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Celiac disease (also known as Herter's illness, nontropical sprue, celiac sprue) is a chronic illness of the small intestine that is characterized by poor absorption and it is caused by an intolerance to gluten, the use of which is absolutely forbidden to those suffering from this disease.
Foods containing gluten cause an auto-immune reaction which damages the mucous membrane of small intestine, leading to the atrophy of the intestinal villi and hindering the absorption of nutritious substances.
This type of illness affects more women than men; it can appear at any age, but is more frequently seen among infants and women around 35 years old after their first or second pregnancy.
Among children, gluten intolerance causes mostly intestinal disturbances: diarrhoea, vomiting, lack of appetite, abdominal swelling. Poor absorption can lead to a lack of important elements such as iron and vitamins.
In adults, this illness can manifest itself in less typical symptoms such as asthenia or in symptoms apparently extra-intestinal such as osteoporosis or anaemia.
The trigger for gluten intolerance requires both exogenous (gluten) and endogenous (genetic control) elements.
Gluten is toxic only in predisposed individuals. Present in many cereals, including wheat, it comprises a family of vegetable proteins, (prolamin), found in wheat (gliadin), barley (ordeine), and rye (secaline).
Prolamin toxicity in oats (avenin) has not been definitively proven.
Rice and corn, naturally containing no gluten, are used in diets for patient suffering from celiac disease.
The genetic control of this illness, whose clinical symptoms can be very variable, is indicated by the fact that eight to ten percent of family members of a person who suffers from celiac illness are affected by the disease.
Various tests can be used for diagnosis:
Blood tests which determine the presence of antitransglutamine (anti-tTG) antibodies
Research of Endomysial (EMA) antibodies, class G.
Culture of intestinal mucous membrane, done by taking a fragment of the intestine, which is then placed for 48 hours alone in a soil culture and in a soil culture with gluten, or gliadin to determine the existence of Endomysial antibodies.
A gluten-free diet is the only therapy currently available.
Gluten is not present in the following cereals and vegetables:
Legumes Rice Chickpeas Corn Potatoes Chestnuts Soy Millet Tapioca
Also allowed:
Rice flour, rice cream and rice starch Potato starch Corn flower, polenta, cornstarch, popcorn Chestnut flour Millet flour Soy flour Tapioca flour Flour of chickpeas and other legumes Flakes of rice, maize, soy, and tapioca without adding malt
In nature, gluten is found only in certain cereals:
Wheat Barley Rye Spelt (old type of wheat, it was very popular in ancient Rome) Sorghum Kamut (old Egyptian name for wheat) Triticale
The following foods are not allowed because they contain one or more of the above ingredients:
Flour, starch, semolina, the above cereal flakes Common and specialty breads, breadcrumbs, white bread Pasta, all types of stuffed pasta Breadsticks, crackers, melba toast, focaccia, pizza Biscuits, cakes, sweets Bran Potato gnocchi Barley malt Malt corn flakes Meuslix Cereal mixes
Oats and Saracen wheat (buckwheat)
Oat is a cereal while Saracen wheat is from legumes; both are inherently gluten-free. In the past, oat was considered toxic for celiac patients, but recent studies have shown that daily and extended consumption of high quantities of this cereal do not cause any damage to a celiac patient's intestinal mucous membrane nor the appearance of other symptoms. It must be noted however, that the major part of the oat-based products on the market at the moment are contaminated by gluten during processing, as also often happens for Saracen wheat.
Gluten is hidden in many manufactured foods, making it indispensable for people with intolerance to know the exact ingredient composition, now possible thanks to labeling which assures safety. Current law states that each ingredient must be listed on the label when its weight is at least 25% of the total weight of the product: this regulation therefore does not give any guarantees.
In July of 1999, The World Food Board CODEX adopted a document which recommends that all foods that can cause hypersensitivity must be listed on the label, including all cereal containing gluten: wheat, oats, rye, spelt, and their derivatives.
The CODEX directive has not yet been adopted by the Italian parliament. The Italian government has, instead, acknowledged the European directive pertinent to wheat starch which requires the listing of the plant origin of starch on labels when it is possible that it contains gluten. The plant origin must also be reported for modified starch when it can contain gluten.
To provide another tool for those who must follow a gluten-free diet, celiac patients and subjects suffering from dermatitis herpetiformis, and want to avoid traces of gluten potentially found in some food categories, the AIC ( www.celiachia.it) has written a "Handbook of Gluten-Free Products on the Market".
The handbook is a list of food products sold in Italy (in shops, supermarkets, discount stores, etc.) that belong to categories normally at-risk or forbidden for a celiac patient, which manufacturers have declared free of gluten, considering not only ingredients but also possible contamination during production.
Gluten-free products distributed by pharmacies, prescribed by a doctor, and given out freely by the Italian Health Department, are listed in the "Gluten-Free Product List", published and updated by Celiachia News and on the internet at the above address.
At our Pharmacy you will find qualified staff available to provide dietetic advice relevant to celiac illness; for more personal information and advice please do not hesitate to visit or contact us.