1. What is Celiac Disease?
(Pronounced: SEE-lee-ack disease)
Celiac disease (CD), also known as celiac sprue or gluten-sensitive enteropathy, is a genetically
linked autoimmune disorder that can affect both children and adults. In people with CD, eating
certain types of grain-based products set off an immune response that causes damage to the
small intestine. This, in turn, interferes with the small intestine’s ability to absorb nutrients found
in food, leading to malnutrition and a variety of other complications. The offending amino acid
sequences are collectively called “gluten” and are found in wheat, barley, rye, and to a lesser
extent, oats* (WBRO). Related proteins are found in triticale, spelt, kamut. Refer to the grains
and flours glossary for a more extensive classification of grains.
In people with CD, eating certain types of protein fractions, collectively called gluten, set off
an immune mediated response at the site of the epithelial cells. This abnormal, cellular level
immune activity evokes damage to the lining of the small intestine. The damaged small intestine
lining, mucosa and villi, interferes with the ability to absorb the nutrients available in food.
Without adequate nutritients available, malnutrition and a variety of other related complications
become apparent.
Celiac Disease is: an inherited disease. Celiac disease effects those with a genetic
predisposition.
● COMMON. Approximately 1 in 133 people have CD, however, most have yet to be
diagnosed.
● This number is based upon a milestone multi-center study of blood samples collected
from 13,145 people from
● February 1996 to May of 2001. This means that there were over 2.1 million undiagnosed
people with celiac
● disease in the United States in 2001.
● characterized by (IgA mediated) damage to the mucosal lining of the small intestine
known as villous atrophy.
● responsible for the malabsorption of nutrients resulting in malnutrition.
● linked to skin blisters known as dermatitis herpetiformis (DH).
● linked to gluten ataxia.
● not age-dependent. It may become active at any age.
● linked to genetically transmitted histocompatibility cell antigens (HLA DR3-DQ2, DR5/7
DQ2, and DR4-DQ8).
● Other genetic links have been identified.
Celiac Disease is NOT:
● simply a food allergy (IgE).
● an idiosyncratic reaction to food proteins (mediated by IgE).
● typified by a rapid histamine-type reaction (such as bronchospasm, urticaria, etc.).
● an intolerance, a non-immune system response to food.
The Damaging Protein Fractions
The term "gluten" is, in a sense, a generic term for the storage proteins that are found in
grains. In reality, each type of protein - glutenin and gliadin in wheat, secalin in rye, hordein
in barley, avenin in oats, zein in corn and oryzenin in rice - is slightly different from the others.
The "gluten" in wheat, rye, barley, and in a much lower amount, oats, contains particular amino
acid sequences that are harmful to persons with celiac disease. The damaging proteins are
particularly rich in proline and glutamine (especially the amino acid sequences which are in the
following orders: Pro-Ser-Gln-Gln and Gln-Gln-Gln-Pro). As peptides, some such as 33-MER,
cannot be broken down any further. In people with celiac disease, 33-MER stimulates T-cells to
produce antibodies. Sequences containing as few as 7 amino acids can be toxic to those with
celiac disease. The antibodies, in turn, attack the villi in the small intestine, reducing their ability
to absorb nutrients.

2. It is important to note that these sequences are NOT found in the proteins of corn and rice.
The Nature of the Injury
The damage to the small intestine (the jejunum) caused by this disease is very slow to develop
and is insidious. It is:
● almost certainly mediated by the immune system.
● associated with ANTIBODIES to glutenin, gliadin, reticulin and/or endomysial (smooth
muscle) proteins.
● probably not directly caused by the antibodies, though they may be signals for cell-
mediated immunity.
● probably produced by the cellular immune system (T and B cells) - but only when gluten-
type prolamins are present.
● reversible, in most cases, to completely normal bowel function, if the injurious protein is
excluded from the diet.
● normal bowel function, diarrhea, constipation or irritable bowel symptoms may be
present.
How Do You Get Celiac Disease?
Celiac disease cannot be "caught," but rather the potential for CD may be in the body from
birth. Its onset is not confined to a particular age range or gender, although more women are
diagnosed than men. It is not known exactly what activates the disease, however three things
are required for a person to develop CD:
● A genetic disposition: being born with the necessary genes. The Human Leukocyte
Antigen (HLA) genes specifically linked to celiac disease are DR3, DQ2 and DQ8...and
others.
● A trigger: some environmental, emotional or physical event in one’s life. While triggering
factors are not fully understood, possibilities include, but are not limited to adding solids
to a baby’s diet, going through puberty, enduring a surgery or pregnancy, experiencing a
stressful situation, catching a virus, increasing WBRO products in the diet, or developing
a bacterial infection to which the immune system responds inappropriately.
● A diet: containing WBRO, or any of their derivatives.
Summary
Celiac disease is life-long and currently incurable. The only known treatment at this time is strict
adherence to a gluten-free lifestyle, free of WBRO. Oats are not a risk free choice for those with
celiac disease and not reccommended during the first year. There is no way to determine in
advance whether or not a person will be able to tolerate uncontaminated oats. Contact CSA for
assistance and guidance on beginning a gluten-free lifestyle. What is the prevelance of celiac
disease in the United States?
The National Health and Nutrition Examination Survey (NHANES) is a program of studies
designed to assess the health and nutritional status of adults and children in the United States.
The survey is unique in that it combines interviews and physical examinations. Two new
questions added to include celiac disease. MCQ082 - Ever been told you have celiac disease?
MCQ086 - Are you on a gluten-free diet? NHANES Statement.