What is celiac disease?
Celiac disease is an immune reaction of the intestine related to gluten intolerance . It is an autoimmune disease, that is, the body’s own cells act by attacking themselves. Some of its most common symptoms include diarrhea, vomiting, anemia and intestinal pain. A gluten-free diet can solve the problem.
In this disease, inflammation occurs in the body, caused by an exaggerated reaction of the intestine that does not tolerate gluten . This mechanism is the same as that of allergic rhinitis, which is characterized by an inflammation of the nasal mucosa due to allergenic particles in the air. The difference is that, in celiac disease, it is the intestine that suffers from gluten.
Research carried out in 1970 showed that 0.03% of the world population was celiac. These numbers have grown considerably from 1% to 2% of the world population. Experts say they are unaware of the reasons for this alarming growth, but there are some guesses that the poor processing of grains and the greater sensitivity of diagnostic methods may be some causes.
When touching the walls of the intestine to be absorbed, gluten causes celiacs to exaggerate, responsible for their symptoms. In order to better understand how this occurs, it is interesting to know how the intestine works and how nutrient absorption occurs. Keep reading to learn more!
The walls of the intestine are entirely lined with small villi that allow nutrients to be absorbed by the body. As it passes through the intestine, the food comes into contact with these villi which, in turn, absorb the vitamins and minerals from the food.
In the celiac patient, when gluten comes into contact with the intestinal walls, it ends up “killing” these villi, leaving them atrophied and unable to perform their function correctly. This leads to malabsorption of all other nutrients. Can you imagine our bald gut, unable to take advantage of the nutrients in the food we eat?
This fact explains the cause of anemia in celiac patients: the intestine ends up not absorbing the nutrients in the correct way. When food “runs” through the walls of the naked intestine, it also causes chronic diarrhea .
Gluten is the main protein in certain cereals, but what is really harmful are its parts. Some of these proteins are: in wheat, gliadin and glutenin, in barley, hordein, in rye, secaline and in oats, avenin.
These proteins are found separately inside the grains, more specifically in the endosperm of the grain. When we prepare the dough for some recipe and add water, these proteins, previously separated, meet and create bridges, thus forming gluten.
Who doesn’t remember your grandmother kneading a dough before letting it rest? In fact, what it is actually doing is activating gluten (forming the bridges) in its dough, which has the function of making the dough more elastic and easier to work with so as not to break when it is stretched.
Another function of gluten in preparations is to make the dough rise. When kneading the dough, the gluten forms a “web” that holds the carbon dioxide formed during fermentation. The gas itself, in turn, helps in the growth of the cake, dough or pizza, leaving them soft and fluffy.
Celiac disease can be divided into four types, the differences of which are only in the symptoms. Are they:
It is more frequent in the pediatric age group, especially between 6 and 24 months, that is, in children who are starting to eat more solid foods such as bread, cake, pasta or foods with cereals.
The child may have chronic diarrhea, malnutrition, poor appetite, bloating and vomiting. It is very important to take her to the doctor if she presents any of these symptoms, because the sooner the diagnosis is made, the more chances the child will have to have a normal life, since acute untreated malnutrition can lead to death.
Non-classical or atypical DC
This, in turn, has few symptoms, mostly mild and extra-intestinal. Some examples are medication-resistant anemia, weight loss, constipation and, in adolescents, growth difficulties may occur.
Other exclusively extra-intestinal symptoms are infertility, alteration and stains on the tooth enamel, osteoporosis before menopause , liver changes, arthritis or damage to the peripheral nervous system.
Asymptomatic, oligosymptomatic or silent CD
Asymptomatic celiac disease has no symptoms or is less severe than a classic celiac disease.
When a person is diagnosed, his first-degree relatives are instructed to perform an examination for verification, as they have a 10% predisposition to develop asymptomatic celiac disease.
Because there are no apparent symptoms, it is important to be aware of the smallest changes in the body.
Latent celiac disease occurs in patients who carry the HLA-DQ2 and HLA-DQ8 genes and who have mild symptoms, without changes in the intestine. The carrier of latent celiac disease is already born with these genes. When diagnosed, it means that the patient is in a pre-celiac period. However, there is no evidence that anything can change if the patient is on a gluten-restricted diet.
The different types of celiac disease can develop at different ages.
Classical CD usually occurs in children aged 1 to 3 years. This is because the child begins to eat foods with gluten. When breastfeeding, gluten is passed through the milk, but not in significant amounts to give any reaction to the baby.
