If you answered "celiac," you get the prize. Previously regarded as a rare disorder, celiac disease is now recognized as a major healthcare problem affecting 1 percent of the general population. Celiac disease is an autoimmune disease which affects the small intestine and interferes with the body's ability to absorb nutrients from food. Among its many symptoms are gas/flatulence, reflux, abdominal bloating and pain, chronic diarrhea, and fatigue and depression. Gluten, found in wheat (and its various forms), rye, barley, and sometimes oats (usually the result of cross-contamination) is the culprit. Going "gluten-free" controls celiac symptoms.
If there is any good news in celiac, it is that there is a reduced risk of breast cancer in female celiacs and lower total cholesterol in comparison with the general population. It is encouraging that the frequency of malignant complications of celiac disease is much lower than earlier studies had indicated, and reproductive problems have been over-exaggerated.
Certain autoimmune diseases constitute clinically important association, of which type 1 diabetes and thyroid disorders are the most important. Several liver disorders, including primary biliary cirrhosis and primary sclerosing cholangitis, are also associated. Other autoimmune diseases that have a positive association with celiac disease include Addison's disease, immune thrombocytopenic purpura, and psoriasis. The prevalence of ulcerative colitis and Crohn's disease has been found to be significantly higher in celiac disease than in the general population. Autoimmune diseases having only a small association with celiac are Sjögren's syndrome, primary hyperparathyroidism, hypoparathyroidism, hypopituitarism, and systemic lupus erythematosus. The prevalence of rheumatoid arthritis is not increased in celiac disease.
It is important that these associated diseases be recognized because if not, symptoms will be attributed falsely to deliberate or inadvertent ingestion of gluten rather than prompt a search for a second diagnosis. The opposite may also be true: In a patient with an established diagnosis that is considered falsely to account for the whole clinical picture, celiac disease is likely to remain undetected. [Editor's note: Most persons diagnosed with celiac are middle-aged and asymptomatic.]
Despite the development of highly sensitive and specific serological tests allowing noninvasive and large-scale screening of the general population in order to identify individuals with celiac disease, there remains a substantial gap between the number of adults with clinically diagnosed celiac disease and those with undetected celiac disease.
Who needs to follow a gluten-free diet? Only people who are diagnosed with celiac disease, a gluten sensitivity or allergy, or dermatitis herpetiformis (a very itchy chronic skin rash of bumps and blisters) need to eat a gluten-free diet. In fact, a gluten-free diet can promote certain nutrient deficiencies since many gluten-free products are not fortified with vitamins and minerals. Also, some gluten-free foods have more sugar and fat to mimic the texture and mouth-feel of foods with gluten, and the low fiber content of many gluten-free foods may cause constipation. However, a gluten-free diet based on fruits, vegetables, lean proteins, nuts, seeds, legumes, and whole grains that do not contain gluten--such as brown rice and quinoa--can be quite healthy.
Only a doctor can diagnose celiac disease for sure. If you decide to see your doctor for testing, don't limit gluten in your diet before any blood tests or biopsies. This could affect the reliability of the diagnosis.
--Sources: Excerpted from "Risk of Morbidity in Contemporary Celiac Disease," Nina R. Lewis, Geoffrey K.T. Holmes, Expert Reviews Gastroenterology & Hepatology, January 3, 2011; "Who Needs a Gluten-Free Diet?" Jody Paglia Tanzman, B.S., Brigham and Women's Hospital, January 5, 2011; "Celiac Disease: The Facts," American Autoimune Related Diseases Association
