What Is Celiac Disease? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Celiac disease is an autoimmune condition that prevents proper nutrient absorption and the digestion of gluten.
When people diagnosed with the condition are exposed to gluten — a binding protein common in grains but also in makeup products — the immune system malfunctions and attacks the walls of the small intestine, which is responsible for absorbing nutrients from food, according to the Celiac Disease Foundation. People with celiac disease have a swollen and irritated small intestine, which can interfere with this absorption, leading to nutrient deficiencies.
The condition requires avoiding gluten to manage symptoms.
Signs and symptoms of celiac disease vary widely from person to person. Indeed, some people with the condition are asymptomatic. Generally speaking, though, there are some telltale signs you should know.
First, digestive problems can occur in anyone with celiac disease, but they may be more common in children with the disease than adults. Here are some of the digestive symptoms that may occur, per the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):
Unfortunately, researchers haven’t yet been able to identify exactly what causes celiac disease. Currently they think it has something to do with genetics combined with environmental factors.
If you have a family member with celiac disease, you're at higher risk for the condition, research shows. For example, someone with a first-degree relative has a 10 to 15 percent risk of also having the condition.
Indeed, there’s a so-called “celiac gene.” Among those with celiac disease, 95 percent have the HLA-DQ2 gene, and most of the rest of that remaining 5 percent have the HLA-DQ8 gene.
People with a genetic disorder, such as Down syndrome or Turner syndrome, are also more likely to develop the disease.
If you have another autoimmune disorder, you're also more likely to develop celiac disease. Those conditions include:
A number of tests can help your doctor figure out whether you have celiac disease or another digestive condition.
Per the Mayo Clinic, your doctor may recommend:
Blood tests Your blood sample will be checked for special proteins called antibodies. Certain antibodies tend to be elevated in people with celiac disease. Before your blood test, you should continue to eat foods containing gluten. Cutting out gluten before testing is complete could delay your diagnosis.
Endoscopy Your doctor may ask a gastroenterologist to perform an endoscopy to confirm your diagnosis if a blood test shows you may have celiac disease. You'll swallow a small, flexible tube containing a tiny camera. Through this tube, your doctor will perform a biopsy, removing a tiny piece of tissue from the wall of your small intestine. A specialist (usually a pathologist) will view this tissue under a microscope to see whether it has been damaged by celiac disease.
Genetic testing Your doctor may order a genetic test to rule out a celiac disease diagnosis. Most people with celiac disease carry a certain variant of the HLA-DQ2 or HLA-DQ8 genes. But many people without celiac disease also have these variants, so celiac disease can't be diagnosed by genetic testing alone.
Capsule endoscopy Your doctor may order this test, in which you swallow a tiny camera inside a small capsule that travels through your digestive tract. The camera takes thousands of photos that are transmitted and recorded.
Celiac disease is a lifelong disease and not something individuals can outgrow. People with the condition must stop eating gluten for the rest of their lives.
In general, once individuals with celiac disease stop eating gluten, their symptoms will ease within a few days. The small intestine should heal completely in several months, though it may take up to two years for the body to heal completely in older individuals, per Johns Hopkins Medicine.
Adhering to a gluten-free diet and avoiding medicines and products that contain gluten is the best way to keep symptoms of celiac disease under control, according to some research.
You can ask your pharmacist if gluten is an ingredient in certain medicines, herbal supplements, vitamins, or minerals.
Other types of products may have hidden sources of gluten, including:
Cosmetics
Skin and hair products
Toothpaste and mouthwash
Play-Doh
Communion wafers
Glue on envelopes and stamps
You can never be too careful. Read ingredient labels carefully when you're out shopping and advise family and friends to do the same when shopping for you.
At first, the news of a celiac disease diagnosis may be tough to hear. For some, it might mean completely overhauling their diet. But a dietitian can help you transition to a gluten-free diet in which you still eat healthy and nutritious foods. You'll be instructed how to:
Use food and product labels to identify ingredients that contain gluten
After starting on a gluten-free diet, individuals with celiac disease will continue to see a doctor for periodic checkups to make sure the condition is improving. Many doctors recommend a follow-up visit four to six weeks after you start the diet, notes Coeliac UK.
Are There Supplements That Are Good for People With Celiac Disease?
People with celiac disease are at risk of nutritional deficiencies because the disease can limit the small intestine's ability to absorb nutrients from food, per the Celiac Disease Foundation. Your doctor can test for nutritional deficiencies with blood tests.
People with celiac disease often have low levels of:
Iron
Calcium
Vitamin B12
Vitamin B6
Folate
Vitamin A
Vitamin E
Vitamin D
Vitamin K
Zinc
Copper
A multivitamin or nutritional supplement can help you rebuild your levels of essential nutrients.
But keep in mind that some vitamins, minerals, and herbal supplements may contain gluten. Talk to your doctor or pharmacist before taking any nutritional supplement to make sure it doesn't contain gluten.
Gluten-free diets are sometimes low in fiber, which can lead to constipation. A fiber supplement with psyllium seed husks can also help, as can fiber-rich foods, like fruits and veggies.
Can Medication Help Manage Celiac Disease?
