Celiac disease is caused by an immune response directed at the small intestine due to immune complexes deposited in the mucosa after ingestion of gluten-containing foods. The endothelium (or the innermost lining of the small intestine) is damaged along with the intestinal folds that increase the absorption surface and the villi that are responsible for absorbing nutrients.
Gluten-containing foods are abbreviated as BROW, to make it easier to remember. This means barley, rye, oats and wheat. Some gluten-containing dishes and foods you’ll want to avoid are donuts, meatballs, crackers, cookies, biscuits, bread, hamburger buns, whole-grain crackers, ice cream cones, waffles, pancakes, the pasta and the pizza dough, basically almost everything. that tastes good
Upon visual inspection of the upper small intestine (where the involvement is more concentrated) of someone with the disease, it appears shiny, cobbled, and thin. The shiny, cobbled appearance may be due to inflammation caused by the immune response, and the thinness is caused by destruction of the intestinal folds found in the mucosa.
The pathophysiology of this disease explains the malabsorption of nutrients that causes the train of signs and symptoms, and if left untreated, secondary diseases and complications. Firstly, due to the damage that occurs in the mucosal absorptive and secretory bodies, the secretion of intestinal hormones such as secretin and cholecystokinin-pancreozyme is drastically reduced. The pancreas and gallbladder are then affected, also decreasing their secretion of enzymes and bile to help digest nutrients, especially fats.
Without the secretory capabilities of these organs, further digestion other than by the stomach is prevented. Coupled with the lack of means of absorption from the small intestine, the resulting stool (which is passed frequently) is bulky, foul-smelling, floats on water, and pale in color. This type of stool is called steatorrhea, and its characteristics can be attributed to unabsorbed nutrients, usually fats.
Frequent trips to the bathroom result in significant loss of fluids and electrolytes like sodium, potassium, and chloride. This causes muscle weakness, among others. Other lost electrolytes such as phosphorous, magnesium and calcium are misused mainly due to compensation by the body. Its absence can cause convulsions and involuntary spasms of the muscles. In addition, bone and tooth weakness may occur due to the resulting bone reabsorption of phosphorus and calcium.
If this is left untreated and progresses to full-blown disease, secondary conditions may arise. Hyperoxaluria (also known as oxalosis) can result due to the absorption of oxalate in the body that does not normally occur if calcium is readily available.
Fat-soluble vitamins, iron, folic acid (Vit. B9) and cyanocobalamin (Vit. B12) can become deficient. These can manifest as cheilosis (lip breakage), easy bruising, a soft, red tongue, fatigue, and anemia.
A gluten-free diet is the only accepted treatment for celiac disease and dermatitis herpetiformis, which is a related condition that can coexist with the disease. This diet excludes barley, rye, oats, wheat, cereals, and even triticale as food additives, flavorings, thickeners, or stabilizers.
Foods like ice cream and ketchup sometimes use gluten as a stabilizer, so they’re best avoided. Some over-the-counter and prescription medications, including vitamins, also use gluten as an ingredient, so it’s best to be careful. Beauty products like lipstick, lip balm, and lip gloss should also be checked out because some of these products also use gluten.
Some of the accepted substitutes are rice, cassava-derived tapioca, corn, potato, amaranth, arrowroot, montina, millet, lupine, quinoa, sorghum, sweet potato, teff, taro, yam and chia seed. Beans, nutmeal, and soy can be added to include protein in the diet.
