Celiac disease is a digestive disease that adversely affects people when they eat foods that contain the protein gluten.
Celiac disease (CD) (also coeliac and can be referred to by such names as gluten sensitive enteropathy and celiac sprue) is a digestive disease that adversely affects both children and adults when they eat foods that contain the protein gluten. The inability of some people to digest gluten completely is the reason behind celiac disease. Although it resembles a food allergy * , celiac disease is not one. Instead, it is an autoimmune disease * (an adverse reaction of antibodies * within the body) of the small intestine. The primary difference between the two conditions is that people sometimes resolve their food allergies, but people with celiac disease will not outgrow it. They will always be intolerant to gluten.
The Celiac Disease Foundation states that about 1 person in 133 in the United States is affected with CD. Moreover, a person is at an increased risk (about 5 to 10 percent) when an immediate family member has celiac disease. Without proper diagnosis and treatment of the disease, people with CD may develop medical complications such as cancer or osteoporosis * . Research estimates that 18 million Americans have non-celiac gluten sensitivity, six times the number of those who have CD.
The symptoms experienced by people with CD vary widely. Moreover, they may appear for the first time at any point during a person's life. In fact, some people with the disease do not have symptoms. Other people mistake their symptoms for an intestinal problem, such as irritable bowel syndrome or lactose intolerance. Medically, the disease is thought to be brought on by a stressful physiological event such as pregnancy, childbirth, major surgery, or a viral infection. Severity of the symptoms, along with when they first appear, may be caused by the severity of the particular stressful event. For instance, a minor viral infection may initiate less severe symptoms of CD than a major infection.
The range of symptoms may in part be determined by the length of time that individuals were breastfed as a baby, the age in childhood at which they were first fed gluten-containing food, or the amount of gluten-containing foods that they eat as an adult. Another factor that can influence the severity of the symptoms is the length of time before a person is diagnosed, with the longer period without diagnosis increasing the risk of more severe symptoms.
Symptoms of CD usually, but not necessarily, involve the digestive tract. The more common digestive-based symptoms include the following:
Non-digestive symptoms in adults include the following:
Because people with CD are malnourished, the disease can lead to neurological problems such as epilepsy * and chronic diseases such as liver and gastrointestinal cancers, thyroid disease, and Type 1 diabetes.
Celiac disease results from an intolerance to gluten. Actually called gliadin, gluten is found in certain grains, including all types of barley, rye, triticale, and wheat. Gluten is an ingredient in many common foods, such as bread, pizza, pasta, breakfast cereal, cakes and cookies, and beverages such as beer. However, it is also contained in less common products such as certain vitamins and medicines.
When digested, gluten is modified so the body's immune system * reacts abnormally to it in the intestines, creating a toxic (inflammatory) reaction, which interferes with the absorption of nutrients such as vitamins and minerals. The digestive system is unable to absorb the necessary nutrients. Even small amounts of ingested gluten cause health problems and can eventually flatten the lining of the small intestine * . This flattening, which is called villous atrophy, damages the small intestine, reducing the ability of the body to absorb nutrients (malabsorption).
The small intestine is compromised because the modified gluten damages, and sometimes destroys, millions of microscopic-sized, finger-tip-like protrusions called villi, which line it. Under normal conditions, the villi allow nutrients to be absorbed through the walls of the small intestine and into the bloodstream. However, individuals with CD do not obtain all of these nutrients so they become malnourished regardless of the quantity or quality of food they eat.
The risk of developing CD may be genetically determined. Africans and Asians are less likely to get CD, and Caucasians of Northern European descent are more at risk for developing it. Individuals may be predisposed to the disease when they are born, and a specific physical or emotional event may cause the disease to become apparent. A similar stressful event may also trigger CD in the offspring of these parents. Having one parent with CD increases the risk of the disease by 5 to 15 percent in children. People with autoimmune disorders such as type 1 diabetes and rheumatoid arthritis * are 25 percent more at risk for CD than others.
To detect CD several blood serum (serologic) tests must be performed. These show if levels of gluten-sensitive antibodies and certain proteins are abnormally high within the body. Tests for the following antibodies are usually performed:
If the results are “positive,” then a biopsy * is usually performed on the small intestine. The doctor performs a procedure called endoscopy, which involves inserting a long, thin, fiber-optic tube through the mouth and stomach into the small intestine. The doctor takes a small tissue sample from the small intestine for analysis in the laboratory. The biopsy reveals the amount of damage to the villi in the lining of the intestine.
If these tests and the biopsy are inconclusive, then two genetic tests (HLA-DQ2 and HLA-DQ8) should be run to identify human leukocyte antigen (HLA) genes, which are present in people with CD. These tests are not conclusive because one-third of all people in the United States have these genes without having celiac disease. However, people with these genes are considered to be highly susceptible to the disease. By contrast, if these genes do not appear in the tested person, then their absence essentially rules out CD as the problem. Other tests can be performed in order to reach a definite diagnosis.
