San José, Costa Rica, since 1956

Celiac Disease Gets You Right in the Gut

If you suffer from chronic digestive problems, the culprit may be a little protein called gluten.

Gluten intolerance, also known as celiac sprue or celiac disease, is a lifelong digestive disorder in which the small intestine fails to digest and absorb food. In Spanish, the disease is called enfermedad celíaca or celiaquía.

Celiac disease (CD) is caused by intolerance to gliadin, a gluten protein found in all kinds of wheat, and similar proteins found in crops of the wheat family, including barley, rye and oats. While classically an illness of infants, gluten intolerance can affect all ages and types of people, often manifesting itself between ages 10 and 40. However, CD seems to be more common among Caucasian people of northern European ancestry.

According to the Canadian Celiac Association and the U.S.-based Celiac Disease Foundation, one in every 133 people suffer from gluten intolerance in North America.

Though statistics on CD are unavailable in Costa Rica, Dr. Hernando González, a gastroenterologist with CIMAHospital in the western San José suburb of Escazú, says the country has more glutenin-tolerant inhabitants than its neighbors because it has a higher percentage of European immigrants.

“In Costa Rica, celiac disease is most prevalent among members of the Ashkenazi Jewish community from Poland,” he says. González, 48, studied internal medicine here in his native Costa Rica. Specializing in gastroenterology and therapeutic endoscopy, he later went to the United States, where he studied and trained for seven years at HennepinCountyMedicalCenter in the U.S. city of Minneapolis, in Minnesota.

“Celiac disease is not a food allergy. Food allergies, including wheat allergy, are conditions people can grow out of. CD is understood as an immune disorder that is triggered by an environmental agent – the gliadin component of gluten – in genetically predisposed people,” explains González, who is a post medical adviser for the U.S. Embassy in Costa Rica and president of the Central American Gastroenterology Association.

The ancient Greek physician Aretaeus of Cappadocia recorded symptoms of a similar bowel disease as far back as the second century. The first modern-day description of CD was given by English pediatrician Samuel Gee in 1887. But the cause of gluten intolerance remained unexplained until the 1940s, when Dutch pediatrician Willem- Karel Dicke discovered the link with wheat, recognizing an association between the consumption of bread and cereals and relapsing diarrhea.

Celiac disease often mimics other intestinal disorders, with symptoms including abdominal pain, bloating, chronic diarrhea, vomiting, unexplained weight loss or gain, fatigue and anemia. While CD is primarily a bowel disease, bowel symptoms may be limited or even absent. González says manifestations of the illness can differ greatly from case to case, and can range from a silent to a full-blown disorder. Celiac disease may appear at any time in a person’s life, and can be triggered for the first time after surgery, viral infection, severe emotional stress, pregnancy or childbirth.

When patients with CD ingest gluten, the villi – tiny hair-like projections that absorb nutrients from food – in the small intestine are damaged, González explains. Damaged villi do not effectively absorb basic nutrients, such as proteins, carbohydrates, fats, vitamins and minerals. If celiac disease is left untreated, damage to the small intestine can be chronic and life-threatening, causing an increased risk of associated disorders, including vitamin and mineral deficiencies, lactose intolerance, diabetes, osteoporosis, gall bladder malfunction, pancreas problems and intestinal cancer.

To diagnose celiac disease, antibody tests via blood screening are performed. For patients with positive antibody tests, a biopsy of the small intestine is recommended to confirm the diagnosis and determine the degree of damage to the villi. All testing should be done while patients are on a gluten-rich diet.

“The traditional approach of performing a small-bowel biopsy after a period of gluten challenge remains the gold standard for diagnosis,” González says.

At the moment, lifelong abstinence of wheat gluten is the only therapy for CD. Thus, treatment of celiac patients begins with dietary counseling. Because gluten is present in a variety of foods commonly consumed in the western diet, consumption of a gluten-free diet requires a major lifestyle change. Gluten-free products are usually more expensive and harder to find than common gluten-containing foods. Moreover, it’s not just pasta, bread and pastries that contain gluten; foods such as sausage, ice cream, ketchup, beer and condiments do as well. Even toothpaste, lipstick and medicine can contain traces of it.

González recommends reading labels on prepared foods and condiments carefully, paying particular attention to additives, such as emulsifiers and stabilizers, which may contain gluten.

“The rapidity of the response to a gluten-free diet is variable,” the expert explains, “but approximately 70 percent of patients notice remarkable improvement within two weeks.”


Get Info and Help

For more information on celiac disease, consult a skilled dietician and informative Web pages such as, or contact an advocacy group. The president of Costa Rica’s celiac self-help group is writer Ani Brenes, a celiac patient who founded Asociación Pro-Personas Celíacas (APPCEL) five years ago. In her bimonthly online magazine, Brenes gives reliable, up-to-date information in Spanish on issues related to the illness.

“First you have to accept the problem, the special situation,” Brenes says. “You have to investigate and learn about it. Then you can talk about it, get active and help each other.”

Brenes says gluten-free products are available in Costa Rica mainly at Bio Salud stores in Multiplaza, in the western suburb of Escazú, and in Plaza del Sol, in Curridabat, east of San José. Auto Mercado supermarkets sell imported Glutano-brand pasta and confectionery. Tips stores in the western Pavas district and in the eastern suburb of San Pedro offer gluten-free flours.

Brenes can be reached at 2273-3559. APPCEL’s Web page:

Dr. Hernando González can be reached at 2208-1417 or, or at Escazú’s CIMAHospital, Medical Tower 1, fourth floor, room 17.



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