Celiac disease

Despite the fact that until recently celiac disease was considered a childhood disease, thanks to continuous technical advances we can affirm that currently more than 50% of diagnoses occur in people over 50 years of age. In fact, 20% of diagnoses are people over 60 years of age, the female population being the most affected.

Although it hinders the daily life of patients, the symptoms of celiac disease remit once gluten and its derivatives from the diet have been definitively eliminated.

What causes celiac disease

The sensitive enteropathy to gluten or celiac disease is a pathology chronic that cause inflammation in the mucosa of the small intestine by immunological intolerance gluten. This situation compromises the assimilation of the macronutrients. Specifically, it hinders the synthesis of:

• The fat-soluble vitamins A, D and K.
• Vitamins B6 and B12.
• Folic acid.
• Minerals such as iron, calcium, copper or zinc.

This malabsorption damages the health of these people and increases their probability of contracting other pathologies such as:

• Diabetes .
• Thyroiditis
• Lactose intolerance.
• Dermatitis.

Not receiving treatment can lead to the development of osteoporosis , malnutrition problems or even lymphomas.

It affects 1% of the population of Western countries. In our country its incidence is approximately 1 in 80 people. Although according to the Federation of Celiac Associations of Spain more than half of the patients have not yet been diagnosed, the incidence of this incurable pathology is increasing. Most likely due to the overexposure to which we have been subjected to industrial wheat for many years.

Causes of celiac disease

Both internal and external factors intervene as triggers of celiac disease :

Internal factors:

• The genetic predisposition .
• The patient’s own immune system .

Around 15% of those diagnosed have direct relatives who are also celiac. In the case of twins, the probability is 70%.

External or environmental factor:

• The gluten .

This protein is composed of gliadins, glutenins, albumins and globulins, with gliadins and glutenins being responsible for intestinal damage.

Symptoms of celiacs

In this regard, it should be noted that age conditions and varies the peculiarities of the symptomatology.

In the first years of celiac disease, the most notable symptoms are summarized in:

• Under weight.
• Lack of appetite
• Loss of muscle mass in the thighs, buttocks and arms.
• Tiredness.
• Vomiting
• Diarrhea.
• Low leukocyte index.

In adolescence, however, celiac symptoms evolve to:

• Recurring headaches and stomach aches.
• Hepatitis .
• Constipation .
• Diarrhea.
• Anemia.
• Atopic dermatitis .
• Delay in the first menstruation.
• Juvenile chronic arthritis .

In adulthood we highlight as symptoms:

• Asthenia.
• Constipation or diarrhea
• Lack of appetite.
• Apathy.
• Depression.
• Irritability.
• Anemia.
• Digestive cancer
• Osteoporosis.
• Irritable bowel .
• Early menopause
• Abortion
• Trouble getting pregnant

Celiac profile and typology

It has been found that the incidence of celiac disease is higher if any of these circumstances are met:

• First degree celiac relatives.
• Dermatitis in the form of herpes.
• Thyroid disease
• Lupus.
• Arthritis.
• Psoriasis .
• Biliary cirrhosis
• Colitis.
• Down syndrome.
• Hepatitis.
• Areata .

Types of celiac disease

Although the most common celiac disease , present at any age, is the so-called Pauci or monosymptomatic celiac disease , from a clinical point of view there are other variants that we will develop below:

Classic celiac disease

It is most common in babies between 9 and 24 months. They present some of the aforementioned symptoms such as diarrhea, loss of appetite, low weight or nausea, although the most unique is recurrent abdominal pain in the form of colic. These babies usually have a prominent abdomen and flattened buttocks.

If not diagnosed in time, between 12 and 24 months of life a baby can suffer serious gastrointestinal bleeding and / or skin as a result of poor absorption of vitamin K .

At 3 years of age, anemia and constant mood changes are added to the loose stools as the most notable symptoms.

Once this phase is overcome, in adolescence and during adulthood, the symptoms remit or at least the seizures space out their frequency. The most common complaints are:

• Heavy digestions.
• Abdominal swelling
• Gastroesophageal reflux.
• Constipation.

Silent celiac disease

It is asymptomatic despite being able to have positive antibodies. It is usually discovered by an analysis or by belonging to one of the risk groups.

