- What is Celiac Disease?
- What is Gluten Intolerance or Gluten Sensitivity (GS)
- What is Gluten?
- What Happens When a Patient with Celiac Disease Consumes Gluten?
- What are the Symptoms of Celiac Disease?
- Symptoms of Celiac Disease in Children
- Symptoms of Celiac Disease in Adults
- What Other Health Problems are Associated with Celiac Disease?
- Why are Celiac Disease Symptoms so Hard to Diagnose?
- How Common is Celiac Disease?
- How to Diagnose Celiac Disease.
- How to Treat Celiac Disease.
- The Gluten Free Diet
- What Causes Celiac Disease?
Celiac disease is an increasingly common digestive disorder that causes damage to the villi of the small intestine and prevents the proper absorption of nutrients from food. People who suffer from celiac disease are unable to tolerate gluten, a protein in wheat, rye, and barley.
Celiac disease is a genetic disease that runs in families and is more common in persons of European ancestry and in Caucasians. More than 2 million Americans have been diagnosed with celiac disease; however, recent studies have suggested that as many as one in every 133 Americans may have it, and that the disease is under-diagnosed .
If left undiagnosed, the long-term complications associated with the disease may include anemia, miscarriage, liver diseases, cancers of the intestine and liver diseases or gluten ataxia.
When a patient who suffers from celiac disease ingests or consumes gluten, the body’s immune system will respond by damaging and sometimes will completely destroy the lining of the small intestine. Although this usually occurs over a number of years, in some extreme cases the damage can happen rapidly. The small intestine is one of the most important parts of the digestive tract because it helps to absorb essential vitamins and nutrients into the bloodstream. When damage occurs, a patient suffering from Celiac Disease can become fatigued, malnourished and suffer from a number of health related ailments and can increase ones risk of death four times. 
Symptoms of celiac disease are can vary from patient to patient. Some may endure severe symptoms and suffer from several signs of the disease while others may suffer from just a few symptoms and others still may show no signs of the disease at all. This often causes difficulty in preliminary diagnosis of the disease because of the different symptoms from each patient. Symptoms may include diarrhea, vomiting, weight loss and fatigue or extreme tiredness. This disease can also affect many other parts of life including emotional heath and personal relationships. The symptoms associated with celiac disease are often easier to diagnose in children than they are in adults.
Symptoms of Celiac Disease in Children:
- Poor appetite, irritability and a failure to gain weight are usually the first symptoms
- chronic diarrhea
- weight loss
- failure to thrive
- abdominal bloating or swollen stomach and pain
- Attention Deficit Disorder (ADD)
- pale, foul-smelling, or fatty stool
- arm and leg muscles may become wasted and thin
- Juvenile Idiopathic Arthritis
Nutrients are essential for children as they grow and mature. Because Celac Disease prevents nutrients and vitamins from being properly absorbed children become especially vulnerable to health related issues. Other issues a child may experience include delayed growth and short stature, dental enamel defects of the permanent teeth and delayed puberty. It is known that if only one parent has been diagnosed with Celiac Disease, each child should be tested for the disease, or for gluten intolerance.
- fatigue or extreme tiredness
- an itchy skin rash called dermatitis herpetiformis
- unexplained iron-deficiency anemia
- abdominal pain and cramping
- alternating bouts of diarrhea and constipation
- lactose intolerance
- hair loss (Alopecia)
- bone loss or osteoporosis
- bone or joint pain and sometimes even fractures – which are due to thinning of the bones
- depression or anxiety
- headaches and migraines
- vitamin and mineral deficiencies
- tingling numbness in the hands and feet
- canker sores or ulcers inside the mouth
- missed menstrual periods
- infertility or recurrent miscarriage
- malodorous flatulence
- unexplained weight loss
Celiac disease is often difficult to diagnose in adults because there are sometimes few or no symptoms, however a person can still develop complications of the disease such as cancers of the digestive tract, liver diseases, and malnutrition — which can lead to anemia, osteoporosis, and miscarriage.
People with celiac disease tend to have other diseases in which the immune system attacks the body’s healthy cells and tissues. The connection between celiac disease and these diseases may also be genetic.
