Celiac Disease

1 What is celiac disease?

How does celiac disease occur?

Celiac disease is a serious disorder of the immune system that causes damages in the small intestines when you eat any food that contains a protein called gluten.

Before we learn more about how celiac disease occurs, you should know a more about how you may develop an auto-immune disease.

Celiac disease statistics:

  • On average, 1 in 133 healthy people has celiac disease. If anyone in your family has it, the risk increases to 1 in 22
  • Approximately 60% of children and 41% of adults diagnosed with it had no symptoms at the time
  • Chronic diarrhea is present in only 35% of the patients. Therefore, it suggests that diarrhea is not a strong indicator of celiac disease
  • At least 3 million US citizens are living with this disorder, compared to 2.1 million with rheumatoid arthritis (RA). Remember RA is also an autoimmune disorder. Unfortunately, only 3% of them are diagnosed
  • Most of the 2,000+ gluten-free food items are available in your standard grocery stores

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Celiac disease is an auto-immune disorder

In a normal condition, your immune system acts as the body’s wall of defense. It protects you from a number of microorganisms by destroying them before they can turn infectious. The immune cells do so by secreting certain chemicals called antibodies.

As long your immune system works optimally, you remain safe as it keeps the infections at bay. But in some patients, the immune cells lose their ability to differentiate healthy cells of the bodies from the microorganisms.

Consequently, they launch an immune attack on the healthy cells and tissues and damage them. It is not exactly clear why such immune misfire happens. This is known as an autoimmune disorder.

Some well-studied autoimmune disorders are rheumatoid arthritis, systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), multiple sclerosis (MS), and Type I diabetes.

Understandably, the same is the case when you have celiac disease. When you have it, the immune system attacks the cells in the small intestine. As a result, your ability to absorb nutrients from the ingested food is greatly affected.

This is because the small intestine has numerous small projections that have thin walls allowing more of the nutrients to pass into the blood circulation. These are called villi.

Celiac disease irreversibly destroys the villi when you eat any food that contains a plant protein called gluten.

Therefore, celiac disease is also called gluten sensitivity, nontropical sprue, or gluten enteropathy.

The celiac disease diet: Avoiding gluten improves symptoms

You should know that there is no cure for celiac disease. However, dietary modification can play a pivotal role in alleviating the distressing symptoms. It can also help to curb further damages to the small intestines, thereby preventing complications.

Doctors recommend a gluten-free diet, also referred to as a celiac disease diet, for patients. Avoiding gluten helps the damaged parts of the intestine heal faster. A complete reversal of the symptoms may not be possible in all patients.

Nevertheless, significant healing has been observed in almost every celiac patient who has started a gluten-free diet.

It may take up to 2 years for a complete recovery after giving up gluten-containing foods. In essence, the earlier the diagnosis, the better chance for complete reversal of celiac disease.

What is gluten?

Gluten is a protein found in grains that include wheat, rye, barley, and oat. Common food items such as bread products, imitation meats, beer, soy sauce, ice cream and ketchup also contain gluten in different proportions. 

What foods should you eat with celiac disease?

You may find it really challenging to completely avoid gluten from your diet. You can consider the following food groups:

Naturally gluten-free foods: These include fruits, vegetables, meat and poultry, fish and seafood, dairy, beans, legumes, and nuts.

Gluten-free grains and starchy foods: These include rice, cassava, maize, soy, potato, beans, millet, flax, and chia. In addition, you can also get gluten-free oats at your grocery store.

What do gluten-free food labels mean?

Due to the seriousness of celiac disease and its potential complications, the US FDA issued the criteria for gluten-free labels on foods.

According to this, any food that contains less than 20 parts per million (ppm) of gluten is eligible to have the label. Depending on the manufacturers, other terms such as “no gluten”, “free of gluten”, and “without gluten” may also be used.

It may seem counterintuitive as these gluten-free foods contain very little gluten. But the amounts within the limit are not able to trigger celiac disease or aggravate its symptoms.

