Celiac Disease: No Grain, No Pain?

Celiac disease meaning: What is it?

Celiac disease is an inherited autoimmune condition where the consumption of gluten triggers the body’s immune system to attack its tissues in the small intestine. It is not an allergy or food intolerance. If a person with celiac disease consumes gluten, the lining of the small intestine may become damaged and unable to absorb nutrients, eventually leading to malnutrition, anemia and other symptoms associated with celiac disease.

Celiac disease symptoms

Symptoms of celiac disease can be very non-specific and overlap with many other gastric conditions or mimic food intolerance, therefore celiac disease often goes undiagnosed.

Typical symptoms of celiac disease include:

• Chronic diarrhea, which may smell particularly unpleasant 
• Abdominal bloating
• Children with celiac disease may not grow at the expected rate or may have delayed puberty 

Atypical symptoms of celiac disease due to malabsorption include:

• Recurrent abdominal pain
• Unexplained iron-deficiency anemia 
• Prolonged fatigue as a result of malnutrition and anemia
• Farting (flatulence) 
• Problems getting pregnant (infertility)
• Short stature 
• Sudden or unexpected weight loss

Other atypical symptoms of celiac disease include:

• An itchy rash (dermatitis herpetiformis) 
• Hair loss (alopecia)
• Poor coordination 
• Tingling and numbness of hands and feet (peripheral neuropathy)
• Seizure disorder
• Patches of depigmentation on the skin (vitiligo)
• Dental enamel loss 
• Thinning of bones (osteoporosis and osteopenia)

Celiac disease causes

Celiac disease is an autoimmune condition where the body’s defence against infection mistakes gluten as a threat to the body and attacks healthy tissue of the small intestine. It is not entirely clear what causes the immune system to act this way, however, a combination of genetics (HLA-DQ2, HLA-DQ8, or both) and the environment appear to play an important part in the onset of celiac disease. 

Celiac disease and gluten sensitivity: What is gluten?

Gluten is a general name for the protein found in wheat, barley, spelt and rye. Gluten is found in any food that contains these dietary proteins including:

• Breakfast cereals
• Cakes
• Pasta
• Most types of bread
• Certain types of sauce
• Some ready meals 

Celiac disease diagnosis

Celiac disease testing is not routinely recommended unless patients experience symptoms or are at an increased risk of developing them.

Test for celiac disease involves:

• Blood test - to look for celiac antibodies such as tissue transglutaminase (TTG) antibodies (IgA and IgG), endomysial antibody (IgA) and anti-gliadin antibodies (IgA and IgG)
• Biopsy - if the blood test is positive, a gut biopsy may be carried out to confirm the diagnosis, which can be done endoscopically through the insertion of a long thin tube into the mouth and gently passed down to the small intestine

While being tested for celiac disease, you should not remove gluten from your diet until all tests are completed or until recommended by your gastroenterologist, to ensure the test for celiac disease is accurate.

Tests after diagnosis

If the diagnosis of celiac disease was confirmed, other tests may be required to assess the impact on other systems.

• Further blood tests - to check for levels of iron and other vitamins to help determine if the condition has led to malnutrition or anaemia 
• DEXA scan - a type of x-ray that measures bone density to check for weakened bones (osteoporosis)
• Skin biopsy - if you developed an itchy rash (dermatitis herpetiformis), a skin biopsy may be required to confirm it

Celiac disease treatment

Gluten-free diet 

Once the diagnosis of celiac disease is confirmed, all sources of gluten must be stopped. This can help to prevent damage to the lining of the intestine and alleviate the associated symptoms. The good news is that many foods are naturally gluten-free. 

Gluten is not essential in our diet, and it can be replaced by other foods, there are also gluten-free versions of food available in supermarkets. Many foods such as meat, vegetables, potatoes and rice are naturally free from gluten so these can still be included in the new diet. A dietician will be able to offer help in adjusting a new diet without gluten, ensuring the new diet is balanced and contains all the nutrients required. 

Common foods that contain gluten include:

• Bread 
• Pasta
• Cereals 
• Cakes or pastries
• Biscuits 
• Pies

It is important to always check the food labels before you buy any food. Many foods, especially processed foods, include additives which contain gluten. 

Immunisation

Patients with celiac disease often have a weaker spleen function, making them more vulnerable to infection. It is recommended for those with celiac disease to have a pneumococcal vaccine with a booster every 5 years and an annual flu jab on an individual basis.

Conditions linked to celiac disease 

Celiac disease itself is an autoimmune disease, people with celiac disease have a genetic predisposition to other autoimmune conditions, such as:

• Type 1 diabetes 
• Autoimmune thyroid disease 

Other conditions linked to the celiac disease include:

• Lactose intolerance - celiac disease damages the part of the gut where the enzyme that breaks down lactose (lactase) is produced
• Osteoporosis - the undiagnosed and untreated celiac disease can lead to reducing calcium absorption, resulting in thinning of the bones (osteoporosis) 
• Infertility - the celiac disease does not have an extra risk for infertility, but the undiagnosed and untreated celiac disease may be the underlying cause in cases of unexplained infertility 
• Cancer - people with celiac disease have a slightly increased risk of developing certain cancers such as small bowel cancer, small bowel lymphoma and Hodgkin lymphoma. However, cancer is a very rare complication and if the gluten-free diet was strictly followed for 3-5 years, the risk of developing these types of cancer is no greater than that of the general population.