Celiac disease is characterized by an intolerance to gluten, which compromises the digestion of certain nutrients.
Celiac disease, which affects both children and adult patients, is a chronic autoimmune inflammatory bowel disease. induced by the food antigen gluten gliadin. Celiac disease is characterized by an intolerance to gluten, which compromises the digestion of certain nutrients.
Also called disease celiac“gluten intolerance is a chronic autoimmune intestinal disease linked to gluten ingestion“, immediately explains Dr. Evelyne Chartier, general practitioner and nutritionist, member of the Union of Liberal Doctors. In detail, the people who suffer from it gliadin intolerant, a protein contained in gluten. Note that gluten is present in certain cereals, such as wheat, barley, oats or rye.
Be careful not to confuse intolerance and allergy : “Allergy to wheat or gluten is rarer, but causes an immediate reaction, such as angioedema” Moreover, “alongside gluten intolerance and gluten allergy, hypersensitivity to gluten has been described in a large number of people who are in principle tested non-celiac and non-allergic and who say that they get better if they no longer eat gluten. gluten. This could be a hypersensitivity due to intestinal hyperpermeability.“, specifies Dr. Evelyne Chartier.
In the case of Crohn’s disease, things are more complex. “When you suffer from this disease, you can experience three phases: a flare phase / one during which the patient gets better / a remission phase. Excluding gluten may have a beneficial effect during the first two phases, but this is not certain. What is certain is that during these phases, the patient is offered a residue-free, lactose-free diet.“, underlines Florence Thorez, Dietitian Nutritionist, member of the AFDN.
Gluten is found in some cereals. There is a memotechnical way to remember the 5 main cereals that contain it, thanks to the word SABOT:
S: Rye
A: Oats
B: Wheat (wheat, kamut, spelled, etc.)
O: Barley
T: Triticale (hybrid cereal of rye and wheat).
Gluten is found in most flours and therefore in foods prepared from flour:
- pasta,
- bakery products (bread, sandwich bread, biscuits, pastries, brioches, pancakes, waffles, muffins, donuts, etc.),
- most breakfast cereals,
- malted beers,
- quantity of prepared dishes (pizzas, quiches, breaded meats and fish, etc.),
- sauces, soups and desserts bound with wheat flour,
- certain seasonings and condiments.
Gluten can also be found in other foods: cold meats, pâtés, sausages, soy sauces, surimis, icing sugar, garlic powder, certain natural and artificial flavorings based on malt flavoring, etc.
Concretely, gluten attacks and destroys the villi in the walls of the duodenum, internal lining of the small intestine, thus preventing the proper assimilation of food. This disease causes chronic inflammation of the intestine causing a malabsorption of many nutrients. “In Europe, the United States, North Africa, the Middle East and India, celiac disease is estimated to affect 0.7 to 2% of the population. The frequency is probably underestimated due to the existence of forms with few symptoms”, specifies the specialist. Gluten intolerance is two to three times more common in women than in men. Celiac disease can occur at any age. It can appear in young children from 6 months to 2 years after the introduction of cereals into their diet, just as it can appear in adults between 20 and 40 years of age. The presence of certain illnesses in the family represents a risk factor, such as diabetes, autoimmune diseases (such as Down syndrome) and psoriasis. Finally, “close family of people with gluten intolerance develop the disease more often: 10% risk in first-degree relatives, namely the father, mother, brothers and sisters, and any children“.
Gluten intolerance is complicated to diagnose because its symptoms are very diverse and are not specifically linked to this disease. Furthermore, the symptoms differ if the disease occurs in children or adults.
In infants and young children, symptoms only appear after the introduction of gluten-containing flours with diarrhea classically described as greasy, fatigue and abdominal pain. These manifestations can be more or less important, follow one another, or sometimes not even occur for several weeks. The diagnosis then becomes more difficult. A break in the growth curve responsible for stunted growth and short stature can in this case alert the parents and the doctor. Delayed puberty in older children may also be observed. Good psychomotor development can also be affected by gluten intolerance. The presence of a slightly larger abdomen associated with this curve break can also be indicative of gluten intolerance.
In adults, however,, there are frequently forms without clear symptoms, or even completely asymptomatic, but in the typical picture, we find intestinal manifestations (abdominal pain, weight loss, diarrhea, bloating and fatigue). Celiac disease also results in other possible manifestations such as “weight loss, fatigue and irritability, paleness if anemia, depression, bone and joint pain, muscle cramps, infertility or absence of menstruation, numbness or neuropathic pain in the limbs, skin rashes, canker sores or ulcers in the mouth“, lists Evelyne Chartier.
Symptoms such as epilepsy, bone pain, osteoporosis, hepatitis, or even thyroiditis and deficiencies in vitamins (A, D, E, B12, K), iron, folate, calcium, magnesium can be observed. “In adults, the disease is diagnosed on average more than ten years after the first symptoms appear.“, adds our specialist.
“To make a diagnosis of gluten intolerance, it is necessary to look for disease-specific antibodies (anti-transglutaminase) into the blood via a blood test. If positive, perform an endoscopy with samples (biopsies) from the upper part of the small intestine (duodenum). Finally, notice a remission of symptoms after starting a gluten-free diet“, explains Evelyne Chartier. Indeed, the effectiveness of the gluten-free diet on the improvement and disappearance of manifestations and on the restoration of intestinal villi (between 12 and 18 months) is an element confirming the diagnosis of gluten intolerance. gluten. Furthermore, “some celiac patients have negative antibodies and, in cases of strong suspicion, an endoscopy may be necessary to make the diagnosis”, she specifies.
Celiac patients must “eliminate all foods wheat base (wheat) and its derivatives (spelt and Kamut)but also foods made from barley, oats and rye such as bread, pasta, pie crusts, biscuits, semolina, ravioli, couscous, breadings, donuts, puff pastries“. Evelyne Chartier recommends “reading labels carefully because gluten is present in products that we don’t necessarily think of, such as chocolate bars, ice creams, sauces, instant soups, preserves, ready meals, cold meats, beers”.
The treatment is based on the total and definitive elimination of foods containing gluten.
The treatment is based on the total and definitive elimination of foods containing gluten. Many food products, particularly those intended for infants, are now available gluten-free. It is also possible to “take probiotics or food supplements which are anti-inflammatory for the intestinal wall”, adds Evelyne Chartier. There are no other treatments for celiac disease.
Gluten intolerance can develop into more severe forms if a strict gluten-free diet is not followed. The most common complications are the consequences of poor absorption of nutrients in the intestine, such as proteins, vitamins, minerals (such as iron) and lipids. As nutrients are poorly absorbed in the intestine, a form of malnutrition can appear and cause fatigue, muscle weakness, weight loss and nutritional deficiencies.
- Moreover, when iron is poorly absorbed, the reserves in the body decrease, causing anemia. Severe fatigue, weight loss, shortness of breath, lack of appetite, pallor, tachycardia, etc. appear.
- Lactose intolerance, arthritis and the occurrence of urolithiasis may be observed.
- Finally, celiac disease can promote the appearance of osteoporosis. It is a disease that weakens bones by reducing their strength, thus exposing those affected to the risk of fracture.
Thanks to Dr Evelyne Chartier, general practitioner and nutritionist, member of the Union of Liberal Physicians.