Are gluten-free foods totally safe?

A strict gluten-free diet may lead to a deficiency of minerals, vitamins, and other essential nutrients. Therefore, you should always plan your meals wisely.

In addition, a recent study suggests there may be a weak link between such a diet and Type II diabetes. However, the benefits of a gluten-free diet outweigh the risk if you’re suffering from celiac disease. You may ask your doctor about this if it concerns you.

Notably, such a link may be more relevant if your risk of diabetes is high. The risk factors include obesity, heredity, and lifestyle factors.

Key points to remember:

  • Patients with celiac disease should avoid gluten for the rest of their life
  • If you have not been diagnosed, you should not start a gluten-free diet on your own. Always talk to your doctor if you think you have celiac disease
  • You can enjoy delicious foods even when avoiding gluten. Talk to a nutritionist who can design gluten-free meals that best meets your needs and tastes

2 Symptoms

Signs and symptoms of Celiac disease vary greatly. However the typical signs and symptoms are:

Symptoms in infants:

  • Chronic diarrhea
  • Swollen belly
  • Pain
  • Growth retardation
  • Weight loss

Symptoms in older children:

Neurologic symptoms, including attention-deficit/hyperactivity disorder (ADHD), learning disability, headaches, and lack of muscle sometimes occur.

3 Causes

The precise cause of celiac disease is yet to be determined. If you are gluten sensitive and take any food that contains gluten, an immune attack is launched against gluten which damages the tiny, hair-like projections (villi) lining the small intestine. Nutrients from food are absorbed by villi.

Consequently, your body cannot absorb nutrients necessary for normal health and growth. Genetic mutations may play a role in increasing your risk of celiac disease. However, only your genes cannot be blamed for the condition.

There are various other contributing factors that add to the risk. Sometimes, conditions like surgery, pregnancy, childbirth, viral infection or severe emotional stress may trigger the disease.

4 Making a diagnosis

The diagnosis of celiac disease is a challenging task for physicians. This is because many of its symptoms overlap with those of other health conditions.

Additionally, a small fraction of patients develop undesirable symptoms when they have glucose, but they do not test positive for celiac disease. This condition is called non-celiac wheat sensitivity (NCWS).

Symptoms may include:

How to test for celiac disease

Your immune system produces certain antibodies when you take gluten. Understandably, measuring the blood levels of these antibodies can help your doctor determine if you have a chance of developing celiac disease. These tests are useful for screening purposes.

You should understand that these antibody-measuring tests may be erroneous at times. Only biopsy can confirm a true diagnosis.

Tissue Transglutaminase Antibodies (tTG-IgA) Test: It measures the blood levels of antibodies released against gluten. Approximately 95% of patients on a gluten-containing diet will have a positive result in this test.

Nonetheless, if you already have another autoimmune disorder, the results may be positive, but in reality, you do not have celiac disease.

IgA Endomysial antibody (EMA): It is a more expensive but less sensitive test. It may be used in the patients who have difficulty getting diagnosed using other antibody tests.

Deaminated gliadin peptide (DGP IgA and IgG): This test helps in the further screening of the patients. It may be used in those who show negative results in the tTg or EMA tests.

Genetic testing: Since the celiac disease has its origin in the genetics, you can consider this test. It can be particularly very beneficial if you have a first-degree family member with celiac disease. Positive test results mean you should get tested every 2-3 years even when you do not have the symptoms.

Your doctor can analyze the blood or saliva for the genetic testing.

Your doctor can also order other celiac disease tests such as:

  • Stool examination: To determine if you have a problem with the absorption of fats
  • Tolerance test: Lactose tolerance test to see if you can digest milk sugar, or lactose
  • Imaging tests help to evaluate if you have abnormally dilated small intestines. These tests are particularly more useful to detect celiac disease that is untreated

How to prepare for celiac disease testing

Before taking any of the tests for celiac disease, you should learn about the sensitivity of each test.

