Low-carb diets are gone, but celiac disease is on the rise

Rosie Schwartz
National Post

Tuesday, August 22, 2006

Don't be surprised if you start noticing more people avoiding the bread basket. No, it's not a case of diet deja vu. Low carb is not making a comeback. But the diagnosis of celiac disease is on the rise. Or at least that's what the U.S. National Institutes of Health expects as the group embarks on a heightened awareness campaign for health professionals.

Through the campaign, launched in July, the experts hope to increase physician awareness of the disease, resulting in earlier diagnosis and better outcomes for celiac patients. Also known as gluten-sensitive enteropathy, celiac disease occurs when the immune system responds to the consumption of gluten with the production of antibodies. The disease can cause delayed growth in children, certain skin rashes, infertility, osteoporosis and an increased risk for certain cancers such as lymphoma.

The term gluten includes a group of proteins found in the grains wheat, barley, rye, kamut, spelt, triticale and possibly oats. While oats themselves may not trigger a response, it may likely be cross-contaminated by other gluten-containing grains. But for those with celiac disease, consuming gluten can have a wide range of adverse consequences including damaging the lining of the small intestine and poor absorption of a range of nutrients.

Celiac disease was thought to be somewhat rare, affecting only about one in 3,000 people in North America. For physicians, the typical picture of a patient who had undiagnosed celiac disease was an unwell-looking emaciated person with a host of gastrointestinal complaints.

Well, it's now apparent that the experts were way off in their estimates. The incidence in North America is around one in 133 people. And those with the disease can suffer from a variety of vague symptoms, making it much harder to even suspect celiac disease. In addition, it can strike at any age.

The range of gastrointestinal symptoms can include chronic or intermittent diarrhea and possible weight loss. But those with vague abdominal bloating, gastric reflux or heartburn, or those thought to have irritable bowel syndrome, may actually have celiac disease.

Also on the list are those with iron deficiency anemia, lactose intolerance, infertility, osteoporosis or autoimmune illnesses. And many people with the disease may be anything but emaciated and may be struggling with weight management issues.

Many health care professionals are not aware of the updated incidence figures on celiac disease nor the change in thinking about the typical person with the disease. Added to the mix is the method of diagnosis. It is a very confusing state of affairs for those who must come up with the diagnosis. There are relatively new blood tests that can be used to help pinpoint cases. But all across the country, medical laboratories are using the old ones such as the determination of anti-gliadin antibodies -- tests that have been shown to be unreliable.

When a physician orders a celiac disease screen in many health centres, it's not the recommended state-of-the-art tests that are performed. This is occurring for a few reasons. One is that many labs aren't aware of and don't perform these tests -- known as IgA antihuman tissue transglutaminase and IgA endomysial antibody immunofluorescence -- both of which are related to antibodies produced when gluten is consumed by those with celiac disease.

Another reason for the lack of appropriate testing is that there is not uniform coverage for these tests by provincial health care plans. For example, in Alberta, there is no extra charge for having these tests, while in Ontario, an individual has to pay out of pocket for them. The unreliable ones, though, are paid for.

The Canadian Celiac Association is also lobbying for the inclusion of the test names on lab forms so that the requests for the tests are simplified.

And for those who have been avoiding gluten, there's another real concern about making a diagnosis. The tests may reveal a false result because in order for the antibodies to be produced and measured, gluten must be regularly consumed prior to the test. But for a definitive diagnosis of celiac disease, a biopsy of the small bowel must be done.

The treatment for celiac disease is straightforward -- a gluten-free diet. With no gluten being consumed, over time many of the associated health problems then may disappear. But it's not just about avoiding the gluten-containing grains outright. The assortment of products containing gluten is astounding. Terms such as hydrolyzed vegetable protein, modified food starch or modified starch, caramel colour and malt or malt flavouring on an ingredient list in such products as soy sauce can signify the presence of gluten. Even beer, which is almost always made from barley, is on the gluten-free hit list.

Following a gluten-free diet may be a clear-cut treatment, but easy it's not. To the rescue is Shelley Case, a Regina-based dietitian and one of North America's foremost dietary experts in the field. The latest edition of her book, Gluten-Free Diet -- A Comprehensive Resource Guide, is an invaluable tool that should be in the kitchen of every person who has celiac disease.

It should also be on the bookshelves of health and food service professionals. Besides providing an overview of the disease and diet, Ms. Case has provided a wealth of details including the foods where gluten may be unknowingly found. Preparation basics, recipes and sources for alternative grain products such as quinoa, sorghum, amaranth and millet are also included along with more than 2,600 gluten-free specialty foods listed by company.

The book is available at most bookstores across Canada or can be ordered from Ms. Case's Web site at www.glutenfreediet.ca.

- Rosie Schwartz is a Toronto-based consulting dietitian in private practice and is the author of The Enlightened Eater's Whole Foods Guide: Harvest the Power of Phyto Foods (Viking Canada).

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