Atypical and asymptomatic CD do not have a specific age, as they can be triggered at any age in the life of a person who is predisposed to develop the disease.
Although the disease has no sex restriction, the female is the most affected, with a statistics of 3 sick women for every 1 celiac man. According to the G1 news portal, “Almost 2 million Brazilians cannot eat gluten”, with 75% of diagnoses being made by women.
Some other illnesses may predispose a patient to celiac disease, such as type 1 diabetes , autoimmune thyroid disease, thyroid problems, Down’s syndrome and Turner’s syndrome.
In the case of identical twins, if one of the individuals is diagnosed with the disease, his brother is up to 70% willing to develop it as well. However, celiac disease can develop at different ages.
The dermatitis herpetiformis is a manifestation of celiac disease in the skin. It is characterized by benign rashes (wounds) and gluten intolerance. However, some patients may not have intolerance, but show a positive biopsy for celiac disease. These rashes can appear on the knees, shoulders, buttocks and face.
Typically, patients with this disease can be treated with a restricted gluten diet, so that the rashes stop.
There is also sensitivity to non-celiac gluten, also called gluten intolerance. It is a less severe disease and its damage can be more reversible than a diagnosis of celiac disease.
Some differences are:
- Systemic inflammation: intolerance presents inflammation related to the whole body, not only to the intestine but to CD;
- Bowel regeneration time: in intolerance, it can be up to ¼ faster than in celiac disease;
- Shortage of tests: the lack of tests to diagnose non-celiac intolerance is another difference, studies are being carried out to facilitate the diagnosis;
- Diet with partial exclusion of gluten: unlike celiac disease, intolerance does not need the total exclusion of gluten from the diet.
Sensitivity is much more difficult to diagnose. It is not possible to perform a biopsy because there is no damage to the intestine. A gastroenterologist can make the diagnosis using the gluten exclusion diet, which allows you to check if the symptoms improve by removing the gluten or worsen with the ingestion of it.
For the reason of diagnosis, non-celiac gluten intolerance can be confused with other diseases such as irritable bowel syndrome, lactose intolerance and allergy to wheat. It has not yet been proven whether sensitivity is a persistent disease or not, so it is recommended to consult a doctor every 12 months for further tests.
Some symptoms of gluten sensitivity include:
- Inflammation on the tongue;
- Mental confusion;
- Pain in the bones and joints;
- Numbness in the legs;
- Abdominal pain;
- Dizziness or tiredness after meals.
Celiac disease is an autoimmune disease, its cause is related to a malfunction of the immune system related to gluten intolerance. Its cause is not necessarily gluten, but a defect in the body that does not accept it.
The HLA-DQ2 and HLA-DQ8 genes are only genetic markers of celiac patients, their presence does not mean that the patient will develop the disease. If it does not develop in early childhood, it can appear throughout adulthood, with some external factors, such as rotavirus infection.
According to the Labcen laboratory, 95% of patients with celiac disease have the genes. In addition, genes were not found in 0.4% of confirmed celiacs.
With that, we can see that the genes may or may not be present in the organisms of celiacs and healthy people. These genes do not determine their cause, they are only a risk factor.
Among the various symptoms of this disease, the most common and related to the intestine are:
- Chronic diarrhea;
- Common or drug-resistant anemia;
- Abdominal pain;
- Lactose intolerance;
- Stools with strong unpleasant smell, bulky and pale / clear;
- Lack of appetite;
- Abdominal distension;
- Weight loss;
- Vomiting cravings;
- Blood evacuation;
- Dyspepsia (indigestion).
Other symptoms that do not occur in the intestine can be:
- Changes and stains in the tooth enamel;
- Liver changes;
- Damage to the peripheral nervous system;
- Spontaneous abortions followed;
- Growth difficulties in adolescents.
Some symptoms are related to the lack of nutrients common in celiac disease. Are they:
- Osteoporosis caused by non-absorption of vitamin D;
- Canker sores;
- Nail weakness related to anemia;
- Loss of hair;
- Lack of air;
- Reduction of calcium levels;
Remembering that not treating these symptoms can lead to the appearance of tumors in the intestine and even lymphoma. If you suspect that something is wrong with your body, consult a doctor!
While the person with celiac disease is not aware of it, the walls of the intestine start to wear off with the presence of gluten in the diet. With the wear and tear, the symptoms of the disease start to appear more frequently and intensely, which makes the person worry and seek medical help.
