Happy May! Since this month is Celiac Awareness Month, I wanted to dedicate a few posts to this disease to help YOU become more aware. Many people are aware of the “gluten-free” trend that has been sweeping through grocery stores for the past several years, but many people don’t realize that being gluten-free is medically important for some of us. No, it won’t be okay if we just have a little bit, or just don’t eat the bread…that little protein can cause a whole bunch of problems for people with celiac and Non-Celiac Gluten Sensitivity (NCGS)! I recently wrote a couple of research papers on celiac disease, so I could go into extensive detail on the physiology of it, BUT that gets complicated so I’ll just give you guys a brief overview. 🙂
So what is it?
Celiac disease is an autoimmune disorder characterized by a variety of digestive and non-digestive symptoms in response to the ingestion of dietary gluten proteins, specifically the gliadin subunit. The protein causes intestinal damage –villous atrophy, or flattening of the intestinal villi – resulting in the decreased absorption of nutrients and leading to malnutrition.
There are two hallmark identifiers of CD:
- Histological – villous atrophy
- Serological – tissue transglutaminase (tTG) autoantibodies; may have antigliadin antibodies as well
There are four different types of CD:
- Classic – characterized by digestive symptoms (diarrhea, weight loss, etc.)
- Atypical – characterized by extraintestinal symptoms
- Silent – no outward symptoms, but histological and serological abnormalities
- Latent – serological abnormalities but no villous atrophy
How does it work?
The Immune Response
Gliadin is resistant to human digestive enzymes, and can cross through the intestinal mucosa without being digested. This can happen in two ways: transportation in between the enterocytes, leading to increased intestinal permeability, or endocytosis (transportation into the enterocytes themselves). Tissue Transglutaminase (tTG) is an enzyme that we produce that is activated by the presence of gliadin in the intestinal lumen. Once activated, tTG deamidates the gliadin fragments to form a complex that acts as an antigen as constantly stimulates an innate immune response. Cytokines are produced by the enteric immune cells, facilitating an inflammatory response which is chronically stimulated with further gluten ingestion. This chronic response leads to villous atrophy, that is, physical damage to the intestinal villi. The patient may also display an adaptive immune response, and produce antigliadin antibodies, although this is not necessary for a celiac diagnosis.
The Autoimmune Response
Autoimmune (AI) disorders occur when the body creates an immune response against its own cells. In the case of celiac, the innate immune response triggers an adaptive immune response to tTG (remember this is an enzyme that we produce). The tTG autoantibodies that are produced as a result are another hallmark of CD and are thought to contribute to the extraintestinal symptoms associated with the disease.
I tried to spare you the bulk of the technical details, but that’s a basic overview of Celiac Disease. With the growing knowledge of gluten and nutrition-related disorders that is hitting society, this month is extra important for education on CD so that we can all be more aware of how to deal with it and make improvements for the future.
Stay tuned for more Celiac Awareness Posts in the future, AND an extra special giveaway coming up next week!
- Ash, Sarah. “NTR 419: Human Nutrition and Chronic Disease.” NC State University. Spring 2015.
- Ballantyne, Sarah. The Paleo Approach: Reverse Autoimmune Disease and Heal Your Body. Las Vegas, NV: Victory Belt Publishing Inc., 2013.
- National Foundation for Celiac Awareness, “Celiac Disease.” Last modified April 7, 2014. Accessed April 7, 2014. http://www.celiaccentral.org/Celiac-Disease/21/.
- National Foundation for Celiac Awareness, “Celiac Disease Facts and Figures.” Last modified April 7, 2014. Accessed April 7, 2014. http://www.celiaccentral.org/celiac-disease/facts-and-figures/.
- National Foundation for Celiac Awareness, “Celiac Symptoms.” Last modified April 7, 2014. Accessed April 7, 2014. http://www.celiaccentral.org/Celiac-Disease/Celiac-Symptoms/32/.