Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.
Dear Doctor: My 40-year-old grandson has just been diagnosed with celiac disease after months of feeling poorly and being underweight. What’s next? Where can he go for guidance and what should he do? I want to help, but don’t know where to start.
Dear Reader: Let’s begin with the basics: Celiac disease is an inflammatory reaction within the small intestine. The reaction is caused by gluten, a protein found in wheat, rye, spelt and barley, and occurs in people genetically prone to the disease. Symptoms vary depending upon the extent of inflammation.
In years past, celiac disease was diagnosed only in people with the classic, or severe, form of the disease, which damages the finger-like projections of the small intestine that help absorb nutrients. When those projections are damaged, the body is unable to absorb fats, leading to increased abdominal gas; stools that are bulky, foul-smelling and float; and poor absorption of vitamins and nutrients. The ultimate result can be anemia, weight loss, nerve dysfunction and osteoporosis. Today, we’ve realized that the prevalence of celiac disease is much greater than initially thought because many patients have milder symptoms, such as fatigue and generally loose stools.
Your grandson probably suffered for months prior to his diagnosis because his symptoms were mild. In less-debilitating forms of the illness, symptoms can be either misdiagnosed or not severe enough to push someone to seek medical attention.
Regardless of severity, however, celiac disease can be addressed. The cornerstone of treatment is removing gluten from the diet. That means avoiding wheat, rye and barley, which are in a surprising number of foods — not just breads, pastas, crackers and snacks, but also sauces, vinegars, salad dressings, marinades, seasonings, soup stocks, soy sauces, and even beers, ales and lagers. For that reason, anyone with celiac disease should carefully read the labels of all prepared foods and condiments that they consume. Although such restrictions can make going out to restaurants more difficult — and potentially affect a person’s ability to socialize — the health benefits outweigh the difficulties.
On the plus side, many condiments and beers are increasingly available without gluten, as are breads and pastas. The latter foods are made with quinoa, tapioca, rice, soybeans or buckwheat, all of which are safe to eat. In fact, over the past 20 years, a whole industry has developed to cater to people who are intolerant to gluten, and many restaurants now provide gluten-free options as well.
In 70 percent of patients with celiac disease, following a gluten-free diet leads to a reduction in symptoms within two weeks, and levels of inflammatory antibodies decline substantially after six weeks.
Among people who continue to have symptoms, 90 percent either don’t adhere properly to a gluten-free diet, or they consume foods they mistakenly believe are gluten-free. For those who are strict about a gluten-free diet but still have severe symptoms, oral steroids or other medications to suppress the immune system can relieve symptoms.
Your grandson is probably already seeing a gastroenterologist who is monitoring his symptoms and evaluating him for nutritional deficiencies, but he also should consult a nutritionist to review the types of foods and drinks he is consuming. With a gluten-free diet, he should be feeling better soon.