The diagnosis of the disease can be in the following ways:
The blood test checks for the presence of specific genes and antibodies to the problem. Although it is not enough for the final diagnosis, it helps in the doctor’s decision.
Some exams that can be ordered are:
- Genetic typing: This is an exam to check for the presence of the HLA-DQ2 and HLA-DQ8 genes. The acronym HLA stands for Human leukocyte antigen. These genes are responsible for some functions of the immune system and are found in all cells of the human body.
- Antibodies such as antigliadin, antitransglutaminase and antiendomíso: These terms refer to antibodies that, when present in the bloodstream, indicate the existence of celiac disease. It is important to highlight a negative result does not completely exclude the diagnosis of celiac disease, especially in patients who are already on a gluten-free diet.
Examination of feces and urine
For the verification of fat in the stool, which indicates malabsorption of nutrients.
Gluten exclusion diet
When reporting symptoms, your doctor may advise you on a gluten-free diet to see if the symptoms subside or even disappear during the diet.
Small intestine biopsy
If all of the above tests showed signs of celiac disease, this test is a general confirmation that, when performed, checks whether the villi of the intestine are atrophied. It is important to perform these tests with some food with gluten in the intestine, otherwise it can result in a false negative.
To perform these exams, the patient can turn to a specialist in the digestive system: a gastroenterologist will assist in the diagnosis.
To perform some exams, an immunoallergologist is the doctor most sought by celiacs for exams.
If the disease occurs in a child, parents can see a pediatrician to help with treatment.
Once diagnosed, a nutritionist can become a great friend to follow a restricted gluten diet.
Unfortunately, celiac disease has no cure .
Once diagnosed, it is necessary to go to your gastroenterologist to receive the correct treatment. That’s because the only treatment is a change in diet with special diets for life.
There are no drugs that can directly treat the disease. However, after starting the diet with the nutritionist, he can indicate a vitamin supplementation to replace nutrients that are missing, due to their malabsorption by the intestine, to prevent some other diseases such as anemia and osteoporosis.
When gluten is removed from the celiac diet, the symptoms cease and, within two years, the intestine is completely recovered. Because it is an allergy-related illness, any amount of gluten in the diet is sufficient to cause vomiting and diarrhea.
It is important to be attentive to food, as a patient who continues to eat gluten is at risk of developing other problems, such as thyroid disease, kidney or skin problems, bowel cancer and even infertility.
Despite the various restrictions, if the diet is followed correctly, the celiac patient can lead a normal life . Here are some restrictions and substitutes for gluten:
Foods that contain gluten
In our day-to-day diet, we eat thousands of foods that contain gluten.
Among these are:
- Vegetable protein;
- Group E-14 additives;
- Spelled flour;
- Cookies and crackers;
- Cereal bars;
- Industrialized sauces;
- Soy-based sauces;
- Processed fats.
That is, it is very complicated for a celiac to deviate from foods that are very present in our daily diet. But, with the right guidance and a balanced diet made by a nutritionist, the celiac man can live normally.
Often, whole families are diagnosed with the disease and change their diets together, which makes it much easier to take gluten out of food.
Although they are not able to eat almost all types of cereals, some other foods are released for celiacs.
Among these foods are:
- Cassava flour, rice, corn, cornmeal, starch;
- Chickpea flour;
- Milk and its derivatives such as butter and cheese;
- All kinds of fruits and vegetables;
- Meat, eggs and seafood.
Corn starch, starch biscuit, corn and oats naturally have no gluten, but if packaged, treated or stored with the same machines or places that are treated with gluten foods are at risk of being infected , and this small amount of gluten can be enough for a celiac to have an intestinal crisis.
Attention to labels
In addition to foods prohibited to celiacs, cosmetics and some medications may contain protein and bring severe adverse reactions to intolerants. Therefore, it is important to always read the labels of food and other products.
Avoid products with the following ingredients in their composition:
- Wheat germ;
- Spelled flour;
- Hydrolyzed wheat protein;
- Avena sativa ;
- Wheat ;
- Wheat ;
- Rye cereals ;
- Malt extract;
- Wheat amino acids;
- Hydrolyzed vegetable protein;
- Group E-14 additives;
According to the Brazilian Legislation for Celiacs, federal law nº 10.674 of 2003 says: “All industrialized foods must contain on their label and package insert, mandatorily, the inscriptions” contains Gluten “or” does not contain Gluten “, as the case may be.”
