Dr. Bella Beraha, born in Venezuela, joined the International Medical Group from Miami.  She is an M.D. in Internal Medicine and runs a successful medically supervised weight loss programme from the clinic.  The International Medical Group is a multi-disciplinary medical practice that offers professional and personalised care.

Celiac disease is a condition in which the immune system responds abnormally to a protein called gluten, which can cause damage to the lining of the small intestine.

The small intestine is responsible for absorbing food and nutrients. Thus, damage to the lining of the small intestines can lead to difficulty absorbing important nutrients.

Although celiac disease cannot be cured, avoiding gluten usually stops the damage to the intestinal lining and the malabsorption that results. Celiac disease can occur in people of any age and it affects both genders.

It is not clear what causes celiac disease. A combination of environmental, and genetic factors, are important since celiac disease occurs rarely in people from certain parts of Asia or sub-Saharan Africa.

SYMPTOMS 

The symptoms of celiac disease vary from one person to another. In its mildest form, there may be no symptoms whatsoever. However, even if you have no symptoms, you may not be absorbing nutrients adequately, which can be detected with blood tests. As an example, you can develop a low blood count as a result of decreased iron absorption.

Some people have bothersome symptoms, including diarrhoea, weight loss, abdominal discomfort, excessive gas, and other signs and symptoms caused by vitamin and nutrient deficiencies.

DIAGNOSIS 

Celiac disease can be difficult to diagnose because the signs and symptoms are similar to other conditions. Fortunately, testing is available that can distinguish celiac disease from other disorders.

A blood test can determine the blood level of antibodies (proteins) that become elevated in people with celiac disease. Over 90 percent of people with untreated celiac disease have elevated antibody levels, while these levels are rarely elevated in those without celiac disease.

Before having these tests, it is important to continue eating a normal diet, including foods that contain gluten. Avoiding or eliminating gluten could cause the antibody levels to be normal, delaying the diagnosis.

If your blood test is positive, the diagnosis must be confirmed by examining a biopsy of the intestinal lining with a microscope. The sample is collected during an upper endoscopy, a test that involves swallowing a small flexible instrument with a camera. In people with celiac disease, the lining of the small intestine has a unique appearance. Normally, the lining has distinct finger-like structures, which are called villi. Villi allow the small intestine to absorb nutrients. The villi become flattened in people with celiac disease. Once you stop eating gluten, the villi can resume a normal growth pattern. Approximately 70 percent of people begin to feel better within two weeks after stopping gluten.

One way to determine if the gluten free diet is working is to monitor the levels of antibodies in your blood. If your levels decline on a gluten-free diet, this indicates that the diet has been effective.

You should be tested for nutritional deficiencies if your blood test and bowel biopsy indicates celiac disease. Common tests include measurement of iron, folic acid, or vitamin B12, and vitamin D.

Other standard tests include a CBC (complete blood count), lipid levels (total cholesterol, HDL, LDL, and triglycerides), and thyroid levels. Once your celiac antibody levels return to normal, you should have a repeat test once per year.

Many clinicians recommend a test for bone loss 6 to 12 months after beginning a gluten free diet. One method involves using a bone density (DEXA) scan to measures your bone density.

COMPLICATIONS

Lymphoma — Cancer of the intestinal lymph system is an uncommon complication of celiac disease. Avoiding gluten can usually prevent this complication.

Skin conditions — Celiac disease is associated with a number of skin disorders, of which dermatitis herpetiformis is the most common. Dermatitis herpetiformis is characterized by intensely itchy, raised, fluid filled areas on the skin, usually located on the elbows, knees, buttocks, lower back, face, neck, trunk, and occasionally within the mouth. The condition will improve after eliminating gluten from the diet, although it may take several weeks to see significant improvement.

TREATMENT

The cornerstone of treatment for celiac disease is complete elimination of gluten from the diet for life. Gluten is not only contained in wheat, rye and barley; it is also hidden as an ingredient in a large number of prepared foods, as well as medications and supplements.

Maintaining a gluten free diet is a challenging task that may require major lifestyle adjustments. Strict gluten avoidance is recommended since even small amounts can aggravate the disease.

Working with an experienced celiac dietitian can help you to learn how to eat a gluten free diet, what foods to avoid, and what foods to add for a nutritionally balanced diet.

Your celiac dietitian can also educate you on shopping, food preparation and lifestyle resources. Excellent resources are also available from celiac medical centres, organisations, and support groups. One such resource is the Celiac Disease Forum (http://celiacdisease.about.com/forum).

Fortunately, life on a gluten free diet becomes increasingly easier each year due to the rising popularity of gluten free foods among those with celiac disease, gluten intolerance and wheat allergies. Excellent gluten free substitute foods are now widely available in supermarkets, health food stores, and on-line.

General tips

• Avoid foods containing wheat, rye, barley, malt, brewer’s yeast, and oats (unless labelled gluten free).
• Naturally gluten free foods include rice, wild rice, corn & potato.
• Read labels on prepared foods and condiments carefully, paying particular attention to the “Contains” statement and the ingredient list. The word “wheat” will be included if the product is FDA regulated and it contains wheat.
• You may not tolerate dairy products initially, while your intestines are healing. If you tolerated lactose before your diagnosis, you may be able to tolerate it again after the intestine heals. In the meantime, choose lactose-reduced or lactose-free products if your symptoms are worsened by dairy products.
• Choose gluten free, dairy-free alternatives, such as rice, soy, hemp, or nut (almond, hazelnut) beverages that are enriched with calcium and vitamin D. Gluten free lactase enzyme supplements are also available, which may help you to tolerate foods that contain lactose.
• Discuss your need for calcium and vitamin D supplements with your doctor and dietitian.