Celiac Disease

What is Celiac disease?

Celiac disease, also known as celiac sprue, is an inherited, chronic, autoimmune disorder in which the body negatively reacts to the protein, gluten. It occurs in the small intestine and ultimately damages the lining of the gut which may affect the ability of the body to absorb nutrients from food. For people diagnosed with celiac, when gluten is consumed, the body mounts an immune response to destroy the gluten. An unfortunate side effect is that the small intestine becomes damaged.

There are individuals who may experience a gluten sensitivity. This may look like celiac disease in terms of the symptoms experienced however the body is not mounting an immune response. Therefore, there is likely little to no damage in the small intestine. A journal recalling the food eaten along with symptoms experienced, and a negative celiac test would confirm a gluten sensitivity.

What is Gluten?

Gluten is a protein found in grains like wheat, barley, rye, and triticale. It functions as a binder, holding the components of a food together. It’s what gives bread and pizza dough it’s stretchy quality.

The other grains that contain gluten are wheat berries, spelt, durum, emmer, farina, semolina, graham, farro, einkorn, Khorasan wheat, wheat gluten, and seitan. Foods that are naturally gluten free, like oats for example, may contain gluten due to cross-contamination during production. Gluten is also found in soy sauce and modified food starch for example. It can be found hiding in many different types of foods.

For individuals who do not have celiac disease or a gluten sensitivity, gluten is a perfectly fine and possibly good thing to consume. It may act as a prebiotic, helping to feed the good bacteria in the gut!

Is gluten bad?

For someone with Celiac disease, gluten should be avoided, because the risk of damage to the small intestine outweighs the benefits. For someone without celiac it’s not necessary to avoid gluten. In fact, for people without celiac avoiding gluten can lead to other health issues like micronutrient deficiencies. Gluten-free has become a health trend as gluten has been demonized due to celiac disease. As a result, many people end up avoiding it, even when they don’t have to. Unless someone is diagnosed with celiac disease, it may not be necessary to avoid gluten. If you think you have a sensitivity to it, schedule a visit with your doctor and dietitian to check and see if it’s necessary to cut it out.

How common is celiac?

It is most common in people of Northern European descent and is estimated to affect about 1% of the populations in North America and Europe. According to the Celiac Disease Foundation, incidence is increasing by 7.5% each year.

Is celiac disease serious?

The short answer is yes. Undiagnosed and mismanaged celiac disease may damage the small intestine. It is in the small intestine where many nutrients are absorbed. If the small intestine becomes damaged to the point where nutrients are not being absorbed properly, this can lead to malnutrition which can have serious consequences and lead to other diseases. Other diseases linked to celiac include cancer, compromised immunity, liver disease, and other gastrointestinal diseases like bowel obstructions.

What are common symptoms?

The symptoms with celiac disease can vary widely from no symptoms to horrible debilitating ones. Symptoms may include belly pain, gas, bloating, diarrhea, constipation, pale or bad-smelling stool, vomiting, fat in the stool, headaches, fatigue, extreme fatigue, flu-like symptoms, rashes and other dermatological symptoms, tingling or numbness in extremities, cold hands, sores in the mouth, pale complexion, brittle or concave nails, weight loss, muscle wasting, growth delays in children, mood changes, abnormal periods, and difficulty getting pregnant.

Then again, someone may have little to no symptoms at all, however damage to the small intestine is still being done.

How is it diagnosed?

There are non-invasive tests to diagnose celiac disease. Doctors can look for inflammatory, autoimmune, and genetic markers on blood tests. In addition they can perform colonoscopies and endoscopy’s and take biopsies to measure any inflammation and damage present. And they can interpret food and symptom journals. Blood tests can also look at micronutrient deficiencies to see how far celiac has progressed.

What can be done about it?

First and foremost, if celiac is suspected, or a gluten sensitivity, schedule an appointment immediately with your medical doctor. They will perform blood testing and refer you to a gastroenterologist for further diagnostic testing as needed.

Schedule an appointment with a registered dietitian as well, they can help to interpret your food and symptom journal and guide you in the right direction with food and nutrition.

