What is Celiac Disease:
Celiac disease is an autoimmunedisease that mostly affects the small intestine and is caused by gluten, a
protein present in wheat, barley, and rye. In celiac disease, the immune system
reacts inappropriately to gluten, causing damage to the small intestine lining.
This damage hinders nutritional absorption from food, resulting in a variety of
gastrointestinal and systemic symptoms such as diarrhea, abdominal pain,
bloating, lethargy, and skin problems. To manage symptoms and prevent further
damage to the gut, the only effective treatment for celiac disease is a
strict gluten-free diet that excludes all sources of gluten.
Where can you find Gluten?
Gluten
can be present in wheat, barley, and rye. Gluten may be found in bread, pasta,
cereals, wheat, cakes, and biscuits. It's additionally found in processed foods
like soups, sauces, and ready meals. Gluten is only harmful if consumed; it
cannot be absorbed via the skin.
Pathophysiology of Celiac Disease:
Celiac
disease pathogenesis involves a complicated combination of genetic
predisposition, environmental factors, and immunological responses. Here's a
rundown of the essential aspects of pathophysiology:
1. Genetic Predisposition:
Celiac disease has a substantialhereditary component. The HLA-DQ2 or HLA-DQ8 genes, which are human leukocyte
antigen (HLA) class II genes implicated in immunological modulation, are found
in most affected individuals. These genetic variations are required but not
sufficient for celiac disease to develop. Approximately 95% of celiac disease
patients carry either HLA-DQ2 or HLA-DQ8.
2. Environmental Trigger (Gluten Exposure):
Consumption of gluten-containing
foods is an environmental trigger for celiac disease. Gluten proteins are
difficult to properly digest in the small intestine, resulting in the creation
of peptides that can elicit an immunological response in those who are
vulnerable.
3. Immune Response:
Gluten ingestion causes an immunological
response, especially in the small intestine, in a genetically predisposed
individual. Both the innate and adaptive immune systems are involved in this
response:
a) Innate Immune Response:
Gluten-derived peptides are
recognized by antigen-presenting cells (APCs) and intraepithelial lymphocytes,
resulting in an inflammatory reaction. As a result, pro-inflammatory cytokines
and other immune mediators are produced.
b) Adaptive Immune Response:
Gluten-derived peptides are delivered by APCs to CD4+ T cells (helper T cells) via the HLA-DQ2 or HLA-DQ8 molecules, resulting in an adaptive immune response. This interaction causes gluten specific CD4+ T lymphocytes to become activated and proliferate. These T cells produce cytokines, most notably interferon-gamma (IFN-), which amplify the inflammatory response.
Epithelial Damage and Villous Atrophy:
In celiac disease, the immune response damages
the lining of the small intestine, specifically the mucosal coating of the
villi. The villi are finger-like projections that considerably enhance the
small intestine's surface area for nutrient absorption. Villous atrophy occurs
when the villi become flattened and atrophic because of repeated immunological
activation and inflammation.
1.
Malabsorption:
Malabsorption occurs when villous atrophy
alters the small intestine's natural structure, reducing its capacity to absorb
nutrients efficiently. This can lead to malabsorption leading to nutrient
deficiencies like vitamins (such as vitamin D, vitamin B12, and
folate), minerals, and macronutrients.
1 Clinical Symptoms:
Nutrient malabsorption and the inflammatory response inside the small intestine cause a variety of clinical symptoms such as diarrhea, steatorrhea (fatty stools), stomach pain, feeling full, weight loss, exhaustion, and nutritional deficiencies.
1 Autoantibodies:
People with celiac diseasefrequently develop autoantibodies in response to immune-mediated stimulation,
such as tissue transglutaminase (tTG) antibodies and endomysial antibodies.
These antibodies can be discovered in blood testing and utilized to make a
diagnosis.
2 Diagnosis:
Celiac disease is diagnosed using a combination
of clinical assessment, blood tests for specific antibodies, and intestinal
tissue biopsy. Villous atrophy and increased intraepithelial lymphocytes are
common findings in biopsies.
1 Treatment:
The main course of treatment for
celiac disease is a gluten-free diet for life. Gluten-free diets help to reduce
symptoms, boost small intestine healing, and prevent long-term consequences.
Brief Summary:
Celiac disease is an autoimmune condition
marked by a complicated immune response to gluten that results in small
intestine inflammation, villous atrophy, malabsorption, and a variety of
clinical symptoms. The pathogenesis of the disease is influenced by genetic
predisposition, gluten exposure, and immunological dysregulation.
exposure,
and immunological dysregulation.
Complications of Celiac Disease:
A.
Malabsorption
(When your body does not fully absorb
nutrients) can result in vitamin and mineral deficiencies. This can result in
conditions such as:
Insufficient
iron stores in the Body leading to Iron Deficiency Anemia.
