Celiac disease is an incurable autoimmune condition in which eating foods with gluten can cause damage to the small intestine. Gluten is a protein found in wheat, rye, and barley. When people with celiac eat foods containing this protein, their bodies respond by launching an attack on the small intestine.

Celiac tends to run in families, so if someone in your family has celiac (a parent, child, or sibling), you have a 1 in 10 chance of getting it, too. It’s thought that  1 in 100 people have celiac worldwide, though the disease often goes undiagnosed. Experts believe that 250,000,000 Americans may have undiagnosed celiac disease, putting them at risk for all sorts of long-term health issues.

In the healthy person, the small intestine is lined with hair-like villi (pronounced VILL-eye) that look like the fibers in a carpet. These villa help the gut take in the nutrients from the food we eat. When the person with celiac eats gluten, it is these villi that are attacked by the body’s immune system. Damage to the villi means that nutrients from food cannot be properly absorbed by the body.

The villi in the gut of a healthy person makes the small intestine look as though it is lined with a plush carpet. In the person with celiac, the gut will look less like a carpet and more like a tile floor. If you spill water on a rug, the fibers will soak up the water. If you spill water on a tile floor, the water just sits on the surface until it dries up. In the same way, in a person with celiac, the nutrients in food will not be absorbed by the gut, because the nutrient-absorbing villa are damaged, worn down, with the nutrients having nowhere to go.

A person can develop celiac disease at any age, as a response to having eaten foods or taken medications containing gluten. When celiac goes untreated, other health problems can develop. Some of the health issues that can affect people with celiac include autoimmune diseases like multiple sclerosis (MS) and Type 1 diabetes, anemia, infertility, migraines, epilepsy, osteoporosis (bone loss), intestinal cancer, and an itchy skin rash called dermatitis herpetiformis.

There’s no cure for celiac and the only treatment for the disease is to avoid eating anything containing gluten (for instance bread and beer), and that’s forever. Even a small amount of gluten, for example crumbs on a cutting board, can bring on an attack that can damage the small intestine. People with celiac have to check the labels of everything they eat and drink. Sometimes, lipsticks will have gluten and this can be a problem, too, since lipstick tends to get chewed off and ingested by the wearer.

Celiac disease has other names. The other names for celiac disease include coeliac disease, celiac sprue, non-tropical sprue, and gluten sensitive enteropathy.

Chronic Conditions From Untreated Celiac

The damage from untreated celiac can bring on any of these long-term health conditions:

• Iron deficiency anemia
• Early onset osteoporosis or osteopenia
• Infertility and recurrent miscarriage
• Lactose intolerance
• Vitamin and mineral deficiencies
• Central and peripheral nervous system disorders
• Pancreatic insufficiency
• Intestinal lymphomas and other GI cancers (malignancies)
• Gall bladder malfunction
• Neurological manifestations including migraine, ataxia (lack of involuntary muscle coordination), epileptic seizures, dementia, , neuropathy (nerve pain), myopathy (muscle tissue disease), and multifocal leucoencephalopathy (damage to the brain’s white matter)

Celiac is not easily diagnosed because different people with celiac will have different symptoms. There are some 300 symptoms that are known to come with celiac. Some of these symptoms look like tummy trouble and other symptoms have nothing to do with the stomach. Meantime, some people with celiac don’t seem to have any symptoms at all. Still, they could be damaging their small intestines and not realizing it, leaving them at risk for all sorts of long-term health issues.

