Celiac Disease and Adherence to a Gluten Free Diet

An autoimmune disease is a disease in which the body produces antibodies that attack its own tissues, leading to deterioration and destruction of said tissue. Celiac disease is one of these bodily disorders, in which the villus of the small intestine is severely damaged when the protein gluten is consumed. For ultimate restoration of this digestive organ, it is imperative that diagnosed individuals adhere to a gluten free diet.

The G Word

What is gluten you ask? Gluten is the common name for two proteins, glialdin and glutenin, found in barley, wheat, and other popular grains. These compounds are commonly found in bread, pasta, cereal, baked goods, and popular liquids. Gluten, the most consumed protein, forms when the chemical bond is formed between glialdin and glutenin.

Celiac Disease

It is very important to understand what makes up gluten for future studies and potential medicinal options for individuals who are diagnosed with celiac disease. Celiac disease is unlike any other autoimmune disease because the trigger is environmental and a human leukocyte must be present. What is meant by this is that the trigger is due to exposure to an irritant, and that the disease is strictly hereditary. Within diagnosed individuals glialdin and glutenin are deemed toxic and disturb the lining in the small intestine. This disturbance results in a reaction against the two compounds, resulting in anatomical problems such as villi atrophy. Villi atrophy is the loss of absorption ability in the small intestine.

Call the doctor

In addition to villi atrophy, other symptoms arise in an individual who is diagnosed with celiac disease. These symptoms can be nutritional or gastrointestinal. Nutritional problems include such as anemia and vitamin D deficiency, while gastrointestinal symptoms include bloating, diarrhea, excessive gas, and abdominal pain. When celiac disease is found in children, adolescents will be smaller in height and/or weight, while adults are diagnosed after uncontrollable diarrhea in addition to osteoporosis. Some psychiatric disorders may be present among the diagnosed including depression, anxiety, and irritability. In an experiment preformed on three hundred individuals, one hundred had celiac disease and within the diagnosed, fifty percent had neurological abnormalities.

They Have to do what?!

As an individual experiences these symptoms, diagnosis of celiac disease is performed by a procedure called a biopsy. A biopsy begins with a local anesthetic sprayed on the throat of the patient to provide local numbing. A physician then inserts the tube into the mouth, and down the esophagus until the tube reaches the stomach. A small syringe that is within the tube, obtains a sample by cutting a piece of tissue off the intestinal lining. The tube is extracted back through the esophagus and the sample is analyzed. Samples are stained with various solution dyes, and examined under microscopes for villi atrophy. Villi atrophy is displayed as positively stained cells on the exterior layer and found as deep as the basal layer of the lining.

A second way one would test for celiac disease is serological testing. This test is performed in individuals who experience malabsorbtion, osteoporosis, or are high risk for the disease, such as immediate family members of a currently diagnosed patient. These tests display the presence of the HLA DQ2 or HLA DQ8 antigen that is always seen in the disorder. Once a positive diagnosis has occurred, unfortunately there is only one available treatment for the disease.

Kiss me, I’m gluten free

Today the only way to cope with celiac disease is to comply with a gluten free diet. Although it is the only option for these patients, those who are complying with this diet are at risk of zinc and iron deficiencies, as well as loss of vitamins such as K, A, and E. In multiple studies, adherence to a gluten free diet restores villi to a normal level and decreases symptoms ten fold.

Adherence to a gluten free diet is essential but the recovery time of the small intestine varies from person to person. Discussed in Lee et al. 2002, duodenal biopsies were taken from thirty-nine patients to examine anatomical improvement to a gluten free diet for roughly eight years. After the collection of samples, it was discovered that normal mucosa appeared in 23% of the individuals and 46% had visible damage with improved lining. According to the results of the mentioned experiment, adhering to a diet that is gluten free will restore intestinal damage and relieve symptoms from the diagnosed.

What Next?

Although the gluten free diet is the only available treatment for celiac disease, there is research happening to find other options and potentially a cure. The Kansas Wheat Commission is spending over two hundred thousand dollars on an attempt to grow gluten free wheat. Research is not only being done on food, but on mice as well. Bana Jabri, MD is the lead researcher at the University of Chicago’s Celiac Disease Center and has constructed a model that consists of genetically modified mice that display the same symptoms as humans who have the disease. Her campaign received a two million dollar investment and hope to provide new treatments and therapies for the disease. Celiac disease is being diagnosed more now than in previous years, but with technological advancement, those diagnosed may no longer have to comply with a gluten free diet in the near future.

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