Digestive Problems: Could It Be Celiac Sprue?
People have different relationships with their bowels. Most people give little acknowledgment to their bowels, eating what they want and having the minor inconvenience of a regular, daily bowel movement. Others must treat their bowels with kid gloves, judiciously putting in agreeable foods, lest they pay the price. Some hold vigil, tracking bowel movements and letting the bowels dictate whether it is a good day or a bad day.
Needless to say, bowel issues are common and frustrating. And frustrated people go looking for answers. Invariably those looking for answers and solutions in regards to their bowels come across a condition called "celiac sprue."
What Is Celiac Sprue/Gluten Sensitivity?
Celiac spue is more descriptively named "gluten sensitivity syndrome." It is difficult to characterize this problem as a true allergy to gluten or even an intolerance to it, but an immune reaction does occur.
Gluten is a protein that is found in products made from wheat, barley, and rye. When gluten is consumed by a person with celiac sprue, it passes from the stomach without issue. In the small intestine, however, the immune system is stimulated causing an inflammatory reaction. This reaction disrupts the tiny finger-like projections on the lining of the small intestine tasked with absorbing nutrients. In fact, the inflammation can be so disruptive as to cause these projections to just slough off completely.
Symptoms of Celiac Sprue/Gluten Sensitivity
I have some patients who are barely symptomatic and are only diagnosed in a workup for anemia. On the other side of the spectrum, I have patients who seriously pay the price with any gluten consumption. One even has her own toaster so as not to expose her gluten-free bread to any trace of the regular bread the rest of the family eats.
No two patients will exhibit exactly the same, but here are a few of the classic signs we see:
- Digestive Problems:The results from the above process is usually cramping and diarrhea.
- Anemia: Often this damage can cause microscopic blood loss and lead to anemia.
- Nutrient Deficiencies: With the problem ongoing, serious nutritional deficiencies can develop as the small intestine becomes ineffective.
- Other Problems: Beyond weight loss, deficiencies of vitamins and minerals can cause syndromes in and of themselves such as skin conditions, nerve problems and memory loss.
Celiac Sprue/Gluten Sensitivity Risk Factors
The best place to start an investigation for celiac sprue is with family history. Most often, there is a genetic component. While the genetics follow an inheritance pattern, certain gene mutations have been recently discovered. Genetic risk factors include a family history of:
- Celiac Sprue
- Type 1 Diabetes
- Thyroid Disease
- Down's Syndrome
Diagnosing Celiac Sprue/Gluten Sensitivity
If suspicion persists, testing can be performed.This is not so black and white, however.
- Blood Tests: A panel of blood tests can be done to help determine if celiac disease exists, but a positive test does not give a definitive diagnosis nor does a normal test completely rule it out.
- Biopsy: The gold standard test is a biopsy of the small intestine that can be done with a scope down through the stomach. While this seems a bit drastic, it gets the diagnosis and allows other problems like ulcers or erosions of the esophagus to be ruled out.
- Gluten Elimination Trial: Still, with some patients, deductive removal of gluten is an effective test. I will generally have patients eliminate gluten completely from their diet for about two weeks to see how they feel. If there has been no change, we are likely barking up the wrong tree. If patients feel the best ever, celiac sprue or not, this is the best dietary regimen for them to pursue.
Dietary Modifications for Celiac Sprue/Gluten Sensitivity
Gluten seems so ubiquitous in our daily diet that at the onset, the elimination of gluten from the diet can seem like a very daunting task. I hear, "No cereal, no bread, no more pizza, no more cake or baked goods? Are you kidding me!?" But I am not a "can't do" person and I tell them that while they will need to be creative, they can continue to eat these foods.
We have come a long way. Supermarkets have gluten-free aisles. Networks have developed, sharing ideas and recipes. Restaurants have developed gluten-free options on their menus. PF Chang's has been especially good in this regard. However, I must admit eating gluten-free can be more expensive than a gluten-inclusive diet.
Conditions Commonly Mistaken for Celiac Sprue/Gluten Senstivity
Celiac disease is but one of many causes of bowel problems. Patients are often left playing detective with eliminating certain foods and other lifestyle modifications. Food intolerance syndromes are quite common. Another common condition to consider is irritable bowel syndrome.
Celiac sprue (or gluten sensitivity syndrome) is a relatively common bowel condition involving cramping and diarrhea due to inflammation in the small intestine. Those with celiac sprue are often left with nutritional deficiencies and anemia. Diagnosing celiac sprue can be difficult, but while challenging, eating gluten-free is becoming easier due to growing availability of products at supermarkets and on menus of restaurants.
Photo Credit: Leonid Mamchenkov