It involves inflammation and destruction of the inner lining of the small intestine and can lead to the malabsorption of minerals and nutrients.
Symptoms may include chronic diarrhea, weight loss, and fatigue. In some cases, the only symptom is anemia, and celiac disease is not be diagnosed until later in life.
Celiac disease affects about 1 in 141 Americans. It can affect a person of any age who is genetically predisposed, but it often begins in middle infancy.
There is no cure, and the only effective treatment is a gluten-free diet.
Here are some key points about celiac disease. More detail is in the main article.
- Celiac disease is an autoimmune disorder that causes people to become intolerant to gluten.
- Long-term effects include anemia and malnutrition.
- The only effective treatment is a gluten-free diet.
- A gluten-free diet is only recommended for people who have a gluten allergy or intolerance.
People with celiac disease must avoid bread and other foods that contain gluten.
Celiac disease is a permanent disorder. Symptoms can range from mild to severe, they can change over time, and they can vary between individuals. Some people may have no symptoms, or symptoms may not appear until later in life.
Some common symptoms of celiac disease include:
- gastrointestinal symptoms, such as abdominal cramps, diarrhea, gas, nausea and vomiting, and bloating
- foul-smelling stools with excess fat in them
- bone and joint pain
- depression, irritability, and panic attacks
- weakness and fatigue
- easy bruising and nose bleeds
- fluid retention
- persistent hunger
- iron deficiency anemia
- malnutrition and nutrition deficiencies, including a lack of vitamin B12, D, and K
- mouth sores and tooth discoloration
- muscle wasting, muscle weakness, and muscle cramps
- nerve damage, leading to tingling in the legs and feet
- blood in the stools or in the urine
Some people develop a type of skin rash known as dermatitis herpetiformis (DH). Red, raised patches, and blistering may affect the elbows, knees, shoulders, buttocks, and face.
Celiac disease can lead to malabsorption and malnutrition, damage to the large intestine, and subtle damage to other organs.
Many adults with mild symptoms experience fatigue and anemia, or possibly only vague abdominal discomfort, such as bloating, abdominal distention, and excess gas. Some people have no clear signs of disease, but a general feeling of being unwell.
Variations in symptoms may may depend on:
- the length of time a person was breastfed, as symptoms tend to appear later in those who were breastfed for longer
- the amount of gluten consumed
- the age at which a person starts eating gluten
- the level of damage to the small intestine
People with celiac disease may be at higher risk of neuropathy, according to a study published in JAMA Neurology.
Stress and anxiety may bring on symptoms.
Symptoms in infants and children
In children and infants, there may be intestinal problems, such as diarrhea, irritability, and a failure to thrive, or delayed development.
In time, children may experience weight loss, damage to tooth enamel, and delayed puberty.
The doctor will examine the patient and ask about signs and symptoms, and they may request some tests.
Blood tests may detect:
- antigliadin antibodies
- endomysial antibodies
- anti-tissue transglutaminase antibodies
Blood is screened for antibodies against deamidated gliadin peptide (TTG) and sometimes antigliadin (AGA) and andomysium antibodies (EmA).
A small intestinal biopsy is considered the most accurate test for celiac disease. The doctor uses endoscopy to take samples of the intestinal lining. Usually, several samples are obtained to increase the accuracy of the diagnosis.
Conditions that have similar symptoms to celiac disease include:
- pancreatic insufficiency
- Crohn's disease of the small intestine
- irritable bowel syndrome
- small intestinal overgrowth of bacteria
- gluten sensitivity, which has similar, but milder symptoms and is being debated as an entity
The doctor should eliminate these possibilities when making a diagnosis.
Currently, the only treatment is to avoid gluten for life.
With strict observance of the diet, the intestines will normally heal and symptoms disappear, but eating gluten again can cause a relapse.
Patients need to be aware which foods contain gluten and which do not, but this may be difficult, as many products contain hidden gluten.
A qualified dietitian can help a person with celiac disease follow a healthy diet.
Products with and without gluten
A wide range of products are available labelled gluten-free. These include gluten-free breads, pasta, cookies and so on. Manufacturers are required to provide information about the ingredients used to make their food products, but individuals must check the label carefully before buying or consuming any product.
