Celiac Disease is an autoimmune disease. It affects infants, children and adults and results in a permanent intolerance to gluten, a protein found in wheat, rye and barley.
While not a food allergy, Celiac is nonetheless a common disorder and about 1% or more of North Americans may develop it and it can occur at any age. With progression, there is increasing damage to the villi of the small intestine, which are responsible for uptake of nutrients, leading to nutrient- related diseases such as osteoporosis, malabsorption syndromes, anemia, even lymphoma and other cancers. 1-2
Celiac is an inherited disease which can show up because of a variety of different conditions. The most important factor in preventing development of celiac in at-risk babies is breastfeeding up to a year or more, especially upon first exposure to gluten.
Studies show that the timing of the introduction of gluten and amount of gluten given is important. Babies ingesting gluten laden cereals, crackers or other gluten containing foods during the first three months of life are an increased the risk for development of celiac disease, compared to infants who were first given gluten around six months of age.
In Swedish studies from the 1990,’s prompted by an epidemic of celiac disease, it was found that babies given higher amounts of wheat baby foods were much more likely to develop celiac disease. 3
For persons who have a relative or parent with celiac disease, the disorder can show up after a virus, accident, pregnancy, or stressful situation. 1
But celiac disease is often silent and insidious. A certain degree of damage must occur before the disease can be diagnosed through blood testing. 4 Although it is a relatively common condition, of those susceptible, 90% can remain undiagnosed. In fact, the average time to diagnosis in a Canadian study was 12 years. 2
Tests for Celiac Disease Less Reliable in Children
The laboratory diagnostic tests for celiac disease is the serum immunoglobulin A (IgA) tissue transglutaminase (TTG) antibody test and the IgA-endomysial antibody (EMA) test. However, these tests are less reliable in children under 3 years of age and a negative test does not rule out celiac disease. An invasive endoscopic biopsy is the gold standard for confirmation of the disease. 2
Abdominal issues are pain, diarrhea, weight loss, and bloating. But because celiac disease is often misdiagnosed and doesn’t necessarily show the typical digestive symptoms that would be expected, it can manifest as migraines, acne and other skin issues like dermatitis herpetiformus (DH), anemia, and/or short stature. 4
Signs of Celiac Disease in Children
Symptoms in infants and young children include failure to thrive, swollen tummies, pale stools and smelly diarrhea, 5.
In addition, dental enamel defects, which can be confused with dental fluorosis, may manifest in either baby or adult teeth. It is also important to remember that a child or adult with celiac disease may have no symptoms other than oral and dental abnormalities. 2
In a recent study, 55 percent of children with Celiac Disease had enamel defects compared with only 18 percent of children in the control group. 6 When examined under an electron microscope the teeth of celiac subjects appear significantly different from others with nonceliac disease. They are highly hypomineralized (bright, white marks).7 This condition is most often seen in permanent teeth (9.5 to 95.9 % of patients) but can also be seen in baby teeth (5.8 to 13.3 %). It is obvious the condition occurred when the enamel was forming. 2
In a Finnish study, 83 percent of adults aged 19 to 67 years with celiac disease had enamel defects but only 4 percent of those in the control group suffered from this problem. Altogether 69 percent of the permanent teeth in adults with celiac disease were found to be defective while only 19 percent were found in the controls. 8 In a study of first degree relatives of patients with celiac disease published in the medical journal, Lancet, about half of first degree relatives had enamel defects. All those with enamel defects had positive endoscopic results for celiac disease. 9
Range of Enamel Defects in Children with Celiac Disease
The enamel defects range from slight defects in color of enamel, with white yellow or brown opacities or spots, rough enamels, horizontal groves, large vertical pits to severe structural defects with possible total loss of enamel (enamel hypoplasia).
Other causes of enamel defects are vitamin D deficiency, prematurity, dental fluorosis, trauma, localized infection and antibiotics.
Enamel defects are an important early indication that the child may suffer from celiac disease and is a noninvasive way for dentists to diagnose it in those with suspected disease and should be a part of every oral examination. 2 Unfortunately, the majority of dentists peg these enamel defects on excess fluoride or an early illness, missing an opportunity to alert parents to possible celiac disease.
Can Gluten Cause Cavities?
Dr. Richard Herbold of Capital District Vitality Center in New York writes that gluten can be the culprit in extensive dental decay in children as well. He writes:
Some parents are unprepared for the staggering dental bills and persistent cavities children get, even when they brush and floss regularly. Parents know to restrict sugar, but what they may not realize is that a hidden gluten intolerance and poor gut health, not a fluoride deficiency, may be the cause of those cavities. For many children, simply transitioning to a gluten-free diet works wonders for halting decay and improving dental health.
Gluten Cross-Reactors Can Cause Dental Problems Too
Wheat products, which make up about 20% to 50% of the American diet, contain higher levels of gluten than in the past. In addition, meat substitutes can contain it labeled as seitan, which adds to exposure levels. Ingestion of gluten, antibiotics, etc, causes damage to the barrier which protects the gut. The gluten particles are able to “leak” into the blood and travel to other parts of the body which causes a condition called gluten sensitivity (GS).