If you’re diagnosed with celiac disease, your doctor may prescribe medications or supplements to calm any inflammation present and begin to heal the gut. What is most important is that you begin to follow a gluten free diet. Nowadays there are a lot of options in the grocery store for people who need to eat gluten free, and the foods offered taste pretty good. Unfortunately they tend to be more expensive. Shop the gluten-free aisle and make sure what you’re purchasing is either labeled “gluten-free” or does not contain any gluten-containing ingredients. Gluten can hide in many products including soups, sauces, dressings, cheese, packaged dinners, sweets, and others. Check out the resources section below to learn more about ingredients that contain gluten.

One thing to know is that the FDA has allowed manufacturers to label an item as “gluten-free,” “no gluten,” “free of gluten,” or “without gluten” as long as that item contains 20 ppm (parts per million) of gluten or less. This level is the lowest that can be reliably detected using validated analytical laboratory methods. Be advised however that a food which contains 20 ppm of gluten still contains gluten. Someone who has celiac disease may still experience a reaction, and the small intestine may still sustain damage. So, choose foods that mention gluten-free and ensure they actually do not contain any gluten ingredients.

One such example of this is beer. There are beers out there that can claim they are “gluten-reduced” because they test at less than 20 ppm of gluten. Again, someone who has celiac may still react. That being said, there are breweries out there who choose to brew with gluten-free ingredients thus making their beers gluten free. And they taste delicious!

Question. Ask. Inquire. When you’re out to eat, ask the owner/server/chef whether they are using gluten containing ingredients in their cooking. Do they have a separate area of preparation for the foods. Do they use the same fryer and cook-top for gluten-free foods as they do for gluten-containing foods. It never hurts to ask and tell them you have celiac disease, so they’re aware of the consequences if they aren’t telling you the truth or unaware of what’s happening in their own kitchen.

Foods that are naturally gluten-free include fruits and vegetables in their whole form, legumes, nuts, seeds, fish, eggs, and poultry. Beef is also gluten free however it’s not the healthiest protein to consume all the time. Grains that are also naturally gluten-free include quinoa, rice, amaranth, buckwheat, corn, millet, teff, sorghum, and gluten-free oats. Ensure that the grains you’re purchasing are labeled gluten-free or were produced in a facility that does not utilize gluten.

Resources

This article does not contain all the information or foods that someone needs to be aware of, therefore it’s important to continue doing research and becoming aware of all the resources out there. They change daily! Below are some resources that to consider checking out.

Celiac Disease Foundation – a foundation that offers celiac information.

Gluten-free Passport – dining out resource.

Beyond Celiac – a research-oriented organization on finding a cure for celiac.

National Celiac Association – a non-profit advocacy and support organization

Celiac.com – a support organization

Gluten-free living magazine – a magazine offering resources, recipes and more

Find me gluten-free – a resource for eating out

Gluten-free Drugs – a resource for drugs that qualify as gluten-free

References

Celiac Disease Foundation. (2020, February 2). Incidence of Celiac Disease Steadily Increasing. Retrieved from https://celiac.org/about-the-foundation/featured-news/2020/02/incidence-of-celiac-disease-steadily-increasing/

Celiac Disease Foundation. (n.d.). What is Celiac Disease? Retrieved from https://celiac.org/about-celiac-disease/what-is-celiac-disease/

Cleveland Clinic. (2022, December 1). Celiac Disease. Retrieved from https://my.clevelandclinic.org/health/diseases/14240-celiac-disease

Cision PR Newsire. (2023, May 24). Two-Thirds of American Are Living With Gut Issues, Unaware of the Health Consequences. MDVIP. Retrieved from https://www.prnewswire.com/news-releases/two-thirds-of-americans-are-living-with-gut-issues-unaware-of-the-health-consequences-301833342.html

Harvard T.H. Chan School of Public Health. (n.d.). Gluten: A Benefit or Harm to the Body? Retrieved from https://www.hsph.harvard.edu/nutritionsource/gluten/

Johns Hopkins Medicine. (n.d.). Celiac Disease. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/celiac-disease

U.S. Food and Drug Administration. (2018, July 16). Gluten and Food Labeling. Retrieved from https://www.fda.gov/food/nutrition-education-resources-materials/gluten-and-food-labeling