Celiac disease — also known as celiac sprue or gluten-sensitive enteropathy — is a digestive and autoimmune disorder that results in damage to the lining of the small intestine when foods with gluten are eaten. Gluten is a form of protein found in some grains. The damage to the intestine makes it hard for the body to absorb nutrients, especially fat, calcium, iron, and folate.
What Causes Celiac Disease?
Normally, the body’s immune system is designed to protect it from foreign invaders. When people with celiac disease eat foods containing gluten, their immune system forms antibodies to gluten which then attack the intestinal lining. This causes inflammation in the intestines and damages the villi, the hair-like structures on the lining of the small intestine. Nutrients from food are normally absorbed by the villi. If the villi are damaged, the person cannot absorb nutrients properly and ends up malnourished, no matter how much he or she eats.
What Are the Symptoms of Celiac Disease?
Symptoms of celiac disease vary among sufferers and include:
- Digestive problems (abdominal bloating, pain, gas, diarrhea, pale stools, and weight loss)
- A severe skin rash called dermatitis herpetiformis
- Iron deficiency anemia (low blood count)
- Musculoskeletal problems (muscle cramps, joint and bone pain)
- Growth problems and failure to thrive (in children)
- Tingling sensation in the legs (caused by nerve damage and low calcium)
- Aphthous ulcers (sores in the mouth)
- Missed menstrual periods
What Health Problems Accompany Celiac Disease?
Celiac disease can leave a person susceptible to other health problems, including:
- Osteoporosis, a disease that weakens bones and leads to fractures. This occurs because the person has trouble absorbing enough calcium and vitamin D.
- Miscarriage or infertility.
- Birth defects, such as neural tube defects (improper formation of the spine) caused by poor absorption of such nutrients as folic acid.
- Growth problems in children because they don’t absorb enough nutrients.
- Cancer of the intestine (very rare).
People who have celiac disease may have other autoimmune diseases, including:
- Thyroid disease
- Type 1 diabetes
- Rheumatoid arthritis
- Sjögren’s syndrome (a disorder that causes insufficient moisture production by the glands)
How Is Celiac Disease Diagnosed?
If your doctor suspects you have celiac disease, he or she will perform a careful physical exam and will discuss your medical history with you. He or she may also perform a blood test to measure for higher levels of certain types of antibodies (substances produced by the immune system to fight harmful invaders) found in people with celiac disease.
Your doctor may perform other tests to detect nutritional deficiencies, such as a blood test to detect iron levels; a low level of iron (which can cause anemia) can occur with celiac disease. A stool sample may be tested to detect fat in the stool, since celiac disease prevents fat from being absorbed from food.
Your doctor may take a biopsy from the small intestine to check for damage to the villi. To perform a biopsy, the doctor inserts an endoscope (a thin, hollow tube) through your mouth and into the small intestine under mild sedation and takes a sample of the small intestine with an instrument to examine under a microscope.
How Is Celiac Disease Treated?
If you have celiac disease, you can’t eat any foods that contain gluten (including wheat, rye, barley, and oats). Dropping gluten from your diet usually improves the condition within a few days and eventually ends the symptoms of the disease. In most cases, the villi are healed within six months.
You’ll have to remain on this diet for the rest of your life; eating any gluten at all can damage the intestine and restart the problem.
Some people with celiac disease have so much damage to their intestines that a gluten-free diet will not help them. These patients may have to receive nutritional supplements through an IV.
Living With a Gluten-Free Diet
A gluten-free diet will be a big change in your life. You have to rethink your eating habits, including what you buy for lunch, what you eat at parties, or what you snack on. Following a gluten-free diet means you cannot eat many dietary “staples,” including pasta, cereals, and many processed foods that contain grains. You will need to be careful when eating packaged foods, as they may contain gluten. Always read the ingredients of packaged foods and when eating in restaurants, ask about the ingredients of a dish before ordering.
But, just because you have celiac disease, it doesn’t mean you can’t enjoy a well-balanced diet. For instance, bread and pasta made from other types of flour (potato, rice, corn, or soy) are available. Food companies and some grocery stores also carry gluten-free bread and products. You can also eat fresh foods that have not been artificially processed, such as fruits, vegetables, meats and fish, since these do not contain gluten.
A dietitian, a health care professional who specializes in food and nutrition, can help you with the gluten-free diet. There are also support groups that can help people with celiac disease make the adjustment.