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Senior Health:
What’s All the Fuss about Gluten?

By Mia Smitt
Nurse Practitioner
Sacramento Family Medical Clinic


Is “gluten-free” the latest health fad? How much information was there in the popular press on gluten five or ten years ago. Nutrition fads seem to come and go, as do popular “in” illness diagnoses (remember when every other person claimed to have low blood sugar?). But perhaps there is something to the phenomenon called celiac disease and it’s increasing numbers. In the past celiac disease was a rare condition and testing was difficult.

Celiac disease, also known as celiac sprue or gluten sensitive enteropathy is a digestive disorder caused by an immune system reaction to eating gluten, a protein in wheat, barley, and rye and other grains. Gluten is found in pasta, breads, cookies, crackers, processed meats, imitation meats and seafood, salad dressings, soups, beer and list goes on because so many foods have the wheat protein. It is uncertain as to what sets off this immune response but those with a genetic predisposition (that is a person has the gene for the disease), have a family history, or who have other immune disorders such as Type 1 Diabetes, lupus, rheumatoid arthritis, microscopic colitis or thyroid disease may be more likely to have celiac. Celiac seems to run in families. It is more common people of European heritage, and women are affected more often than men. The small intestine is lined with tiny projections called villi. These villi pull the nutrients from food into the intestine where it is utilized. Celiac disease damages these villi and the nutrients (fats, protein, vitamins, and minerals) pass through the body and are not absorbed.

The incidence of celiac disease is rising and this may due to the ongoing breeding of wheat strains to increase a particular crop and increase disease resistance. It is estimated that about one percent of the population in the United States have celiac disease. Many are unaware that they have it because they have no symptoms or symptoms mild enough that they think they are normal (such as loose stools).

The most common complaints with celiac are abdominal pain, a bloating sensation, and diarrhea. These are similar to those with Crohn’s disease, irritable bowel syndrome, gastric ulcers, and other gastrointestinal maladies. Less common symptoms may include nausea, anemia, fatigue irritability, joint and muscle pain, osteoporosis, and a tingling and numbness in feet. Weight loss is common and is a result of the poor absorption of nutrients as are anemia, stunted growth in children, weakness, and oily stools. The malabsorption can cause severe vitamin deficiencies that will damage the brain, nervous system, bones, internal organs and skin. Dermatitis herpetiformis is a blistering skin condition that also comes from a gluten intolerance. This too causes changes to the lining of the small intestine but may cause fewer digestive symptoms. People with celiac disease have a greater risk of developing bowel cancer and intestinal lymphoma.

There is no cure, but celiac can be effectively managed through a gluten-free diet. To be avoided are any foods or beverages that wheat, barley, bulgur, graham flour, rye, triticale, farina, semolina, and spelt. When the offending foods are eliminated the inflammation will settle down. It may take months to years for the villi to heal.

The difficulty lies in identifying the foods that are made with those ingredients to be avoided. Unless foods such as bread, pasta, cookies, and cereals are labeled “gluten free,” they should be avoided. There are grains and starches that are naturally gluten free. Corn, rice, quinoa, buckwheat, arrowroot, and tapioca do not have the gluten protein. Other foods to include in the diet are fruits, vegetables, rice, potatoes, fresh meats, seafood, and poultry. Wine and most liquors are OK but no beer.

Vitamin and mineral supplements such as calcium, folic acid, Vitamins D, K, and B12 may be necessary to combat the malnutrition that can occur with celiac disease. Since absorption is an issue they may need to be injected. When the inflammation is very severe, steroids may offer some symptom relief until the gluten-free diet effects are established.

If you feel you have celiac symptoms, make an appointment with your primary care provider. There are different methods of diagnosing this illness. A blood test will show whether or not the person has higher than normal levels of certain antibodies that are common in celiac disease. A biopsy will show the inflammation, and an endoscopy will show the whole small intestine. Sometimes just adopting a gluten free diet will relieve the uncomfortable symptoms, but if you are going to seek testing do not start the gluten-free diet until after the testing is done to avoid a false negative result.



Mia Smitt, a Sacramento native, is a family nurse practitioner who has given presentations at national conferences. She is married with two kids (one currently serving in Iraq) and works at Sacramento Family Medical Clinic at 3637 Mission Ave, Carmichael.

 

 

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