WHAT IS CELIAC DISEASE?
Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for health maintenance. Damage to the small intestine occurs in reaction to gluten, which is found in wheat, barley, rye, and possibly oats. When people with celiac disease eat foods or use products containing gluten, their immune system responds by destroying the villi —the tiny, finger-like protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished, no matter how much food they eat.
The exact cause of celiac disease is unknown and the disease can develop at any point in life, from infancy to late adulthood. People who have a family member with celiac disease are at greater risk for developing the disease. Celiac disease is passed on genetically – meaning it runs in families – with women being affected more often than men. Sometimes the disease is triggered after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.
The symptoms of celiac disease can differ from person to person. This is part of the reason why the diagnosis is not always made right away. For example, one person may have constipation, a second may have diarrhoea, and a third may have no problem with stools.
- Abdominal pain, bloating, gas, or indigestion
- Decreased appetite (may also be increased or unchanged)
- Diarrhoea, either constant or off and on
- Lactose intolerance (common when the person is diagnosed, usually goes away after treatment)
- Nausea and vomiting
- Stools that float, are foul smelling, bloody, or “fatty”
- Unexplained weight loss (although people can be overweight or of normal weight)
Because the intestines do not absorb many important vitamins, minerals, and other parts of food, the following symptoms may start over time
- Bruising easily
- Depression or anxiety
- Growth delay in children
- Hair loss
- Itchy skin (dermatitis herpetiformis)
- Missed menstrual periods
- Mouth ulcers
- Muscle cramps and joint pain
- Tingling or numbness in the hands or feet
- Unexplained short height
Celiac In Children
- Defects in the tooth enamel and changes in tooth colour
- Delayed puberty
- Diarrhoea, constipation, nausea, vomiting, “fatty” or foul-smelling stool
- Irritable and fussy behaviour
- Unable to gain weight
- Slowed growth and shorter than normal height for their age
Celiac disease cannot be cured. For most people, following a diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvement begins within days of starting the diet. The small intestine usually heals in 3 to 6 months in children, but may take several years in adults. A healed intestine means a person now has villi that can absorb nutrients. Do not eat foods, beverages, and medications that contain wheat, barley, rye, and possibly oats.
To stay well, people with celiac disease must avoid gluten for the rest of their lives. Eating even a small amount of gluten can damage the small intestine. The damage will occur in anyone with the disease, including people without noticeable symptoms. Depending on a person’s age at diagnosis, some problems will not improve, such as short stature and dental enamel defects.
You must read food and medication labels carefully to look for ingredients that may contain gluten. Because wheat and barley grains are incredibly common, sticking with this diet is challenging. With sufficient education and planning, you will heal.
Some people with celiac disease show no improvement on the gluten-free diet. The most common reason for this is that small amounts of gluten are still being consumed. Hidden sources of gluten include additives such as modified food starch, preservatives, and stabilizers made with wheat. Because many corn and rice products are produced in factories that also manufacture wheat products, they can be contaminated with wheat gluten.
Rarely, the intestinal injury will continue despite a strictly gluten-free diet. People with this condition, known as refractory celiac disease, have severely damaged intestines that cannot heal. Because their intestines are not absorbing enough nutrients, they may need to receive nutrient intravenously. Researchers are currently evaluating drug treatments for refractory celiac disease.
Blood tests can detect several special antibodies, called anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). The health care provider will order these antibody tests if celiac disease is suspected. If the tests are positive, upper endoscopy is usually performed to a tissue sample (biopsy) from the first part of the small intestine (duodenum). The biopsy may show flattened villi in the parts of the intestine below the duodenum. Genetic testing of the blood is also available to help determine who may be at risk for celiac disease.
A follow-up biopsy or blood test may be ordered several months after the diagnosis and treatment. These tests evaluate your response to treatment. Normal results mean that you have responded to treatment. However, this does not mean that the disease has been cured.
The Gluten-Free Diet
A gluten-free diet means not eating foods that contain wheat, rye, and barley. The foods and products made from these grains should also be avoided. In other words, a person with celiac disease should not eat most grains, pastas, cereals, and many processed foods.
Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods. They can use potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour. They can buy gluten-free breads, pastas, and other products from stores that carry organic foods. They can also order products from special food companies, though gluten-free products are increasingly available from mainstream stores.
“Plain” meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can freely eat these foods. In the past, people with celiac disease were advised to avoid oats, but new evidence suggests that most people can safely eat small amounts of oats, as long as they are not contaminated with wheat gluten during processing. People with celiac disease should work closely with their health care team when deciding the role of oats in their diet.
The gluten-free diet requires a completely new approach to eating. Newly diagnosed people and their families may find support groups helpful as they learn to adjust to a new way of life. People with celiac disease must be cautious about what they buy for lunch at school or work, what they purchase at the grocery store, what they eat at restaurants or parties, and what they snack on. Eating out can be a challenge. When in doubt about a menu item, a person with celiac disease should ask the waiter or chef about ingredients and preparation or if a gluten-free menu is available.
Gluten is also used in some medications. People with celiac disease should ask a pharmacist if prescribed medications contain wheat. Because gluten is sometimes used as an additive in unexpected products – such as lipstick and play dough – reading product labels is important. If the ingredients are not listed on the label, the manufacturer should provide a list upon request. With practice, screening for gluten becomes second nature.
Things to Remember
- People with celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley.
- Untreated celiac disease damages the small intestine and interferes with nutrient absorption.
- Without treatment, people with coeliac disease can develop complications such as osteoporosis, anaemia, and cancer.
- A person with celiac disease may or may not exhibit symptoms.
- Diagnosis involves blood tests and, in most cases, a biopsy of the small intestine.
- Since celiac disease is hereditary, family members of a person with celiac disease may wish to be tested.
- Celiac disease is treated by eliminating all gluten from the diet. The gluten-free diet is a lifetime requirement.
- A dietician can teach a person with celiac disease about food selection, label reading, and other strategies to help manage the disease.
You must carefully continue to follow a gluten-free diet. When untreated, the disease can cause life-threatening complications. Delaying diagnosis or not following the diet puts you at risk for related conditions such as:
- Bone disease (osteoporosis, kyphoscoliosis, and fractures)
- Certain types of intestinal cancer
- Low blood count (anaemia)
- Low blood sugar (hypoglycaemia)
- Infertility or repeated miscarriage
- Liver disease
Because the exact cause is unknown, there is no known way to prevent celiac disease from developing. However, being aware of the risk factors – such as having a family member with the disorder – may increase your chances of early diagnosis, treatment, and a long, healthy life. AVAILABLE TESTING