Celiac disease is an autoimmune disorder that effects one percent of the U.S. population. Celiac disease only occurs in persons with the HLA DQ2 or HLA DQ8 gene. About 20% of the U.S. population carries one of these genes, and simply having the gene does not mean that you will have celiac disease. What causes celiac disease in people with this gene is unclear, some say it can be brought on by stress, a virus or environmental toxin, or even over-use of antibiotics. Basically, anything that puts undue stress on the immune system is a risk factor. If a person’s immune system is thrown off balance and they develop celiac disease, they become unable to digest gluten, a protein found in the endosperm of wheat barley and rye.

 Fig. 1. Gluten proteins shown in the endosperm of a wheat grain.  When a person with celiac disease eats gluten, the gluten travels from the stomach into the small intestine, where it is should be absorbed into the bloodstream as a nutrient. But with celiac disease, the immune system does not recognize the protein as a food, and sends out cells to attack and destroy this protein. While attacking this protein, the immune system inadvertently destroys the villi of the small intestine as well. Villi are small fingerlike protrusions that pull nutrients out of food particles and into the bloodstream. Without these villi, a person with celiac disease cannot absorb nutrition from their food.  This is what the difference between healthy and celiac damaged looks like. 

Fig. 2. Diagram showing the difference between healthy small intestine villi (left)and celiac damaged villi (right).  This damage creates a variety of symptoms. These symptoms have a wide range from intestinal issues such as cramping, discomfort, constipation and diarrhea to symptoms stemming from nutrient loss such as weight loss, anemia, osteoporosis, miscarriage, infertility and intestinal cancer. Many patients also present with a harsh rash, known as dermatitis herpretiformis, which will disappear upon treatment. 

  Fig. 3. Common symptoms of celiac disease, ranging from constipation to anemia and neurological disorders.  In order to stop this disease process, persons with celiac disease must eliminate gluten from their diet. This may sound like a simple fix, and it is, but gluten is a staple of our modern diet and eliminating it completely presents unique challenges to celiac patients. Those on a gluten free diet must eliminate wheat, barley rye, in all of their forms, many of which are often unseen. For instance, gravy may be assumed to be gluten free by many people, but in fact, nearly all gravies are made with wheat flour. The same goes for Twizzlers candy. This a product that would not seem to have any kind of grain component, and yet it is made with wheat flour and is toxic to people with celiac disease. Because gluten is so often a hidden ingredient in many foods, celiac patients must become expert and vigilant readers of nutritional labels, and also be unafraid to ask questions of chefs and servers when dining out.  Some celiac use dining cards to help chefs understand their dietary needs. These cards explain what is safe and unsafe for celiacs to eat. 

 Fig. 4. Ingredient list for Hershey's Twizzlers candy, showing the ingredient of wheat flour. This makes Twizzlers unsafe for consumption by celiacs.  

 Fig. 5. Example of a dining card, used by celiacs to explain their needs to chefs and servers when dining out. Possible issues include soy sauce and broth. Despite these issues, awareness and offerings of gluten free foods have become ever more common due to people giving up gluten for reasons unrelated to celiac disease, such as non-celiac gluten sensitivity and increased awareness of the harmful effects of consuming modern wheat. Marketing experts expect the demand for gluten free foods to grow steadily for at least another ten years, after having seen 30% growth in the last five years alone (Case). 

 Fig. 6. Projected sales growth of U.S. gluten free foods. Shown in the millions.  Often, when discussing celiac disease, or the gluten free diet, the human element of those suffering undiagnosed with celiac disease is left out. In light of this, I have provided some before and after pictures of people

diagnosed with celiac and treated with the gluten free diet. This shows that this is a serious disease, and also the remarkable success and health benefits that those with celiac disease can achieve with proper diagnosis and dietary treatment.  

 Fig. 7. (Left) Man emaciated from advanced celiac disease. (Right) Same man after treatment for celiac disease with gluten free diet.  For instance, the picture above shows a man with prolonged celiac disease. In the left picture, you can see how emaciated and stricken his body is. Look at how the bones in his legs, arms and ribs are nearly poking out of his skin. This man in clearly very ill. But then, look at the right picture. The change is clear and pronounced. His body looks full and robust. Gone is the pallor of illness, replaced by the pink color of blood flow and nutrition and muscle tone is greatly improved. This is what the gluten free diet can do for a person with celiac disease.  

 Fig. 8. Three year old Anthony, shown left before celiac diagnosis. Right, now healthy after three months on a gluten free diet.  The young boy shown in the picture above is Anthony. His mother shared his story with Debbie Simpson, a celiac disease author on her blog,www.dsimpsonbooks.com. Anthony suffered for the first three years of his life, vomiting constantly, suffering multiple bouts of pneumonia, and obvious malnourishment. He was finally diagnosed with celiac disease through an intestinal biopsy.  He is now on the gluten free diet and has made a full recovery.  However, celiac disease can present itself in many ways, not always in the malnourished sickly presentation of the last two cases. 

Fig. 9. Jacqui, shown left suffering from undiagnosed celiac disease, and then shown right after ten months of a gluten free diet.  This is Jacqui. Jacqui suffered myriad symptoms for over three decades. Her anxiety, depression, excess weight, intestinal issues, and heart palpitations were all symptoms of celiac disease. Since going gluten free, these symptoms have disappeared, and Jacqui has a new lease on life.   I myself have shared a similar path to the people shown in the pictures above. I suffered many symptoms of celiac disease, and I was in extremely poor health when I was diagnosed after over 12 years of searching for an answer. I think that celiac disease is an important issue that more people should be aware of. I hope that my photos have shown both the biological structure of how the disease effects patients, and also the human suffering that this disease inflicts.  

                                               

 Works Cited

Case, Shelley, RD. "The Gluten Free Boom." Grocery Headquarters Magazine. N.p.,  n.d. Web.

11 May 2014.

Fig. 1. N.d. Nutrition Remarks. Web. 12 May 2014.

Figure 2. N.d. American College of Gastroenterology. Web. 12 May 2014.

Figure 3. N.d. Healthy Haven Blog. Web. 12 May 2014.

Figure 4. N.d. Dye Diet. Web. 12 May 2014.

Figure 5. N.d. Thank Heavens The Gluten Free Lifesaver. Web. 12 May 2014.

Figure 6. N.d. Robecosam. Web. 12 May 2014.

Figure 7. N.d. GastroHep. Web. 12 May 2014.

Figure 8. N.d. DSimpson Books. Web.

Figure 9. N.d. DSimpson Books. Web.

Simpson, Debbie. "A Picture Speaks a Thousand Words." Web log post. DSimpson   Books.

N.p., 19 May 2013. Web. 11 May 2014.