| Extraintestinal Celiac Disease Symptoms: | |||
|---|---|---|---|
| bone demineralization | osteoporosis | joint pains | |
| weight gain | weight loss | elevated liver function tests | |
| enamel defects | apthous stomatitis | lower birth weights | |
| poor childhood weight gain | hypocalcemia | fatigue | |
| weakness | dry skin | blistering rash | |
| eczema | iron deficiency anemia | infertility | |
| microscopic colitis | pancreatic exocrine dysfunction | depression | |
| neuropathy or numbness of the extremities | cerebellar ataxia | epilepsy | |
| cognitive dysfunction | headaches | tongue soreness | |
| tongue burning | tongue redness | tongue atrophy |
The Difference Between Celiac Disease and Gluten Sensitivity in Children
According to Ludvigsson JF, et al (2) classic celiac disease or celiac sprue is characterized specifically as symptoms of malabsorption, failure of growth, diarrhea, poor fat absorption and/or weight loss. The authors recommended that gluten sensitivity be renamed as non-celiac gluten sensitivity. Those with non-celiac gluten sensitivity may have many similar but more mild symptoms than celiac disease. These individuals have an immune response to gluten, but do not have the elevation in transglutaminase (TTG) antibodies or the pathologic changes of celiac disease present within the bowel walls on a biopsy. There is no current standard diagnostic test for non-celiac gluten sensitivity, nor is there a method available to measure a immune response.
Gluten and Tooth Enamel Defects
Dentists have an important role in identifying patients with celiac disease. Enamel defects may be the only sign of celiac disease and are found in about 85% of patients with celiac disease at the time of diagnosis (13). Children without signs or symptoms of celiac disease should be screened for celiac disease if hypocalcemia and poor weight gain is present (14).
Gluten and Recurrent Apthous Stomatitis:
It is common for celiac disease symptoms in children to include development of ulcers in the mucosal lining of the mouth. These may occur at much higher rates in those who have celiac disease. A high rate of patients with recurrent apthous stomatitis and celiac disease respond well to treatment with a gluten-free diet. Patients with recurrent apthous stomatitis were found to have a higher rate of gluten sensitive bowel disease than the general population which supports screening these patients for celiac disease (15).
Gluten Worsens Depression in Children and Adults
Depression may affect children and young adults as well as older adults. Simsek S, et al found that children with celiac disease who maintained a gluten free diet had less symptoms of depression. (18). A study showed that adult patients who self-reported non-celiac gluten sensitivity were given a short term challenge with 16 grams of gluten, 16 grams of whey protein, or placebo daily for 3 days. The subjects were tested for signs of depression with the Spielberger State Trait Personality Inventory (STPI) and found that gluten induced more feelings of depression compared to whey or placebo (16). Celiac disease patients with a better adherence to a gluten-free diet over the long term had a lower risk of developing symptoms of depression. About a third of patients develop symptoms of depression over their lifetime despite adherence to a gluten-free diet (17).
Autism and a Gluten-Free Diet
Diets free of gluten have some evidence of benefit in autism. In as little as 2 weeks, autistic children changed to a gluten-free diet have shown improvements in social isolation, eye contact, speech, learning skills, hyperactivity, stereotypical activity, panic attacks, self-mutilation, total autistic trait score (measured by the Diagnosis of Psychotic Behavior in Children [DIPAB]), nonverbal communication, stereotypy, social interactions, normalizing of behavior, language skills after 1 year, language skills after 4 years, social interaction, play based creativity, motor abilities, decrease in urine peptide levels (UPL), decrease in urinary metal concentrations, and behavioral improvements (6). A Cochrane Database Systematic Review described research showing a reduction of autistic traits, but a benefit in cognitive skills, linguistic ability and motor ability was not seen (8). Additional research showed that only parents saw some improvement of symptoms by their children on this diet. (7)
Schizophrenia and Gluten
Some schizophrenia patients have improvement of symptoms on a gluten-free diet. Cascella, NG et al found that testing for a specific type of transglutaminase autoantibody may be useful to identify patients who might respond (10).
Diagnosis of Gluten Disease and Gluten Related Disorders
Proper diagnosis of children with celiac disease symptoms may be complicated and is best accomplished by the primary care physician and gastroenterologist. Celiac disease should not be self-diagnosed by patients since the condition has non-specific symptoms which require to be distinguished from other gastrointestinal conditions. If a patient is believed to have symptoms of celiac disease, testing is done by antibody testing and a small bowel biopsy. These tests should ideally be done while on a diet containing gluten.
The Gluten Free Diet for Celiac Disease Symptoms in Children
Even small amounts over 1 gram of residual gluten in the diet are known to contribute to the celiac disease process (inflammation due to gluten). Gluten sensitive individuals are able to tolerate up to 5 grams of gluten without symptoms of sensitivity. The general guideline is that anything containing wheat contains gluten. Dietary counseling is based on support of the patient in the major lifestyle change of a gluten-free diet for life best accomplished by a qualified dietitian. Education is necessary to avoid all foods containing wheat, rye, barley, and oats. Avoid these gluten containing foods.
Gluten Containing Foods
Gluten containing foods should be substituted with the following gluten free foods (Yes, these foods are OK to eat):
- Grains including rice, corn, quinoa, soy, and buckwheat
- Acceptable flours include tapioca, rice, potato, corn, and coconut
- Meats without coatings or additives which include beef, bacon, pork, chicken, and turkey.
- Fish and shellfish without coatings or additives.
- Fresh or frozen fruit without additives.
- Nuts and seeds
- Vegetables, beans, herbs, spices, and coconut.
- Gluten free pasta is available containing rice, quinoa, and corn
- Pay special attention to labels for retail and processed foods and avoid those with labels which include gluten, wheat protein, and vital wheat protein as ingredients.
- Oat consumption is controversial, with research showing that oats may provoke gluten related disorder, while other research has supported oats as generally safe to consume