Latent celiac disease

It refers to people who have manifested or will manifest symptoms throughout their lives.

Potential celiac disease

It covers people who, due to their genetic or immunological traits, are at risk of developing celiac disease at some point in their life.

Refractory celiac disease

It refers to the persistence of symptoms 6 months after having drastically eliminated gluten from the diet.

Diagnosis of celiac disease

Its diagnosis is complicated and even more so in incipient stages, since its symptoms are easily confused with those of other digestive conditions.

It is estimated that, on average, about 20 years must elapse from the appearance of the first symptoms to the diagnosis, the patient having to wander through different medical specialties until the definitive diagnosis is reached.

To detect celiac disease, in addition to observing the symptoms, certain tests such as intestinal biopsy are performed , markers such as anti-tissue transglutaminase antibodies are analyzed and the evolution of the patient is monitored, using clinical and analytical symptoms, once the gluten has been removed from its diet.

Treatment of celiac disease

Although several drugs are being investigated, the truth is that currently the only treatment for celiacs is to strictly follow a diet without gluten or its derivatives.

This means discarding from the diet those foods that contain wheat, spelled , barley, rye, triticale, kamut, oats and any of their derivatives (starch, flour, semolina, pasta, bread, cookies, pastries, pastries). This is the only way to control the symptoms and repair the intestinal lesion of the villi.

This regeneration materializes after 3-6 months in children, and 2-3 years in the case of adults. The specialist will determine the need or not for specific supplementation in children.

Final thoughts

Given the relevance of dietary control, these cereals should be replaced by other gluten-free ones, which in many cases also provide a higher fiber and micronutrient content. We refer to:

• Corn.
• Buckwheat.
• Rice.
• Amaranth.
• Quinoa .
• What’s good.
• Flax.
• Sorghum.
• Sesame.
• Tapioca .
• Sunflower seeds.
• Pumpkin seeds.

Chestnuts or legumes are also a nutritious alternative to conventional gluten-containing cereals.

The healthiest celiac diet should contain these foods in their fresh version, never in preserved form:

• Fruit.
• Vegetables and vegetables.
• Meat.
• Fish.
• Eggs.
• Milk and derivatives (butter, cream, cottage cheese).
• Vegetables.
• Shellfish
• Tubers
• Soy.
• Olive oil.
• Honey.
• Polyunsaturated fats.

Spices (pepper, turmeric, cinnamon …) should always be consumed in their most natural form (branch, leaf, root or seed). The infusions of chamomile, pennyroyal and lemon verbena are very appropriate in case of celiac disease due to their well-known digestive and antispasmodic properties.

To replace the breadcrumbs with another batter suitable for coeliacs, you can use rice flour, almond powder or potato flakes.

To thicken the sauces or cook an appetizing but safe bechamel you can use starch or corn flour.

Other practical recommendations are to take the habit of labeling foods with gluten than those that do not contain it to avoid confusion, as well as using aluminum foil to bake the doughs for celiacs, since they take less time to brown.

Precautions

It is convenient to look at the label of processed and packaged foods, however tedious it may be, since gluten is commonly used as a flavoring , thickener or to make manufactured products heavier . It is advisable to only consume foods that are gluten-free or whose label indicates “gluten-free” or “suitable for coeliacs.” When in doubt, better abstain.

Exercise extreme precautions when cooking to avoid cross contamination . This translates into separating the containers and utensils, as well as using different cooking oils. Otherwise, even if we were to prepare a gluten-free food, if it has previously been in contact with another that does contain it, our precautions will be of no use.

Celiacs with anemia are advised to take iron and vitamin B12 supplementation.

Only by deepening our knowledge of the disease and reviewing food labels in detail will we be able to avoid unpleasant surprises. Gluten, even in small proportions, is present in a multitude of food products that at first glance do not belong to the group of critical foods.

Yogurts, sausages, spices, spreadable cheeses, tea infusions with mixtures of flavors, nuts dispensed in bulk, chocolates, malts, preserves, pâtés … carry traces of gluten that every celiac should avoid.

The celiac disease is not incompatible with being able to eat varied, delicious and nutritious. More and more cases are detected, we are more aware and the food industry offers new alternatives so as not to impoverish the quality of life of those affected.

With rigor, cleanliness and organization, the life of celiacs should not be too different from that of non-celiacs.