Approximately 300,000 Canadians have been diagnosed with celiac disease and there are an estimated quarter million more undiagnosed or mislabelled as some other type of digestive disorder. Coeliac is a primary member of a group of about 80 diseases known as autoimmune disorders where the body’s own immune system attacks the self. While we don’t know what triggers many of these auto immune disorders we do know with which can now be screened for with a simple blood testing. Coeliac is genetically based, autoimmune and is triggered when the small intestine is damaged by consumption of gluten, a complex protein found in wheat, barley and rye grains…all staples in North American and European diets and therefore much less often encountered in Asian and African diets where soy, rice, and millet are the staples. Celiac is seen less in South America where corn, potato, quinoa and more recently, hemp are the staple food/fibre sources.
Celiac is an elusive imitator for several reasons .Fortunately, only 5 to 10% of individuals carrying the gene will get the disease. This is the unexplained perplexing component of this disease and symptoms do not necessarily appear immediately after birth though first degree relatives of a known celiac (parents, sibs and children) are more likely to manifest the disorder and in a more severe form earlier. But the two most prominent reasons for under-diagnosis is celiac remains collectively low on our diagnostic radars and the similarity of its symptoms to generic irritable bowel syndrome, lactose intolerance, Crohn’s, even ulcerative colitis and peptic ulcer mitigate against an early diagnosis. Presentation is another factor. Wasting and underweight have always been considered benchmarks of the disorder but a recent study by University of Chicago nutritionists reviewing known Celiac patients showed fully a third were grossly overweight and fully greater than one half had a normal to above normal body mass index.
In its severest presentation, children will be brought to medical attention early for vomiting, cramping, bloating and pain but they are just as likely to manifest behavioural changes, delayed dental eruption and/or enamel defects, delayed growth, even delayed puberty.
In adults, although abdominal symptoms are usually present, the patients are just as likely to come to medical attention with anemias, iron, B12 or folate, vitamin deficiencies usually A, D, E and K. Joint pain, chronic fatigue and weakness, menstrual irregularity, even infertility.
The only treatment for celiac disease is a strict life-long gluten free diet.
Screening blood tests are available and on occasion may require follow up with a small intestine biopsy. The proof , as they say, is in the (gluten free) pudding in which most patients experience an immediate improvement in symptoms with the appropriate restrictive diet. Since this is a life long problem, I strongly urge every patient be referred for nutritional counselling. Once again I must repeat my caveat: READ THE LABELS. All foods in Canada are required by law to state gluten content. The prevalence of this disease and the level of public awareness about the role of gluten has generated a veritable supermarket of gluten-free food choices from pasta substitutes to lager beers. A common complaint by consumers, and its a factor that infuriates me, is the food industry unnecessarily hiking gluten free pricing to unjustifiable levels. The silver lining for celiacs is Revenue Canada now accepts gluten costs as tax deductions to a total of $2200 or 3% of taxable income, whichever is lower. There is even now a smart phone APP for the calculation.
Research in multiple centers including our own McMaster are pioneering knowledge regarding the role complex gut bacteria play in the clinical presentation of celiac syndromes in at-risk patients. With the trending in Canada’s population mosaic, one would expect the prevalence of this disorder to be decreasing. It is assuredly not. Just the opposite is occurring. The North American diet has changed drastically, newcomers are adopting our life style and the prevalence of antibiotic over-usage we know is modifying digestive system bacteria. Hopefully, this in part home grown research will help us stay ahead of the curve. Realistically and practically GLUTEN AVOIDANCE is the definitive answer in our lifetimes.
Written by: Dr. David Carll