Mauro Lombardo
www.maurolombardo.it
Celiac disease, also known as celiac disease or gluten enteropathy, is a condition characterized by permanent intolerance to gluten, a protein complex content in wheat , barley and rye. Among the cereals "toxic" for celiac disease was also included oats, which, according to the latest data, it would not seem really detrimental if introduced "pure", that is not contaminated with gluten in the process.
Gluten consists of four main protein components, the gliadins, glutenins, albumins and globulins, these gliadin and glutenin comprise the majority of wheat proteins. The alcohol-soluble gliadin fraction of gluten, when ingested by a susceptible host, is responsible for the onset of intestinal damage.
Based on gel electrophoresis, the gliadins can be separated into four main fractions: gliadins alpha, beta, gamma and omega.
Studies show that all major subgroups gliadin can produce characteristic lesions of the intestinal mucosa of celiac disease. Similar alcohol soluble proteins called prolamins, such as Segalin in rye, hordein in barley el'aveina oats can also trigger the disease, unlike the rice flour or corn produces neither clinical nor histologic changes, on the other hand are far from the wheat grass or rye in the botanical classification.
In genetically predisposed individuals, the introduction of foods containing gluten, such as bread, pasta and biscuits, it leads to abnormal immune response in the small intestine, which results in chronic inflammation and the progressive disappearance of intestinal villi
The typical celiac lesion is often defined by the pathologist who analyzes the biopsy villous atrophy Subtotal with hypertrophic crypts and increased infiltration of the lamina propria lifoplasmacellulare "terminology indicates that the finding of a flat intestinal mucosa and" desert ", where, in normal conditions, there are the" mountains "of villi, structures that play a primary role in the absorption of nutrients in the diet.
The elimination of foods containing gluten leads to the complete normalization of the intestinal biopsy (with regrowth of villi of normal height) and the disappearance of symptoms may be present.
Gliadins consist of single chains polypeptide of molecular weight between 30,0000 and 75,000 daltons and are characterized by a high content of glutamine and proline (32-56 glutamine and proline per 100 amino acid residues 15-30).
E 'known that celiac disease is triggered by two sets 57-68 and 62-75 of the 266 amino acids of alpha and especially in the deamination of glutamine residue 65 glutamic acid. In patients with DQ2 (DQA1501, DQB1201) and DQ8 (DQA1301, DQB302) would lead to a correct relationship with the antigen and presentation of this condition a "anomaly" of gliadin peptides to TCR Lymphocytes triggering an abnormal immune response against . It would also seem that the transglutaminase (TG) has a role in the deamination of gliadin and therefore can play an important role in the pathogenesis of celiac disease. The link between TG and gliadin form of neopitopi capable of triggering the immune response underlying celiac disease. This could also justify why-transglutaminase antibodies are formed only when the patient ingests gluten! Another data imported can be seen from a study that shows a reduction in the expression of celiac patients zonulin, a protein that modulates intestinal permeability by the assembly of tight junctions. This could lead to increased permeability and thus an important factor in triggering species of different sequences for the presentation of gliadin, which could also occur in an environment of what is bacterial overgrowth in the case of patients with Crohn's disease.
Very recently an interesting study shows that first described the classic immunologic event may be an additional mechanism that is more rapid in the early hours of exposure to gluten and that is not subject to the processing of gluten by the transglutaminase.
This process triggered by IL-15 seems a polypeptide of molecular weight of 15KD. From the structural point of view IL-15 is homologous to IL-2 and translates the signal through the low affinity receptor complex in fact used by IL-2. The binding of IL-15 in this low-affinity IL-2R is greatly enhanced by interaction with a polypeptide does not signal that binds IL-15 chain called IL-15 R-alpha. THE 15R chain is structurally homologous to IL-2R alpha chain, but is unable to bind IL-2, however, the primary function of IL-15 seems to be to encourage the proliferation of NK cells and to decrease ' apoptosis of T cells The IL-15 is, in fact, synthesized early in response to LPS or virus and can mediate the expansion of NK cells during the first 24-72 hours after infection. IL-15 can also act as a growth factor for T lymphocytes in that it binds and transduces the signal through this low-affinity IL 2R on resting T cells. It is still unclear whether in the course of infection has produced enough IL-15 to translate a signal through the receptor for IL-2 with low affinity, it is unclear if the T cells can express IL-15 R alpha chain.
DIET AGLUTINATA
gluten-free diet is the single, unique, real treatment of celiac disease and must be continued throughout life. If a person does not take gluten can have no manifestation of celiac disease.
