Imagine what it would be like to suffer fatigue, anemia, diarrhea, cramps, bloating, reflux, osteoporosis, depression or an unbearable, itchy rash. Now, imagine that your doctor keeps telling you that there’s nothing really wrong with you and that it’s all in your head.
This is a surprisingly familiar scenario for too many people. They suffer from a common but often unrecognized condition called celiac disease that can cause such symptoms and many more.
This autoimmune disorder is often called the “Great Imposter” because it frequently mimics chronic fatigue, osteoporosis, irritable bowel syndrome (IBS), dermatitis or dementia. Some people suffer from migraines while others experience infertility. All these problems can be caused by an inability to tolerate gluten, a protein found in wheat, barley and rye.
Who would ever suspect that such all-American favorites as pizza, pasta and pretzels could be poison? But for those with celiac disease, such foods and many others create a chain of events that destroys the lining of the small intestine.
When this happens, people with celiac cannot absorb critical nutrients such as iron, calcium and magnesium from the food they eat. Bones can become brittle, blood has a harder time carrying oxygen and brain function may be compromised. Nerves that detect pain may go haywire, resulting in tingling, burning or numbness in the hands or feet and legs.
Most doctors learned in medical school that celiac disease is a rare pediatric condition, affecting only one child in 5,000 and that it results in diarrhea and failure to thrive. Researchers now have data showing that celiac actually affects one person out of 100. That makes it the most common inherited autoimmune disease in the United States.
Millions of adults have celiac and don’t even know it. Peter Green, MD, Director of the Celiac Disease Center at Columbia University, estimates that 97 percent of such victims are undiagnosed. Their symptoms may be as varied as severe heartburn or migraine headaches. A rash, called dermatitis herpetiformis, may be mistaken for mosquito bites, eczema, allergies, psoriasis or hives.
If celiac patients continue to eat foods containing gluten they increase their risk of developing certain cancers, including non-Hodgkin’s lymphoma, esophageal cancer and adenocarcinoma of the small intestine.
Diagnosis is easier than it used to be. There are blood tests (tTG, EMA) that can be helpful, although they are not perfect. The gold standard for diagnosis is an endoscopy in which a tiny bit of intestinal tissue is snipped out for examination (biopsy). All of these tests are accurate only if the patient eats gluten in the weeks beforehand. A gene test under development should show who is susceptible to celiac disease.
Readers who would like to learn more about celiac disease may want a CD of our recent one-hour radio interview with Dr. Green. The show covers symptoms, diagnosis and treatment. It is available for $16 from the People’s Pharmacy (CD- 594), P. O. Box 52027, Durham, NC 27717-2027 or from www.peoplespharmacy.com.
Now that celiac disease is known to be common, patients deserve to be tested. A strict gluten-free diet may be life saving.
The People's Perspective on Medicine