US Pharm. 2023;48(12):15-16.

Intolerance to Gluten

Celiac disease is a disorder in which the body’s immune system damages the villi, or lining of the small intestine, when gluten is consumed. Villi are responsible for absorbing nutrients in the gut. Left untreated, chronic poor absorption and inflammation can lead to serious long-term complications. Gluten is a protein found in wheat, rye, barley, and triticale. Avoiding these grains can prevent the immune reaction that causes intestinal damage and enables the villi to begin to heal. After some time, the villi properly absorb nutrients again. With a gluten-free diet, symptoms in a patient with celiac disease are often relieved quickly. Unfortunately, the disease is not curable, so patients must avoid gluten for the rest of their lives.

Patients With Celiac Disease Must Avoid Gluten

Celiac disease, also known as gluten intolerance or celiac sprue, can occur anytime after gluten is introduced. It is more common in Caucasians of European ancestry and in people with a first-degree relative with celiac disease. Patients with type 1 diabetes, Down syndrome, Turner syndrome, Williams syndrome, or autoimmune diseases such as rheumatoid arthritis, microscopic colitis, Addison’s disease, or autoimmune thyroid disease have an increased risk of celiac disease.

Nonspecific Symptoms Complicate Diagnosis

Many people with celiac disease are not aware of their disease because symptoms can be caused by many conditions. A wide variety of symptoms can come with celiac disease, including diarrhea; constipation; abdominal cramping; abdominal pain; bloating; gas; foul-smelling, fatty, or floating stools; weight loss; fatigue; a change in appetite; anemia; osteoporosis; joint pain; neuropathy; and other neurologic symptoms, such as mood changes. Some patients with celiac disease may have lactose intolerance and have trouble digesting dairy products. Patients can also experience itchy skin rashes with or without gastrointestinal symptoms, known as dermatitis herpetiformis.

Since these symptoms are not specific, it can take a significant amount of time before the proper diagnosis is made. Ultimately, the diagnosis of celiac disease is often a result of ruling out other causes of the symptoms and obtaining an accurate patient family history. Blood tests can be used to check for antibodies that attack gluten proteins. Additional tests include passing a tiny camera through the body to take a closer look at the small intestine and to take a biopsy.

A Gluten-Free Diet Relieves Symptoms

Although celiac disease does not have a cure, it can be managed by diet. Treatment for celiac disease is complete avoidance of gluten-containing foods. If strictly followed, a gluten-free diet relieves the symptoms and allows for eventual healing of the small intestinal wall lining. A dietician can provide patients with a comprehensive list of foods, beverages, nutritional products, and drugs that contain gluten, along with a list of gluten-free products. This list should also include gluten-free toothpastes, mouthwashes, and lipsticks since even small amounts of gluten can trigger small intestinal damage.

Complications from celiac disease that is not well managed can be serious. The chronic immune response and small intestinal wall damage can lead to complications such as malnutrition, lactose intolerance, intestinal cancer, heart disease, liver disease, anemia, diabetes, infertility, miscarriage, osteoporosis, and neurologic symptoms such as headaches, seizures, dementia, and neuropathy.

More and more gluten-free products are becoming available and are clearly labeled as “gluten free” on their packaging. Recently, grocery stores have established gluten-free sections, and restaurants are labeling menu items as “gluten free.” These conveniences make it easier for people with celiac disease to eat a wider variety of foods.

If you think you might have celiac disease, see your doctor. Do not begin a gluten-free diet prior to evaluation, because avoiding gluten can affect the diagnostic tests for celiac disease. Your pharmacist can tell you which medications or nutritional supplements contain gluten and should be avoided.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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