Symptoms of Celiac Disease in Children

Children with celiac disease are more likely to have stomach problems. Here are some of the symptoms that are common in children with celiac:

• Bloated stomach, stomach pain
• Often has diarrhea
• Vomiting
• Constipation
• Light-colored, smelly or fatty bowel movements
• Losing weight
• Always tired
• Cranky, acts out
• Permanent teeth have thinning or pitted enamel
• Slow growth or late-onset puberty
• Short for age
• Doesn’t seem strong or healthy (failure to thrive)
• Attention Deficit Hyperactivity Disorder (ADHD)

Other Celiac Symptoms

Adults with celiac don’t always have stomach distress. Only one-third will report having chronic diarrhea. On the other hand, adults with celiac are more likely than children to have the following symptoms:

• Iron-deficiency anemia not explained by diet
• Fatigue
• Joint and bone pain
• Arthritis
• Osteoporosis (bone loss)
• Depression or anxiety
• Tingling or numbness in the hands and feet
• Migraines or seizures
• Skipped menstrual periods
• Infertility or recurrent miscarriage
• Canker sores in the mouth
• Dermatitis herpetiformis (a very itchy blistery skin rash)

Celiac Disease Diagnosis

Celiac diagnosis involves two steps:  a blood test to screen for the possibility of celiac and a biopsy of your small intestine to confirm or disprove the disease. Anyone over the age of three with celiac symptoms or those who have close relatives (parent, child, sibling) with celiac should be tested for celiac because of the danger of long-term health issues. If you have celiac, there’s a 1 in ten chance your close relatives will have it, too.

Since celiac cannot be cured, it is essential that once diagnosed, a strict, no-gluten diet is followed for life. People with celiac need close monitoring by a doctor to make sure that they’re sticking to their gluten-free diets and to ensure that any nutritional deficiencies are treated. The doctor can also watch for and treat any of the health conditions that tend to come with celiac.

Screening for celiac involves taking one of several blood tests. The most common blood test used to screen for celiac disease is the tTG-IgA test. If the results of your blood test show you might have celiac, your doctor may decide to send you for a biopsy of your small intestine. The biopsy is the only way to know for sure whether or not someone has celiac. In a biopsy, a small sample of tissue is taken and sent to a lab to be analyzed. The doctor will base the diagnosis on the lab findings and also from the patient’s response to a  gluten-free diet.

During the screening and biopsy it is important that you NOT be on a gluten-free diet. In fact, experts recommend that those on a gluten-free diet who want to find out if they have celiac should take the “Gluten Challenge.” This means eating the equivalent of 4 slices of bread for 1-3 months followed by an endoscopic biopsy of the small intestine, an outpatient procedure. In this case, the blood test is unnecessary.

Other Celiac Considerations

Celiac is a response to the ingestion of gluten, or eating and drinking products with gluten. But breathing is considered similar to ingestion. That means it’s probably not a good idea for someone with celiac disease to work in a bakery, where he would be likely to inhale flour particles in the air.

While gluten can be absorbed through eating, drinking, and breathing, it cannot be absorbed by the skin. That means you don’t have to worry about using shampoos and soaps that might contain gluten, if you have celiac.

Lipstick, on the other hand, could be a problem for you, if it contains gluten. Best to stick with gluten-free lip products.

Celiac and School Lunches

The Americans with Disabilities Act (ADA) means that schools are require to provide children with celiac gluten-free lunches. That doesn’t mean that your child will receive a gluten-free version of mac and cheese on the day that the other “normal” kids are having the normal version of that classic. Children with a 504 plan or those who can document their disability, are entitled not only to lunch but to a plan for classroom management of their celiac disease. That might mean that small children with celiac will not have access to paste or other gluten-containing art class items they might taste or put in their mouths. It might mean that such children will not have field trips where they might come in contact with gluten, such as a tour of a bread factory.

Celiac? Or a Gluten Sensitivity?

Not everyone who is sensitive to gluten has celiac. Some people have the same symptoms as those with celiac, but without intestinal damage and without having blood test results that show the presence of celiac disease antibodies. These people are said to have non-celiac gluten sensitivity.

Doctor are still learning about non-celiac gluten sensitivity. Right now, there is no way to diagnose the condition accurately or know how many people really have this condition. If you don’t have a wheat allergy and you don’t have celiac, but you feel better when you avoid gluten, you can be considered to have non-celiac gluten sensitivity.

 

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