Celiac Disease

What is celiac disease?

Just about everybody loves the smell of freshly baked whole-wheat bread, but not everyone can afford to take a bite. For anyone with celiac disease, this treat is practically poison. People with this condition are extremely sensitive to gluten, a class of proteins found in all foods made with wheat, rye, or barley. Even small amounts of these proteins can damage the intestines and block the absorption of vital nutrients.

Gluten doesn't harm the intestines directly. Instead, the proteins set the immune system into attack mode. The body releases powerful antibodies to fight the "intruder." Finding no germs to destroy, the cells turn against the lining of the intestine.

What causes celiac disease?

People with celiac disease have inherited genes that make them sensitive to gluten. However, not everybody with such genes shows signs of the disease.

Scientists believe the disease needs to be "turned on" before it can cause any problems. Large amounts of gluten during infancy and early childhood seem to help set the disease in motion. Some adults first notice symptoms after injury, infection, childbirth, or period of severe stress.

What are the symptoms of celiac disease?

The symptoms of celiac disease can vary widely from person to person, and tend to change with age. Infants often have stomach pain and diarrhea (possibly bloody) and may be slow to gain weight.

In toddlers and older children, common symptoms are nausea, stomach pain, a lack of appetite, anemia, mouth sores, and a blistering rash. The rash, most often found on the elbows, knees, or buttocks, may be the only indication of the disease. Children who don't absorb enough nutrients can show signs of malnourishment. They may become pale and thin with a bulging stomach. The disease may delay puberty and slow down growth in the teenage years.

Adults who develop celiac disease may have only mild intestinal problems, but most don't get off easy. Adult patients often feel tired, irritable, and depressed. And because celiac disease can block the absorption of calcium and iron, many adult patients develop osteoporosis and anemia. Untreated celiac disease can raise the risk of many other conditions, including an inflamed liver (hepatitis), an inflamed thyroid (thyroiditis), infertility, lymphoma, diabetes, and rheumatoid arthritis.

How is celiac disease diagnosed?

Tests that measure the levels of certain antibodies in the blood are good screening tools for diagnosing celiac disease. Since current tests aren't 100 percent accurate, however, you probably won't know for sure if you have celiac disease until you start avoiding gluten. If your symptoms go away quickly, the diagnosis is still more certain. The gold standard of diagnosis, however, is a biopsy of the small intestine.

Medical associations say there is not enough evidence to screen for celiac disease if you don't show symptoms of it. However, if you are experiencing regular symptoms (diarrhea, gas, bloating, vomiting, and fatigue), consider talking with your doctor about getting tested.

How is celiac disease treated?

There's only one sure cure for celiac disease: Give up gluten. It's simple advice that can be very difficult to follow. Gluten can lurk in strange places, from soy sauce to luncheon meat. To protect yourself, you'll have to learn to avoid gluten in all its forms.

With a little planning, people with celiac disease can enjoy varied diets. Several types of grain are perfectly safe, including rice, corn, flax, and sorghum. Oats were long considered a forbidden food, but recent studies suggest some people with celiac disease can safely eat them. Be cautious with oats, though; they can be contaminated with gluten during harvesting or milling.

To be sure to avoid foods with gluten and to plan your meals more creatively, you may want to talk with a registered dietitian. A dietitian can also help you to find a good gluten-free cookbook. Most stores now carry gluten-free flour, breads, and snack foods. And don't be shy about eating out -- many restaurants will be happy to discuss which of their menu options will work with your diet, especially if you are a repeat customer.

Feel free to indulge in potatoes, fruits, vegetables, aged hard cheese, meat, poultry, and eggs (well-cooked). Of course, any of these foods can be risky if they are combined with additives or other foods containing gluten.

People with celiac disease soon become experts at reading labels. Watch for any mention of the forbidden grains. Also look out for hydrolyzed vegetable protein, textured plant protein, or hydrolyzed plant protein. These can be made of either corn or soy (safe foods) or corn or soy mixed with wheat (unsafe). Contact the manufacturer if you have any questions or concerns.

Eating a gluten-free diet may be a hassle, but the rewards are tremendous. Your symptoms should quickly disappear, your intestines will heal, and your risk of developing other digestive diseases drops dramatically. Not even the taste of fresh whole-wheat bread can beat that.

Further Resources

Celiac Disease Foundation
13251 Ventura Boulevard, #1
Studio City, CA 91604
818/990-2354
818/990-2379 (fax)
http://www.celiac.org/

Celiac Sprue Association
PO Box 31700
Omaha, NE 68131-0700
402/558-0600
402/558-1347 (fax)
http://www.csaceliacs.org/

References

Evidence Lacking to Support Screening for Celiac Disease. American Association of Family Physicians. March 29, 2017.

Fasano A and C Catassi. Current Approaches to diagnosis and treatment of celiac disease: An evolving spectrum. Gastroenterology. Vol. 120(3): 636-651.

American Academy of Family Physicians. Celiac Disease.

Celiac Sprue Association. Gluten-Free Diet: Basic Diet Choices.

National Digestive Diseases Information Clearinghouse. Celiac Disease.

Mayo Clinic. Celiac Disease.

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