Your Health by Dr. Rallie McAllister

Scientists have long known that people with celiac disease have a higher than average risk for developing osteoporosis, but until recently the link between the two conditions was poorly understood.

Celiac disease is caused by an immune system reaction to gluten, a natural protein found in grains such as wheat, barley and rye.

When individuals with the disorder eat gluten-containing foods, their immune systems rebel, launching an attack against tiny intestinal structures called villi. These fingerlike projections serve to dramatically increase the surface area of the lining of the small intestine and facilitate the absorption of nutrients from food.

After repeated assaults from gluten in the diet, the intestinal villi of affected individuals can become so damaged that they're incapable of absorbing nutrients properly. As a result, people with untreated celiac disease can become dangerously malnourished.

While scientists once believed that celiac disease led to bone mineral loss and an increased risk of osteoporosis by impairing the absorption of bone-building nutrients, including calcium and vitamin D, the results of a new study published in the New England Journal of Medicine suggest this isn't the case. Scientists at the University of Edinburgh found that people with celiac disease are more likely to develop osteoporosis because their immune systems attack and damage their bone tissue directly.

Once considered to be rare, celiac disease is now known to affect approximately one in 100 Americans. The condition is becoming increasingly prevalent in the U.S., according to the findings of a Mayo Clinic study published last month in the medical journal Gastroenterology.

For the study, the researchers evaluated recently collected blood samples as well as samples that had been collected between 1948 and 1954. After testing the blood samples for the presence of a protein produced by individuals with celiac disease, the Mayo team determined that young people today are 4.5 times more likely to have celiac disease than youngsters in the 1950s. More research is needed to understand the reasons for this finding.

Although it is becoming increasingly commonplace, celiac disease poses a considerable diagnostic challenge for physicians. Symptoms of the disorder are highly variable and can be mistaken for other disorders of the gut, including irritable bowel syndrome, ulcerative colitis and intestinal infections.

Common digestive complaints associated with celiac disease include abdominal pain, cramping and bloating, and a perplexing mix of diarrhea, flatulence and constipation.

Celiac disease is a known cause of seizure disorders, migraine headaches, infertility and miscarriage.

Symptoms may arise at any stage of life, from infancy to adulthood. Babies and children with the disorder may suffer from chronic abdominal pain and developmental delays, and affected teenagers may experience delayed puberty and remain short in stature.

In some youngsters, symptoms may be so vague or poorly understood that they often go unrecognized until adulthood. Emotional stress, surgery, pregnancy or illness may trigger the first noticeable symptoms of the disease.

Once the condition is suspected, doctors can perform tests that lead to the correct diagnosis. Although new and effective blood tests for celiac disease have been developed in recent years, biopsy and microscopic examination of the intestinal tissue may be needed to confirm the diagnosis.

Currently, the best treatment for celiac disease is following a gluten-free diet, which can be challenging at best. Obvious sources of gluten include most breads, pastas and cereals, which are often considered staples of the American diet.

Although it may not show up on the manufacturer's list of ingredients, gluten can be found in a variety of seemingly innocent foods, including canned soup, ice cream and processed meat. Hidden sources of the troublesome protein include additives, preservatives and stabilizers used in products ranging from mouthwash to prescription medication.

Living a gluten-free life isn't easy, but it is important in terms of alleviating gastrointestinal discomfort and reducing the risk of bone fractures and osteoporosis. In children with celiac disease, a gluten-free diet promotes a rapid increase in bone mineral density that can lead to complete recovery of bone mineralization within six to 12 months.

In adults with the condition, following a gluten-free diet typically isn't sufficient to repair extensive bone damage, but it does help. Recent research suggests that eliminating dietary gluten for a period of one year can significantly improve bone mineral density in most adults.

If you suspect that you have celiac disease, it's important to discuss your concerns with your doctor. Early diagnosis and proper treatment can have a dramatic impact on your health and happiness both now and in the future.

Rallie McAllister, M.D. is a family physician, author, speaker, and founder of www.MommyMDGuides.com, a website featuring child-raising tips from trusted doctors who are also moms. To find out more about Rallie McAllister, M.D., and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Webpage at www.creators.com.

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