These partially digested particles put the immune system on alert which results in the dispatch of inflammatory messengers to other parts of the body, including the brain whenever the “enemy” is present. Gluten even crosses the blood brain barrier and inflames the brain tissues. Many studies have shown complete or partial remission of brain-related problems such as schizophrenia, depression, ADHD, autism, migraines and Alzheimer’s Disease when gluten is removed from the diet. 12
Gluten sensitivity differs from celiac disease in that the autoimmune response is not yet active and extensive damage to the intestinal villi has not occurred. The problem is that GS may lead to celiac disease in those at risk. Once the immune system has been sensitized to gluten, it may recognize other substances as foreign and another food allergy can result. 13
If the gut can be healed, allergic reactions (cross reactions) to other foods may be prevented. Food intolerances are somewhat different in that they do not cause an immune response but rather a local one, such as lactose intolerance, where the lactose cannot be digested because of lack of an enzyme. This causes bloating, gas, cramping, etc. Intolerance can become a side effect of celiac disease. 12
Because research shows that mothers who are gluten sensitive are 50% more likely to give birth to a child who later develops schizophrenia, it is important to identify and control gluten sensitivity early on with a gluten free diet, especially before pregnancy and childbirth. Recently testing has become available through Cyrex Laboratories to identify gluten sensitivity. 12
The treatment for GS and celiac disease is a gluten-free diet for life but in some cases, the diet alone does not lead to improvement. It is very complicated because twelve components make up the proteins in wheat and a person can be sensitive to one of more of these components. Other foods, such as milk, eggs, nuts, soy foods and/or other grains, may be at fault. 12
Destruction of the intestinal villi may cause other digestive issues, such as loss of disaccharidase enzymes which leads to maldigestion of carbohydrates, milk sugar and starches. 1
Other grains, coffee and chocolate can often cross react with gluten, even though they are gluten-free. The immune system, unhappy about encountering gluten before, identifies these substances as gluten’s kin and acts accordingly. PEG (polyethylene glycol), found in many personal care products, baby teething gel, and food items, is also gluten look-alike and the immune system considers it a foe, worthy of destruction. This generates further inflammation. These foods may worsen symptoms. Cyrex Laboratories also has a series of laboratory testing for cross- reactive substances. 13
Lack of probiotic bacteria and leaky gut may cause cross reactions with other foods which can lead to autism and behavioral issues. Dr. Natasha Campbell McBride, who is an expert in treating such conditions, prescribes probiotics and the GAPS (Gut and Psychology Syndrome) diet as helpful in such cases. 14
Because celiac disease can be a devastating disease which often presents with no gastrointestinal symptoms, dentists and other health care providers should consider identification of enamel defects as a noninvasive method of diagnosing celiac disease in those with suspected disease and should be a part of every examination. 2
For parents it is very important to be aware of celiac disease and its manifestation in dental enamel because these indications occur early in a child’s life, and prompt attention to celiac disease can make all the difference in the future health of their child.
1 Mahan LK and Escott-Stump S. Krause’s Food, Nutrition and Diet Therapy, 11th Edition. 2004. Philadelphia: Saunders. (712-715).
2 Rashid M1, Zarkadas M, Anca A, Limeback H. Oral manifestations of celiac disease: a clinical guide for dentists. J Can Dent Assoc. 2011;77: 39b. (1-6). Full Text here: http://www.jcda.ca/uploads/b39/b39.pdf
3 Guandalini S. Infant Feeding Practices and Risk for Subsequent Development of Celiac Disease. Impact. Winter 2010. http://web.archive.org/web/20120510074448/http://www.cureceliacdisease.org/wp-content/uploads/2011/09/1209CeliacCtr_News_v5links.pdf
4 O’Bryan T. Unlocking the Secrets of Gluten Sensitivity. Implications for Neurological, Musculoskeletal and Immune Health. 2008 Seminary Series Syllabus. First Edition. 2008. San Clemente: Metagenics.
5 National Library of Medicine. Celiac disease-sprue. MedlinePlus. http://www.nlm.nih.gov/medlineplus/ency/article/000233.htm
6 Wierink C et al. “Enamel defects in children.” Int J Pediatr Dent. 2007. 17:163-168
7 Bossù ML et al. Enamel hypoplasia in coeliac children: a potential clinical marker of early diagnosis. Eur J Paediatr Dent. 2007 Mar;8(1):31-7.
8 Aine LL, Mäki M, Collin P, Keyriläinen O. Dental enamel defects in celiac disease. J Oral Pathol Med. 1990 Jul;19(6):241-5.
9 Mäki M1, Aine L, Lipsanen V, Koskimies S.Dental enamel defects in first-degree relatives of coeliac disease patients. Lancet. 1991 Mar 30;337(8744):763-4.
12 Perlmutter D. Grain Brain. The Surprising Truth About Wheat, Carbs and Sugar- Your Brain’s Silent Killers 2013. New York: Little, Brown and Company.
13 Onusic, Sylvia P. All Thumbs Book Review. “Grain Brain (David Perlmutter).” Wise Traditions in Food, Farming and the Healing Arts. Winter 2013. 14(4).
14 Campbell McBride N. Gut and Psychology Syndrome: Natural Treatment for Autism, Dyspraxia, A.D.D., Dyslexia, A.D.H.D., Depression, Schizophrenia. Cambridge UK: Medinform Publishing. 2010
Sylvia Onusic is a board certified, licensed nutritionist with a PhD in Public Health Education. She helps individuals and families recognize the physical and mental conditions related to gluten sensitivity, Celiac, and other food-related disorders, and how to deal with them most effectively.