May is National Celiac Disease Awareness Month - What is Celiac Disease?

Celiac disease is a severe, autoimmune disease where gluten ingestion causes damage to the small intestine lining. Celiac disease affects an estimated 1 in 100 people worldwide. Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative with Celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease. Celiac disease can develop at any age after people start eating foods or medicines that contain gluten. Two and one-half million Americans are undiagnosed and are at risk for long-term health complications. Gluten is a general name for the proteins found in wheat, rye, barley that help foods maintain their shape, acting as a glue that holds food together. When people with Celiac disease consume gluten, their body generates an immune response that attacks the small intestine. These attacks lead to damage to the lining of the small intestine that promotes nutrient absorption. When the intestine lining is damaged, the body cannot absorb needed nutrients properly. 

Common Symptoms of Celiac Disease 

Both adults and children can be affected by Celiac disease. 

Common Symptoms of Celiac Disease in Adults include:  

• unexplained iron-deficiency anemia 
• fatigue 
• bone or joint pain 
• arthritis 
• osteoporosis or osteopenia (bone loss) 
• liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, etc.) 
• depression or anxiety 
• peripheral neuropathy (tingling, numbness, or pain in the hands and feet) 
• missed menstrual periods 
• infertility or recurrent miscarriage 
• canker sores inside the mouth 
• dermatitis herpetiformis (itchy skin rash) 

Common Symptoms of Celia Disease in Children include:  

• abdominal bloating and pain 
• chronic diarrhea 
• vomiting 
• constipation 
• pale, foul-smelling, or fatty stool 
• iron-deficiency anemia 
• weight loss 
• fatigue 
• irritability and behavioral issues 
• dental enamel defects of the permanent teeth 
• delayed growth and puberty 
• short stature 
• failure to thrive 

Diagnosing and Treatment for Celiac Disease 

Celiac disease can be challenging to diagnose because it affects people differently. Diagnosing Celiac disease can typically be done through various blood tests. However, there are rare situations where patients have seronegative celiac disease that is missed by the blood test. People with celiac disease who eat gluten have higher than normal levels of specific antibodies in their blood. The immune system produces these specific antibodies because it views gluten as a threat. For the gluten antibody (blood) test to be accurate, patients must be on a diet that contains gluten. Other than the antibody blood tests, a biopsy of the small intestine is the best alternative method to effectively diagnose Celiac disease. 

Testing 

All celiac disease blood tests require that you be on a gluten-containing diet to be accurate. The tTG-IgA test will be positive in about 98% of patients with celiac disease on a gluten-containing diet. The test's sensitivity measures how correctly it identifies those with the disease. The same test will come back negative in about 95% of healthy people without celiac disease. The tTG test is the most sensitive test for celiac disease. Several other antibody tests also serve to double-check for potential false positives or false negatives. While the blood tests are extremely valuable, the gold standard for diagnosing Celiac remains an upper endoscopy with small bowel biopsy. 

Treatment of Celiac Disease 

Although there are many therapies in clinical trial to treat Celiac disease, the only available treatment today, is lifelong adherence to a strict gluten-free diet. People living gluten-free must avoid foods and or any cross-contamination with foods that contain gluten. For most people with Celiac disease, ingesting small amounts of gluten, like crumbs from a cutting board or toaster, can cause damage to the small intestine. A strict gluten-free diet can appear very limiting; however, building a nutritional plan using the fundamentals of naturally gluten-free ingredients can make sticking to a gluten-free diet easier to manage. 

Naturally gluten-free food groups include:  

• Fruits 
• Vegetables 
• Meat and poultry 
• Fish and seafood 
• Dairy 
• Beans, legumes, and nuts 

Naturally gluten-free grains include:  

• Rice 
• Cassava 
• Corn (maize) 
• Soy 
• Potato 
• Tapioca 
• Beans 
• Sorghum 
• Quinoa 
• Millet 
• Buckwheat groats (also known as kasha) 
• Arrowroot 
• Amaranth 
• Teff 
• Flax 
• Chia 
• Yucca 
• Gluten-free oats 
• Nut flours 

Minimally processed fresh foods are a crucial part of a healthy gluten-free diet. People with Celiac disease need to base their diet around fruits, vegetables, meats, and other healthy food groups listed above. Commercially produced “gluten-free” products are also available in many markets and specialty stores. When incorporating any commercially produced product into the diet of anyone with Celiac disease, it is essential to read the ingredients label and disclaimers properly. Product labels, which are different from ingredient labels, may promote items as "wheat-free" or even gluten-free GI Alliance Gastroenterologist and Senior Medical Research Director, Timothy Ritter, MD recommends the app “ipiit” (available via Google play and iTunes), that enables users to scan the barcode on any product label verify ingredient lists and nutrition panels. The app enables personal preferences to avoid foods that trigger allergies or contain certain ingredients such as gluten, lactose, MSG, etc. 

When to see your Gastroenterologist? 

People with the following conditions are at greater risk for Celiac disease:  

• A family member with celiac disease or dermatitis herpetiformis 
• Type 1 diabetes 
• Autoimmune thyroid disease 
• Microscopic colitis (lymphocytic or collagenous colitis) 
• Addison's disease 

If you or a family member have any of the above indicators or are experiencing persistent diarrhea or digestive discomfort that lasts for more than two weeks, you need to schedule a visit with a gastroenterologist. If your child appears pale, irritable, has a bloated/potbelly, foul-smelling/bulky stools, or is failing to thrive/grow, you need to schedule a visit with a pediatric gastroenterologist. To find an Adult or Pediatric Gastroenterologist near you, click below. 

Resources: 

https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220 

https://www.mayoclinic.org/diseases-conditions/celiac-disease/diagnosis-treatment/drc-20352225 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6115770/ https://celiac.org/about-celiac-disease/what-is-celiac-disease/