Celiac disease is an autoimmune condition in which the ingestion of gluten (a protein found in wheat, barley, and rye) leads to an immune response that damages the small intestine. According to The Celiac Disease Foundation, 1 in 100 people worldwide have celiac disease.
What Is Celiac Disease
When someone with celiac disease eats gluten, their body’s immune system treats it as an invader, and attacks the villi that line the small intestine. Villi are small, fingerlike projections that line the small intestine and absorb nutrients from food. When damaged, nutrients from food cannot enter the body, so you can be eating the healthiest most nutrient-dense food but still be malnourished and deficient in many important vitamins and minerals. The intestinal damage from celiac can lead to weight loss, fatigue, anemia, and other complications.
Causes of Celiac Disease
While the exact cause of celiac disease is unknown, there seems to be a genetic component. If you have a first-degree relative with celiac, you have a 1 in 10 risk of developing the disease. Having a second-degree relative with celiac, or several more distant relatives, is also a risk factor. According to the Mayo Clinic, risk factors other than a family member with celiac include:
- Type 1 Diabetes
- Down syndrome or Turner syndrome
- Autoimmune thyroid disease
- Microscopic colitis (lymphocytic or collagenous colitis)
- Addison’s disease
There are over 200 known symptoms of celiac disease. How each person experiences them can range dramatically, from being almost incapacitated, to having no symptoms at all. But even if asymptomatic, untreated celiac can have serious long-term health consequences.
With the wide range of symptom presentation in mind, here are some common celiac symptoms for adults:
- Signs of indigestion like abdominal pain, diarrhea, gas, constipation, and bloating
- Unexplained weight loss
- Headache or migraines
- Canker sores (also known as mouth ulcers)
- Iron-deficiency anemia
- Vitamin deficiency, especially folic acid and B12
- Loss of bone density (osteoporosis), softening of bone (osteomalacia)
- Bone or joint pain, or arthritis
- Numbness or tingling in hands and feet
- Depression or anxiety
- Menstrual issues like missed periods, late onset of first period, early menopause
- Infertility or recurrent miscarriage
- Dermatitis herpetiformis (itchy skin rash)
How Is Celiac Disease Diagnosed?
Diagnosis can be tricky because of the different ways celiac disease presents itself, or doesn’t, in different people. While some might not have any symptoms at all, they can still be diagnosed through a positive blood test. Others might have many symptoms, but test negative on the blood test, and require an intestinal biopsy for a positive result.
According to The Celiac Disease Foundation, two and one-half million Americans are undiagnosed, and are at risk for long-term health complications. It’s important to undergo thorough testing for diagnosis, as all people with celiac disease are at risk for long-term complications, even if they have no symptoms at all.
You can be diagnosed with celiac through a blood test and/or an endoscopy. The blood test checks for antibodies that show an immune reaction to gluten. It can also check genetics to determine your predisposition to it. In an endoscopy, a doctor views and analyzes your small intestine and villi with a tiny camera that’s either swallowed (capsule endoscopy) or at the end of a long tube that enters through your mouth.
Important note: If you suspect you have celiac disease, you must be tested before beginning a gluten-free diet, as not ingesting gluten might make your blood tests results appear normal.
Treatment for Celiac Disease
Celiac disease has no cure, but most people can manage or eliminate their symptoms by following a strict gluten-free diet. Removing gluten from your diet can gradually reduce inflammation in the small intestine, causing it and its villi to heal. This can take between several months to several years, with children and younger people healing more quickly.
It’s important to remember that for some with Celiac, ingesting even a few crumbs of gluten can have a significant negative impact on symptoms and gut health. To avoid ingesting food contaminated with gluten, make sure to read all ingredients on packaged foods, let wait-staff know about your allergy when dining out, and buy your grains and flours from companies that have the certified “gluten free” label.
Celiac Disease Diet
A strict gluten-free diet is the only way to manage celiac disease. Foods that contain gluten are:
- Graham flour
- Spelt (a form of wheat)
Many foods that might not seem glutinous can have hidden gluten in the form of preservatives, additives, and stabilizers. Common sources of hidden gluten in foods are contained in:
- Vegetarian forms of imitation meat and fish
- Processed deli meats
- Rice mixes (such as rice pilaf)
- Salad dressings and sauces, including soy sauce
- French fries
- Self-basting poultry
- Non-food sources of gluten can also trigger an immune response. Make sure to check for gluten-containing ingredients in:
- Preservatives and food stabilizers
- Vitamin, mineral, and herbal supplements
- Makeup and lipstick products
- Toothpaste and mouthwash
- Envelope and stamp glue
It’s a good idea to check in regularly with your health care provider to make sure your gluten-free diet is adequately controlling your celiac. Your doctor can monitor your immune response with blood tests. If your symptoms or inflammation markers do not improve, medications such as steroids, azathioprine (Azasan, Imuran) or budesonide (Entocort EC, Uceris) might be necessary.
There are still plenty of healthy and delicious foods to eat that are gluten-free. Some basics are:
- Fresh meats, fish and poultry
- Lentils and legumes
- Dairy products like cheese and yogurt (but read labels)
- Vegetables and potatoes
- Wine, distilled liquor, ciders, and spirits
- Gluten-free grains and starches including amarynth, buckwheat, corn, tapioca, rice, quinoa and many more
If celiac has caused anemia or nutritional deficiencies, your doctor may prescribe vitamins and supplements such as:
- Vitamin B-12
- Vitamin D
- Vitamin K
Related Conditions and Celiac Risk Factors
People with celiac disease are twice as likely to develop coronary artery disease, and four times more likely to develop bowel cancers as people without it.
Untreated celiac can lead to:
- Lactose intolerance
- Vitamin and mineral deficiencies
- Multiple Sclerosis
- Dermatitis Herpetiformis (an itchy skin rash)
- Osteoporosis or osteopenia
- Infertility and miscarriage
- Pancreatic insufficiency
- Intestinal lymphomas and other GI cancers (malignancies)
- Gallbladder malfunction
When to Seek Help
It’s a good idea to consult with your doctor if you suspect you have celiac, have relatives with celiac, or have had diarrhea or digestive discomfort for more than two weeks. If you have a child with digestive upset, or who is pale, failing to grow, has a potbelly, or large worse-than-normal smelling stools, take them to a doctor to be evaluated for celiac, as children can present symptoms differently from adults. And remember to consult with your doctor before trying a gluten-free diet, as even reducing the amount of gluten you eat can alter test results.
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