Vitamin B12 Deficiency Anemia.
Folate
Deficiency Anemia.
Osteoporosis, a condition in which your bones
become weak and fragile.
B.
Lactose
Intolerance:
If
your celiac disease is untreated, you are more likely to develop lactoseintolerance, which occurs when your body lacks the enzyme required to digest
the natural sugar (lactose) present in dairy products. Symptoms of lactose
intolerance include bloating, diarrhea, and abdominal discomfort.
Lactose,
unlike gluten in celiac disease, does not harm your body. However, because you
can't digest lactose effectively, you may experience certain gut-related
problems when you take it.
Lactose
intolerance normally improves once you switch to a gluten-free diet and your
intestinal tract has restored. It can be treated by not eating or drinking
lactose-containing dairy products. You may also need to take calcium
supplements; dairy items are a good source of calcium, so you'll need to
supplement your diet with calcium supplements.
C.
Cancer:
Cancer
is a rare but serious celiac disease consequence. Coeliac disease increases the
risk of developing some tumors slightly. According to new research, this
elevated risk is less severe than previously thought.
Small
bowel cancer, small bowel lymphoma, and Hodgkin lymphoma are all linked to
celiac disease. However, there is a strong likelihood that most people
with celiac disease will not develop these.
After
some time on a gluten-free diet, your risk of developing certain types of
cancer is similar to that of the general population.
D.
Malnutrition:
Because coeliac disease impairs the
function of your digestive system, severe cases can occasionally result in a
critical deficiency of nutrients in your body. This is known as malnutrition,
and it can prevent your body from functioning normally or recovering from wounds
and illnesses.
Severe malnutrition can cause
tiredness, dizziness, and confusion. Malnutrition in children can result in
stunted growth and delayed development.
Malnutrition treatment may include
increasing the number of calories in your meals and taking supplements.
E.
Celiac
Disease and Pregnancy:
Untreated celiac disease increases the probability of reproductive issues for women. If a gluten-free diet is not followed, your baby may be born with a low birth weight or at an elevated risk of premature birth.
Which Foods to Avoid in Celiac Disease:
If
you have celiac disease, it is critical that you eliminate gluten in your diet.
Here are some things to stay away from:
Gluten Containing Grains:
Avoid
gluten-containing grains such as wheat, barley, rye, and derivatives. Bread,
pasta, cereal, and baked items prepared from these grains are examples.
Processed Foods:
Gluten
can be concealed in many processed foods such as thickeners, flavorings, or stabilizers.
Always read labels carefully to detect potential gluten sources.
Cross-Contamination:
Even
minimal levels of gluten might cause a response in celiac disease patients.
When preparing gluten-free foods, use separate utensils, cooking surfaces, and
equipment to avoid cross-contamination.
Oats:
While
oats are naturally gluten-free, they are frequently processed in facilities
that simultaneously process gluten-containing grains. To ensure that they
haven't been cross-contaminated, look for certified gluten-free oats.
Fried foods:
Foods
fried in the same oil as gluten-containing products may become contaminated.
Choose dishes that have been prepared in gluten-free fryers.
Sauces and Condiments:
Gluten can be found in a variety of sauces, gravy,
and condiments. Check the labels and choose gluten-free options or prepare your
own at home.
Deli Meats and Processed Meats:
Gluten
may be used as a filler or binder in some processed meats. Choose basic,
unprocessed meats or gluten-free meats.
Beer and Other Alcoholic Beverages:
Most beers are prepared with
gluten-containing grains. Look for gluten-free beer options or naturally
gluten-free wines and spirits.
Certain Medications and Supplements:
Gluten may be used as a filler in
some medications and supplements. To confirm that your prescriptions are
gluten-free, check with your doctor or chemist.
Unlabeled Foods:
If the gluten status of a food is uncertain or not
labelled, it's best to avoid it.
To
develop a safe and balanced gluten-free diet plan, it is critical to
collaborate with a healthcare professional and a certified dietitian who specializes
in celiac disease. They can assist you in making food choices, ensuring
sufficient nutrition, and providing advice on how to properly manage your
disease.
Alternative Gluten Free Food Options for Celiac Disease Patients:
Fruits:
All
fresh fruits are naturally gluten-free.
Vegetables:
Similarly,
most fresh vegetables are gluten-free.
Meats and Poultry:
Unprocessed
meats and poultry are gluten-free.
Fish and Seafood:
Fresh fish and seafood are generally
gluten-free.
Eggs:
Eggs
in their natural state are gluten-free.
Most
dairy products, like milk, cheese, and yogurt, are gluten-free.
Grains:
There
are several gluten-free grains, including rice, quinoa, corn, millet, and
buckwheat.
