DEAR DR. GOTT: I have celiac disease and with it came mouth ulcers. Do I see my doctor about it or a dentist?
DEAR READER: The damage from celiac disease is caused by a reaction to consuming gluten, a product found in rye, barley, and wheat. Many oat manufacturers also process gluten-containing grains so products they market should be avoided unless they are certified as being gluten-free. The condition damages the lining of the small intestine and prevents absorption of nutrients properly. The lining of the intestines contain villi, protuberances that grow out from some mucous membranes (such as the lining of the small intestine). When a celiac patient consumes foods that contain gluten, the immune system reacts by damaging these villi. Left untreated, a person will eventually become malnourished.
The condition can affect anyone at any age from infancy through adulthood. It is more commonly diagnosed in those that have autoimmune thyroid or liver disease, type 1 diabetes, Down syndrome, certain intestinal disorders, rheumatoid arthritis, Addison’s disease, and Sjogren’s syndrome.
Symptoms vary widely, making diagnosis rather difficult. Digestive symptoms are more common in infants and children and include vomiting, constipation, diarrhea, weight loss, abdominal pain and bloating, and/or pale, foul-smelling or fatty stools. They may also experience delayed growth, short stature, irritability, failure to thrive (infants), dental enamel defects of the permanent teeth, and delayed puberty. Adults more commonly experience fatigue, arthritis, osteoporosis, seizures, canker sores, missed menstrual periods, unexplained iron-deficiency anemia, depression, anxiety, infertility or recurrent miscarriages, dermatitis herpetiformis (a type of skin rash), tingling or numbness of the hands and feet, and bone or joint pain.
Some sufferers will not have symptoms but they can still develop complications such as malnutrition, liver diseases, and intestinal cancers.
Diagnosis can be made through blood tests and intestinal biopsy. It is important that a normal diet be maintained before testing since eliminating gluten can cause falsely normal results.
The only treatment for celiac disease is strict avoidance of gluten-containing foods and products. This is vital to preventing, and even correcting, intestinal damage. As awareness increases, more individuals are being diagnosed, which increases the demand for gluten-free products. Today finding gluten-free pastas, breads and other baked goods is easier. Rice, potatoes, corn, and other gluten-free flours are available for a wide array of baking needs.
Some individuals may continue to experience symptoms because small amounts of gluten remain in the diet. Foods, certain medications, some beauty products such as lipstick, lip balm, and others also contain gluten, so it is important to avoid use unless the packaging states the product is gluten-free. Rarely, even strict avoidance of all gluten, isn’t enough to stop symptoms. This is known as refractory celiac disease and is the result of severely, permanently damaged intestinal linings. In this situation, intravenous nutrition may be necessary. Currently there are no medications specifically directed at this disease, but research is ongoing.
It is rare that long-term damage will be done to the intestinal lining prior to receiving a correct diagnosis. Your condition can likely be brought under control through an appropriate diet. Beyond that, there are support groups available to work with you.
If your mouth ulcers are truly related to the celiac, they should clear up once a gluten-free diet is followed. In the meantime, try covering them with a layer of powdered or crystallized alum one to two times a day, rub L-lysine on the affected areas or take a daily supplement, and perhaps switch to an SLS-free toothpaste. Speak to your physician for further information and help.
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