Michelle Burke
"I just don't understand it, no matter what I do my child won't gain weight and she is sick all the time. What am I doing wrong?" This is a comment from Julie who can't understand why Jenny her six year old just doesn't seem to thrive. Jenny is constantly sick with a painful upset stomach and poor appetite, she is underweight for her age and suffers from constant hay-fever, despite all the measures Julie has taken to get rid of pets and dust mites in their home.
Julie has done research on a healthy diet for her daughter and Jenny gets lots of fiber in the form of fruits and vegetables and plenty of whole-wheat bread, pasta and other cereals which Julie knows are good for the digestive system and general health.
What Julie doesn't know is that it's the wheat products in Jenny's healthy diet that are making her sick. Jenny has celiac disease, an intestinal disorder that means she cannot tolerate gluten, a naturally occurring protein found in grains like wheat, barley, oats and rye. Celiac disease is also known as gluten intolerance or gluten-sensitive enteropathy.
As many as 1 in 250 people in the United States have celiac disease but most probably don't know it. Many cases remain undiagnosed and children like Jenny suffer needlessly for years without knowing why. The disease can masquerade as other illnesses or be silent, not producing any recognizable symptoms at all.
What Is Gluten And How Does It Cause Illness?
Gluten is a harmless natural protein. In healthy people it's easily digested and absorbed by the small intestine. For the most part wheat products are a good source of fiber and B vitamins and are valuable for good health. For people like Jenny wheat can be deadly.
In people with celiac disease an immune system reaction causes damage to the villi of the small intestine. These villi are tiny finger-like projections responsible for the absorption of nutrients into the body. When these villi are damaged they can't function properly and the body is starved of vital nutrients. Celiac disease has a 95% hereditary predisposition. This means that if your child has it there is a good chance that one or both parents and other siblings may have it too.
What Symptoms Will Celiac Disease Cause in My Child?
In children, a sensitivity to gluten causes symptoms which include upset stomach, failure to grow normally (often called "failure to thrive") or delayed growth, weight loss, painful abdominal bloating or distention, pale, foul-smelling, greasy stools, chronic or recurrent diarrhea and irritability. A different type of immune response related to the same protein may give symptoms of allergic rhinitis or hay-fever.
Celiac disease is frequently associated with other autoimmune conditions such as diabetes mellitus type 1 and thyroid disease. In about 10% of patients an itchy skin rash (dermatitis herpetiformis) occurs. Celiac disease is usually discovered between the ages of six months to two years, often following the introduction of cereals to the diet.
How Is Celiac Disease Diagnosed?
Celiac disease can be difficult to diagnose because its symptoms are often confused with those of more common diseases and may involve many different parts of the body. Your doctor will first want to rule out any other diseases and then may recommend an intestinal biopsy. A small portion of intestinal tissue is removed and examined under a microscope. This is done to ascertain damage to the tiny villi and to look for any inflamed cells underneath them.
Blood tests are normally done to check for the presence of immune system antibodies to gluten. If these tests are positive and general health improves on a gluten free diet, the diagnosis will be confirmed. Your doctor may also want to test for iron and other vital vitamins and mineral deficiencies. As the disease runs in families, it may be wise to have the whole family tested, whether they show symptoms or not.
How Is Celiac Disease Treated?
The treatment for celiac disease is simple but not always easy. A gluten free diet must be followed for life. If exposure to gluten continues, the damage to the intestine will grow worse and health will continue to deteriorate. Once gluten is withdrawn from Jenny's diet the intestine will heal and she will begin to feel like a normal, healthy six year old. In a few weeks to a few months she will feel better and will be able to lead a perfectly normal life. If left untreated the disease can lead to severe malnutrition, loss of bone density and many other disorders including seizures and even intestinal lymphoma. However, there is hope for Jenny. Gluten free products are available from many specialty food stores and with careful research and meal-planning Julie should be able to provide tasty, nutritious meals for her daughter.
Tips For A Gluten Free Diet
• All cereals, breads or other grain products that include wheat, rye, barley or oats, must be avoided. These include refined white or whole-wheat flour (including cookies, crackers, cakes and most other baked goods), semolina, couscous, bread crumbs, most pastas and malt. Check for gluten-free pastas, cookies and breads at specialty stores.
• Processed cheese, cheese spreads, low-fat or fat-free cottage cheese or sour cream may also need to be avoided as these may contain wheat derivatives. Check the list of ingredients or contact the producers of these goods for accurate information as many labels don't clearly indicate the presence of gluten.
• Avoid any dairy products, such as yogurt or ice-cream. These often contain fillers or additives that are gluten based.
• Canned soups or soup mixes often contain wheat or barley based thickeners.
• Avoid creamed vegetables, unless they are made with cornstarch.
• Many commonly consumed foods that contain modified food starch, food starch, hydrolyzed vegetable protein, stabilizers or fat replacers or substitutes. These include ice-cream cones, processed meats and sausages.
• Avoid flavored coffee, malted milk, health drinks or herbal tea with malted barley.
• Gluten free foods include: products made with soybean or tapioca flours, rice, corn, buckwheat or potatoes; nuts; fresh fish, meat or poultry; fresh, frozen or canned vegetables without sauces; and plain, natural cheeses and yogurt. The jury is still out about oats but recent research suggests up to twqo ounces of oats each day may be tolerated well by people with celiac disease. Some sources advise avoiding oats until more conclusive evidence has been gathered.
• Many websites on the internet provide gluten-free diet information and meal plans. Do research and compile a list of safe foods for various meal times. Recipes are freely available and many have been created by celiac disease sufferers. These include breads, cookies and sweet treats. You need not deprive your child of pleasurable eating. Search your local library for gluten-free recipe books. Join a support group and trade ideas, information and recipes with fellow disease sufferers.
• As this disease is becoming better understood, responsible companies now market products labeled "gluten-free." Look out for these and if in doubt contact the company to find out.
For more information contact:
National Institute of Diabetes and Digestive and Kidney Disorders
Office of Communications and Public Liaison
Building 31, Room 9A04
Center Drive, MSC 2560
Bethesda, MD 20892-2560
Phone: (301) 496-3583
Fax: (301) 496-7422
www.niddk.nih.gov
American Dietetic Association
216 W. Jackson Blvd.
Chicago, IL 60606-6995
Phone: (312) 899-0040
Toll-Free: (800) 877-1600
E-mail: cdr@eatright.org
www.eatright.org
American Gastroenterological Association
7910 Woodmont Ave.
Seventh Floor
Bethesda, MD 20814
Phone: (301) 654-2055
Fax: (301) 652-3890
E-mail: webinfo@gastro.org
www.gastro.org
Celiac.com
www.celiac.com.
The Celiac Sprue Association
P.O. Box 31700
Omaha NE, 68131-0700
Toll Free: 877-CSA-4CSA
Fax: 402-558-1347
E-mail: celiacs@csaceliacs.org
Michelle Burke is a freelance writer from Cape Town South Africa. She has a background in Biology and a passion for primary health care, especially issues that pertain to children's and women's health.
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