Ask your doctor what positive or negative results mean for you. It is very important to inform your doctor if you are pregnant or have some other autoimmune disorder. 

Celiac Disease

5 Treatment

A gluten-free diet is the only treatment for managing celiac disease. 

Talk to your dietitian for help with a gluten-free diet regimen.

An inflamed small intestine generally begins to resolve within several weeks. However, you may have to wait for several months to several years before your intestine heals completely and regrows. Intestinal healing is more rapid in children than adults.

  • Vitamin and mineral supplements: You may be recommended to take vitamin and mineral supplements if deficiencies are severe. Some common supplements include those for calcium, folate, iron, vitamin B-12, vitamin D, Vitamin K, and Zinc. Generally, oral supplementation is advised, but if there is any serious issue with absorption, your doctor may give them by injection.
  • Medications to control intestinal inflammation: You may have to take steroids if intestinal inflammation is severe. The steroids can alleviate the severe signs and symptoms of celiac disease.
  • Dermatitis herpetiformis: Itchy, blistering skin rash associated with celiac disease can be treated with skin medication.

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to prevent the symptoms of Celiac disease.

Avoiding gluten is the only way for preventing the symptoms of celiac disease. Talk to your doctor or dietician to plan a gluten-free diet regimen.

Select the packaged foods that are labeled as gluten-free or have no gluten-containing ingredients.

Foods to avoid:

Cereals, pastas and baked goods such as breads, cakes, pies and cookies, beer, candies, meats or seafood, processed luncheon meats, salad dressings and sauces, including soy sauce. You may need to avoid oats unless they are specifically labeled gluten-free.

Food to eat:

Fresh meats, fish and poultry that aren't breaded, batter-coated or marinated, fruits, most dairy products, potatoes, vegetables, wine and distilled liquors, ciders and spirits, Amaranth Arrowroot Buckwheat Corn Cornmeal Gluten-free flours (rice, soy, corn, potato, bean) Pure corn tortillas Quinoa Rice Tapioca .

7 Risks and complications

There are several risks and complications associated with celiac disease.

Risks

The risk for celiac disease in raised if you have:


The effects of celiac disease go beyond the digestive system

Celiac disease primarily affects the digestive tract. This is the reason why typical celiac disease symptoms are related to it. Nonetheless, a certain fraction of the patients may develop widespread symptoms.

What further complicates diagnosis is most of these symptoms are not specific and could also be due to other conditions.

Celiac disease is associated with other conditions including:

Dermatitis herpetiformis: This is a common effect of celiac disease seen on the skin. It occurs when the antibody produced against gluten destroys the enzyme which helps to keep the skin intact. Then, lesions that are red and very itchy appear on the skin in the extremities, scalp, elbows, and buttocks. Males are more prone to develop it and it affects individuals aged between 10 and 50 years.

Hormonal disorders: They may cause fertility problems in both males and females. In addition, males may also have erectile dysfunction while women may have problems with the abnormal absence of menstruation.

Bleeding disorder: This is due to reduced intestinal absorption of vitamin K which is a fat-soluble vitamin.

Celiac disease and pregnancy: What you should worry about

It is quite natural that nutritional demands are higher during pregnancy. Since celiac disease impairs your ability to absorb vital nutrients from the intestinal walls, your worry is understandable.

However, you should also understand that maintaining a healthy gluten-free diet is invariably enough to nourish you and your baby. The real threat comes from not following a gluten-free diet. It can lead to complications in the mother and resultant health problems in the baby.

They include:

  • Low birth weight of the baby
  • Risk of early delivery
  • Increased chances that you need a cesarean section

No strict dietary guidelines have been recommended for pregnant women who also have celiac disease. Nevertheless, following a healthy and customized diet plan can help you and your baby stay in a good health.

In addition, you should consult your doctor to know if you need vitamins and other dietary supplements.

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