Celiac disease is on the rise. The condition, also called celiac sprue, coeliac, and gluten-sensitive enteropathy, was once considered rare, but it is now affecting more people than ever, 1 in 100. Many physicians believe it is a grossly undiagnosed disease, and some doctors now regularly screen anyone with severe digestive complaints for the hazardous disease. The reality is celiac disease is more than an uncomfortable condition - it's life threatening. According to the Mayo Clinic, there is a fourfold higher death risk for people with undiagnosed gluten intolerance.
So what is celiac disease then? It's a reaction triggered by gliadin, a type of gluten protein. There may be confusion about the term 'gluten,' and to clarify, gluten is the cohesive, stretchy protein found in wheat, rye, barley and triticale. It's the smaller proteins it's broken down into, including gliadin, that causes reactions in celiac disease. The body creates an autoimmune response to the offending protein, wearing down the villi in the small intestine, similar to what's happening in leaky gut. The damage of the intestinal lining causes chronic inflammation and malabsorption of vital nutrients, resulting in any of the many symptoms listed below. Part of the reason why celiac disease often goes undetected for so long is because symptoms vary so widely from person to person. Some people suffer for decades before knowing the culprit; others never receive a diagnosis.
The onset of symptoms is due to a combination of genes, diet and the environment. There are two genes that are known to be involved in celiac disease. One or both of the genes is necessary for the onset of celiac disease, yet some people may carry the gene(s) and never express symptoms. Some people suffer symptoms from birth, while others begin to express symptoms later in life - that's where diet and environment comes in. For many people, it's the exposure to levels of gluten and/or a trigger which can instigate a reaction. People often think of wheat as a nutritious food source, which it can be, but we must recognize the commercial wheat we eat today is a vastly different substance than wheat produced only 50 years ago; its genetic makeup has changed due to cultivation, and our bodies can't always handle the current processing methods. Triggers can be anything from emotional stress or pregnancy to a virus or trauma. Compromised digestive health can also contribute - if you have a weak intestinal lining that allows passage of large particles of food, gliadin may enter your blood stream and provoke a reaction. Regardless of why or how you have celiac disease, your body will maintain a constant level of inflammation as long as gluten is consumed. Research articles devoted to celiac disease can be found here.
Symptoms can begin at birth or at any point in life. Symptoms in children under the age of two tend to be more severe 'classic' gastrointestinal symptoms than in older children (see below). Older children and adults tend to suffer from similar symptoms, although sometimes milder manifestations, or from entirely different associated conditions. Although celiac disease is directly affecting the small intestine, many people exhibit no gastrointestinal symptoms at all. It's also not uncommon for symptoms to disappear and reappear later on, but know that intestinal damage continues as long as you consume glutinous substances. Intestinal damage causes malabsorption, which leads to deficiencies of vital nutrients, including iron, folc acid, calcium, vitamin D, vitamin E and vitamin B12. Malabsorption leads to a host of associated symptoms and conditions, listed below.
'Classic' Gastrointestinal Symptoms
- Chronic diarrhea
- Abdominal pain and bloating
- Pale stool
- Weight loss/gain
- Failure to thrive in children
Associated Symptoms & Conditions
*note this list is not all inclusive, there can be other manifestations
- Itchy rash (dermatitis hepetiformis)
- Peripheral neuropathy
- Behavioral changes
- Irregular menstrual cycle
- Addison's disease
- Chronic fatigue syndrome
- Inflammatory bowel disease
- Irritable bowel syndrome
- Severe headaches/migraines
- Rheumatoid arthritis
- Hashimoto's thyroiditis & Graves disease
- Type 1 diabetes
- Pancreatic disorders
- Multiple sclerosis
Anyone with classic symptoms of celiac should be tested. You are at a higher risk of celiac disease if you have family members with any or all of the following: celiac or gluten sensitivity, diabetes type I, autoimmune thyroidtis (Graves, Hashimoto's) and neurological conditions such as ataxia. Children with failure to thrive or learning disabilities may be sensitive to gluten. If you have amenorrhea or fertility issues, it may be related to celiac or gluten sensitivity as well.
