Celiac Disease

1. What Causes Celiac Disease?

Celiac disease is triggered by the consumption of gluten, but the underlying cause is a combination of genetic predisposition and environmental factors:

• Genetics: People with celiac disease usually have specific genetic markers, particularly HLA-DQ2 and HLA-DQ8, but having these genes doesn’t mean a person will definitely develop the disease.
• Immune Response: When a person with celiac disease eats gluten, their immune system mistakenly attacks the lining of the small intestine, leading to inflammation and damage.

2. Symptoms

Celiac disease symptoms can vary widely, ranging from severe digestive issues to symptoms outside of the gastrointestinal tract. Some people may be asymptomatic. Common symptoms include:

Digestive Symptoms:

• Diarrhea or constipation
• Abdominal pain and bloating
• Weight loss
• Fatigue
• Nausea and vomiting
• Foul-smelling, fatty stools (steatorrhea)

Non-Digestive Symptoms:

• Dermatitis herpetiformis: A skin rash characterized by itchy, blistering bumps.
• Iron-deficiency anemia
• Osteoporosis or osteopenia (due to calcium and vitamin D malabsorption)
• Neurological symptoms like headaches, brain fog, or peripheral neuropathy
• Joint pain or arthritis
• Infertility or recurrent miscarriage
• Delayed growth or short stature in children

3. Diagnosis

Diagnosing celiac disease involves a combination of tests:

• Serologic Tests: Blood tests that detect antibodies associated with celiac disease, such as tissue transglutaminase antibodies (tTG-IgA) or endomysial antibodies (EMA).
• Genetic Testing: This can identify the HLA-DQ2 or HLA-DQ8 genes, which are necessary but not sufficient on their own to cause celiac disease.
• Endoscopy and Biopsy: A biopsy of the small intestine taken during an endoscopy can confirm damage to the villi, which is the gold standard for diagnosis.

It’s important to note that these tests are most accurate when a person is still consuming gluten. A gluten-free diet can cause these markers to disappear, leading to false-negative results.

4. Treatment

The only effective treatment for celiac disease is a strict, lifelong gluten-free diet. Even small amounts of gluten can trigger symptoms and cause damage to the intestine. A gluten-free diet involves avoiding foods and products that contain wheat, barley, rye, and their derivatives.

• Allowed Foods: Rice, corn, quinoa, potatoes, fruits, vegetables, meat, fish, dairy, and gluten-free grains (such as oats that are certified gluten-free).
• Hidden Sources of Gluten: Gluten can be found in processed foods, medications, and even personal care products. It’s essential to read labels carefully.
• Cross-Contamination: Even trace amounts of gluten from shared kitchen utensils or surfaces can be harmful.

After starting a gluten-free diet, symptoms may begin to improve within weeks, though it can take months to fully heal the intestinal damage.

5. Complications of Untreated Celiac Disease

Without treatment, celiac disease can lead to a variety of serious health issues:

• Malnutrition: Damage to the small intestine reduces nutrient absorption, leading to deficiencies in vitamins and minerals.
• Osteoporosis: Poor absorption of calcium and vitamin D can lead to weak bones.
• Infertility and Miscarriage: Celiac disease can affect fertility in both men and women.
• Neurological Issues: Including seizures, migraines, or peripheral neuropathy.
• Increased Risk of Other Autoimmune Diseases: Such as type 1 diabetes, thyroid disease, and multiple sclerosis.
• Cancers: People with untreated celiac disease have a higher risk of developing certain types of cancers, including lymphoma of the small intestine.

6. Non-Celiac Gluten Sensitivity

Some individuals experience symptoms similar to celiac disease but do not test positive for celiac disease or wheat allergy. This is known as non-celiac gluten sensitivity (NCGS). While the immune system may be involved, the small intestine does not show the same type of damage as in celiac disease. The treatment is also a gluten-free diet, though it may not need to be as strict as in those with celiac disease.

7. Living with Celiac Disease

Managing celiac disease requires vigilance in maintaining a gluten-free diet. Many social situations, such as dining out, require special care to avoid gluten exposure. However, with growing awareness, many restaurants and food manufacturers offer gluten-free options.