Celiac disease is an immune disorder triggered by gluten, a protein found in wheat, rye and barley. The disease is considered common and affects 2 to 3 million people in the United States.
A person with celiac disease has antibodies to gluten which means that when gluten is eaten, the antibodies’ reaction to gluten causes inflammation and damage in the small intestine. This leads to symptoms such as pain, bloating, diarrhea and nausea. Damage to the intestine also may result in the malabsorption of food and nutrients, which can cause many other symptoms such as fatigue, anemia, nerve disorders, weight loss, thin bones, rashes, menstrual disorders, infertility, delayed growth and possibly cancer.
There is a genetic predisposition to celiac disease, which can be identified with specific blood tests. Therefore, if a family member has celiac disease, relatives are more likely to have this disorder. It also is associated with other immune disorders such as type-1 diabetes, autoimmune thyroid diseaseand other genetic disorders.
Diagnosis can be challenging and often is delayed because celiac disease can mimic many other disorders. Diagnosis is now made easier by testing specific antibodies in the blood. If the antibodies are found, then a physician may recommend a small intestinal biopsy to confirm it because celiac disease involves lifelong dietary changes.
Before the blood test was available, diagnosis was much more difficult. Because two of my three children have had celiac disease for almost 10 years, and I have treated many patients in my internal medicine practice, I understand that the process can be difficult.
Treatment of celiac involves a strict gluten-free diet. In recent years, the availability of gluten-free food has become more widespread, which makes this diet easier to follow. However, it is important to read all food labels because even the smallest amount of ingested gluten can cause symptoms and lead to long-term damage.
There also are many hidden sources of gluten. These may include such things as lipstick, Play-Doh, some medications, vitamins, preservatives and additives found in food such as modified food starch. “Natural flavor or spices” do not always mean the food is free of gluten. Consultation with a certified dietitian often is very helpful.
Gluten-free diets are restrictive but include fresh meats, fish, fruits, vegetables and some dairy products. Also, common grains such as corn, quinoa, rice, tapioca and buckwheat are permitted as well as gluten-free pastas.
Gluten sensitivity is another area of concern. People with this sensitivity do not have celiac disease; they do not have antibodies to gluten. Nevertheless, they feel better by avoiding gluten. For these people, a strict avoidance of gluten is probably not as important as in people with celiac disease. However, by avoiding gluten in their diet, many problematic symptoms disappear.
If you think you or a family member has celiac disease or gluten sensitivity, it is important to speak with your health care provider. Because of recent media attention to gluten-free diets, many find they feel better when they cut out excess gluten. However, if celiac disease is present and not diagnosed, it could cause long-term damage.