A Guide to Celiac Disease

Celiac disease is an autoimmune condition. This disease afflicts roughly one percent of the world's population. While it's not possible to cure celiac disease, those with the illness can control their symptoms by following a strict gluten-free diet. Although eating gluten-free has its challenges, it is well worth the effort to manage celiac disease.

What Is Celiac Disease?

Celiac disease is an autoimmune disorder that causes damage to the small intestine. The small intestine has tiny villi along the inside surface, and these villi are responsible for absorbing nutrients from foods. However, with celiac disease, the immune system attacks the villi and gluten whenever gluten is present. The damaged villi are unable to absorb nutrients properly. When gluten is not present in the system, the immune system won't engage in this defense mechanism. Gluten is a protein that's present in some grains, including wheat, rye, and barley. Any products made with these grains will contain gluten.

Celiac Disease and Gluten Intolerance

It's common to confuse celiac disease with a gluten intolerance. Some people have non-celiac gluten sensitivity, which has been officially recognized as a health condition by the scientific community. Those with a gluten intolerance are often able to tolerate consuming small amounts of gluten. But those with celiac disease cannot consume any gluten whatsoever.

Symptoms of Celiac Disease

Although celiac disease shares some symptoms with irritable bowel syndrome, the two conditions are different, and celiac disease can affect organs throughout the body. Symptoms of celiac disease include:

• Abdominal pain
• Anxiety
• Bloating
• Dementia
• Depression
• Diarrhea
• Fatigue
• Iron deficiency
• Skin rash
• Spots on teeth
• Vitamin deficiency
• Weight loss

Long-Term Complications of Celiac Disease

It's important to get treatment for celiac disease promptly to avoid long-term health effects. Many of the typical celiac disease complications are connected with nutrient malabsorption. Following a gluten-free diet usually helps reduce the risk of complications. Complications can include:

• Bone density issues due to malabsorption of vitamin D and calcium
• Non-Hodgkin's lymphoma or small bowel adenocarcinoma
• Lactose intolerance due to damage to the small intestine
• Malnutrition, associated with delayed growth in children
• Neurological issues such as seizures and neuropathy
• Reproductive issues including infertility and miscarriage

Celiac Disease Testing and Diagnosis

It can be difficult to diagnose celiac disease, which is often the reason for people going undiagnosed. Symptoms also vary from patient to patient, and some people have very few symptoms. Anyone with Type 1 diabetes or hypothyroidism has a higher risk for developing celiac disease. Genetics are also a risk factor for the disease, so people with parents or siblings with celiac disease should consider getting tested. Children who have parents with celiac disease are often tested between the ages of 2 and 3.

Before getting blood work to test for celiac disease, a patient must be consistently eating gluten for several weeks. Doctors commonly refer to this test as the gluten challenge. Then, diagnosis usually involves a blood test to look for antibodies that the immune system produces in response to gluten. After a positive blood test, the next step involves a bowel biopsy. Results of the bowel biopsy usually take about 30 minutes. Some patients are reluctant to reintroduce gluten for the gluten challenge. In this case, genetic testing may be an option.

The Gluten-Free Diet

Following a gluten-free diet carefully should remove most of the gluten, but it's almost impossible to avoid gluten completely. Doctors suggest that consuming less than 10 mg of gluten per day is acceptable. In the United States, foods have to have less than 20 parts per million of gluten to be labeled as gluten-free. Cross-contamination with foods that contain gluten is a constant challenge. When family members consume gluten, someone eating gluten-free will need to be vigilant to prevent cross-contamination.

Aside from avoiding wheat, barley, and rye, patients be careful to avoid sources of hiding gluten. Wheat might hide in foods under the names bulgur, durum, farro, kamut, semolina, or spelt. A crossbreed of wheat and rye is called triticale. Malt and brewer's yeast also contain gluten. Gluten can also be present in marinades, sauces, beer, and packaged foods not labeled as gluten-free. The ingredients starch and dextrin can also contain gluten.

Watch for non-food sources of gluten as well. These items include lipsticks, medications, play dough, herbal supplements, and vitamin and mineral supplements. Medications containing gluten will often list wheat starch on the ingredient list.

Naturally gluten-free foods are ideal for a gluten-free diet. These foods include:

• Dairy products
• Eggs
• Fats and oils
• Fruits and vegetables
• Gluten-free grains such as corn, millet, rice, and sorghum
• Meat
• Nuts and legumes

Oats are also naturally gluten-free. However, oats might be contaminated by other grains during harvest or packaging, so some people prefer to purchase gluten-free oats that are processed separately from other grains. And some people with celiac disease also have a sensitivity to avenin, which is a protein present in oats.

Although following a gluten-free diet is essential for symptom control with celiac disease, some people experience vitamin deficiencies when eating gluten-free. The most common nutrient deficiencies involve folate, iron, magnesium, and zinc. Another potential issue is eating an excess of simple carbohydrates and saturated fats.

Does a Gluten-Free Diet Ever Fail?

When changing over to a gluten-free diet, it's important to watch for some pitfalls. Not finding hidden sources of gluten can be detrimental; it's possible to consume gluten even when striving to eat gluten-free. If eating gluten-free doesn't alleviate symptoms, it's possible that the issue is not celiac disease. In this case, it will be important to investigate other health issues. If the symptoms don't subside after about a year, refractory celiac disease might be the culprit. Although this is rare, it may be necessary to treat symptoms with steroids or immunosuppressants.

Additional Resources

• Celiac Disease
• Overview of Celiac Disease
• Celiac Disease
• Five Facts About Celiac Disease
• Definition and Clinical Manifestations of Celiac Disease
• Celiac Disease: Diseases of the Small Intestine
• Gluten Sensitivity or Celiac Disease? Same Symptoms, Different Causes
• Celiac Disease (PDF)
• Dietary Changes for Celiac Disease
• Diagnosis of Celiac Disease
• Celiac Disease
• Celiac Disease May Be Caused by Virus, New Study Finds
• Healing Grain: Scientists Develop Wheat That Fights Celiac Disease
• Dr. Runa Watkins Answers Common Celiac Disease Questions
• Symptoms of Celiac Disease
• Celiac Disease Symptoms List
• What Is Celiac Disease?
• Celiac Disease Symptoms, Tests, and Treatment
• Symptoms of Celiac Disease
• Celiac Disease
• Celiac Disease: An Introduction

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