “coeliac”. In 1940s Willem Karel Dicke first pointed the pathogen as wheat and rye flours. Observing the improvement in condition by removing the wheat from diet proved it to be treatable rather than fatal. With the invention of intestinal biopsy in 1950s and 1960s the diagnosis and pathogenesis became clearer to the doctors. The Crosby capsule and the Rubin tube were commonly used and were given the term of suction biopsy based on their mechanism of action. (Green et al 2010) It has been recently suggested on the basis of evidence that a strong link is present between the gut flora and the celiac disease. They observed fecal samples taken from healthy individuals, symptom-free but celiac positive and celiac patients with symptoms. Laboratory tests proved that the diseased fecal matter produced increase in the pro-inflammatory cytokine production. On the other hand, the gut flora of diseased patients reduced the IL-10 production which is responsible for increasing immune tolerance. Additionally, fecal matter was also tested against Bifidobacterium longum ES1 and B. These bacteria resulted in suppression of the pro-inflammatory agents which suggested its therapeutic roles. These tests suggest the use of bacteria as probiotics in infant’s diet which can serve as prophylactics to celiac disease. The fecal matter containing a healthy mix of flora can be transplanted to the patient’s gut whose own gut flora has been reduced. This is termed as fecal transplant or fecal bacteriopathy and can be used as a therapeutic measure on the basis of the researches. (Jamron 2008) Management of Celiac disease solely involves complete elimination of gluten from diet. Even a small amount of gluten will result into intestinal damage. A large number of patients respond very dramatically to gluten-free diet and show improved status within 48 hours. Children also respond very quickly and positively to gluten-free diets. A gluten-free diet is completely free of any amount of gluten in it. It is very important also to avoid processed foods that might contain wheat like soups, pasta, ketchup, mustard, coffee, yoghurt, sausages and some other food items. For detailed knowledge of food items patient should refer to a dietician. Certain vitamin or mineral capsules also contain wheat in them and they should also be avoided. Patient should make a habit of reading food labels to keep themselves protected. Starting gluten-free diet demands a complete change of lifestyle. Such people have to control their cravings, always be cautious about their food intake, and check for food ingredients at restaurants, difficulty in eating out with friends or family and much more. This change can only be adapted by support of family, interaction with other celiac disease patients and little patience. Some patients do not respond to gluten-free diet which can be because of several reasons. It might be because the person is unknowingly ingesting gluten in any form or he is not following a completely gluten-free diet. Alternative treatments are also being explored which include destruction of gliadin peptides which are resistant to digestive enzymes by exogenous endopeptidases. Cytokine antagonists or immunomodulatory cytokines are also being studied for inhibiting the actions of pro-inflammatory cytokines on the digestive tract (National Digestive Diseases Information Clearinghouse 2008; Marks n.d.; Schuppan et al 2005). Bibliography Jamron, (2008). More Evidence Links Gut Bacteria to Celiac Disease - Celiac.com. Celiac Disease & Gluten-free Diet Information at Celiac.com. Retrieved November 29, 2011, from http://www.celiac.com/articles/21685/1/More-Evidence-Links-Gut-Bacteria-to-Celiac-Disease/Page1.html The author independently researches celiac disease and the habitat of the pathogen and related diseases. With a M.S in Engineering Applied Science from the University of California at Davis, he explores the gut bacteria and the makeup of the fecal microflora in celiac disease patients to see if it can be linked directly to a bacteria; with question if there is a link in Vitamin D Deficiency. Celiac Disease - National Digestive Diseases Information Clearinghouse. (2008). Home - National Digestive Diseases Information Clearinghouse. Retrieved November 29, 2011, from http://digestive.niddk.nih.gov/ddiseases/pubs The National Digestive Diseases Information Clearinghouse explores celiac disease in a whole. The extensive research on what the disease is, what the symptoms are and how it can be treated. They also researched how rare the disease is and what other health issues a person could have with celiac disease. Schuppan, Detlef (MD, PhD), Dennis, D. Melinda (MS, RD, LDN) & Kelly, P. Ciaran (MD). 2005. Celiac Disease: Epidemiology, Pathogenesis, Diagnosis, and Nutritional Management. Home - Celiac Disease: Epidemiology, Pathogenesis, Diagnosis, and Nutritional Management. Retrieved November 29, 2011, from http://csaconference.homestead.com/schuppankelly.pdf The authors discuss the history of celiac disease and what the disease is. With research and examples, the authors show the genetic components and celiac disease associated with autoimmunity. Tissue Transglutaminase and the missing links, damages it causes on the digestive system. As well as the impact of celiac disease on a nutritional status and managing the disease Marks, W. Jay (MD). Celiac Disease (Gluten Enteropathy). MedicineNet.com. Retrieved November 29, 2011 from http://www.medicinenet.com/celiac_disease/article.htm The Author goes in detail about celiac disease and the facts behind the disease. Discussing not only the causes and symptoms but the different types of celiac disease; laten and silent celiac disease, as well as refractory celiac disease. He also does research on how to manage the disease. Green, P. H., & Jones, R. (2010). Celiac Disease: A Hidden Epidemic (ISBN 978-0-06-172816-7 ed.). New York, New York: Harper Collins. The author, with accomplished science writer, research in depth celiac disease. With a personal connection to the disease, they discuss how the body suffers without the essential nutrients due to the melabsobtion of food with celiac disease. The author revisits current information on celiac disease and examines the disease on level of not just being gluten intolerant but also the psychological affect it can have with living with a chronic disease. Read More