Everything You Need to Know About Celiac Disease

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Celiac Disease: Symptoms and DietOur immune systems are supposed to protect us from a host of invading threats.

To get a better picture, let’s think of the immune system like Superman—instead of fighting criminals, our “Superman” protects our bodies from dangerous viruses, bacteria, and diseases.

But what would happen if there was a disease that could break through your immune system and damage it?

Celiac Disease

Celiac disease is a medical condition where the body’s immune system reacts adversely to the consumption of gluten; this can eventually break down the lining that protects the small intestine, making it difficult for the small intestine to absorb the necessary nutrients that our bodies need to function. This absorption issue is called malabsorption.

Celiac Symptoms in Adults

Celiac disease symptoms vary, depending on the person, but they typically include diarrhea, weight loss, abdominal pain, and excessive gas. Keep in mind that at the beginning, you may not have any symptoms at all! A simple blood test will detect whether or not you are absorbing nutrients properly. Here is a list of more common symptoms that are associated with celiac disease for adults:

  • Osteoporosis
  • Iron deficiency anemia (low blood count because of insufficient iron)
  • Diabetes mellitus
  • Thyroid issues
  • Dermatitis herpetiformis (skin disease)
  • Disorders of the nervous system
  • Liver disease

How is Celiac Diagnosed?

Celiac disease is not something that can be diagnosed immediately. Medical history can push the diagnosis in that direction, but it typically takes many visits to the physician, and many months of you complaining about the same symptoms, before celiac disease is considered to be the source of your pain. There is a two-step screening process to make a celiac diagnosis:1. The first step is to test the blood for immunoglobulin A, an anti-tissue transglutaminase antibody.2. If the test comes back positive, then an endoscopy and biopsy of the duodenum (the first part of the small intestine) will be recommended. During this procedure, a fiber optic tube is pushed through the mouth, through the esophagus and stomach, and all the way into the duodenum. Tissue is then taken from the duodenum and examined under a microscope.

Celiac Disease Causes

You can find gluten in wheat, rye, barley, as well as various types of processed foods. For some people who are exposed to gluten, an enzyme by the name of tissue transglutaminase  turns the gluten protein into a chemical, which can cause an immune response that leads to inflammation in the lining in the small intestine. This inflammation is eventually what ends up inhibiting the small intestine’s ability to properly absorb nutrients.

Malabsorption of vitamins, minerals, and other nutrients, as we have already discussed, can lead to damage of certain organs in the body, including the liver, bones, and brain.

Like many diseases, family history can play a role in celiac disease, mainly with people who have a history of type 1 diabetes, microscopic colitis, Sjogren’s syndrome, and autoimmune thyroid disease.

Celiac disease is common in most parts of the world, but is rare in certain parts of Asia and Sub-Saharan Africa.

Complications of Celiac Disease

Even after being diagnosed with the disease, many people still experience complications, despite taking the proper precautions to help treat the disease. Below are a few of the possible complications of celiac disease:

• Nonresponsive celiac disease: About 10% of people who are diagnosed with celiac disease continue to experience symptoms, even after refraining from gluten. Other causes may be food intolerances, food allergies, or an overgrowth of bacteria in the intestine. If you are experiencing symptoms even after getting rid of the gluten in your diet, consult an experienced celiac dietitian.

• Refractory Celiac Disease (RCD): Some people who develop symptoms do not see improvement, even after removing gluten from their diets. People who continue to experience symptoms could have refractory celiac disease. You can treat it with medications that speed up the immune system’s abnormal response. If the symptoms are not treated, then anemia can develop, along with bone loss.

• Lymphoma: If gluten is removed from your diet, then lymphoma, which is a cancer in the intestinal system, can be avoided.

• Skin Conditions: Celiac disease can be associated with certain skin disorders, such as dermatitis herpetiformis. It is characterized by intense itching and fluid-filled patches on the skin; these symptoms are usually found on the knees, elbows, lower back, buttocks, neck, face, and occasionally on the mouth. This condition usually improves after you eliminate gluten from your diet; however, it can take several weeks to clear up completely.

The Celiac Disease Diet Menu

Most foods that contain gluten are delicious and can be very difficult to eliminate from your diet. With time and patience, you can reconstruct your diet so your intestines do not suffer.

First, let’s start with the foods you are not allowed to eat; it’s always good to eliminate the bad before implementing the good:

  • Barley (malt and malt vinegar are usually made from barley)
  • Rye
  • Wheat (flour, bromated, enriched, phosphated, plain, and self-rising)
  • Durum flour
  • Farina
  • Spelt
  • Graham flour

The following should also be avoided, unless they say gluten-free:

  • Beer
  • Bread
  • Cakes and pies
  • Candies
  • Cereals
  • Cookies and crackers
  • French fries
  • Pastas

Now let’s focus on the gluten-free foods that you can eat; get accustomed to them before fully implementing them into your diet:

1. Grains: There are many gluten-free grains in grocery stores and health food stores. Avoid purchasing non-gluten grains in bulk bins, because there is a higher chance it was cross-contaminated with grains that contain gluten. Look for the following items that state they are gluten-free: rice, soy, potatoes, beans, millet, quinoa, and tapioca.

2. Cereal: Most cereals contain gluten or wheat-based ingredients, but there are some cereals that are gluten-free. Always look for the gluten-free label on the box. Not all cereals advertise “gluten-free,” so read the ingredients to double-check.

3. Oats: People with celiac disease can consume about a half-cup to three-quarters of a cup of rolled oats daily, without any complications.

4. Soups and sauces: One of the biggest sources of gluten—many companies use wheat as a kicker for soups and sauces. Thankfully, there are gluten-free soups and sauces; just read the ingredients to find the ones that are gluten-free.

Cross Contamination

Cross-contamination happens more often than not when it comes to gluten and gluten-free products. When buying from bulk bins, you always run the risk of cross-contamination.

Foods that say “may contain” usually mean that there is gluten in the product. Even products that say “gluten-free” don’t always mean that there is no gluten in them.

For instance, if a product carries a gluten-free label, there can still be about 20 parts per million of gluten in the product. The label only requires the product to contain 20 or less parts per million.

If nothing else, be cautious. Always read labels and ingredients for any product you pick up. Finally, always consult a nutritionist or your physician before making any changes to your diet.

Kelly, C.P., et al., “Patient information: Celiac disease in adults (Beyond the Basics),” UpToDate web site; http://www.uptodate.com/contents/celiac-disease-in-adults-beyond-the-basics, last accessed May 4, 2015.
“Gluten-free diet,” Mayo Clinic web site; http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gluten-free-diet/art-20048530?pg=1, last accessed May 4, 2015.
Wedro, B., “Celiac Disease,” Medicine Net web site; http://www.medicinenet.com/celiac_disease_gluten_enteropathy/article.htm, last accessed May 5, 2015.
“What Can I Eat?” Celiac Disease Foundation web site; http://celiac.org/live-gluten-free/glutenfreediet/food-options/, last accessed May 5, 2015.