"Celiac disease" and particularly "gluten" are the buzz these days, with more people gluten-restricted than on any other diet. But relatively few understand the disease (also called celiac sprue, or in Europe, coeliac disease). But it is extremely important to understand that this is a life-long condition that, at least for the present, requires dedicated devotion to the diet.

A fraction of certain grains (wheat, rye, spelt and barley) contains gluten, a normally harmless protein that allows dough to hold its shape when it rises. In susceptible infants, children and adults, gluten triggers an immune reaction that damages the upper intestine.

What Makes Someone Susceptible?

Celiac disease runs in families, as a somewhat complicated genetic condition. The gene is actually present in as many as 1/3 of the population, going from at least one parent to a child, but the disease doesn't actually develop until something turns it on. We think it might be a virus that, in part, has a similar structure to gluten. The body develops an immune reaction to the virus and that carries over so that it also reacts to gluten. So instead, only 1 out of a hundred or so individuals actually has celiac disease.

Gluten Damage

That reaction damages the intestine to various degrees, flattening the surface and interfering with absorption. Because the enzymes to digest lactose (milk sugar) and sucrose (simple sugar) are also temporarily destroyed, the body does not absorb those sugars as well either. Together this can result in severe diarrhea and weight loss (though for some reason, to be discussed in another post, constipation can result as well).

But the effects extend far beyond the intestinal tract. For a child, their growth can be stunted. A bumpy rash (dermatitis herpetiformis) can develop. Fractures can occur more readily (as a result of decreased calcium) absorption; women can have fertility problems; and intestinal cancers can form.

In the past, children suffered horribly and died. In fact, it was only because the death rate went down during a Dutch wheat famine in the 1940s and rose again after the famine was over, that the cause of celiac disease was recognized.

Intestinal Healing

Fortunately, the intestine rapidly repairs itself once gluten is removed from the diet. The intestine heals, absorption is improved, and it seems, the other problems quickly go away. Within days of restricting the responsible grains, children and adults begin to feel better. Within a month, absorption is improved and the lactose enzymes return to their normal digestive processes. And over a number of months, the blood markers improve to the point that most look like they never had the disease. But restart them on a diet that contains gluten (as little as a slice a bread daily), and all the problems quickly return.

Enormous Confusion

We used to think that celiac disease was a relatively rare condition, affecting only 1 out of 3-5000 children, mostly those from northern Europe, and that everyone of them had bad diarrhea, bloated bellies and difficulty gaining weight. Because we've been able to diagnose the condition more easily (discussed in a different post), we now know that's not true. And we also know that it's more common in those who have certain other auto-immune conditions (like diabetes and thyroid problems) and in selected genetic defects (like Turner's and Down's syndromes), but the word hasn't gotten out to everyone yet.

The other problem is that celiac disease is only one of a number of similar conditions. Wheat allergy can seem similar (but those with that allergy don't have to restrict other grains). And a newly recognized disorder, currently called non-celiac gluten sensitivity, also exists (and is explored in another post) and another post that discusses safe grains for those with gluten sensitivity (celiac and otherwise).

The Good News

Because the medical community has learned more about the impact of gluten, we've found that the immune reaction disrupts the junctions between cells (often referred to as a leaky gut). This has allowed us to understand the entire illness better. More importantly, it is leading to some possible drugs to combat the problem, so that one day diet may not be the only way to correct the condition (stay tuned).

Bottom Line:

Following the gluten-free diet will stop the symptoms, allow the small intestine to heal, and prevent further damage. A gluten-free diet can provide all of the nutrition an individual needs. Fruits, vegetables, corn, potatoes, rice, beans, most dairy products, nuts, seeds, eggs, and plain meats can be eaten on a gluten-free diet.

Some individuals with severe symptoms may need to follow a lactose-free diet until the intestine is healed. This is because there are decreased amounts of lactase, the enzyme that breaks down lactose, in the damaged intestine. Lactose intolerance will usually go away within weeks to months of following a gluten-free diet.