Celiac Disease

What is celiac disease?

Celiac disease is an autoimmune disorder of the intestinal tract. In autoimmune disorders, the immune system directs antibodies that attack the body itself.

The antibodies of celiac disease target gluten, a protein found in grains. Symptoms of celiac disease vary and may include digestive problems, anemia, skin rashes, and pain in the bones and joints. If you have celiac disease, you should not eat foods that contain gluten (wheat, rye, barley, oats).

What causes celiac disease?

Normally, the body’s immune system is designed to protect it from foreign invaders. When people with celiac disease eat foods containing gluten, their immune system produces antibodies to gluten, which then attack the intestine. This causes inflammation (swelling) in the intestines and damages the villi, which are tiny structures on the inner surface of the small intestine. Nutrients from food are absorbed through the villi; if the villi are damaged, the individual cannot absorb nutrients and may become malnourished, regardless of how much they eat.

Other causes of malabsorption include:

• Genetics (a close relative with the disease)
• Medical conditions such as surgery, pregnancy, or childbirth
• Diseases like viral infections

What are the symptoms of celiac disease?

Symptoms of celiac disease vary among individuals and include:

• Digestive problems (abdominal bloating, pain, gas, diarrhea, pale stools, and weight loss)
• A severe skin rash known as dermatitis herpetiformis
• Anemia
• Musculoskeletal problems (muscle cramps, pain in bones and joints)
• Growth problems and failure to thrive (in children)
• Tingling in the legs (caused by nerve damage and low calcium levels)
• Mouth ulcers (sores in the mouth)
• Menstrual disorders

What other health problems may accompany celiac disease?

Celiac disease can make a patient vulnerable to other health issues, including:

• Colorectal cancer (very rare)
• Osteoporosis, a disease that weakens bones and leads to fractures. This occurs because the individual has trouble absorbing calcium and vitamin D.
• Miscarriage or infertility
• Genetic anomalies, such as neural tube defects caused by poor absorption of nutrients like folic acid
• Growth problems in children due to inadequate nutrient absorption

People with celiac disease may also have other autoimmune diseases, including:

• Thyroid disease
• Type 1 diabetes
• Lupus
• Rheumatoid arthritis
• Liver disease
• Sjögren’s syndrome (a disorder that causes inadequate saliva and tear production from the glands)

How is celiac disease diagnosed?

If your doctor suspects you may have celiac disease, they will conduct a thorough clinical examination and discuss your medical history with you. They may also recommend blood tests to measure levels of antibodies to gluten. Individuals with celiac disease have higher levels of certain antibodies in their blood.

Your doctor may recommend additional tests to check for nutritional deficiencies, such as blood tests to detect iron levels. A low iron level (which can cause anemia) may occur in celiac disease. A stool sample may be tested for fat content, as celiac disease prevents fat from being absorbed from food.

Your doctor may take a biopsy from the small intestine to check for damage to the villi. In a biopsy, the doctor inserts an endoscope (a thin tube) through your mouth to the small intestine and takes a biopsy sample.

How is celiac disease treated?

If you have celiac disease, you cannot eat foods that contain gluten (wheat, rye, barley, oats). Avoiding gluten from your diet usually improves your condition within a few days, and symptoms of the disease eventually cease. In most cases, the villi heal within six months.

You must remain on this diet for the rest of your life; eating gluten will damage your intestine and restart the problem. Some individuals with celiac disease have such significant damage to their intestines that a gluten-free diet does not help them. These patients may need to receive intravenous (IV) nutritional supplements.

A gluten-free diet means that you cannot eat many foods, including the following: pasta, cereals, and many processed foods that contain grains. Gluten may also be present in ingredients added to foods to improve texture or flavor, and in products used in food packaging.

If you have celiac disease, you can eat a well-balanced diet. For example, bread and pasta made from other types of flour (potato, rice, corn, or soy) are available. Food companies and some grocery stores also carry gluten-free breads and products. You can also eat fresh foods that have not been artificially processed, such as fruits, vegetables, meats, and fish, as these do not contain gluten.

What are the practical aspects of celiac disease?

A gluten-free diet will be a significant change in your life. You will need to reconsider your eating habits, including what you buy for lunch, what you eat at parties, or snacks. When shopping, be sure to read ingredient labels carefully. A dietitian, a healthcare professional who specializes in food and nutrition, can help you with a gluten-free diet. There are also support groups that can assist patients who have just been diagnosed with celiac disease.

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