When I was in medical school, about 40 years ago, I was taught about a disorder called celiac disease, which students were told was “extremely rare.”
As it was explained to us, celiac disease was a disorder of the gastrointestinal tract, occurring mainly in the small intestine, in which people could not tolerate gluten, a component of wheat and some other grains.
For people with celiac disease, eating grains that contained gluten resulted in damage to cells lining the intestine that are responsible for absorbing nutrients from digested food. The most common symptoms of this disease included diarrhea alternating with constipation, abdominal cramping, muscle wasting, irritability, and sleep disturbances — almost all of which are related directly to the gastrointestinal tract.
Because it affected the intestinal cells, severe cases of the disease could cause impaired absorption of fats and proteins, and less so of carbohydrates. Victims of this disorder — called malabsorption — were also unable to absorb many vitamins and minerals that are critical for health.
Severe vitamin deficiencies can lead to health problems such as anemia, osteopenia and osteoporosis, and unhealthy skin.
New evidence has demonstrated that gluten sensitivity (also called gluten intolerance) is much more common than was first thought. In fact, it may affect as much as 30 to 40 percent of the population.
We have also learned that gluten intolerance is a multisystem disease affecting a great number of systems in the body, along with the GI tract. For example, it affects fat metabolism, is associated with diabetes, can trigger autoimmune diseases (such as rheumatoid arthritis, lupus, and thyroid autoimmune disorders), and can affect the brain, including higher functions such as memory, earning, attention, and behavior.
Gluten sensitivity is caused by an interaction between specific inherited genes and environmental factors — in this case, exposure to gluten in the diet. It is possible to have the gene and never develop the condition, if you avoid exposure to the environmental agent.
Some 95 percent of people with celiac disease have the gene HLA-DQ2; 5 percent have the gene HLA-DQ8. Overall, about 30 percent of the general population has these genes, yet only 1 percent will get celiac disease. The reason for this disparity is that full expression of these genes depends on a number of other factors.
In identical twins, if one child develops celiac disease there is a 70 percent chance the other twin will also get the disease. The risk is just 10 percent in cases of first-degree relatives where there is a family history.
Typically, the disease is diagnosed in children less than two years old. These children present with symptoms such as:
• Failure to thrive (small, malnourished)
• Distended belly
• Muscle wasting
• Difficulty sleeping
Yet despite all of these symptoms, most cases go undiagnosed for many years, or even a lifetime.
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