What is Celiac Disease?

What is celiac disease?

Celiac disease is a condition that is triggered by exposure to a protein called gluten in genetically susceptible individuals. It is a type of autoimmune disorder which means a person’s own immune system is attacking the body. Celiac disease specifically effects the small intestines. 

Celiac disease is not a rare disease.

There is a misperception in the public and medical community that the disease is rare, but it affects about 1% of the entire human population. In the United States, 1 in 133 people (approximately three million) have Celiac disease and  97% of them are unaware. That’s more than Crohn’s disease, cystic fibrosis, multiple sclerosis, and Parkinson’s disease combined! 

It was previously thought to only occur in people of Northern European descent. However, we now know that celiac disease is present in all racial and ethnic groups. It occurs in people who are genetically predisposed, so it is commonly present in families. 

Currently, the only treatment is strict adherence to a gluten free diet which is challenging.

  • When a person with celiac disease eats food that contains gluten, the gluten is absorbed and causes an abnormal response in the immune system. The immune system ‘attacks’ the lining of the small intestine and this leads to damage over time so that the small intestine has difficulty absorbing nutrients. This can cause a variety of symptoms that can vary significantly in people who have celiac disease. Some patients have severe symptoms and some have no symptoms at all. Examples of symptoms include diarrhea, bloating, abdominal pain, weight loss, and other symptoms due to nutrient deficiencies such as anemia due to low iron.

  • Some folks with celiac disease have relatively mild symptoms and may choose to ignore the dietary restrictions. I don’t recommend this approach! A gluten free diet is still recommended in people who have celiac disease with mild symptoms because they can develop vitamin deficiencies such as vitamin D and mineral deficiencies such as iron. People with celiac disease have an increased overall risk of death and increased risk of cancer. With a strict gluten free diet, the overall mortality or risk of death is the same as the general population. Celiac disease is associated with an increased risk of other diseases such as:

    Autoimmune disorders: type I diabetes mellitus, lupus (SLE), autoimmune thyroid disease (Hashimoto’s thyroiditis, Grave’s disease)

    Fertility issues

    Cancer

    Skin rashes (dermatitis herpetiformis)

    Osteoporosis

    Iron deficiency anemia

    Depression

    Neuropathy

    Inflammatory bowel disease

    Liver disease – autoimmune liver disease, elevated liver tests

    Heart disease – autoimmune myocarditis.

    Kidney disease – IgA nephropathy

    Overall, people with celiac disease should follow a gluten free diet to avoid the above medical issues and increased risk of death.

  • Celiac disease is diagnosed by a combination of symptoms, blood tests, and a biopsy of the small intestine. Symptoms alone are not able to diagnose celiac disease because the signs and symptoms of celiac disease are very similar to several other conditions. Also, a dietary trial is not adequate to diagnose celiac disease because it can take months on a strict gluten free diet to notice symptomatic improvement. Learn more about the process of diagnosis here.

  • Celiac disease is treated by completely eliminating gluten from your diet. In other words, celiac disease is treated by following a gluten free diet. As mentioned above, gluten is a protein that is found in wheat, barley, or rye. In the United States, gluten is most commonly present in foods that are prepared with wheat flour. Gluten is also present as a hidden ingredient in many prepackaged foods, medications, make-up, and supplements. Maintaining a gluten free diet can be very challenging because the use of wheat flour is so common. Following a strict gluten free diet can be tough because wheat is found in so many different types of food and at restaurants. In people with celiac disease, strict gluten avoidance is recommended because even small amounts of gluten can aggravate the disease and cause symptoms. Unlike other diets, people with celiac disease cannot occasionally ‘cheat’ on their diet and eat gluten containing foods without experiencing significant symptoms that can last for days. Learn more about eating gluten free here.