Gluten-free alternatives to bread, flour, pasta, and other foods are now widely available.
"Gluten-free" normally indicates that there is a harmless level of gluten rather than a total absence of it.
Regulations about the use of labelling on gluten-free products vary between countries, so patients should use caution.
A person who is following a gluten-free diet should avoid:
- all foods made from wheat, rye, bran, enriched flour, bulgur and barley, including cereals, breads, pasta, croutons, crackers, cakes, and cookies
- beer and other grain-based alcohol
Some oat preparations can be contaminated with wheat. In some cases, small quantities of oats are allowed into the diet under medical supervision.
Care should be taken with some food products that are produced in facilities that manufacture products containing gluten.
Many processed foods contain gluten, including:
- canned soups
- salad dressings, ketchup, and mustard
- soy sauce
- ice cream and candy bars
- processed and canned meats and sausages
Gluten may also be used in:
- some prescription and over-the-counter (OTC) medications
- vitamin products
- cosmetic products such as lipstick, lip gloss, chapstick, and toothpaste
- postage stamps
People with celiac disease often have a lactose intolerance, so avoiding lactose may help.
Anyone with celiac disease should read food labels carefully and check which restaurant foods are gluten-free. Some restaurants have a gluten-free menu.
A gluten-free diet for all?
Those who do not have celiac disease or a diagnosed gluten intolerance should speak to their doctor if they are thinking of "going gluten free."
A gluten-free diet can lead to other deficiencies, if not followed with care.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), "No current data suggests that the general public should maintain a gluten-free diet for weight loss or better health."
Foods that are safe to consume
Cereals such as corn, millet, sorghum, teff, rice, and wild rice are safe to consume.
Non-cereals such as amaranth, quinoa, or buckwheat are also harmless, as are potatoes and bananas, tapioca, and garbanzo beans. They do not contain gluten and do not trigger symptoms.
A person with celiac disease may need to take vitamin and mineral supplements to reduce the risk of deficiencies caused by the disorder.
Recipes can be made gluten free by substituting ingredients and adjusting the time and temperature used for baking.
Scientists are investigating medications that work directly in the intestines, treatments that affect the immune system, and vaccinations to treat celiac disease.
However, there is currently no treatment, except for avoiding gluten.
If the individual continues to consume gluten, this can affect their quality of life, and it may increase the risk of some medical conditions.
Hair loss, anemia, and osteoporosiscan occur because the body does not absorb nutrients effectively. Small bowel ulcers may develop.
Celiac disease has been linked to certain types of cancer, including intestinal lymphoma and adenocarcinoma of the small intestine, of the pharynx, and of the esophagus.
In rare cases, refractory disease may occur, if action is not taken to manage celiac disease. This most commonly happens because it is difficult to maintain a fully gluten-free diet.
In people with refractory disease, the condition has been present for so long that the intestines are no longer able to heal on diet alone, and a gluten-free diet will not help.
Medications, such as corticosteroids and immuno-suppressive drugs, may be prescribed.
Children with celiac disease
Left untreated, childhood celiac disease can result in small height in adulthood, but a child with celiac disease who switches to a gluten-free diet often starts to grow in height and recover any delay caused by the disorder. Intestinal damage begins to heal within weeks of removing gluten from the diet.
As time goes by, children may experience spontaneous remissions and remain free of the signs and symptoms of celiac disease until later in life, but symptoms can later reappear.
Celiac disease is an immune disorder. When a person with celiac disease eats gluten, their cells and immune systems are activated and attack and damage the small intestine.
In celiac disease, the immune system mistakenly attacks the villi in the small intestine. These become inflamed and impacted, and they may disappear. The small intestine is no longer able to absorb nutrients effectively. This can lead to a number of health risks and complications.
People who are more likely to have celiac disease include those with:
- another autoimmune disease, such as type 1 diabetes, rheumatoid arthritis, or an autoimmune disease that affects the thyroid or the liver
- a genetic disorder, such as Down syndrome or Turner syndrome
- a family member who has the disease
Having a family member with celiac disease increases a person's chance of having it to 1 in 10.
