What Is Celiac Disease?
You’ve probably heard of the gluten free diet – you may have even tried it yourself. As popular as the gluten free diet is, many people fail to realize that it is much more than just another fad diet. For roughly 1% of the American population, it is a medical necessity.
Celiac disease is a condition in which consuming gluten triggers an immune response in the body that causes inflammation and damage to the small intestine. The only treatment is a gluten free diet.
Though celiac disease affects as many as 1 in 100 people around the world, many people don’t even know they have it. In fact, there are estimates that as many as 2.5 million Americans are suffering from undiagnosed celiac disease. Keep reading to learn more about this condition including its symptoms, diagnosis, and treatment options.
What Is It, Anyway?
Many people confuse celiac disease with wheat allergy, though the two are distinctly different.
Wheat allergy involves an abnormal immune system response to one or more of the proteins in wheat and, in some people, the allergic reaction can be life-threatening. Celiac disease, on the other hand is an autoimmune disease triggered by gluten, a specific protein found in wheat, barley, and rye. Because it affects the small intestine, it is also classified as a digestive disorder.
Celiac disease is a permanent disorder and the symptoms range from mild to severe. In fact, there are over 300 symptoms that have been linked to celiac disease – this may be why there are so many people who have it that remain undiagnosed. Though celiac disease is not curable, it can be managed by removing gluten (including trace amounts) from your diet.
Signs and Symptoms of Celiac Disease
On the outside, celiac disease may present with mild symptoms such as bloating, abdominal cramping, and fatigue. What’s happening inside your body, however, can be much more serious.
When someone with celiac disease consumes gluten, the body launches an immune response to the protein, creating antibodies designed to fight it. These antibodies are designed to attack gluten, the perceived threat, but in doing so also end up damaging the villi lining the walls of the small intestine. These tiny fingerlike projections support nutrient absorption, so damage to the villi can reduce the body’s ability to absorb nutrients.
Because celiac disease often leads to malabsorption of nutrients, chronic fatigue is one of the major symptoms. Other common symptoms of celiac disease include the following:
- Weight loss
- Itchy skin rash
- Bone or joint pain
- Brain Fog
Many adults with celiac disease experience symptoms unrelated to the digestive system such as anemia, osteoporosis, headaches, fatigue, neuropathy, and joint pain. Children with celiac disease, on the other hand, are more likely than adults to experience digestive symptoms. Common symptoms of celiac disease in children include nausea, vomiting, diarrhea, abdominal distention, constipation, and gas. The inability to absorb nutrients may result in additional symptoms like failure to thrive, weight loss, anemia, irritability, stunted growth, delayed puberty, and neurological symptoms.
Though many people with celiac disease experience digestive symptoms, between 10% and 15% have skin-related symptoms instead. Dermatitis herpetiformis (also known as gluten rash) is a chronic skin condition linked to gluten consumption that leads to bumps, blisters, and lesions.
Diagnosis and Treatment Options
Diagnosing celiac disease can be tricky for a number of reasons. As already mentioned above, there are more than 300 different symptoms that have been linked to celiac disease and many of those symptoms overlap with other diseases, particularly digestive disorders.
The first step in diagnosing celiac disease is often a blood test to screen for the antibodies previously mentioned. Screening is recommended for the following:
- Children over 3 years old and adults experiencing symptoms of celiac disease
- First-degree relatives of people with celiac disease
- Individuals with an associated autoimmune disorder
The primary screening for celiac disease is a tTG-IgA test. Tissue Transglutaminase IgA antibodies and IgA antibodies are present in 98% of individuals with celiac disease who are currently following a gluten-inclusive diet. If the blood test is positive, your doctor may then recommend an intestinal biopsy to check for damage to the villi lining the small intestine that would confirm a diagnosis of celiac disease.
The only successful treatment for celiac disease is a lifelong gluten free diet. Celiac disease is a chronic autoimmune disease and, as such, you can’t expect children to grow out of it or for adults to recover from it. In order to resolve symptoms and allow the digestive tract to heal, you must limit yourself to food and beverages with gluten content under 20 ppm.
In addition to following a gluten free diet, the following may also be recommended:
- Dietary supplements for fiber, iron, calcium, magnesium, zinc, folate, niacin, vitamin B12, and vitamin D to resolve related nutritional deficiencies.
- Increase in calorie and protein content of the diet to resolve issues with weight loss.
- Continued supplementation with Vitamin B in cases where patients continue to be deficient after going gluten free.
- A bone density test to check for osteopenia/osteoporosis, generally taken at the time of diagnosis or for children with severe malabsorption.
- Many people with celiac disease also develop lactose intolerance because the lactase enzymes used to digest it are located on the ends of the villi in the small intestine – people with lactose intolerance should avoid lactose as well or take lactase enzymes to help them digest it.
If you suffer from dermatitis herpetiformis, switching to a gluten free diet should provide long-term relief. In some cases, however, more immediate relief from symptoms is desired in which case treatment with dapsone may be recommended by your doctor. Dapsone is a medication prescribed for short-term itch relief – people who can’t tolerate it may be given sulfapyridine. If you have any questions regarding these medications, please contact your doctor.
Getting Started with the Gluten Free Diet
The gluten free diet is the only treatment currently available for celiac disease. As the name suggests, this is a diet that does not contain gluten – this means avoiding foods and food products made with wheat, barley, and rye.
Switching to the gluten free diet can be a significant change, but it is something you will get used to over time. The first step is to learn how to identify gluten in the foods you eat. There are obvious sources like wheat flour and foods made with it like cookies, cakes, and pasta. You also need to keep an eye out for hidden sources of gluten, however, like some brands of soy sauce, certain seasonings or soup mixes, salad dressings, and more.
Here is a quick list of some foods that are naturally gluten free:
- Fresh, canned, or frozen vegetables
- Fresh, canned, or frozen fruits
- Plain meat, poultry, eggs, and seafood
- Plain dairy products like milk, cheese, and yogurt
- Plain nuts, seeds, nut butters, and seed butters
- Beans and legumes like lentils, chickpeas, and peas
- Natural fats and oils
- Natural beverages like water, coffee, tea, and juice
- Gluten free grains like buckwheat, corn, rice, quinoa, and sorghum
In addition to these foods, you can find plenty of delicious gluten free packaged foods at your local grocery store or online. Just make sure they are labeled gluten free and double-check the ingredients list for gluten-containing ingredients to be safe. Keep in mind as well that just because these foods are gluten free doesn’t necessarily mean they are low in fat or calories – you still need to pay attention to what you eat and make an effort to follow a healthy and balanced diet.
Not only do you need to avoid foods that contain gluten, but you also need to be careful about eating foods that have come into contact with food sources of gluten – this is called cross-contamination. You may need to purchase separate dishes, cleaning supplies, and utensils to use for your gluten free foods and you’ll need to keep your food separate if you share a house or a kitchen with other people. You’ll also need to be very careful when eating out at a restaurant.
As long as you strictly adhere to the gluten free diet, you should start feeling better very soon!