Celiac Disease and Lactose Intolerance

By Michelle Liu, R.N.

Parents seem to be hearing more and more about two diseases that affect the digestive system-celiac disease and lactose intolerance.

Celiac disease
Celiac disease is an inherited autoimmune disease that affects 1 in 133 Americans. It is likely that many people who have celiac disease do not know that they are affected. Celiac disease damages the small intestine and interferes with the absorption of food from the small intestine when those affected eat specific food antigens (gluten) that are found in wheat, rye, barley and maybe oats. Celiac disease mostly affects people of Northern European descent, but recent studies have shown it to affect Hispanics, Blacks and Asians as well. Many disorders are associated with celiac disease. They include: anemia, lactose intolerance, osteoporosis, fertility issues, and other types of autoimmune disorders.

Symptoms of celiac can vary, which makes diagnosis difficult. Diagnoses have been made in those as young as toddlers and as old as people in their 60s. Gastrointestinal symptoms of celiac disease include abdominal pain, distention, diarrhea (chronic or occasional), lactose intolerance, and unexplained weight loss. Non-gastrointestinal symptoms include bone pain, bruising, fatigue, delayed growth in children, and vitamin and mineral deficits.

When celiac disease is suspected, there are several blood tests which, if positive, can increase suspicion but, at this time, the only way to know conclusively is through a small bowel biopsy. This test sounds worse than it is and can be completed as an outpatient with little or no discomfort. If a person has celiac disease, the villi in the small bowel will be flattened if gluten is ingested.

Treatment for celiac disease means consuming a gluten-free diet for life. Since wheat, rye, barley, and oats are staples in the American diet, this can be a challenge. Unacceptable foods include many types of cereal, canned soup, snack food like chips or trail mix, pudding, and even some frozen fish which have been dusted with flour. Many alcoholic drinks are made with gluten. Gluten can also be found in stamps, envelope adhesive, and medication. Finding food to eat at home may require trips to more than one store and online shopping. Restaurants are even more of a challenge, and patrons may need to speak with the chef about ingredients used in prepared dishes.

If people with celiac disease continue to ingest gluten, they place themselves at a much higher risk of developing gastrointestinal cancer than those in the regular population. The only acceptable treatment is a 100% gluten-free diet.

In the Midwest, there are two university hospitals that do excellent work with this disease—the University of Iowa and the University of Chicago. Also there are celiac support groups available to help the newly diagnosed.

Lactose intolerance
In contrast to celiac disease, lactose intolerance is a relatively common problem. Thirty to 50 million Americans are suspected of dealing with lactose intolerance. It holds no potential health risks, but can be uncomfortable and embarrassing.

Lactose intolerance is the body’s inability to digest the sugar in milk. Lactase is the enzyme produced by the small intestine that breaks down lactose so that the intestines can absorb the sugar. If you are lactose intolerant, symptoms begin between 30 minutes to two hours after ingesting any food containing lactose. Symptoms include abdominal cramping, gas, and diarrhea and are related to the degree of severity of intolerance and the amount of lactose containing food ingested.

Lactose can be found in milk, ice cream, and cheese. As with gluten, it can be a dressing and even in medication. Getting enough calcium in your diet can take a little planning for those with lactose intolerance. Dark greens like broccoli and spinach, salmon, some kinds of tofu and enriched soy milk can make up for the lack of dairy products.

Lactose intolerance is a complication of aging. Our bodies decrease producing lactase, beginning at age two. Up to 75% of African-Americans, Jews, Mexicans, and Native Americans are affected. Ninety percent of Asians are lactose-intolerant.

Most health care providers diagnose and treat lactose intolerance based solely on the symptoms. If foods that are high in lactose are avoided for a few weeks and symptoms subside, it can be useful at this time to test for this problem. If dairy can not be avoided, there are over-the-counter tablets to consume just before a meal containing lactose. Other medications are available to deal with the symptoms if lactose-containing foods have been eaten by mistake.

Michelle Liu, R.N., is a former school nurse and the mother of four children. She has also worked in neurology and neurosurgery at Northwestern. This article was first published in the Spring/Summer 2007 issue of Early Childhood.