Dr. Dawn Adams, Director of the Celiac Disease Clinic and Assistant Professor in the Department of Gastroenterology, discusses celiac disease, its signs and symptoms, and lifestyle modifications to manage the disease.
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Tanicia Haynes: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Tanicia Haynes with Occupational Health. For this edition of the Vanderbilt Health and Wellness Wellcast, we will be speaking with Dr. Dawn Adams, Director of the Vanderbilt University Medical Center Celiac Clinic and Assistant Professor of Medicine in the Department of Gastroenterology. Thank you for speaking with us.
Dr. Dawn Adams: Thank you for inviting me.
Tanicia Haynes: For our listeners out there, could you tell us what celiac disease is?
Dr. Dawn Adams: Celiac disease is an immune response that the body has to gluten, which is a specific component that is specifically found in wheat. So, when patients with celiac disease eat this particular component, gluten, they have an inflammatory autoimmune response in their small intestine that leads to intestinal damage.
Tanicia Haynes: What are some signs and symptoms that someone could watch out for that may prompt them to go be evaluated by a provider?
Dr. Dawn Adams: This is an interesting question because the signs and symptoms we think of with celiac disease has really evolved over the last couple of decades. Initially, celiac disease was always described as a very malnourished, losing weight-type of patient with severe diarrhea and anemia and various vitamins and mineral deficiencies. That is described as the classic presentation of celiac disease. Nowadays, we are seeing a lot more patients with what are called atypical symptoms of celiac disease. These patients are presenting with symptoms such as constipation, bloating, fatigue, joint pains, a specific type of rash that they might develop, and still might have some of those vitamin and mineral deficiencies as well. So, it is a pretty broad range of symptoms that people can have with celiac disease. It does take a very thoughtful person or a physician to kind of look into celiac disease and the possible source of these types of symptoms.
Tanicia Haynes: If someone were to be diagnosed with celiac disease, what are treatment options, or are there lifestyle modifications that need to happen?
Dr. Dawn Adams: So, the diagnosis of celiac disease, once it is made, and I do encourage that if someone thinks they have celiac disease, to definitely make sure they actually have it before doing these things, because some of these lifestyle changes can make the diagnosis quite difficult later down the road … but once the diagnosis is made, the typical recommendation is to start with a gluten-free diet, so, basically, remove that component, gluten, that causes that reaction that damages the intestine. Most patients that are on a gluten-free diet will achieve complete remission, which is basically their intestine goes back to normal. This can take a couple of years for that to happen, but 90% plus of patients that do the gluten-free diet should have this happen to them. There are currently no medications approved for celiac disease at this time; however, there are several medications that are in clinical trials that will hopefully be coming out in the next few years that might help patients with either celiac disease that is not responding to a gluten-free diet, or help patients when they are trying to dine out, or have different types of lifestyle issues that are making it very difficult for the gluten-free diet to be done correctly. So, we are looking forward to those medications coming out, but right now, the only treatment for celiac disease is dietary changes.
Tanicia Haynes: You mentioned the gluten-free diet, which I think a lot of us have heard about recently. Do people that have decided to go gluten-free, and they see that they have seen differences maybe in their health, does that mean that they have celiac disease?
Dr. Dawn Adams: Not necessarily, and that is kind of what I was eluding to with the previous question and response, is that if you think you might have celiac disease, it is really important to get tested before making these various changes. The gluten-free diet is quite a trendy diet right now. Many people are going gluten-free for various reasons. I would just like to state that it is not a weight-loss diet. It is actually a very difficult diet to do, to be 100% gluten-free. I think the reason many people feel better on it is because a lot of what we eat is about balance, and the average American western diet has a lot of wheat in it due to just that we like carbohydrates, we like bread, we like pasta. That’s what we like to eat. We like cookies. All those things have wheat in it … pizza. But in addition to that, you are eating those things, and also, the food industry has added wheat to a lot of products because wheat, or gluten, actually, means “glue,” so it helps to thicken food. The food industry loves gluten because it is a thickener. For those reasons, the average American gets a lot of gluten. It might just be just minimizing would help symptoms as opposed to totally excluding it. Also, when you are going gluten-free, you are losing some important B vitamins and some minerals as well as fiber. Whole grains have a lot of those types of micro/macronutrients that we need, and so when we go gluten-free, we are losing those. The gluten-free diet actually is deficient in some of these things, and so if you are going to go gluten-free, you probably would want to meet with a dietician to discuss ways to not be deficient in those. I don’t think just because you feel better on the gluten-free diet that you have celiac. It might just be honestly that you are eating healthier. Things that don’t have gluten in it are fruits and vegetables, and those types of things are just naturally healthier for your body, and I think it is why people do feel a lot better with those types of foods. But if you went gluten-free, and you are really wondering if this is something you need to do for life, again, bring that up with your physician to be tested for celiac disease.
Tanicia Haynes: Well, thank you so much, Dr. Adams, for speaking with us. We really have learned a lot about celiac disease that we weren’t aware of before.
Dr. Dawn Adams. Thank you.
Tanicia Haynes: Thanks for listening. Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page. If you have a story suggestion, please email it to us at health.wellness@vanderbilt.edu, or you can use the “Contact Us” page on our website at healthandwellness.vanderbilt.edu.