Your doctor can administer a test, but you must be consuming gluten at the time of the test, as a gluten-free diet (even if short term) may give you false negative results.
- IgA Anti-tissue Transglutaminase (tTG): Tests for antibodies. Also effective with asymptomatic people.
- Anti-Gliadin Antibodies (AGA): Tests for antibodies. Also effective with asymptomatic people.
- Total Immunoglobulin A (IgA): Will test for low IgA levels, which celiac patients are likely to have. This test can help rule out false negatives.
- Small Intestine Biopsy: Gold standard for confirmation of celiac disease, however, is more invasive and may be prone to false negatives due to patchy occurrence of intestinal damage.
- Genetic testing: available for the celiac gene markers - good for those with inconclusive blood test results (now also included in some stool tests, which can be ordered by all health care professionals).
- Elimination diet: The most simple and least invasive way to determine if your symptoms are due to gluten consumption. With the help of a nutritionist or health practitioner, eliminate all gluten from your diet (wheat, rye, barley & triticale), as well as medications and supplements that may contain gluten - check with your doctor) for a minimum of two weeks. If your health issues are caused by gluten intake, they should subside after a month. Those who achieve lasting relief from a gluten-free diet may choose to do no testing at all, but they must be dedicated to a gluten-free lifestyle.
non-celiac gluten sensitivity
Many people have symptoms of celiac disease but receive negative blood test results and intestinal biopsies that reveal no tissue damage. Patients with gluten sensitivity, as opposed to celiac disease, will have antibodies against gluten, but not the autoimmune antibodies that are characterized by celiac disease. This is increasingly common, and it can be very frustrating as it's difficult to obtain a clear diagnosis. Gluten sensitivity can manifest as the same symptoms listed above, with a greater variability in severity and duration. Since tests can be both expensive and difficult to obtain, your best bet may be to do an elimination diet, with the help of a nutritionist. Food allergy & sensitivity tests, as well as stool tests, can also be extremely helpful for uncovering reactions to gluten and the intestinal damage it may have caused, which will be very beneficial for the healing process. Most people will need to be gluten-free forever to avoid symptomatic flare-ups, but some may be able to ingest gluten in small amounts after an extended period of abstention and healing. Determining if you're gluten sensitive is just as important as determining if you have celiac disease, as over time your health will deteriorate if nothing is done.
The only treatment for celiac disease and gluten sensitivity is a gluten-free diet. That does not mean indulging on weekends or eliminating everything "except beer and late night pizza," which is something I often hear. What it means is eliminating gluten from your diet entirely, in all forms. Once you have done this, your symptoms should subside, relatively quickly in fact, and that will be that. Your small intestine will slowly begin to heal, and your health can return to normal. You can speed up the healing process by following the 4 R Protocol, listed on my treatment page.
Eliminating gluten from your life may be a difficult pill to swallow, particularly once you understand just how much gluten is a part of the standard American diet. It's everywhere, or at least it sometimes feels that way. It can be difficult on a social level as well, as sometimes you may feel like the odd one out or isolated. Giving up gluten can also cause withdrawal for the first few weeks, as grains can induce opiate effects on the brain, which makes the initial elimination no easy feat. But consider this: the standard american diet isn't helping anyone. Cutting out gluten may be your personal first step to overall better health. Consider it an opportunity for change.
Meeting with a nutritionist can help you through the early transition period. Joining an online or local celiac support group may be very helpful for those who feel particularly addicted to gluten containing foods. The good news is that now is a great time for the gluten-free person, as new products are literally coming out everyday. Check out my gluten & wheat page for specific details on how to go gluten-free. It's important you educate yourself on hidden sources, all varieties and types of wheat, and how to read nutrition labels.