An Overview of Celiac Disease

Celiac disease is a condition in which eating foods that contain the protein gluten—found in wheat, barley, and rye—causes damage to your small intestine. People who have celiac disease cannot absorb nutrients from their food and this can lead to serious health complications, such as malnutrition, osteoporosis, infertility, and even cancer.

With celiac disease, the intestinal villi wear down from contact with gluten.

Fortunately, the damage caused by celiac disease can often be reversed once you've been diagnosed and begin following a gluten-free diet, which is the only current treatment. But because celiac causes such a wide range of potential symptoms, it is frequently mistaken for other conditions and even overlooked entirely.

Celiac disease affects approximately one in every 100 Americans. However, most—85 percent or more—don't realize they have the condition and the average patient waits more than four years for an official diagnosis.

However, awareness of celiac disease (also known as coeliac disease, celiac sprue, and gluten enteropathy) is improving dramatically as more people speculate that gluten could be at the root of their health problems. Over the past few years, diagnosis of the condition has risen sharply as well. In addition, eating gluten-free has gotten easier as more food manufacturers produce products that are safe to eat.

What Is Celiac Disease?

Although you might hear people refer to celiac disease as a "gluten allergy," it's not a true allergy at all. Instead, it's what's called an autoimmune disease.

Put simply, in autoimmune diseases your immune system mistakes a part of your body for an invader and your infection-fighting white blood cells begin attacking that body part.

In celiac disease, gluten ingestion triggers your white blood cells to attack the lining of your small intestine.

The lining of your small intestine is made up of tiny, finger-like projections called villi. However, when someone with celiac disease eats a gluten-containing food, that gluten ingestion triggers their white blood cells to attack those little fingers, ultimately eroding the intestinal lining until it's worn smooth.

Since your villi help you digest foods, losing them to celiac disease leads to major problems.

Multiple Symptoms Linked to Celiac Disease

There's a myth that you need to suffer from diarrhea and weight loss in order to have celiac disease, but this is far from true. In fact, the majority of celiacs aren't underweight and many have constipation instead of diarrhea.

In fact, there are more than 200 potential celiac disease symptoms. Even though you might think of celiac primarily as a digestive problem (it originates in your digestive tract, after all), the condition can affect all your body's systems, from your brain to your skin.

The most common symptoms include:

Symptoms vary by gender and by age:

Although celiac disease is technically a condition involving your digestive tract, many people with it don't even report any intestinal problems—they may only have joint pain possibly combined with brain fog.

They may also have depression and/or anxiety or tingling in their arms and legs (a condition known as peripheral neuropathy that involves nerve damage). In fact, there's a huge variety of neurological symptoms associated with celiac disease.

It's also possible to have celiac disease without any symptoms at all. This is what's known as silent celiac disease. People with silent celiac disease don't have any obvious symptoms, but still have the intestinal damage that characterizes the condition.

Although celiac disease was once thought to primarily affect children, it's now clear that people of any age can be diagnosed. It's not at all unusual to find it in people over age 65 whose possible symptoms include potentially reversible dementia. Women are more likely to be diagnosed than men.

Causes of Celiac Disease

You need two things to have celiac disease: the genetic potential to develop it plus gluten in your diet. Without one or the other, you won't develop the condition.

However, that's far from the end of the story since many people who have the genes for celiac never develop the condition.

But it's not at all clear why some people with the so-called "celiac genes" wind up with celiac and others do not.

Some experts believe you also need some sort of "trigger" that causes you to develop celiac disease. There are people who believe a stressful period in their lives triggered their celiac disease. In addition, many women report the onset of symptoms after a pregnancy, another potential trigger. However, others who have celiac report a gradual onset of symptoms, so a trigger may not be essential.

Diagnosing Celiac Disease Requires Blood Tests & Biopsies

It's unfortunately not always straightforward to diagnose celiac disease—it usually takes multiple blood tests plus a procedure known as an endoscopy to determine if you have it. This process can take anywhere from several weeks to several months.

The blood tests, which usually represent the first step in the diagnosis process, screen your blood for high levels of antibodies associated with your body's reaction to gluten in your diet. Because the tests look for the actual reaction to gluten, you must be eating a gluten-containing diet for them to be accurate.

If the blood tests come back positive, the next step, in most cases, is an endoscopy, in which a surgeon uses an instrument to look directly at your small intestine and take samples of your intestinal lining.

In order to be officially diagnosed with celiac disease, those samples of your intestinal lining must show the villous atrophy that's found in the condition. However, it's also possible to obtain a diagnosis through skin testing if you have an itchy, gluten-related rash known as dermatitis herpetiformis.

Some people may suffer from celiac disease symptoms but have negative test results for the condition. In that case, they may be diagnosed with non-celiac gluten sensitivity, a recently recognized condition that's not yet well defined. Not all physicians agree that gluten sensitivity exists, and there's no accepted way to test for it yet.

Celiac Disease Treatment: The Gluten-Free Diet

Although there are currently several potential drugs for celiac disease in development, there's only one treatment you can use right now: the gluten-free diet.

To treat the damage caused by gluten, you need to eliminate gluten from your diet. Once you do that, your intestinal lining will begin to heal and other complications from celiac disease (such as malnutrition) should begin to resolve.

This seems simple but it's more difficult in practice. You literally have to avoid every speck of gluten, which means replacing kitchen equipment, cleaning out your kitchen and your house, and adopting new rules for eating out.

Following a gluten-free diet isn't easy. It takes a fair amount of research and practice before you can expect to get it right and get rid of all gluten. However, even if you slip up occasionally as you learn how to follow the diet, you will likely begin to feel better pretty quickly...and that makes your efforts worthwhile.

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Article Sources
  • National Institute of Digestive and Diabetes and Kidney Disease. Celiac Disease. Accessed July 7, 2016.

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