The first thing I have to do is to apologize to the celiac patients I saw some time ago, because at this moment my vision of the problem is different; and I hasten to apologize also to those I am now treating, because soon I will have a very different discourse. Celiac disease has become the “star” of inflammatory diseases, not only digestive, and it is putting us physicians to the test.
Some classic ideas that have been established about this famous disease and about which everyone has an opinion are not really so taxing in my opinion today. They say that celiac disease is not an allergy to a component of cereals, but a more complex immune-based inflammatory process and in that I agree; but nevertheless there are many celiac patients who develop allergies to other foods, including cereals with gluten, by the very alteration of intestinal permeability existing in these patients. Let us say that there are celiacs and celiacs who are also allergic to gluten. By controlling celiac disease these allergies are recovered in most cases and sometimes not, so that the patient already treated, when taking gluten develops pictures similar to an allergic reaction with abdominal pain and skin rash.
Celiac disease is much more complex than an intolerance.
We agree that celiac disease is a specific disease in itself but with multiple variants. Let us say that being celiac requires several coinciding circumstances, one of them is to recognize gluten as a foreign element with the capacity to generate inflammation; but there are other factors, such as not having the capacity to digest or adequately eliminate gluten from the diet; having an immunological capacity capable of generating a high inflammatory reaction when the lymphocytes contact this protein; or enjoying a good depurative or anti-inflammatory capacity that compensates for this situation.
It follows from the above that another of the admitted paradigms, namely: in celiac disease there are no degrees, is not exactly so. There is no middle ground in the risk of being celiac or not. This risk is a pure coincidence that we will only be able to ascertain by sequencing our DNA, because even the available genetic studies leave out, I estimate, up to 10% of undiagnosed cases. If there are degrees, there are degrees in terms of the inflammatory intensity of the problem and its location, but this can only be seen by highly specialized professionals.
Is there a cure for celiac disease?
The general feeling is that no one can be cured of celiac disease, that once it appears, it is forever, but although the risk of getting sick is genetic, correcting other factors makes the inflammation can be controlled. Therefore, if faced with a diagnosis of gluten-mediated disease, the idea that it has to be eliminated forever and that no one should skip the diet because of the risk of having symptoms or developing complications, has to be questioned and other variants of treatment that allow us to enjoy these products have to be analyzed. As we doctors have tools that allow us to see the evolution of the disease, we are learning to manage the problem and this axiom is not definitive.
Another accepted idea is that once the celiac patient stops gluten, he/she does not have to lose weight, and that when the intestine heals, the normal thing is that he/she regains weight. As almost everything in medicine, the concept is relative, and the opposite could be said. There are celiac sufferers who lose weight because their belly was swollen and full of intestinal contents due to the slowing of the digestive transit that they usually suffer. As the volume of the belly improves, the weight is reduced. Some patients also lose weight because gluten affected some hormonal function and generated metabolic changes.
Over time it has become increasingly clear that gluten is only part of the puzzle that explains the disease.