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Understanding Celiac Disease and What It Does to the Body

Posted Apr 24 2009 7:22am

Celiac disease is an autoimmune disease (a disease in which the immune system attacks the body) that gets activated when someone eats gluten.

Some people think that because celiac disease is an autoimmune disease, someone with celiac disease has a compromised immune system. Not at all! In fact, the opposite is true — the immune system in people with celiac disease is working overtime to fight what it perceives to be bad guys — like gluten.

How your guts are supposed to work

You got guts, but do you know how they work? Skip to the upper part of the small intestine. The food has already been chewed, swallowed, passed through the stomach, and broken down by enzymes into nutrients that the body can use to nourish itself.

The small intestine is lined with hairlike projections called villi. The purpose of the villi is to increase the surface area of the intestine so they have more room to absorb important nutrients.

The lining of the small intestine is basically a solid wall. All the cells on the lining are joined together by tight junctions. When the body is ready to absorb the nutrients, these tight junctions open the space between cells and let the good stuff in — but keep the bigger bad stuff, like toxins, out.

How do the tight junctions know how far to open? They have a comrade-in-arms named zonulin. Zonulin is a protein — its job is to be a gatekeeper, opening the tight junctions just enough to let the good stuff in but keep the bad stuff out.

How your guts work with celiac disease

When someone with celiac disease eats gluten, everything's going along just fine until the gluten reaches the small intestine.

The first thing that goes wrong at this point is that wheat causes the body — in all humans, not just celiacs — to produce too much of the protein zonulin. This excess of zonulin causes the junctions between cells in the small intestine to open too much, and next thing you know, there's a party in the bloodstream and all sorts of things can get into the bloodstream that shouldn't be there — things like toxins and gluten fragments.

When stuff leaks through the intestinal wall that normally shouldn't be able to, the condition's called leaky gut syndrome.

So now, thanks to the excess of zonulin that was released because you ate gluten, the gluten fragment has made its way into the bloodstream. In people with celiac disease, the body sees gluten fragments an invaders — toxins that shouldn't be there. So it launches an all-out attack against these invaders, but — and here's why celiac disease is called an autoimmune response — the body also attacks itself.

An autoimmune disease is one in which the body's immune system produces antibodies that react against normal, healthy tissue (rather than against bacteria or viruses), causing inflammation and damage. Celiac disease is unique, because it's the only autoimmune disease for which people know the trigger that sets off the response. A survey from the American Autoimmune Related Diseases Association found that 45 percent of people eventually diagnosed with an autoimmune disease were initially labeled as hypochondriacs because doctors thought they were imagining their symptoms.

Specifically, the body attacks the villi on the lining of the small intestine. As the villi get chopped down — blunted is the technical term — they can no longer be as effective in absorbing nutrients. That's why you see malabsorption (poor nutrient absorption) and nutritional deficiencies in people with celiac disease who still eat gluten.

Because the food is just passing through without being absorbed the way it's supposed to be, you sometimes see diarrhea. But think about this: The small intestine is nearly 22 feet long, and damage from celiac disease starts at the upper part — so there's lots of small intestine to compensate for the damaged part that's not able to do its job. That means by the time you have diarrhea, you're usually a very sick puppy.

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