Celiac disease

What is Celiac’s disease?

Celiac’s disease is an autoimmune disease where the body produces antibodies to attack gluten in digested food, mistakenly believing it to be harmful. Gluten is a protein found in wheat and various other cereals.

Antibodies usually flight off harmful foreign bodies such as bacteria and viruses, and antibodies produced to flight gluten often damage the lining of the intestine in the process. The surface of the intestine is covered in tube-like growths called villi which help to absorb food and nutrients effectively. The damage and inflammation of the gut caused by gluten fighting antibodies can flatten these villi, preventing the gut from digesting and absorbing food properly.

What are the symptoms of Celiac’s disease?

The symptoms of Celiac’s disease vary greatly from person to person depending on how far the disease has progressed, and the age of the person suffering from the disease. Babies and children show different symptoms to adults.

Adult symptoms may include any combination of the following:

  • Bloating or stomach pain
  • Nausea
  • Heartburn or indigestion
  • Constipation or excessive wind
  • Weight loss
  • Vitamin deficiencies (including iron, vitamin B12 and folic acid)
  • Mouth ulcers
  • Hair loss
  • Regular headaches, excessive fatigue or weakness
  • Tooth decay
  • Depression
  • Infertility or miscarriages
  • Joint and bone pains
  • Nerve problems such as neuropathy and ataxia

Symptoms in babies may appear soon after foods containing gluten are introduced into their diet. Symptoms shown by babies and children may include:

  • Vomiting
  • Pale bulky stools
  • Diarrhea with a strong smell
  • Swelling of the stomach
  • Poor growth
  • Anemia

Who gets Celiac’s disease?

Celiacs are born with genes that predispose them to the condition, although having the genes does not necessarily mean that you will develop the disease. Anyone with these genes can develop Celiac’s disease at any age, including young children, although it is most commonly diagnosed among adults who are between forty and sixty years old.

Celiac’s disease is hereditary, although not in a predictable way. If you have a close relative with Celiac’s disease, the chances that you will develop it are about one in ten, so you should be aware of the symptoms and get tested as soon as possible if you suspect you may have the disease. Even people that don’t have a close family member with Celiac’s disease have a one in a hundred chance of developing the disease.

In people that carry celiac genes, the disease can be triggered at any time, often by a stressful event such as surgery, pregnancy, childbirth, or a severe episode of gastroenteritis. There are other autoimmune conditions that can make you more likely to develop Celiac’s disease, and these include Type 1 diabetes and an under-active thyroid.

How is Celiac’s disease diagnosed?

To effectively diagnose Celiac’s disease, you need to be including gluten in your diet. This is because the tests rely on the fact that the body will be fighting against the gluten, and that this will have caused some damage to the gut, if you do have Celiac’s disease.

If you suspect you have Celiac’s disease, the first step is to have a blood test to see if your body is producing antibodies to fight against the gluten in your diet. If the blood test is positive, your doctor should suggest the next stage of testing. In some cases it is possible to have Celiac’s disease without having these antibodies in your blood. If your symptoms suggest Celiac’s disease, your doctor may recommend the next stage of testing anyway, even if the blood test is negative.

The next stage is a biopsy of the small intestine, performed by passing a thin tube down the throat, using a local anesthetic and a sedative, and collecting a small sample of the gut tissue. The sample will then be examined to check for signs of damage caused by gluten.

What other tests will I need if I am diagnosed with Celiac’s disease?

If you are diagnosed with Celiac’s disease, you will probably have to have a few more tests to find out how far the disease has progressed, and the extent of the damage to your gut. Further blood tests may be recommended to check your iron, and other vitamin levels. The results of these tests will show whether you have developed anemia.

You may have to have a skin biopsy if your doctor suspects you are suffering from dermatitis herpetiformis, just to confirm the condition. A small sample of skin from an unaffected area will be taken and tested for dermatitis herpetiformis.

If your doctor suspects your condition has progressed to the extent where your bones may have been damaged by a lack of nutrients, they may recommend a DEXA scan. This measures bone density, and can detect the onset of osteoporosis.

How is Celiac’s disease treated?

The primary treatment for Celiac’s disease is to adopt a completely gluten-free diet. Once you have eliminated gluten from your diet, the damage to your gut will begin to heal, although this can take up to two years depending on your age and how far the disease has progressed. It may take some time to get used to a gluten-free diet, but the symptoms of Celiac’s disease should ease within a couple of weeks of being gluten-free.