The basic treatment for CD is a gluten-free diet. After gluten is removed from the diet, the small intestine is able to repair itself and return to normal function. Many, if not all, symptoms disappear over a few months. Any lingering imbalances in the body can be corrected with nutritional supplements. Physicians usually do not prescribe medicines; however, regular examinations are highly recommended so the progress and health of the patient can be monitored. According to the Celiac Disease Foundation, the most common medical complication is osteoporosis; three-fourths of all diagnosed people with CD have some degree of bone loss.
The gluten-free diet is challenging to maintain. Grains are common ingredients, second only to sugars, in the average diet. Gluten in tiny amounts may be present and yet not listed in food labels. Obvious foods that must be avoided are those including the following ingredients: binders, fillers, extenders, malt, modified food starch, and unidentified starch. All types of wheat, such as durum, einkorn, farina, faro, kamut, emmer, semolina, and spelt, contain gluten. Cracked wheat, hydrolyzed wheat protein, wheat bran, wheat germ, and wheat starch also contain gluten. Other grains such as barley, rye, and triticale (a wheat-rye blend) include gluten. Oats may not cause a CD reaction; however, it is wise to avoid oat products as well.
Basic foods that do not contain gluten include buckwheat, chia seed, corn (maize), flax, legumes, millet, nuts, quinoa, rice, and wild rice. Non-cereals that do not contain gluten include potatoes and bananas.
Many processed foods contain gluten. These include candy, lunch meats, potato chips and French fries, rice mixes, sauces and gravies, soups, and many others. People with CD should discuss their gluten-free diet with their family doctor, along with a dietitian. Such experts can recommend and guide patients in their food selections.
Although a gluten-free diet is essential for all celiac sufferers, the bright side is that most foods containing gluten can be made by substituting ingredients. Many grocery stores carry gluten-free foods, and some restaurants carry gluten-free meals. Online health-food stores sell gluten-free foods. For celiac sufferers, local and national support groups provide information and a sense of community with others facing the same problem.
See also Dietary Deficiencies • Maldigestion and Malabsorption Syndromes: Overview
Bower, Sylvia Llewelyn, Mary Kay Sharrett, and Steve Plogsted. Celiac Disease: A Guide to Living with Gluten Intolerance. 2nd ed. New York: Demos Health, 2014.
National Foundation for Celiac Awareness. “What Is Celiac Disease?” CeliacCentral.org . Also available online at http://www.celiaccentral.org/SiteData/docs/whatisceli/a89543ceb5cf210a/what%20is%20celiac%20disease%20-%2003-2015.pdf (accessed November 27, 2015).
Celiac Central. “Welcome to Celiac Central.” National Foundation for Celiac Awareness. http://www.CeliacCentral.org/Celiac-disease/21 (accessed November 27, 2015).
American Celiac Disease Alliance. 2504 Duxbury Pl., Alexandria, VA 22308. Telephone: 703-622-3331. Website: http://americanceliac.org (accessed November 27, 2015).
Celiac Disease Foundation. 13251 Ventura Blvd., Suite 1, Studio City, CA 91604. Telephone: 818-990-2354. Website: http://www.celiac.org (accessed November 27, 2015).
Celiac Sprue Association/United States of America. 413 Ash Street, Seward, NE 68434. Toll-free: 877-272-4272. Website: http://www.csaceliacs.org (accessed November 27, 2015).
* allergy (AL-uhr-jee) is an immune system–related sensitivity to certain substances, for example, cat dander or the pollen of certain plants, that causes various reactions, such as sneezing, runny nose, wheezing, or swollen, itchy patches on the skin, called hives.
* autoimmune disease (awtoh-ih-MYOON) is a disease in which the body's immune system attacks some of the body's own normal tissues and cells.
* antibodies (AN-tih-bah-deez) are protein molecules produced by the body's immune system to help fight specific infections caused by microorganisms, such as bacteria and viruses.
* osteoporosis (os-te-o-por-O-sis) is the loss of material from the bone. This makes bones weak and brittle.
* failure to thrive is a condition in which an infant fails to gain weight and grow at the expected rate.
* miscarriage (MIS-kare-ij) is the end of a pregnancy through the death of the embryo or fetus before birth.
* epilepsy (EP-i-lep-see) is a condition of the nervous system characterized by recurrent seizures that temporarily affect a person's awareness, movements, or sensations. Seizures occur when powerful, rapid bursts of electrical energy interrupt the normal electrical patterns of the brain.
* immune system (im-YOON SIStem) is the system of the body composed of specialized cells and the substances they produce that help protect the body against disease-causing germs.
* small intestine is the part of the intestines—the system of muscular tubes that food passes through during digestion—that directly receives the food when it passes through the stomach.
* rheumatoid arthritis (ROOmah- toyd ar-THRY-tis) is a chronic disease characterized by painful swelling, stiffness, and deformity of the joints.
* biopsy (BI-op-see) is a test in which a small sample of skin or other body tissue is removed and examined for signs of disease.