Celiac Diesease

What is celiac disease?
Celiac disease (CD) is an autoimmune disease that affects the small intestine and prevents the absorption of nutrients. It is caused by eating food with gluten, a protein found in rye, wheat and barley. If a person with celiac disease eats food with gluten, his or her immune system reacts by damaging the small intestines. There are about three million Americans diagnosed with CD today. The disease gets genetically passed from generation to generation, so there are many more people suffering from celiac, or have inherited the gene for celiac than reported. Some of them are suffering the debilitating symptoms because they are not aware that they have celiac. The problem is that the disease shows its ugly head with an enormous range of symptoms, some very similar to the symptoms of other diseases. (1)The University of Chicago. Celiac Desease Center. Celiac Disease Facts and Figures. Available here.

Symptoms of Celiac
The symptoms of celiac disease range greatly from person to person. In children, the symptoms mostly affect the digestive system (2)National Institute of Diabetes and Digestive and Kidney Diseases. Celiac Disease. Available here.:

  • bloating and stomach pain after eating food with gluten;
  • vomiting;
  • chronic diarrhea;
  • constipation;
  • weight loss.

Children with celiac also get easily irritable and quickly become anemic. Their problem absorbing nutrients from food when all their systems are developing makes celiac very serious and can make babies fail to thrive. Children can show delayed growth or have short stature. If the condition is not diagnosed and treated, children can have delayed puberty and problems with their permanent teeth.

While many adults with celiac can also have digestive problems, they are more likely to have:

  • iron-deficiency that cannot be explained by the diet;
  • anemia;
  • fatigue;
  • pain in bones or joints;
  • osteoporosis
  • depression;
  • anxiety;
  • numbness and tingling in the hands and feet;
  • seizures;
  • irregular menstrual periods;
  • infertility;
  • miscarriages;
  • sores inside the mouth.

Additionally, people suffering from celiac disease tend to be at higher risk of developing other autoimmune diseases such as:

  • Systemic lupus erythematosus;
  • Sjögren’s syndrome, which destroys glands that produce saliva and tears;
  • Addison’s disease, that damages glands which produce important hormones;
  • autoimmune liver disease;
  • autoimmune thyroid disease;
  • Rheumatoid arthritis.

They are also more prone to:

  • Lactose intolerance;
  • Type 1 diabetes;
  • Down syndrome;
  • Intestinal lymphoma;
  • Intestinal cancer.

Celiac disease can cause a range of mental health problems. These may include anxiety, stress, or insomnia, which can be linked to the fear of dealing with the disease, lack of minerals and/or vitamins due to the poor absorption of nutrients. (3)National Foundation for Celiac Awareness. Celiac Disease and Mental Health: Anxiety. Available here.

People with celiac can also develop Dermatitis Herpetiformis, a severe, itchy, blistering skin condition.

The longer the disease goes undetected and untreated, the more severe the symptoms become and the more the serious potential consequences.

Why did I get celiac disease?
If you have a first degree relative with celiac, you have one in 22 chance of developing the disease. (4)Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92. Available here.
If one of your secondary relatives, such as aunts, uncles or cousins, has celiac, your chance of getting it is one in 39. Most Americans who have been diagnosed with celiac are Caucasians or non-Hispanic whites. Very few minorities have celiac. (5)Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012 Oct;107(10):1538-44; quiz 1537, 1545. Available here.

A Swedish study found that children who had gluten introduced in their nutrition while they were still breastfed had less chances of developing celiac. (6)Ivarsson A, Hernell O, Stenlund H, Persson LA. Breast-feeding protects against celiac disease. Am J Clin Nutr. 2002 May;75(5):914-21. Available here.

Another study suggests that prolonged breast feeding may prevent celiac, that food with gluten should be introduced to children early in their childhood and that other dietary considerations early in life may affect the development of celiac symptoms later in life. The scientists did not clarify though, exactly when children should start eating food with gluten. (7)Ivarsson A, Persson LA, Hernell O. Does breast-feeding affect the risk for coeliac disease? Adv Exp Med Biol. 2000;478:139-49. Available here.

Having genes for celiac disease makes you more at risk, but it does not mean that you have, or will ever develop the disease. It does mean that you should get tested. Scientists believe that a large number of Americans live with celiac which is undiagnosed. On the other hand, most people who are on the gluten-free diet and participated in the research did not have celiac. Testing is crucial. (8)Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012 Oct;107(10):1538-44; quiz 1537, 1545. Available here.

Testing for celiac (9)MedlinePlus. Celiac disease – sprue. Available here.
People who have family members with celiac should conduct genetic testing in order to find out if they are at risk of developing celiac disease. If the gene is present, they have to carefully look for symptoms and get tested as soon as they suspect celiac disease.

Blood testing is designed to detect certain antibodies named tTGAs (antitissue transglutaminase)or EMA (anti-endomysium). If these antibodies are not present, you probably do not have celiac. Keep in mind that these tests will not show correct results if you are already on a gluten-free diet.

If the blood test is positive, your doctor will recommend an upper endoscopy, in order to take a small sample of tissue from the entrance to your small intestine. The test or biopsy will show the amount of damage to the villi, which are small protrusions in the intestine that absorb nutrients.

In elderly people suspected to have celiac, a special hydrogen breath test with D-xylose is sometimes recommended. (10)Casellas F, Sardi J, de Torres I, Malagelada JR. Hydrogen breath test with D-xylose for celiac disease screening is as useful in the elderly as in other age groups. Dig Dis Sci. 2001 Oct;46(10):2201-5. Available here.

Is there a cure?
All you can do to eliminate the symptoms of the disease and to lead a normal life is to completely eliminate gluten from your diet. This will be a life-long commitment. You will feel improvement in just a few days after starting a gluten-free diet. The diet, in most cases, will heal the damage in your intestines and will prevent further damage.

Since gluten is contained only in wheat, rye and barley, you might think that avoiding it will be easy. You can live without those three grains. Unfortunately, gluten is now added in many other products, and not only foods, for various reasons. It will be your job to read labels of everything, from foods, biscuits, candies, sauces, and even lip balm, to make sure that it does not contain gluten.

Because wheat is often mixed with other grains, any grain, cereal, pasta and many processed foods are off limits for you unless they are specifically labeled “gluten free”. Together with your doctor, you should create a gluten free diet that suits you best. With a little adjustment and a careful label-reading, you can live symptom-free and healthy.

References   [ + ]

1. The University of Chicago. Celiac Desease Center. Celiac Disease Facts and Figures. Available here.
2. National Institute of Diabetes and Digestive and Kidney Diseases. Celiac Disease. Available here.
3. National Foundation for Celiac Awareness. Celiac Disease and Mental Health: Anxiety. Available here.
4. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92. Available here.
5. Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012 Oct;107(10):1538-44; quiz 1537, 1545. Available here.
6. Ivarsson A, Hernell O, Stenlund H, Persson LA. Breast-feeding protects against celiac disease. Am J Clin Nutr. 2002 May;75(5):914-21. Available here.
7. Ivarsson A, Persson LA, Hernell O. Does breast-feeding affect the risk for coeliac disease? Adv Exp Med Biol. 2000;478:139-49. Available here.
8. Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012 Oct;107(10):1538-44; quiz 1537, 1545. Available here.
9. MedlinePlus. Celiac disease – sprue. Available here.
10. Casellas F, Sardi J, de Torres I, Malagelada JR. Hydrogen breath test with D-xylose for celiac disease screening is as useful in the elderly as in other age groups. Dig Dis Sci. 2001 Oct;46(10):2201-5. Available here.

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