Celiac disease – also known as celiac sprue or gluten intolerance – is a genetic disease that results in the inability to properly digest gluten, a type of protein found in wheat, barley and rye. When a person with celiac disease eats gluten, it causes damage in the small intestine. About 1% of people around the world have celiac disease, according to the Celiac Disease Foundation.
Celiac disease is an autoimmune disease. This means that the immune system has an overresponse to something in the body. If you have celiac disease, your body views gluten as a foreign invader. So if you eat gluten, the immune system responds by attacking the lining of your small intestine. This leads to damage of the villi, which are finger-like protrusions lining the small intestine that help you to absorb nutrients from food. Once your villi are damaged, it’s hard for nutrients to be properly absorbed.
Gluten Sensitivity vs. Celiac
Gluten sensitivity, which you may hear people talk about, is different from celiac disease. Gluten sensitivity refers to someone who may feel bloating, diarrhea or other symptoms when eating gluten, but they don’t have long-term intestinal damage from eating gluten.
By contrast, someone with celiac disease can have long-term health complications from gluten, says Grace Derocha, a Detroit-based registered dietitian and national spokesperson for the Academy of Nutrition and Dietetics. Gluten sensitivity, sometimes also called non-celiac gluten sensitivity, isn’t an autoimmune disease. Gluten sensitivity is different from a food allergy, which can have more serious health effects.
Symptoms of Celiac Disease
It’s not always clear if someone has celiac disease. That’s because it has more than 200 potential symptoms. Some people don’t have any symptoms at all, says Amy Kimberlain, a Miami-based national spokesperson for the Academy of Nutrition and Dietetics. It may take time to recognize that you have celiac disease because it’s easy to associate the symptoms with other gastrointestinal conditions, such as irritable bowel syndrome or lactose intolerance, Kimberlain says.
Some adults, although not all, have the classic symptoms of celiac, which include diarrhea and foul-smelling stools. Other than digestive symptoms, some of the other most common symptoms of celiac disease in adults include:
- Bone or joint pain.
- Depression or anxiety.
- Unexplained anemia.
- Missed menstrual periods.
In children, some of the most common signs of celiac are:
- Abdominal bloating and pain.
- Behavioral issues.
- Chronic diarrhea.
- Delayed growth and puberty.
Causes of Celiac Disease
Celiac disease is caused by a genetic disposition. That means your genes will determine if you could develop it. Still, not everyone with those genes will develop celiac disease. If you have a first-degree family member with celiac disease, you have a 1 in 10 risk of developing it.
Other factors could play a role in your chance of developing celiac disease: One factor that may contribute to celiac disease is having gastrointestinal infections. Some people have developed celiac disease after childbirth, emotional stress and surgery.
There has been an increase in celiac disease in recent decades. Greater awareness of the disease and more testing may have led to this uptick, says Dr. Benjamin Hyatt, a gastroenterologist at Middlesex Digestive Health & Endoscopy Center in Acton, Massachusetts.
Autoimmune diseases are on the rise in general, including celiac disease, although it’s not clear why that’s happening, he adds.
Diagnosing Celiac Disease
Celiac disease is often diagnosed with a blood test that screens for transglutaminase IgA antibody. An antibody is a protein made by the body in response to something the body recognizes as foreign. An elevated amount of this antibody can indicate an immune reaction to gluten. Sometimes, doctors will test for other antibodies as well.
There also are genetic tests to rule out celiac disease, Derocha says.
Another way that doctors diagnose celiac disease is with a biopsy from the duodenum – which is the region of the small intestine most affected in celiac disease, Hyatt explains. A small sample of tissue is removed and examined for inflammation and damage, such as shrinking of the villi due to frequent gluten exposure.
Treating Celiac Disease
The most effective way to treat celiac disease is to follow a strict gluten-free diet. “By remaining gluten free, your villi are able to heal in the small intestine, and, ultimately, your symptoms will resolve,” Kimberlain says.
Common foods with gluten include:
The trickier part is to stay aware of all the products, even beyond food, that may have gluten. That’s because gluten also can be part of medications and nonfood products, such as:
- Envelope and stamp glue.
- Over-the-counter and prescription drugs.
- Toothpaste and mouthwash.
Even ingesting bread crumbs with gluten that may be found on a cutting board or toaster could lead to small intestine damage, the CDF reports.
There are more gluten-free products nowadays, but it’s always best to double check that a product is gluten-free if you aren’t sure, Kimberlain says. This includes verifying that a product is made in a facility where it did not come into contact with gluten.
Complications From Celiac Disease
There are an estimated 2.5 million people in the U.S. with undiagnosed celiac disease, the CDF reports. When celiac disease is untreated, it can lead to other complications in the body. These include:
- Bone weakening.
- Cancer, such as intestinal lymphoma and small bowel cancer.
- Dermatitis herpetiformis, which is a rash that appears on parts of the body such as the elbows and knees.
- Infertility and miscarriage.
- Lactose intolerance.
- Nervous system problems such as peripheral neuropathy. This causes a tingling, burning or lack of feeling in the hands or feet.
- Nutritional deficiencies, including calcium, folate and vitamins A, B12, D, E and K.
- Other autoimmune disorders, including Type 1 diabetes, multiple sclerosis and Sjögren’s syndrome.
Following a strict gluten-free diet can lead to normal absorption of nutrients and reverse nutritional deficiencies, Hyatt says. It also can reduce the risk for cancers, although there still appears to be a slightly increased risk during the first few years after you’re diagnosed, he adds.
If you have celiac disease, you still have a risk of developing other autoimmune diseases, particularly, Type 1 diabetes and thyroid disease, Kimberlain says. The chance of developing another autoimmune condition increases the later in life you are diagnosed. For instance, those diagnosed with celiac disease between ages 4 and 12 have a 16.7% chance of developing another autoimmune disease, while those diagnosed at age 20 or older have a 34% chance.
If you know that you have celiac disease, work with your doctor or a registered dietitian to address any nutritional deficiencies.
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