Villi are a component of the small intestine that is involved in the efficient absorption of food. Villi slow the passage of food, so nutrients can be properly absorbed into the blood. The stomach liquefies and partially digests many foods, supplements, and medicine, and then food is passed on to the small intestine. Most digestion occurs in the small intestine; and absorption of nutrients occurs there as well, and is then passed to the bloodstream (blood circulates and carries nutrients throughout the body).
Villi act to increase the surface area of the small intestine, increasing absorption. The body has a natural action to maintain a balance of nutrients (through diffusion) between the blood stream and the small intestine. The villi can also hold pieces of food for more thorough digestion that are too large to be passed into the bloodstream.
Celiac Disease is an inflammatory, auto-immune condition of the small intestine that renders the villi unable to absorb nutrients to some degree. Celiac results in the production of antibodies from the ingestion of gluten. The immune system reaction to the inciting antigen, gluten, damages the villi (often resulting in villous atrophy), and is known as celiac. Nutrients that do not become absorbed will be eliminated through stool. Malabsorption leads to malnutrition.
The picture above shows normal villi on the left, and on the right are the villi from someone with Celiac. The villi virtually flatten off and disappear, causing low absorption of nutrients.
How do you know if you have celiac? If you have celiac, you may be eating a healthy, balanced diet, but not reaping the benefits. You can be tested for celiac, (see a gastroenterologist) but testing is not totally accurate. Prior to getting tested, you should not change your diet or eliminate any foods you typically eat, because your test will be even less accurate. You will likely experience stomach pain and diarrhea. It may feel like irritable bowel disease or an ulcer or Crohn’s disease. You may also experience: depression, cramps, joint pain, fatigue, tingling, etc. Celiac often leads to lactose intolerance. Plus, celiac tends to run in families, so this may also be a consideration. “Because vital nutrients are lost in the stool rather than absorbed in the bloodstream, malabsorption can cause a deficiency in vitamins and minerals, vitamin D, folate and iron, resulting in anemia and weight loss. Malnutrition can cause stunted growth and delayed development in children” (mayoclinic.com).
What tests are used to diagnose celiac? Antibody blood tests. Biopsy of small intestine to check villi damage. This is simple and done through an upper GI process. Possibly a capsule endoscopy (pill camera that later gets flushed down the toilet upon elimination).
Risk factors: Celiac tends to be more common in people with type I diabetes, Hashimoto’s thyroiditis, Down’s syndrome, and microscopic colitis.
What not to eat with celiac: To help manage celiac it is important to avoid: barley, bulgur, durum, farina, graham flour, rye, semolina, spelt, triticale, and wheat. (never heard of most of this stuff). Plus you should avoid: beer, most breads, cakes and pies, many candies and cereals, cookies, crackers, croutons, gravy, imitation meat or seafood, oats, pastas, lunch meat, many salad dressings, many sauces, and many soups. Once you quit eating these gluten products you are likely to begin recovery, however, it can take from a few days to a few years, or you may not recover in some cases.
Celiac affects 1 in 133 individuals in the US. It can be difficult to test for since labs are only positive when villous atrophy is present, not just the presence of antibodies or an intestinal biopsy. This difficulty in diagnosis can translate into years of symptoms, non-treatment, and nutritional consequences that may be irreversible; and may even lead to: hypothyroidism, diabetes, pancreatic insufficiency, osteoporosis, osteoporosis, infertility, neurologic and psychiatric disorders, spina bifida, GI cancers, seizures, peripheral neuropathy, cognition issues, and many other issues. It takes early diagnosis to prevent serious issues later.
This suggests that the only current way to diagnose celiac is to find damaged tissue. This leaves room for a whole lot of illness in between the development of symptoms, and a diagnosis of celiac. The end result is that your physician finally finds structural tissue damage to the villi, and you are well into nutritional problems and immune system problems.
Interestingly, celiac is one of those diseases that do not always test positive or negative. In fact, only 30% of patients tested who had partial villous atrophy, revealed a positive test. Our early testing is not sufficient for early detection.
Today, it seems that in order for a physician to begin treating a patient for celiac, or to suggest a gluten-free diet, they need to have an advanced stage of gluten sensitivity, such as villous atrophy, which is really too late for effective treatment for many people. Ironically, many with celiac never develop advanced stages resulting in villous atrophy! So what does this mean for this population of patient?
Having villous atrophy can yield a diagnosis of celiac, but having all the other symptoms and villi that have not totally atrophied at time of testing will likely reveal a negative result for celiac-according to your physician. This population may only present with mild inflammatory abnormality-which will likely go on untreated. At this stage, the patient likely has a gluten intolerance or sensitivity that is going to progress and needs to be addressed.
The longer gluten sensitive people continue to eat gluten, unknowingly, the higher the likelihood of developing a more serious autoimmune disease eventually.
So what now? Well, if you suspect that you may have celiac, or gluten intolerance, get checked out first, and if so, try a gluten free diet for a few months to see if your symptoms let up.
While you’re getting tested consider this: if you are not at end stage celiac disease and are anything short of the extreme stage of it (early or latent celiac sprue), you may test normally in blood work. However, the measurable, antibodies are found inside the intestine only, NOT in the blood, so your labs may look normal.
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