There are other ways that symptoms and complications associated with Celiac’s disease might be treated. Firstly, the disease may prevent your spleen working effectively, which will make you more vulnerable to certain infections. This will mean having a number of vaccinations to protect you from infection. These might include jabs to protect against the flu, blood poisoning, pneumonia, meningitis, and infections caused by streptococcus bacteria.

Because your body will have been deprived of vital nutrients prior to being diagnosed with Celiac’s disease, your doctor may recommend you take vitamin supplements for at least the first six months after diagnosis. This will allow your gut to heal more effectively, and will correct any complications like anemia.

What foods should I eliminate in a gluten-free diet?

When you are diagnosed with Celiac’s disease, you should see a dietician or nutritionist for specialist advice on eliminating gluten, and ensuring you have a healthy and well balanced diet. However, there are some simple rules you should follow, and certain foods to avoid.

Foods to avoid (unless they are labeled gluten-free) include:

  • Foods that contain wheat, barley or rye
  • Breads
  • Pastas
  • Breakfast cereals
  • Cookies and crackers
  • Cakes, pies and pastries
  • Gravies and thick sauces
  • Oats (some celiacs can eat oats but they may be contaminated with wheat)

Here are some rules for following a gluten-free diet:

  1. Check the labels on any food that you buy and look out for gluten additives such as malt flavorings and modified food starch.
  2. Look out for non food items that contain gluten such as lipsticks and some medicines.
  3. There are gluten-free alternatives to many food products available from health food shops, pharmacies and supermarkets. These include pizza bases, cookies, bread, pasta and various types of flour including rice, corn, soy, and potato.
  4. Meat, fish, cheese, vegetables, potatoes and rice are naturally gluten-free and so should still be included in your diet.
  5. Be aware that cross contamination can take place if foods that do not contain gluten and those that do are prepared together using the same utensils.

Is Celiac’s disease an allergy or a food intolerance?

Actually Celiac’s disease is neither; it is an autoimmune disease which is triggered by ingesting gluten from wheat, rye, barley, or possibly oats. The body’s immune system attacks the gluten in these foodstuffs, damaging the gut in the process.

An allergy is a reaction of the immune system which usually occurs within seconds of consuming a particular type of food product. Allergies can be life threatening in the short term, with even the tiniest amount of the food substance can cause a critical reaction that requires immediate treatment. A peanut allergy is a good example.

A food intolerance is not triggered by the immune system, and is unlikely to cause a critical reaction. Food intolerances cause digestive problems such as bloating, excessive gas and diarrhea, but they do not damage the gut in the same way as Celiac’s disease.

What is dermatitis herpetiformis?

Dermatitis herpetiformis is a skin condition that around a quarter of celiacs suffer from. Its causes are exactly the same as Celiac’s disease, and it is characterized by an itchy, raised red rash, that often blisters. Most sufferers develop the rash on their knees, elbows or buttocks, but other areas can also be affected.

People suffering from dermatitis herpetiformis are likely to have bowel damage, just like other celiacs, even if they don’t experience gut related symptoms. It should primarily be treated by adopting a gluten-free diet. Your doctor may also suggest you take a medicine in tablet form called Dapsone which will decrease the time your rash takes to heal. This medication can cause depression and severe headaches, so is only prescribed for extreme dermatitis herpetiformis.

What are the complications associated with Celiac’s disease?

If left undiagnosed, there are many long term complications and health risks associated with Celiac’s disease. People often assume that celiacs can eat a small amount of gluten occasionally, but even the tiniest trace of gluten can cause the immune system to produce antibodies, damaging the gut and leading to long term complications.

Complications include:

  • Osteoporosis, which occurs when the bones become weak and brittle because the digestive system is not absorbing enough nutrients.
  • Bowel Cancer, which has been associated with Celiac’s disease, although there are conflicting views on this. If there is an increased risk of bowel cancer, this may cease after three to five years of following a gluten-free diet. Symptoms of bowel cancer include black stools, blood in your stool, stomach pains and weight loss.
  • Malnutrition, which occurs because your body does not absorb enough food. Malnutrition can make you dizzy, cold and tired, and can and can make it hard for you to recover from illnesses or wounds. It can cause your muscles to waste away and can prevent normal growth in children.
  • Lactose intolerance, which occurs because the damage to your gut makes it hard to digest milk sugar, known as lactose. This can cause bloating and stomach pains.