Legumes:
Beans,
lentils, and peas are gluten-free sources of protein.
Nuts and Seeds:
Most nuts and seeds are gluten-free, including almonds, walnuts, and chia seeds.
Gluten-Free Flours:
Flours made from rice, almond, coconut,
chickpea, and more are used in gluten-free baking.
Gluten-Free Breads and Pastas:
There
are various gluten-free bread and pasta options made from alternative flours.
Potatoes and Sweet Potatoes:
Both
are gluten-free and versatile.
Oats:
While
oats are naturally gluten-free, cross-contamination is a concern; look for
certified gluten-free oats.
Gluten-Free Snacks:
Many
chips, popcorn, and other snacks are available in gluten-free versions.
Condiments and Sauces:
Most
basic condiments and sauces are gluten-free, but it's essential to check labels
for hidden sources of gluten.
Few Gluten-Free Food Recipes:
Quinoa Salad:
Ingredients:
1 cup quiona
1 cup sliced cucumbers 2 cups water
or vegetable broth
1 cup halved cherry tomatoes
1/2 cup red onion, chopped
1/4 cup fresh parsley, chopped
1 lemon juice
three tablespoons of olive oil
Season with salt and pepper to
taste.
Instructions:
Rinse the quinoa properly with cold
water.
Bring 2 cups of water or vegetable
broth to a boil in a kettle. Reduce the heat to a low setting, cover, and let
it simmer for about 15 minutes, or until all the liquid has been absorbed.
Allow quinoa to cool before fluffing
with a fork.
Combine the chilled quinoa,
cucumbers, cherry tomatoes, red onion, and parsley in a large mixing basin.
Whisk together lemon juice, olive
oil, salt, and pepper in a small bowl. Toss the salad with the dressing to mix.
Chill before serving.
Grilled Chicken with Mango Salsa:
Ingredients:
4 skinless, boneless chicken breasts
Season with salt and pepper to
taste.
2 sliced ripe mangoes.
1/4 cup red onion finely chopped.
1/4 cup fresh cilantro, chopped.
One lime juice
1 tablespoon extra-virgin olive oil
Instructions:
Preheat the grill to medium-high
temperature.
Sprinkle Salt and pepper on the
chicken breasts.
Grill the chicken for 6-7 minutes
per side, or until perfectly cooked.
Prepare the mango salsa while the
chicken is cooking: Combine the sliced mangoes, red onion, cilantro, lime
juice, and olive oil in a mixing bowl. Combine thoroughly.
Serve the cooked chicken with the
mango salsa on top.
Zucchini Noodles with Pesto:
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Ingredients:
4 medium spiralized zucchini noodles
1 cup basil leaves, fresh
a quarter cup pine nut
1/4 cup grated Parmesan cheese (or
dairy-free nutritional yeast)
2 garlic cloves
1 tablespoon extra-virgin olive oil
Season with salt and pepper to
taste.
Instructions:
Combine basil, pine nuts, Parmesan
cheese (or nutritional yeast), and garlic in a food processor. Pulse until the
mixture is finely minced.
Slowly pour in the olive oil while
the food processor is running, until the mixture is fully blended and smooth.
Season to taste with salt and
pepper.
Sauté the zucchini noodles in a
large pan over medium heat for about 2-3 minutes, or until slightly softened.
Combine the zucchini noodles and
pesto sauce in a mixing bowl.
Serve hot.
Season with salt and pepper to
taste.
Summary of Dietary Modifications in Celiac Disease:
A
gluten-free diet is a form of eating that avoids gluten, a protein present in
wheat, barley, rye, and their derivatives. This type of diet is generally
followed by people who suffer from celiac disease. Furthermore, some people who
do not have celiac disease opt to follow a gluten-free diet because
of gluten sensitivity or other health concerns. The diet consists of
avoiding gluten-containing foods such as bread, pasta, cereals, and baked goods
in favor of naturally gluten-free foods such as fruits, vegetables, meats,
fish, and some grains such as rice and quinoa. To avoid accidental gluten
intake, those on a gluten-free diet must carefully read food labels and choose
gluten-free goods.
Latest Research on CELIAC DISEASE- Web Resources:
New Study Reveals Important
Information about T Cell Behavior after Gluten Exposure in Celiac Disease
Patients:
Running the numbers in celiac
disease:
https://www.beyondceliac.org/research-news/running-the-numbers-in-celiac-disease/
New insights into the way gluten
causes damage in celiac disease revealed in Beyond Celiac funded research:
https://www.beyondceliac.org/research-news/way-gluten-damages/
Race and its impact on genetic risk
and testing for celiac disease:
Celiac disease articles from across
Nature Portfolio:
https://www.nature.com/subjects/coeliac-disease
New Developments in Celiac Disease
Treatment:
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