Celiac Disease

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Description

Celiac (Coeliac) disease (CD) is an auto-immune condition that causes damage to the small intestine. Ingestion of gluten proteins -- even in very small quantities -- trigger antibody reactions where the body attacks its own cells, which can lead to inflammation, gastrointestinal distress (abdominal pain, diarrhea), nausea, and fatigue. Untreated it can lead to malabsorption and malnutrition, anemia, osteoporosis, joint pain, skin rashes, ulcers, weight loss/gain, neurological disorders, reproductive issues and and a higher incidence of cancer.

Prevalence

Celiac disease has a genetic component, and the majority of individuals who develop it have variants in one of two genes (HLA-DQA1 and HLA-DQB1). While these gene variants are present in populations across the planet, only about 1% of those carriers go onto develop CD. The disease may manifest itself in childhood or it can be triggered by various factors (viral infection, stress, pregnancy, childbirth, etc) later in life. Diagnosis is generally made through blood test and endoscopy. It remains underdiagnosed -- many individuals with celiac disease do not realize they have it or may wait years to be diagnosed and move to a gluten free diet.

Treatment

CD is a life-long illness with currently no cure. Disease management consists of a strict adherence to a gluten free diet. This specifically includes elimination of any foods containing gluten proteins: barley (hordein), rye (secalin), wheat (gliadin) and oats (avenin). (Footnote on oats).

Individuals unfamiliar with Celiac Disease may not appreciate that even very small amounts of gluten consumed by individuals with CD can be harmful -- whether or not that person experiences symptoms associated with consuming gluten ("getting glutened"). For that reason, individuals with CD generally take (or are advised to take) particular precaution around cross-contact with gluten containing foods. That can include foods made with small amounts of gluten containing ingredients (wheat is a common ingredient in many sauces for example), or in kitchen facilities where food preparation areas or equipment are not kept sufficiently separate.

Beer and Celiac Disease

Yes, people with Celiac Disease can and do drink beer -- so long as it's made with gluten free ingredients.

Barley has been the mainstay in the European brewing tradition for centuries, with wheat and occasionally rye playing leading and support roles in various beer styles. All three grains contain subsets of proteins (hordeins, gliadins and secalins) that fall under the gluten umbrella. For that reason, these conventional beers pose health risks for people with Celiac Disease and need to be avoided. Even light lagers like Corona and Budweiser contain barley gluten proteins and are not Celiac safe. Similarly, "gluten reduced" beers that are made with barley and hydrolyzed with prolyl endopeptidase are not safe options for individuals with CD.

Happily, there are a number of naturally gluten-free grains that are adaptable for brewing.

Wheat Allergy, Gluten Sensitivity, and other conditions

Unlike celiac disease, a wheat allergy is not an auto immune response but rather an immunoglobulin E response to one or many of the different proteins in wheat. Symptoms may be similar to those experienced with celiac disease but may also include itching, swelling lips and tongue, difficulty breathing and anaphylaxis. Wheat allergies may extend to proteins found in barley, and it is possible to have both a wheat allergy and celiac disease.

Non-Celiac Gluten Sensitivity (NCGS) is a clinical condition that is not yet well understood. There are no clear tests or biomarkers and a NCGS diagnosis involves exclusionary criteria, i.e. ruling out a wheat allergy and auto-immune reaction (as with celiac disease) when there is a ongoing reaction to gluten-containing food.

Resources