Digestive disorder triggered by intake of protein gluten found in wheat, barley and rye is known as gluten intolerance. It is also known as celiac sprue, gluten sensitive enteropathy and nontropical sprue. Gluten intolerance symptoms develop due to action of immune system triggered by gluten causing damage to the inner linings of the small intestine. Exact cause of gluten intolerance is not known. However, immune system in these people responds abnormally to the gluten in diet. People with family history of celiac sprue are at increased risk for the disease. Disease such as diabetes, Down syndrome, autoimmune thyroid disease and microscopic colitis increase the risk for gluten intolerance.
Categorization of Celiac sprue
Celiac sprue is categorized in to two types
- Latent celiac disease: Blood shows abnormal levels of antibodies but the intestines remain normal. They also do not show any symptoms. However, they develop gluten intolerance symptoms later in life.
- Silent celiac disease: Abnormal antibody levels are observed in blood tests, villi of small intestine are also damaged but the patient does not show any signs of disease even when on normal gluten containing diet. As in latent celiac disease, patients with silent celiac disease also develop symptoms later in life.
Dermatitis herpetiformis is a minor form of gluten intolerance disease characterized by blisters on the skin upon taking gluten containing diet. Rashes generally appear in scalp, buttocks and torso. It also causes damage to small intestine. However, the intensity of gluten intolerance symptoms such as abdominal pain are not noticeable as in celiac sprue.
Gluten intolerance symptoms
- Impaired or poor absorption of nutrients: Damage of villi of small intestine due to action of immune system prevents the normal absorption process. Impaired absorption causes deficiency of vital nutrients such as vitamins and minerals that ultimately affects the functioning of vital organs such as brain, peripheral nervous system, liver and bones.
Commonly observed gastrointestinal symptoms
- Abdominal pain.
- Grey colored foul smelling stools.
- Muscle cramps.
- Skin rashes.
- Mouth sores.
- Tingling sensation in legs and feet.
Symptoms observed in children
- Change in tooth color due to defects in tooth enamel.
- Delay in onset of puberty.
- Very less weight gain.
- Fussy behavior.
- Short stature.
If gluten intolerance symptoms are not given attention at right time serious complications may develop:
Malnutrition: Due to impaired absorption, nutrients get eliminated in the stools. As a result body gets deprived of essential nutrients resulting in malnutrition despite of taking healthy well balanced diet. Deficiency of vitamins, minerals and proteins results in loss of weight and diseases such as anemia. Growth rate drops drastically in children. They even show delay in development. Advanced malnutrition with very low levels of protein in blood causes retention of fluids in the body tissues.
Increased bleeding: Poor absorption of vitamin K increases risk for bleeding and easy bruising.
Infertility: Untreated gluten intolerance can result in infertility, spontaneous abortions, low birth weight babies and lack of menstruation in women.
Osteoporosis and Osteomalacia: Increased loss of fat in the stools results in loss of vitamin D and calcium. As a result bone density decreases resulting osteoporosis that increases risk for bone fractures. Deficiency of calcium also results in Osteomalacia (soft bones) in adults and rickets in children.
Lactose intolerance: Few people with gluten intolerance cannot tolerate lactose, sugar present in milk. They suffer with abdominal pain and diarrhea even after taking lactose containing diet. Hence, they should stay away from gluten as well as lactose. However, few people will be able to digest lactose once the small intestine gets healed. In few people lactose intolerance continues for the rest of life even after regulating gluten intolerance.
Cancer: If gluten intolerance symptoms are not controlled then it increases the risk for various types of cancers such as bowel cancer and intestinal lymphoma.
Nervous system disorders: In few cases delay in treatment of celiac disease causes seizures and damage to peripheral nervous system.
Treatment Gluten intolerance
Gluten intolerance cannot be treated. However, you can relieve gluten intolerance symptoms by taking care of diet. Before starting gluten free diet it is important to get yourself tested for gluten intolerance as diseases such as irritable bowel syndrome and food intolerance show similar symptoms.
Diagnosis is generally made using results of blood tests, studying of sample tissues of small intestine and examining the images of intestine. Presence of high level of antibodies namely anti-endomysium and anti-tissue transglutaminase that generally work to eliminate foreign bodies is an indication for celiac sprue. Confirmation of the disease is done by biopsy i.e. studying tissue sample of small intestine that is collected by passing a thin tube through the mouth. In case of complications, physician prefers to observe the internal condition of the intestine by observing the images taken by pill sized camera contained in a capsule that is swallowed by mouth. Later, the capsule gets eliminated in stools.
To relieve gluten intolerance symptoms it is important to follow strict dietary measures.
- Taking gluten free diet: Foods containing gluten such as wheat, barley, rye, semolina, Bulgur, Durum, Spelt, Triticale and Graham flour should be completely avoided. Healthy diet free of these ingredients should be planned with the help of dietician. Diet can include eggs, meat, fish, fruits and vegetables. Starches and flours made of rice, corn and soybeans can be used.
- Vitamin supplements: As it takes time for the damaged intestine to repair and restore the normal absorption process it is important to take vitamin and mineral supplements to prevent malnutrition and associated complications. Supplements should be taken to improve the levels of folate, vitamin B12, vitamin K, vitamin D, Iron and calcium.
- Drugs to control inflammation: If the symptoms are worse, physician may prescribe steroids to regulate inflammation of the intestines and abdominal pain.
By following these measures gluten intolerance symptoms subside gradually in few days. Small intestine starts to heal and the villi also grow back in few months restoring the normal absorption. In few cases, entire healing process may take two to three years. Extent of recovery and healing is fast in children compared to adults. Patient should stay away from gluten containing diet even after complete healing of intestine. Even traces of gluten in diet results in abdominal pain and diarrhea. However, few patients remain asymptomatic it does not mean they can continue to take gluten.