The Difference between Celiac Disease and Gluten Sensitivity
A traditional gluten free diet eliminates the primary documented glutens which are directly related to
Celiac disease. This would mean elimination of wheat, rye, and barley, oats, spelt and kamut. This
would also mean elimination of the various forms of wheat like farina, semolina, wheat germ, durum,
couscous and bran. There are also hidden sources of wheat in other products – examples of some are soy
sauce, certain creamed soups, hot dogs and processed meats, and beer. Replacements for those
eliminated items are the ‘lesser’ or supposed no-gluten (gliadin) versions are consumed. Examples of
some of those items would be corn, rice, buckwheat, and quinoa. There are also uses of bean flours and
vegetable starches, such as tapioca and potato to be used to ‘replace’ the wheat like products in our
processed goods of breads, pasta, cookies and pastries.
For those who understand the plant families – it is important to clarify that any plant that falls within the
grasses family, sub-classes of monocot and dicot all possess some form of gluten – the sticky protein that
is part of the grain/seed.
Monocots have 2 groups of species – and each of these have similar ‘glutens’ which have been known to
precipitate irritation in gluten sensitive folks:
1. Wheat, Rye, Barley
2. Rice, Oats, Corn, Sorghum, Millet, Teff
Dicots also have 3 groups of species and the jury is out on whether they really have impact to gluten
sensitive folks similar to their Monocot brethren:
1. Buckwheat, Rhubarb (fruits). Buckwheat is a seed that is related to rhubarb plant and has been
generally well tolerated by those who have issues with wheat.
2. Quinoa, Spinach
As for the True Gluten Free diet, it is essentially the removal of all grains from the individuals’
consumption. The diet would consist of a more ‘paleo’ or caveman-style dietary scope. The diet would
consist of organic meats and free range poultry, wild caught fish, organic fruits, vegetables, nuts, nongrain
based seeds and beans which one is not allergic to. Our human genome was geared around the
consumption of raw/cooked meats and foraging for plants in their various forms – tubers, nut, seed, fruit,
gourd or vegetable.
Following this truly gluten free diet is best done in parallel with supplementation to support the healing of
the gastrointestinal lining and mucosa to ensure better absorption and processing of nutrients from the
foods. Additionally it is best to avoid the ‘gluten free’ processed substitutes to mitigate any and all
potential cross-contamination or accidental exposure to a glutinous product.
Describe the differences between gluten sensitivity and celiac disease
The current definition of Gluten Sensitivity is not clear and focuses around the immune reaction to the
protein glutens found in wheat, barley, and rye. Depending on which allergist you speak to it can also
include the restriction of oats or not. The phrase has also been used synonymously with celiac disease
and that is not correct either. Most doctors do not even acknowledge there is such as thing as a Gluten
More realistically and from personal experience, Gluten Sensitivity is a condition stemming from genetic
origins and gets worse over time. This sensitivity does not show up like a traditional allergic reaction
(IgG or IgE) and has been known to weaken immunity. The glutens in the foods we eat destabilize the
gastrointestinal mucosal layer, allowing gaps (leaky gut) for the irritants to permeate the bloodstream. For
those folks who have genetic potentials for this, when the gluten when consumed, it results in abnormal
immune responses. This accumulation of irritants and its resulting antibody reactions has been shown to
triggers diseases. The sensitivity may not be the primary or sole cause of a disease as it can be a
contributing factor to it.
Celiac is one of many diseases that can be triggered from the Gluten Sensitivity condition. Celiac also
has genetic origins and when coupled with environmental exposures (other dietary and lifestyle issues)
becomes are more debilitating disease.
It can be said that you can be gluten sensitive individual, and not have Celiac disease; however if you
have Celiac disease, you do have gluten sensitivity as well. The public and other doctors still have a good
deal to learn about both.
Laura Keiles, PMP, ND, HHC
Keiles Wellness Care
Thank you Dr. Keiles and Welcome to the Gluten Free Society family of certified health care practitioners!
Learn more about the difference between gluten sensitivity and celiac disease below:
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