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Facts and advice about gluten intolerance and celiac disease in children. Celiac disease is an intestinal disease in which the immune system damages the intestinal mucosa when a person eats gluten. Pediatricians do not usually use the word gluten allergy, but there are similarities between celiac disease and allergic diseases.
Gluten is a protein found in wheat, rye and barley
The gluten protein is found in wheat, rye and barley. It is gluten that forms the threads in dough that cause wheat bread to bubble and rise. This is why gluten-free bread does not have the same airy texture as bread with gluten.
Gluten is not toxic or dangerous in itself. Only people with celiac disease need to avoid gluten. For anyone who does not have celiac disease, there is no reason to eat a gluten-free diet.
Celiac disease destroys the intestinal lining
The small intestine is the part of the gastrointestinal tract that absorbs nutrients from food. Absorption takes place on the surface of the intestinal wall, and in order to get as large a surface as possible for nutrient absorption, the intestine lining is fuzzy, like a real carpet. The fuzz, is called villi. When a child with gluten intolerance eats gluten, the child’s immune system destroys the intestinal lining. After a while, all the intestinal villi are gone. The intestinal mucosa becomes completely flat, and full of white blood cells. When the intestinal villi is eroded, it is called “villous atrophy”.
Without the intestinal villi, people become malnourished
Because the function of the intestinal lining is to increase the intestine’s ability to absorb nutrients, that ability decreases when the intestinal lining disappears. When the intestinal mucosa is full of white blood cells that break down the intestinal lining, the absorption of nutrients in the remaining mucous membrane does not take place very efficiently.
A child with celiac disease who eats gluten will suffer from malnutrition, even if they eat a really nutritious meal. The small intestine is too damaged to be able to absorb nutrients, vitamins and minerals.
Malnutrition results in poor growth and often fatigue, and apathy and depression in older children and adolescents. Iron deficiency is common, leading to anemia, pallor and fatigue. Vitamin D deficiency is also common, which can also lead to fatigue and depression and osteoporosis in the long run, among other things. As well as this, puberty does not always start as normal.
When the intestinal lining is gone, the ability to break down lactose in milk can also temporarily disappear. A child who suddenly becomes very lactose intolerant should therefore take blood samples for gluten intolerance. When children with gluten intolerance eats a gluten-free diet, the lactose intolerance disappears.
Symptoms of gluten intolerance
Some children with gluten intolerance get a stomach ache. Others get diarrhea or constipation. Many grow poorly and become tired and apathetic.
Blood test for gluten intolerance
There is a really good blood test that is used to detect gluten intolerance. The sample taken is transglutaminase antibodies. If you take this sample to a hospital laboratory, the answer is very certain.
Children who have no transglutaminase antibodies (and can produce the antibody IgA, which 98% can) are most likely not to have celiac disease. When the suspicion is great and the symptoms are severe, especially in a child who is not growing, you can proceed with a gastroscopy with a biopsy of the small intestinal mucosa. But, in most cases, it is not necessary.
Children who have very high levels of transglutaminase antibodies are also more likely to have celiac disease. That’s when you take the test and also a genetic test before making a diagnosis.
For the blood test to work, you must eat gluten daily. It is therefore not possible to investigate celiac disease in someone who has already started a gluten-free diet without starting to eat gluten again.
In the event of a confirmed gluten intolerance, you need to eat a strict gluten-free diet. Then all symptoms disappear, the transglutaminase antibodies disappear and the intestinal lining grows to its fuzzy-like structure again. In the event of a confirmed gluten intolerance, you therefore need to be instructed by a dietitian, on how to eat a strict gluten-free diet.