- type 1 diabetes
- Turner Syndrome
- rheumatoid arthritis
- Addison’s disease, a condition in which the glands that produce critical hormones are damaged
- autoimmune thyroid disease
- autoimmune liver disease
- Sjögren’s syndrome, a condition in which the glands that produce tears and saliva are destroyed
Celiac disease is very difficult to diagnose because it affects each person differently. To date it is known that three factors may be responsible for the difficult in diagnosis and they include: the age at which a person started to eat food products that contain gluten, how much gluten is consumed by a patient and the length of time a person was breastfed. 
Celiac disease symptoms may also differ due to the age of the person as well as the amount of damage caused to the villi of the small intestine. Some adults may have celiac disease for more than ten years before they are correctly diagnosed. What is more worrying is that most men are not being diagnosed due in part to social stigma or lack of awareness. If left undiagnosed or untreated, a patient has a greater chance of developing long-term complications.
About 1 in 133 people in North America have been tested for and diagnosed with Celiac Disease. There is a 1 in 22 chance that the children of patients who have been diagnosed with Celiac Disease also suffer from it.  It is more common in Europe, Australia, and North America because people tend to eat items that contain wheat, barley or rye as well as consume numerous processed items that contain gluten. Other areas of the world are also starting to see a rise in the disease because gluten is a common ‘ingredient’ in many items.
How to Diagnose Celiac Disease.
As we have discussed earlier, it is often difficult to recognize or diagnose the symptoms of celiac disease due in part to the fact they are extremely similar to other diseases. celiac disease is often confused inflammatory bowel disease, diverticulitis, intestinal infections, with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, and chronic fatigue syndrome. This often causes a misdiagnosis of the disease. When blood tests become more reliable and doctors become more informed about the disease. As a result, celiac disease has long been under-diagnosed or misdiagnosed. Diagnosis rates are expected to increase when researchers and doctors become more aware of the many varied symptoms of the disease and reliable blood tests become more available.
Blood tests are the most common way to tests for celiac disease. Patients who suffer from Celiac Disease will have higher than normal levels of certain autoantibodies—proteins that react against the body’s own cells or tissues—in their blood. To diagnose celiac disease, doctors will test blood for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). If test results are negative but celiac disease is still suspected, additional blood tests may be needed.
Here is a list of blood tests that will be recommended by your doctor:
- Anti-tissue transglutaminase antibody (tTG – IgA and IgG) – commonly used whether or not symptoms are present and the most sensitive test available
- Total serum IgA – used to check levels to exclude selective IgA deficiency that results in a false negative test
- Anti-gliadin antibody (AgA – IgG and IgA) not considered sensitive or specific enough for adults, but used for children under 2 because tTG and EMA antibodies may be absent. The anti-DGP test is sensitive in this group
- Anti-endomysial antibody (EMA-IgA) – highly specific marker for celiac disease
- Anti-deaminated gliadin peptide (DGP – IgA and IgG) – used when tTG or EMA is negative and in cases where patient is IgA deficient
If you think you or a loved one may have celiac disease it is important to note that a diet that includes foods with gluten, such as breads and pastas must remain the same. If gluten is eliminated from the diet before the test, the results may result in a negative diagnosis for Celiac Disease even if the disease is present.
If each of the aforementioned blood tests have resulted in a negative result and symptoms are still present, a biopsy of the small intestine may be requested. Although this procedure may be uncomfortable it is relatively harmless. It is done by using a small flexible biopsy instrument called an endoscope and inserted down the throat, through the stomach and into the upper end of the small intestine where patchy, multiple snippets of tissue are gathered. The tube is removed and the tissue samples are examined under a microscope for signs of injury.
Screening for celiac disease means testing for the presence of the aforementioned autoantibodies in the blood in people who do not display any symptoms. Americans, especially men, are not usually screened for celiac disease, however and increased awareness about the disorder are changing that trend. Celiac disease is genetic and if a family member has been diagnosed there is a chance that about 4 to 12 percent of first-degree relatives will also have the disease.
How to Treat Celiac Disease.
