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School Nurse’s Guide to Celiac Disease

I do love me some bread. We usually don’t buy bread…we make it. Yes, sometimes in our breadmaker (why not?). But, a lot of the time we make it from scratch. Each Sunday, after church, our congregation shares a snack and some “community time.” I’ve noticed that on the days I bake a nice loaf of ciabatta bread and bring it for “community time,” the preacher’s sermon usually finishes up a bit sooner than on the days we don’t bring bread. Maybe it’s a coincidence. Or maybe it’s the aroma of the ciabatta filling up the room we meet in. Either way, that loaf usually doesn’t last long. (If you want the recipe, I will be happy to send it to you. Let me know when you sign up for the newsletter at the end of this article).

The one thing that does make me feel bad about bringing the bread is the folks with celiac disease. This bread is not a gluten-free recipe. We are a caring community; maybe that’s why everyone else eats it up so fast; they don’t want their gluten-challenged brethren to be tempted…for too long anyway..

What is gluten?

Wheat (and other grains) has gluten to allow the bread to become leavened (rise). In the case of my ciabatta bread, the yeast “eats” the flour (carbohydrate) and makes carbon dioxide (like our bodies do when we breathe out). The gluten acts like tiny little balloons that “catch” the CO2 and trap it. All these little “balloons” cause the dough to rise. Once the bread is baked, it “freezes” it into the risen or leavened state. This is what makes it so soft, squishy, and bouncy (and YUMMY!).

Gluten is a general name for the proteins found in wheat, rye, and barley (the Pooideae subfamily of grasses ). Gluten can be found in many types of foods, even ones that would not be expected. Gluten is found in the endosperm of the grass seed. Gluten nourishes the baby plant during germination.

Oats are gluten-free…BUT…they can become contaminated during processing.

With all that being said, gluten is a mixture of proteins with two proteins in particular that cause illness in people with celiac disease. These two proteins are called gliadin and glutenin. People with celiac disease respond negatively to gliadin…as do other people on a much less severe level.

What is celiac disease (gluten-sensitive enteropathy, Celiac sprue, nontropical sprue)?

Celiac disease is a genetic autoimmune disorder. Basically, celiac disease a chronic disorder of the digestive tract that results in an inability to tolerate gliadin. When a person suffering from celiac disease eats gliadin (found in gluten), inflammation occurs due to an autoimmune response by the body (that treats gliadin as an invading pathogen). This, in turn, damages the intestinal lining, eventually destroying the nutrient-absorbing ability of the body’s GI system.

There are three things that must happen in order for Celiac disease to be “activated.”

Genetic predisposition

Be eating gluten

Disease is activated

The first two we understand pretty easily. The “activated” part needs a little explaining. Something happens and a person who is predisposed to celiac disease actually becomes a person suffering from celiac disease (to put it simply). This “something” could be a lot of different “events” such as a life stress, trauma (surgeries count), or even a viral infection.

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When someone with celiac disease eats gliadin-containing gluten, the body’s immune system thinks it’s being attacked, and an immune response occurs. This, in turn, inflames the intestinal wall and eventually damages and destroys the small intestine’s villi. This is the essence of the disease itself. When these villi — very small finger-like projections in the inner lining of the small intestine — are damaged and destroyed, the body’s ability to process nutrients is greatly compromised.

Symptoms of celiac disease

Where the child was A-OK at one point in time, now the child begins to show symptoms such as:

Loose, watery stool is one of the first symptoms (but not all together abnormal in the school nurse’s population).

Inflammation in the GI tract may cause bloating. Not gas-like bloating; more like the bowels themselves are swollen.

The child may be gassy. But what child isn’t? My 11-year-old can “cut ’em” with the best (and usually under not-so-favorable-conditions). A frequently gassy kid demonstrating other, supporting symptoms may be more than just a kid who drinks a lot of soda (which mine doesn’t).

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