The simple definition of Celiac disease is that it is an auto-immune disease (also called gluten-sensitive enteropathy) that causes damage to the small intestine’s absorptive capacity to digest food. For children, this can cause malnutrition and affect growth. Gluten is the culprit here and the immune system’s reaction to it damages the villi (small hair-like projections) lining the small intestine. The villi’s main function is to absorb nutrients your body needs to grow and function.
Gluten is a protein found in grains like barley, wheat and rye. Although we are more aware of it now, this disease has been around for millennia, with references made to it as far back as the first century AD by a Greek physician named Aretaeus of Cappadocia (a region in central Turkey).
Celiac disease is one of the most common lifelong illnesses and it affects both children and adults equally, although studies have found that it is more common in women. It has always been considered a Western illness of Scandinavian origin, but has been detected more and more in Asians over the last decade. It is genetically transmitted so people with a first degree relative (mother, father) with the disease have a one in ten chance of having it too. There are different degrees of severity of Celiac’s and many sufferers actually go through life ignoring the symptoms, while others find the symptoms so severe that they are forced to see a doctor.
SYMPTOMS & TESTING
There are over 200 symptoms which can be attributed to Celiac disease ranging from abdominal discomfort, acid reflux, headaches, weight loss, bloating, constipation, diarrhoea, anaemia, fatigue and even depression. All these can lead to serious complications if left untreated, so the first thing to do is to see a gastroenterologist and get tested.
The first test is usually a blood test which will check for specific antibodies (blood protein used by your immune system to stop antigens like bacteria and viruses) in your blood. There is also a genetic test using blood, saliva or a cheek swab, which checks for the specific genes associated with the disease. These tests are not necessarily conclusive but the results will determine what steps to take next. An endoscopy is usually the next test and this involves the doctor inserting a scope with a camera through your mouth, down the oesophagus and into the intestinal tract. Usually a small piece of tissue will be taken from the lining of the small intestine for a biopsy.
Once a diagnosis has been made, sufferers must change the way they eat as this is the only way to treat the disease. There is no cure and for most people, following a strict gluten-free diet helps to manage symptoms and, more importantly, supports the healing of the intestines. There is ongoing research to develop medication to help, but until then, abstaining from gluten is the only option.
As much as this disease can be managed through discipline and a rigorous gluten-free diet, complications can arise. There are long-term implications such as an increased risk of certain cancers like lymphoma and small bowel cancer, loss of bone density, lactose intolerance, and for some, neurological problems affecting the nerves. For children, delayed puberty, weight loss, failure to grow and anaemia are common effects of Celiac disease.
WHAT AND HOW TO EAT
Gluten is found in grains like wheat, barley, rye, which are found in everything from pasta and cereal to cakes, cookies and bread. This does not mean those with Celiac disease cannot enjoy this type of food as there are so many choices available using gluten-free alternatives like millet, Amaranth, tapioca, quinoa and rice. Vegetables, fruits, dairy, seafood, meat, beans, legumes and nuts are also suitable.
The one thing to be very careful with a gluten-free diet is cross-contamination, as even the tiniest crumb from a regular slice of bread can cause the small intestine to flare up. There are strict rules to be adhered to, especially when it comes to separation of food, storage and even details like cleaning bread bins and boards properly, if other members of the family eat normal bread. It can get dicey if you are eating out, particularly in Malaysia, so it is best to avoid any restaurant that cannot comply with your gluten-free requirements. Fortunately, due to the clean eating movement, certain supermarkets now have organic/whole foods/gluten-free sections. Although the variety is nowhere near what is available overseas, there is enough to put good meals on the table.
Celiac disease is now on the medical radar, and doctors will check for it when presented with patients who complain of vague abdominal issues like the symptoms mentioned above. If you are diagnosed with it, be prepared to drastically change the way you eat. But it isn’t all doom and gloom as a gluten-free diet can be pretty healthy in the long run.
If you would like more information, to get tested or get advice about living with the disease, contact Datuk Dr. Ryan Ponnudurai, one of the top gastroenterologists in Kuala Lumpur, who has his clinic at the Prince Court Medical Centre.