Five years ago, we rarely saw the phrase "gluten-free" on a menu. Now it's everywhere -- restaurants, bakeries, supermarkets and even beers tout a "gluten-free" label. Gluten-free has become a billion-dollar-a-year industry, expected to double over the next two years. But these numbers shouldn't be a surprise for the increasing number of people who are being diagnosed with celiac sprue.
Celiac sprue is known by many names: celiac disease, sprue, gluten-sensitive enteropathy or non-tropical sprue. The condition is a digestive disorder that prevents the body from absorbing nutrients from food. Celiac sprue is caused by a sensitivity to gliadin or gluten. Gliadin is a protein found in wheat, barley and rye. While oats don't naturally contain gluten, they are often contaminated when processed in facilities manufacturing gluten-containing products.
Celiac disease was once thought to be rare; however, over the last few years, increased awareness and improvements in testing have shown it's actually a relatively common disease. Current statistics indicate about one in 300 Americans have been diagnosed with celiac sprue.
Celiac sprue used to be considered a pediatric disease; however, it is being diagnosed more often in adults. The mean age at diagnosis is 45, and approximately 25 percent of patients who are diagnosed are older than 60. Sprue is more common in patients with other autoimmune diseases such as rheumatoid arthritis, lupus, thyroid disease and Type I diabetes
"Sprue" is an autoimmune disorder in which the patient's immune system attacks the small intestine. The immune system is not normally activated by the foods we eat; however in celiac disease, the immune system becomes activated and forms antibodies when the small intestine is exposed to gluten. Antibodies are proteins that are designed to eliminate foreign substances from the body.
The small intestine is designed to absorb nutrients. Small finger-like projections, called villi, line the small intestine and increase the absorptive surface of the bowel. When the immune system is activated, cells migrate to the lining of the small intestine and cause inflammation leading to impaired nutrient absorption, especially calcium, iron, folate and fats.
The most common symptoms of Celiac Disease include diarrhea, bloating, flatulence, weight loss, floating stool (caused by a high fat content) and abdominal pain. The disorder can cause injury to the small bowel and lead to anemia and increased bleeding or bruising. In rare cases, patients may experience muscle weakness, numbness, tingling and difficulty walking. It can even cause infertility in men and women.
If celiac disease is suspected, the physician will look for antibodies in the blood. If those blood tests are normal, the doctor may order an upper endoscopy to verify the presence of celiac.
Celiac is treated by adhering to a strict gluten-free diet. Patients should consult a nutritionist because gluten is used in so many products including medications, lipsticks, communion wafers, drink mixes/herbal teas, fermented beverages and salad dressings.
Patients' quality of life with celiac is improving with so many more dietary options available -- a trend expected to continue in years to come.
Dr. Caroline Tadros received her medical degree from the Albert Einstein College of Medicine and completed an internal medicine residency at New York University Medical Center. She subsequently completed a fellowship in Gastroenterology at the University of Vermont. Tadros' special interests are in the areas of inflammatory bowel disease and therapeutic endoscopy.