Gluten is contained in some cereals, including wheat, barley, rye, barley, kamut, millet, triticale and spelled. Oats is no longer considered to be toxic, but being present in products containing gluten is not recommended for use.
| wheat flour, starch, semolina, corn flakes, barley, rye, oats | |
| Orzo Pasta of all kinds, stuffed pasta (eg ravioli, tortellini, gnocchi made with wheat flour, etc. ....) Special and ordinary bread, bread crumbs | |
| Rye | Breadsticks, crackers, biscuits, sliced \u200b\u200bbread, focaccia, pizza |
| Farro | bran, malt (barley is) , mixtures of cereals |
| Kamut, Spelt Triticale | containing flour cakes, biscuits |
Gluten is not found in the following cereal crops: rice, soy, tapioca, corn, potato, millet and pulses.
| Rice | | Rice flour, cream and rice starch |
| Mile | | millet flour |
| Mais | | corn flour, polenta, corn flour (corn), popcorn |
| Buckwheat | and then | Potato starch |
| Sesame | | pure soy flour and tapioca flour |
| Legumes | | flaked rice, corn, soy, tapioca, without addition of malt |
Gluten is hidden in many foods so it is essential to have a handbook and seek food. For example, "Handbook of the gluten-free products", published by the Association Italian Celiac disease that is continuously revised with the introduction or exclusion of products.
A gluten-free diet does not involve nutritional problems as it can be equally varied. The variety of foods allowed, next to the specific products that industry provides, it allows to formulate a balanced diet for all ages, varied and tasty, adapted to different nutritional needs for a growing child, for a adult.
You can easily do a balanced diet with natural products such as gluten-free rice or corn polenta instead of pasta. In trade there are a number specific products without gluten (bread, pasta, pizza, cookies, etc.)..
The ASL membership entitles individuals with celiac disease, confirmed by intestinal biopsy, a portion of food per month, which, according to the latest regulations published in the Official Gazette of 25.07.2001, corresponding to 35% of caloric intake.
foods are allowed
| vinegar |
| Soft drinks (no beer) |
| Butter (excluding light) |
| olive oil, peanut, sunflower, corn (except the wheat germ or seed number) |
| Coffee (excluding soluble or derived from barley or malt) |
| Meat, Poultry, Prosciutto (except the other sausages, sauce and meat trade breaded or floured) |
| fresh and aged Italian cheeses (except those rendered in slices, spreads, foreign or blue as the gorgonzola) |
| Fresh fruit, syrup or oil (other than flour as figs dried), fruit juices and nectars |
| teas in bags or filter |
| milk (the milk does not contain gluten, and as such can be taken from the celiac patient, however, as soon as possible after diagnosis, can be excluded or recommend a lactose-free milk, for the alteration of the intestinal mucosa caused by the diet with gluten), Fresh cream, natural yoghurt, low-fat or whole (except the malt, grain, and attention to the fruit) |
| Legumes |
| Honey, Sugar |
| Mile |
| Royal jelly |
| fish fresh or frozen (except frozen pre-baked or breaded) |
| Rice |
| Syrups |
| Vegetables, fresh, preserved or frozen raw or cooked, chopped and pureed tomatoes (except soups or stews with pearl barley or barley, vegetables, fried, breaded or batter), potatoes (except frozen chips and instant mashed potatoes). |
The celiac patient must, however, pay attention to labels. The presence of generic terms such as starch, vegetable protein, maltodextrin, malt, cereal flour, unspecified, coffee extract, cocoa mass, as well as other compounds specifically corn, wheat or barley have to suspect the presence of gluten
Specifically of childhood is essential that the family accept the problem calmly and take measures and precautions at home (eg, customized kitchen cupboard in places where there are only gluten-free products, invitations to friends with proposals for gluten-free foods for all etc.) should also notify the teachers on the issue, so as to make the child feel normal while dieting. is very important at this age to refer to a specialized center that periodically checks the child and by specialized staff (dietician or nutritionist and possibly psychologist) to know all the particulars of the case.
A critical time is the age in which the teenage boy in search of an identity tends to dispute the claims of the family (gluten-free diet) and, not wanting to tell the group we belong to the state of the celiac , tends to break easily.
In this age is still more important than participation in group meetings (such as those proposed by the Association celiac) or the guidance of experienced personnel in the field and experience in the pediatric-adolescent.
MALNUTRITION IN CELIAC
In celiac disease the prevalence of malnutrition is below what is considered but is variable
- depending on the degree of mucosal damage (severe form, as "mild "Latent and potential celiac disease, individuals sensitive to gluten)
- depending on the intestinal surface involved
When is concerned a significant part of the small intestine are usually accompanied by diarrhea and malabsorption, weight loss. When one is interested in the cranial part of the small intestine may be the only symptom of iron deficiency. When this deficiency is not corrected by iron therapy permanently is very likely that there is an underlying celiac disease. When a large portion of the small intestine is affected, the result can be generalized malabsorption syndrome with deficiency of water-soluble and fat-soluble vitamins and minerals. Patients with total villous atrophy at diagnosis had the lowest values \u200b\u200bof folate and ferritin levels. Even trace minerals often suffer from malabsorption, in particular magnesium and calcium, because they are the ones that are tied more to fat malabsorption, as well as zinc. The latter mineral supplementation prevents rash and taste disturbances. The gluten-free diet (gluten free diet, GFD) worsens the diet of adolescents that is often already unbalanced, for an increase in protein and lipid (Mariani, 1998). Aglutinata diet must be followed forever. Supporting a gluten-free diet 100% and 100% of remaining life can be very problematic. In fact, wheat flour, wheat starch or containing trace amounts of gluten are found in many foods such as processing aids for their stabilizing properties and the ability to hold water. Help can come from a more correct mode of food labeling food and education.
