Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, affects around 2 million Americans. Its prevalence has increased in the last few decades. Celiac disease is a chronic, auto-immune condition associated with damage to the small intestine. Grains and foods that contain gluten trigger the damage.
In individuals with celiac disease, gluten stimulates the immune system to produce certain antibodies. These antibodies attack and damage the lining of the small intestine. Many nutrients from foods are absorbed in the small intestine. As a result, celiac disease is associated with malabsorption of nutrients and multiple nutrient deficiencies.
The good news is that eliminating gluten from the diet helps restore the small intestine lining in many cases. The gut function, the absorption of the nutrients, and the symptoms also improve with a strict gluten-free diet.
Celiac disease causes and risk factors
- Celiac disease has a very strong genetic predisposition, as this condition only occurs in individuals who have certain genes.
- Having someone in the family with celiac disease also increases the risk of developing this condition.
- Celiac disease is more common among those who have other genetic conditions like Down syndrome or Turner syndrome, and autoimmune illnesses, such as type 1 diabetes and thyroid diseases.
New research and the role of gut flora
The gut flora is important to immune health, digestion, and nutrition and may even play a role in gene expression. Recent studies suggest that certain genes that impact the gut flora may also play a role in celiac disease. Among environmental factors, recent studies found that breastfeeding may be protective against celiac disease, perhaps because breastfeeding is associated with healthier gut flora.
Celiac disease vs gluten sensitivity
Celiac disease is different from gluten sensitivity, also known as gluten intolerance or wheat intolerance. In the case of gluten sensitivity, a person may have similar symptoms with celiac disease like pain in the abdomen, bloating, changes in bowel movements, and fatigue. However, in the case of gluten sensitivity, the small intestine does not show damage characteristic of celiac disease.
A wheat allergy, on the other hand, is a type of food allergy that manifests with allergic-type signs and symptoms like itchy eyes, hives, and in severe cases, difficulty breathing. These symptoms occur right after eating foods with gluten.
Gluten sensitivity and wheat allergies are both managed with a strict gluten-free diet. Food sensitivity tests (IgG, IgM tests) and food allergy (IgE) tests can help detect other food sensitivities or allergies that often occur with intolerance to gluten.
Celiac disease symptoms
The symptoms vary greatly from one person and another, and adults and children. For adults, the most common signs and symptoms include:
- Diarrhea with greasy stools
- Weight loss (without dieting)
- Abdominal pain
More than 50% of adults with celiac disease experience symptoms outside the digestive tract, including anemia due to iron deficiency, osteoporosis, ulcers in the mouth, inflamed tongue, joint aches and pains, headaches, and fatigue. About 10% of people develop a characteristic skin rash with blisters, usually on the elbows, knees, torso, buttocks, and scalp called dermatitis herpetiformis. The nervous system can also be affected leading to numbness and tingling in the hands and feet, balance issues, and cognitive issues. Fertility issues are seen in both men and women with celiac disease.
In children, digestive signs and symptoms are predominant, including:
- Nausea and vomiting
- Stomach discomfort
- Excess bloating
- Chronic diarrhea
- Light-colored and foul-smelling stools
Due to malabsorption, infants may experience failure to thrive while older children may be shorter and experience delayed puberty. Weight loss, anemia, damage to the tooth enamel, irritability, learning disabilities, ADHD, headaches, seizures, and improper muscle coordination are all symptoms and conditions associated with celiac disease in children.
Celiac disease can lead to serious complications if left untreated. Besides reacting to gluten, people with celiac disease may also develop lactose intolerance and sensitivity to other foods. In addition to malnutrition, osteoporosis, infertility, and neurological complications, celiac disease also increases the risk of several cancer types, including lymphoma and cancer of the small intestine.
Celiac disease diagnosis
Many people are not aware they have celiac disease until they develop digestive problems and a doctor orders various tests. Two blood tests can help diagnose this condition. These tests have to be performed before an individual adopts a gluten-free diet.
Testing options include:
- Serology tests evaluate antibodies in the blood. Higher levels of specific antibody proteins suggest an immune response to gluten.
- Genetic testing assesses two human leukocyte antigens: HLA-DQ2 and DQ8. The genetic influence in celiac disease is given mostly by HLA DQ2 and DQ8. Genetic tests can also help rule out celiac disease, because negative tests for both HLA-DQ2 and HLA-DQ8 genes make celiac disease highly unlikely.
- Endoscopy can evaluate the health of the small intestine. A biopsy of the tissue confirms the diagnosis of celiac disease.
- Tests evaluating vitamin and nutrient deficiencies can further assess the nutritional status.
Celiac disease treatment
The following treatment options are available for those with Celiac disease:
Gluten-free diet: Celiac disease treatment involves following a strict free gluten diet for life. Even small amounts of gluten can be damaging to the small bowel. It includes eliminating all grains that contain gluten, including:
Oats can also be contaminated with gluten, and therefore you should only eat those certified as gluten-free. Gluten is found in many processed foods, like modified food starch, food stabilizers, as well in some medications, cosmetics and toothpaste.
Supplements: Vitamin and mineral supplements aim to correct nutrient deficiencies. Vitamins D, K, B9, and B12, iron, copper, and zinc are particularly important for individuals with celiac disease.
Steroid medication: Individuals may use these to control the inflammation in cases that do not respond enough to a gluten-free diet.
While many people manage this condition with a strict gluten-free diet, there are so-called non-responsive celiac diseases. As the name implies, non-responsive celiac means that a person does not respond to the diet. This form of celiac disease often develops due to contamination of the diet with gluten. Avoiding processed foods, choosing only certified gluten-free products, such as foods and cosmetics, and cooking at home can eliminate hidden sources of gluten. Non-responsive celiac disease can also occur when other conditions are associated with celiac disease, particularly irritable bowel syndrome or small intestinal bacterial overgrowth (SIBO).
Cecilio, L. A., & Bonatto, M. W. (2015). The prevalence of HLA DQ2 and DQ8 in patients with celiac disease, in family and in general population. Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery.
Mayo Clinic. Celiac Disease.
National Institute of Diabetes and Digestive and Kidney Diseases. Definitions & Facts for Celiac Disease.
The Institute for Functional Medicine. The Rising Prevalence of Celiac Disease.