In medicines and cosmetics, it is not mandatory to report the presence of gluten in the composition.
In general, people with autoimmune diseases cannot donate blood , but if the celiac is on a 100% gluten-free diet, is not anemic and with the tests totally up to date and healthy, there are chances of being able to donate blood . Remembering that there are other requirements to make the donation such as age, weight, blood pressure, etc.
It is always important to emphasize that avoiding gluten in the diet of healthy people does not prevent the onset of the disease. That is, there is no prevention for celiac disease .
Some special precautions must be taken by celiacs:
- At a party with friends, watch out for snacks, crackers and cereals that may contain gluten;
- Be careful when frying gluten-free foods in the same place where you passed gluten-free foods to avoid contamination ;
- Pay attention to ready seasonings or meat tenderizers that may contain gluten;
- Do not forget that children are the most affected by celiac disease . Never separate the celiac child from other children at the time of feeding, as this can have emotional consequences. Always instruct her not to eat what is offered and always prepare gluten-free snacks so that she can eat together with her colleagues;
- The practice of physical exercises should be performed normally in patients with this disease.
Celiacs should be careful with alcoholic drinks based on barley or malt. The distilled and fermented drinks are allowed to the celiac. Here is a list of gluten free drinks:
- Sake (without the addition of barley);
- Some liquors;
The main complications of this disease are the return of more severe symptoms such as anemia and chronic diarrhea, however this only occurs in patients who do not obey dietary restrictions and continue to ingest gluten. Among the most serious complications are:
Death due to acute untreated malnutrition and anemia
During the time that the patient ingests the gluten, but his intestine does not accept it, the irritations and infections are more and more aggravated. Because celiac disease makes it difficult to absorb nutrients, it can lead to malnutrition and anemia.
Without the necessary nutrients for human survival, the body does not have enough strength to survive and ends up leading the patient to death.
Growth difficulty in adolescents
The period of adolescence is when the body prepares itself to grow, there is the so-called “growth phase”, which is super important for a healthy adult life. Therefore, the body needs several nutrients that are indispensable for this phase. Celiac disease does not allow these nutrients to be absorbed properly, which leads to difficulty in growth.
Infertility and spontaneous abortions followed
In order to generate another life, a woman needs to be prepared both emotionally and physically. Some nutrients are essential to having an organism ready to receive a fetus. The lack of iron, zinc and vitamins like B12, K and B6 can lead to infertility. When pregnant, there may be malformation of the baby and consequently spontaneous abortions.
Changes and stains in the tooth enamel and osteoporosis
During growth, the dentition is being formed, the baby teeth are falling and giving way to the fixed teeth. For this, vitamins A, C, D and calcium are necessary, important nutrients for healthy teeth growth.
The lack of these vitamins can be crucial for growth, causing stains on the tooth enamel. These same vitamins are also necessary for bone growth. Calcium is the main nutrient that, when absent, can cause osteoporosis.
Liver involvement has been increasingly common in celiac patients. Lesions in the intestinal mucosa, caused by gluten intolerance, hinder the absorption of fats, which alters lipid metabolism and can damage the liver.
Arthritis is an inflammation of the joints and joints in the body. There is a type of arthritis that can be caused by the lack of nutrients, this can be a complication of celiac disease due to this lack of nutrients that the untreated celiac has.
Damage to the peripheral nervous system
There are still no answers as to why gluten affects the brain, however in most of the cases studied, there was a decrease in the brain mass of patients with this disease. In the first instance, this does not cause serious damage, but if left untreated it can lead to abnormalities.
Rashes (wounds on the skin) due to herpetiform dermatitis
As seen previously, celiac disease can be accompanied by skin rashes, being related to dermatitis herpetiformis. A gluten-free diet can solve the problem.
Gluten intolerance causes an inflammation at the brush edge of the intestine that makes you more sensitive to other substances, such as lactose.
After ingesting gluten, the person may feel tired, with headaches and mental confusion due to the excessive work that the intestine has to do when eating food.
Tumors in the intestine and lymphoma
By altering the walls of the intestine, celiac disease increases the chances of developing tumors and lymphomas.
In general, taking care of the food, the patient can spend years without any complications .
Celiac disease is becoming increasingly common in Brazilians and, if left untreated, can lead to death. Although there are several books on the subject, information is never too much! So, share this text so that everyone can be aware of the most common symptoms.