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What is Celiac Disease?

Updated: Dec 9, 2022

Celiac Disease is a serious autoimmune disorder in which the body cannot process gluten, a protein found in wheat, rye, & barley. When people with celiac disease eat gluten, their body mounts an immune response that attacks the small intestine. These attacks lead to damage of the villi, small fingerlike projections that line the small intestine, which promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body. Eventually, this can lead to malnourishment, as well as to the loss of bone density, miscarriages, infertility – and even to the beginning of neurological diseases or certain cancers.

Celiac disease isn’t the same thing as a food allergy, so the symptoms will differ. If you’re allergic to wheat, you may have itchy, watery eyes or a hard time breathing if you eat something that has wheat in it. However, if you have celiac disease and accidentally eat something with gluten in it, you may have intestinal problems (like diarrhea, gas, constipation) or any of the following symptoms:

  • Abdominal pain

  • Nausea

  • Anemia

  • Itchy, blistery rash

  • Loss of bone density

  • Headaches or general fatigue

  • Bone or joint pain

  • Mouth ulcers

  • Weight loss

  • Heartburn

This disorder occurs most commonly with a genetic predisposition. People with a first-degree relative with celiac disease (parent, child, or sibling) have a 1 in 10 risk of developing celiac disease. Most people with celiac disease never know they have it. It’s estimated that 2.5 million Americans are undiagnosed and are at risk for serious health complications. The damage to the intestine is very slow and symptoms are so varied, that it can be years before someone gets a diagnosis. Left untreated, celiac disease can lead to the following conditions:

  • Iron deficiency anemia

  • Early onset osteoporosis or osteopenia

  • Infertility and miscarriage

  • Lactose intolerance

  • Vitamin and mineral deficiencies

  • Central and peripheral nervous system disorders

  • Pancreatic insufficiency

  • Intestinal lymphomas and other GI cancers (malignancies)

  • Gall bladder malfunction

Currently, the only treatment for celiac disease is lifelong adherence to a strict gluten-free diet. Many people opt to eat gluten-free diets but for those with celiac disease, it’s a must. Those living gluten-free must avoid foods with wheat, rye and barley, such as bread and beer. Ingesting small amounts of gluten, like crumbs from a cutting board or toaster, can trigger small intestine damage.

Some people have a gluten sensitivity but not full blown celiac disease. People with non-celiac wheat sensitivity experience symptoms similar to those of celiac disease, which resolve when gluten is removed from the diet. However, they do not test positive for celiac disease. Some people experience symptoms the same symptoms found in celiac disease, such as “foggy mind”, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet. The terms non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) are generally used to refer to this condition, when removing gluten from the diet resolves symptoms.

If you are currently on a gluten-free diet, your physician may recommend a gluten challenge to allow antibodies to build in your bloodstream prior to testing. The recommended gluten intake for the gluten challenge is two slices of wheat-based bread for 6-8 weeks. A gluten challenge should only be supervised by a physician trained in celiac disease, who can move you immediately to a biopsy if your symptoms are severe. Never undertake a gluten challenge when pregnant.

Celiac disease can be difficult to diagnose because it affects people differently. There are more than 200 known celiac disease symptoms which may occur in the digestive system or other parts of the body. Some people develop celiac disease as a child, others as an adult. The reason for this is still unknown.

The most common way to diagnose celiac disease is with a simple blood test. People with celiac disease who eat gluten have higher than normal levels of certain antibodies in their blood. These antibodies are produced by the immune system because it views gluten as a threat. You must be on a diet containing gluten for antibody (blood) testing to be accurate. For most children and adults, the best way to screen for celiac disease is with the Tissue Transglutaminase IgA antibody, plus an IgA antibody, in order to ensure that the patient generates enough of this antibody to render the celiac disease test accurate. For young children (around age 2 years or below), Deamidated Gliadin IgA and IgG antibodies should also be included. Some people with celiac disease have no symptoms at all, but still test positive on the celiac disease blood test. A few others may have a negative blood test, but have a positive intestinal biopsy. However, all people with celiac disease are at risk for long-term complications, whether or not they display any symptoms. While it is very rare, it is possible for someone with celiac disease to have negative antibody test results. If your tests were negative, but you continue to experience symptoms, consult your physician and undergo further medical evaluation.

By Gina Stallone

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