The Codex Alimentarius FAO has set the standard for gluten-free products that the total nitrogen content shall not exceed 0.05 g/100 g. of dry product. This value goes beyond the need for the celiac take totally gluten-free foods.
The diet therapy and gluten substitutes
There are few diseases as well as celiac disease in which diet and nutritional problems are more important. The diet therapy of celiac disease is primarily a treatment for exclusion. Will be eliminated all products containing gluten: wheat, barley, rye and commercial products derived from these. This type of diet does not cause nutritional imbalances as cereals to exclude content items are not essential for the survival of the patient. It 's very important that the diet should be followed closely and in full to avoid the known complications of celiac disease including cancer el'osteopenia. It 'important to emphasize that the gluten can be used as a thickener in the food industry, so in an unconscious patient ingests small amounts of the protein with the product. In some subjects with a low tolerance threshold also gluten, used as a thickener and appropriately marked on the label, because the 'atrophy of intestinal villi and events related to it. To properly address this situation it is important information on the composition of food products on the market. Awareness of the patient goes through nutrition education provided to the dietitian or doctor.
The Italian Association for Celiac Disease (AIC) just for this purpose periodically publishes a newsletter containing the list of commercial products that contain gluten. Gluten substitutes are used in the formulation of the dough to give the product the same nutritional and organoleptic characteristics
BEVERAGES
| IS NO | |
| tea, decaffeinated tea, chamomile tea, coffee, decaffeinated coffee, herbal teas | instant coffee or coffee substitutes contain barley or malt |
| Soft drinks | Beer |
| red and white wine, champagne, soft drinks, alcoholic drinks in general (with the exceptions prohibited) | whiskey, vodka, gin, cocktails made with these Drink |
| Juices | Milkshake (ready mixed) |
SWEETS
| IS NO | |
| cakes, biscuits, cakes with rice flour or corn, tapioca flour or soy, potato starch | Chocolate and cocoa paste with starch or flour |
| Gelati and sorbets: Refer to the "Handbook" AIC | cookie with ice cream, waffle, sponge cake |
| honey, sugar, jam, cocoa pure | creams and puddings containing flour and malt |
| Rice pudding or tapioca | Marzipan |
| | sweets, candies and jellies trade with malt, candy with flour |
FATS - CONDIMENTS - MISCELLANEOUS
| IS NO | |
| butter, lard, corn oil, sunflower, olive, peanut and soybean | Sauces, dressings and mayonnaise, mustard commercially prepared with flour or starch |
| Mayonnaise, sauces homemade | seasonings composition undefined |
| Fresh cream and mascarpone | Yeast |
| pepper, saffron and aromatic spices in oil | Products with mixed seed oil |
| baking powder | |
| vinegar and oil products | |
CONTAMINATION:
gluten contamination can be avoided if you follow some basic rules like: no foods with flour flour banned, do not add flour prohibited in sauces and cooking sauces, do not use the cooking water already used for communal meals, avoid contaminating the food with hands flour or flour with dirty utensils, do not place food directly on contaminated surfaces, do not use parchment paper or aluminum foil on counter tops, floured pans, grills where you toast the bread cutting board or municipality, or plates where you bake ovens pizza or baked goods made with plain flour.
Besides giving all information relating to food, there are other rules to follow including:
- Use caution on the home of culinary techniques (pans, utensils separate for the various firings)
- Involve the whole family to be used for all components of flour and gluten free bread crumbs
- make more practical and easier to daily spend at supermarkets making a fair use of the AIC (ie highlight more frequent food consumption).
- frequently without "fear" of eating places where you can have all the safeguards which the celiac dietary needs.
BIBLIOGRAPHY
Tursi A Brandimarte G Giorgetti G. Non-invasive diagnosis of celiac disease in clinical practice Recent Prog Med 2001 November; 92:696-701
Barton SH Kelly DG Murray JA, Nutritional deficiencies in celiac disease. Gastroenterol Clin North Am 2007 Mar; 36:93-108, vi
Schuppan D Dennis MD Kelly CP. Celiac disease: epidemiology, pathogenesis, diagnosis, and nutritional management. Nutr Clin Care 2005 Apr-Jun; 8:54-69
L. Catassi, I.M. Ratsh, M. Fabiani et al. Celiac disease in the year 2000: exploring the iceberg. Lancet 1994;343:200-3
Tursi A Brandimarte G Giorgetti GM. Prevalence of antitissue transglutaminase antibodies in different degrees of intestinal damage in celiac disease. J Clin Gastroenterol 2003 Mar; 36:219-21
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