A small percentage of people with celiac disease find that their symptoms don't improve, even with a strict gluten-free diet.
Symptoms may go away initially but then return, even in the absence of gluten. It's unclear why this happens. If there is substantial inflammation in the small bowel, your doctor may prescribe a steroid medication.
Steroids are typically taken for a short period of time to suppress the immune system and stop the body's harmful immune response.
Gluten is found in many commonly loved foods, including traditional pizza crust, several types of sandwich breads, pasta, tortillas, cake, cookies, and even soy sauce. But for people with celiac disease, knowing the foods and products gluten lurks in — and then avoiding them — is key for keeping symptoms controlled and preventing an attack.
Foods to Avoid if You Have Celiac Disease
Foods that contain gluten include:
Wheat
Barley
Rye
Bulgur
Durum wheat
Farina
Malt
Semolina
Spelt
Graham
Triticale
That means that people with celiac disease shouldn't eat most breakfast cereal, bread, pasta, and processed foods.
Some processed foods that may contain gluten include:
Bouillon cubes
Brown rice syrup
Candy
Chewing gum
Chips, including seasoned tortilla and potato chips
Cold cuts, hot dogs, salami, and sausage
Communion wafers
French fries
Gravy
Imitation fish
Rice mixes
Soy sauce
Beer and malt beverages
Soups and sauces are common sources of hidden gluten, as wheat flour is often used as a thickener. Pay special attention to sauces or soups that are cream-based. The Celiac Disease Foundation website has an extensive list of foods that may contain gluten.
Gluten-Free Foods
Cutting gluten out of your diet may seem like a difficult task, but many foods, including the following, are naturally gluten-free:
Fruits
Vegetables
Fresh cuts of meat and poultry
Fish and seafood
Dairy
Beans, legumes, and nuts
Beware, though, that prepared or processed versions of any of the above foods, such as sausage or ice cream, may contain gluten.
Many gluten-free grains and starches can be substituted for wheat and other gluten-containing grains:
The following strategies may help you stick to your gluten-free diet when eating out:
Choose a restaurant with gluten-free options. This means a place that serves naturally gluten-free foods or has a special gluten-free menu.
Inform your waiter. Let them know you have celiac disease and may get sick if you eat anything containing gluten, including flour, bread crumbs, or soy sauce. Also ask them to inform the chef or cook. This way, you’ll have more confidence that nothing on your plate has touched gluten.
Ask questions. Don't assume anything is gluten-free. Omelets, for instance, may have pancake batter added to the egg mixture to make them fluffier, and baked potatoes can be coated with flour to make the skins brown and crispy.
Prevention of Celiac Disease
At this time, there is no proven way to prevent celiac disease. The best way to keep symptoms of celiac disease under control is to maintain a gluten-free diet.
Treatment for the disease and new lifestyle habits, such as following a gluten-free diet, can help prevent long-term complications.
Dermatitis herpetiformis (an itchy rash of bumps and blisters) or other skin conditions
Regardless of age or other factors, the symptoms of celiac disease can manifest differently depending on who you are. For example, some people with the disease have digestive problems, especially diarrhea, while others experience problems in other parts of the body, such as anemia, fatigue, headaches, and joint pain.
But best estimates put the prevalence of the condition around 1 in 100 people, or about one-half of 1 percent of the U.S. population, per the Celiac Disease Foundation.
Unfortunately, celiac disease can be tough to diagnose in many people because its symptoms are often confused with those of other conditions. But it’s important to know that celiac is distinct from those conditions, including gluten intolerance and a wheat allergy, because it's an autoimmune disease in which the immune system attacks the small intestine, leading to malabsorption.
Could Your Symptoms Be the Result of a Wheat Allergy?
If you’ve been tested for celiac and the results were negative, there’s a chance you simply have an allergy to wheat.
Wheat allergies affect millions of Americans, according to the American College of Allergy, Asthma & Immunology, and symptoms include:
These symptoms may appear after you eat foods with wheat, including bread, cereal, or granola. Because these foods also contain gluten, a wheat allergy is commonly called a “gluten allergy,” though there’s actually no such thing.
Your doctor can do a blood test or skin-prick test to diagnose you with a wheat allergy.
Treatment includes avoiding foods with wheat and using either corticosteroids or antihistamines. You should also have epinephrine on hand in case of an allergic attack.
Could You Have Intolerance to Gluten (Nonceliac Gluten-Sensitivity)?
Gluten intolerance, also called nonceliac gluten sensitivity (NCGS), is a possibility if you’ve tested negative for both celiac disease and a wheat allergy. But unfortunately, there isn’t a good test to diagnose this condition.
If your doctor suspects you have gluten intolerance, he or she may suggest a blood test and then a biopsy. If the biopsy is normal, your physician may suspect NCGS.
The main treatment for NCGS is a gluten-free diet, but as with celiac, be sure to work with your healthcare team to make sure you’re properly nourishing your body.
To date, there is no evidence or reports to suggest that individuals with celiac disease are at a greater risk of severe illness from COVID-19 than those without the condition.
The Celiac Disease Foundation is collecting physician and patient-reported data on people with celiac disease who have been diagnosed with COVID-19. This data will help show the true impact of COVID-19 on people with celiac disease.