The ONLY way to treatment for celiac disease is a gluten free diet. It is recommended that patients who are recently should seek help from a dietitian. They will help create a gluten-free diet plan, give you tips and supply resources for how to properly deal with the gluten free lifestyle.
- To-date there is no cure for celiac disease. A gluten free diet is necessary reduce or eliminate symptoms.
- There are no short cuts. Even small amounts of gluten will see a return of symptoms will cause further damage to the small intestine.
The problems and symptoms associated with celiac disease should progressively get better if a gluten free diet is properly adhered to. Recovery times depend on how long a person has suffered from celiac disease and how much damage has occurred in the villi of the small intestine. Depending on a person’s age of diagnosis, some problems will not improve, such as short stature and dental enamel defects.
Reading labels is essential in attempting to avoid products that contain gluten. The smallest amounts of gluten may cause of symptoms of celiac disease. Be aware of cross contamination when preparing food or eating out with friends and family or at restaurants. Patients who have celiac disease must avoid gluten for the rest of their lives.
Some patients with celiac disease will still have lifelong difficulties even if they are on a gluten free diet. This is probably due to small amounts of gluten that are still being ingested. Gluten is sometimes found in:
- Hidden sources of gluten modified food starch
- preservatives stabilizers made with wheat
It is worth mentioning that most people who correctly follow a gluten-free diet will quickly see an end to their celiac disease symptoms. Because the villi of the small intestine can repair, improvements to overall health will likely begin within a few days of starting gluten-free diet. The small intestine will normally heal itself within several years in adults but can occur as quickly as three to six months in children and infants. once the villi have healed, nutrients can once again be properly absorbed into the bloodstream.
In extreme and very rare instances, a patient will continue to suffer intestinal damage, despite following a completely gluten-free diet. This condition is known as refractory celiac disease, have severely damaged intestines that is unable heal itself. This is often caused by a patient being undiagnosed or misdiagnosed with celiac disease. In some instances, damage caused by the disease is so great and patient will have to receive nutrients intravenously. Research is being done on providing drug treatment for refractory celiac disease.
A gluten-free diet is avoiding food or products that contain rye, wheat and barley. Celiac disease patients cannot eat most cereal, pasta, grain, and many processed foods.
There are many delicious choices for those hoping to live and eat gluten free and still enjoy a well-balanced diet. Food items such as quinoa, soy, amaranth, rice, potato, buckwheat, or bean flour instead of wheat flour are wonderful alternatives. People can easily purchase gluten-free bread, pasta, and other products at most major grocery stores.
“Plain” meat, fish, fruits, vegetables and rice do not contain gluten and are completely safe. Most people can safely eat small amounts of oats, as long as the oats are not contaminated with wheat gluten during processing. People with celiac disease should work closely with their health care team when deciding whether to include oats in their diet.
The gluten-free diet requires a completely new approach to eating. The best way is to educate your family and friends and be open about your condition. You may need to bring food with you when you are visiting a friend or family member for a meal. Tell the host ahead a time and tell them that they should not feel obligated to prepare gluten free foods and offer to bring enough to share with others.
Gluten is also used in some medications or other products such as lip balms. Patients with Celiac Disease should ask a pharmacist if prescribed medications contain wheat or gluten. Gluten is sometimes used as an additive in unexpected products—such as lipstick, lip balms and even play dough—it is important to read all product labels. If the ingredients are not listed on the label, the manufacturer should provide a list upon request, otherwise discontinue use of that product. With practice, screening for gluten becomes second nature.
What Causes Celiac Disease?
As discussed earlier, celiac disease is genetic but there are many causes that may trigger the disease. It is now known through research that a number of factors may be responsible for triggering the disease and they include viral infections, surgery, pregnancy, childbirth or severe emotional stress. More research in necessary to fully determine how and why the disease becomes active but because it is becoming increasingly common and any number of factors may be responsible.
- 1. The Ohio State University Medical Center
- 2. National Institute of Diabetes and Digestive and Kidney Diseases
- 3. U.S. Department of Health and Human Services
- 4. U.S. Department of Health and Human Services