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Celiac Disease

A gluten-free diet

People on a gluten-free diet must avoid all foods containing wheat, rye, barley and (possibly) oats. This includes foods containing spelt, triticale, and kamut and most grain, pasta, cereal and processed foods. While this excludes many foods, people with celiac disease can still enjoy a well-balanced diet, substituting foods made with potato, rice, soy, or bean flour. There are also a variety of gluten-free breads and pastas available at health food stores and through special food companies.

Scientists are still trying to determine whether people with celiac disease can eat oats, as some people are able to without having a reaction. Until studies are more definitive, people with celiac disease should follow their doctor's or a dietitian's advice.

Plain meat, fish, rice, vegetables, and fruits do not contain gluten, so these can be eaten without worry. It is important for people with celiac disease to be especially careful when dining out, or eating at school, work, or social functions. A gluten-free diet must be a lifetime commitment to keep celiac disease under control. Consult your doctor, dietitian, or other health care professional to learn more about a gluten-free diet.

What is celiac disease?

Celiac disease is a digestive disease that damages the small intestine because of a sensitivity to gluten, which is found in wheat, rye, barley, and oats. This hereditary disorder interferes with the absorption of nutrients from food.

When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Tiny fingerlike protrusions, called villi, which line the small intestine and enable the absorption of nutrients from food into the bloodstream, are lost. Without these villi, malnutrition occurs, regardless of how much food a person consumes.

Celiac disease is more common in people of European ancestry, Caucasians, and people with type 1 diabetes. More than 2 million Americans have been diagnosed with celiac disease; however, recent studies have suggested that as many as one in every 133 Americans may have it, and that the disease is underdiagnosed.

What causes celiac disease?

Celiac disease is a genetic disease that runs in families. A person can have the disease and not know it until it is triggered by severe stress, pregnancy, surgery, physical injury, infection, or childbirth.

What are the symptoms of celiac disease?

Celiac disease affects people in different ways. Some persons may develop symptoms as children, whereas others do not experience symptoms until adulthood. Some may have diarrhea and abdominal pains, while others have irritability or depression with the onset of the disease.

While the following are common symptoms of celiac disease, each individual may experience symptoms differently. Symptoms may include:

  • Chronic diarrhea or constipation
  • Weight loss
  • Recurring abdominal pain and bloating
  • Gas
  • Pale, foul-smelling stool
  • Unexplained anemia
  • Muscle cramps and/or bone pain
  • Pain in the joints
  • Tingling numbness in the legs
  • Delayed growth
  • Fatigue
  • Painful skin rash
  • Missed menstrual periods (which is linked to excessive weight loss)
  • Tooth discoloration or loss of enamel

Sometimes, persons with celiac disease are asymptomatic, because the undamaged part of the small intestine is still able to absorb enough nutrients. However, these people are still at risk for complications of the disease.

The symptoms of celiac disease may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is celiac disease diagnosed?

Since symptoms of celiac disease are similar to those of other digestive diseases, such as Crohn's disease, irritable bowel syndrome, ulcerative colitis, diverticulosis, and intestinal infections, it can be difficult to diagnose.

In addition to a complete medical history and physical examination, diagnostic procedures for celiac disease may include the following:

  • Blood work. (To measure the level of antibodies to gluten.) Researchers have found that people with celiac disease have higher than normal levels of certain antibodies in their blood. These antibodies by the immune system in response to substances (such as gluten) that the body perceives as threatening.
  • Biopsy. To diagnose celiac disease, the doctor may remove a tiny piece of tissue from the small intestine to check for damage to the villi. During the procedure, the doctor eases a long, thin tube, called an endoscope, through the mouth and stomach into the small intestine. A sample of tissue is then taken using instruments passed through the endoscope. This procedure is considered the "gold standard" for diagnosis of celiac disease.

What is the treatment for celiac disease?

Specific treatment for celiac disease will be determined by your doctor based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your tolerance of specific medicines, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

A gluten-free diet is the only treatment for persons with celiac disease. Adhering to a gluten-free diet is a lifetime requirement, as eating any gluten will further damage the intestine.

For most people, eliminating gluten from their diet will stop symptoms, heal intestinal damage that has already occurred, and prevent further damage. Usually, a person will see an improvement in symptoms within days of starting the diet and, within three to six months, the small intestine is usually completely healed, with villi intact and working. For older people, complete healing may take up to two years.

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