Celiac disease is an autoimmune disease that affects the small intestine. Additionally, it is one of the only autoimmune diseases that is treated with diet alone. Approximately 2-3 million people in the U.S. have celiac disease, and 1 in 100 people in the world have it as well. Like other autoimmune diseases, it can take up to 10 years to get diagnosed. In fact, many people with this autoimmune disease are asymptomatic. Since May is celiac disease awareness month, I thought I would take the opportunity to discuss what this disease is, how it’s diagnosed, the treatment, and other nutritional considerations to know about.
What is Celiac Disease?
Celiac disease is an autoimmune disease where eating gluten can lead to an immune response against the small intestine. This immune response causes inflammation and wipes out the villi lining the small intestine. Furthermore, damaged or eliminated villi impact the absorption of nutrients. People with undiagnosed celiac disease can experience a host of other symptoms and conditions, including:
- Early onset osteoporosis or osteopenia
- Heart disease
- Infertility and/or miscarriages
- Iron deficiency anemia
- Gall bladder and liver failure
- Malnutrition
- Neurological symptoms
- Vitamin and mineral deficiencies, and
- Cancer
Celiac disease is also hereditary. If you have a first-degree relative with celiac disease, you have a 1 in 10 risk of developing this autoimmune disease. In addition, this autoimmune disease can be diagnosed at any age. The later in life this is diagnosed, the higher the risk is of developing a second autoimmune condition.
How is Celiac Disease Diagnosed?
While gastrointestinal symptoms are usually the most obvious, celiac disease has other not so obvious symptoms. Some of these include: fatigue, weight loss, anemia, loss of bone density, mouth ulcers, joint pain, damage to tooth enamel, irritability and failure to thrive for children.
There are a few tests that help confirm a celiac disease diagnosis. They include:
Blood testing
- Tissue Transglutaminase IgA test (IgA-tTG): When celiac disease is present, the immune system makes antibodies that attack an enzyme in the small intestine called tissue transglutaminase, or tTG. If these antibodies are present, celiac disease is more likely. This is the most sensitive test for celiac disease but the person must have adequate Immunoglobulin (IgA) levels for this to be accurate.
- Deamidated Gliadin Peptide Antibody test (IgG-DGP): This is a less sensitive test but used when an individual does not have adequate IgA levels. DGP is an immune-dominant peptide that activates the immune response in celiac disease.
Small intestinal biopsy
- If either of the 2 blood tests are positive, then a small intestinal biopsy is recommended. This is done with an upper GI endoscopy. They use a camera to look at the lining of the small intestine and take a tissue sample to analyze.
Genetic Testing
- Some doctors may also run genetic testing. They look for gene variants called DQ2 and DQ8. If you do not have these variants, it’s unlikely you have celiac disease. However, having these 2 variants does not mean you do have the disease either.
In most cases, a celiac disease diagnosis requires both a positive blood test and positive endoscopy results.
Treatment
Celiac disease is treated entirely with diet. Those with this disease must remove gluten from their diet. Gluten is found in a lot of products including breads, pastas, baked goods, soy sauce, and processed foods. Gluten is also hidden in many processed foods as food starches, flavorings, preservatives and stabilizers.
Cross contamination is also a big issue for those following a strict gluten free diet. It’s recommended to have separate dishes, cookware and ovens for gluten free foods. One expert said to treat gluten like raw chicken. You must clean everything it touches.
Going out to eat can be extremely challenging too. Thankfully there are gluten free restaurants opening up around the country. In fact, here is a great searchable lists of 100% gluten free restaurants around the World. If you plan to eat out, please make sure you call the restaurant in advance to see if they can accommodate you. Treat gluten like a severe allergy and ask that all of your food be cooked separately.
Other Things to Consider
Nutrient deficiencies are common with celiac disease. That is because of the villi damage. It is a top concern when people are first diagnosed. Key nutrients to consider supplementing include: iron, B12, calcium, vitamin D, folate and zinc.
It is also important to monitor for fiber, B vitamins, iron, calcium, vitamin D, zinc and magnesium in the long run. Many of the gluten containing foods contain these vitamins and minerals. One way to ensure that your diet includes all of these key nutrients is to eat plenty of fruits and vegetables, and gluten free grains like rice and quinoa.
This autoimmune disease is not a death sentence. Yes, it can be difficult to cut gluten from your life. However, there are so many great substitutes for gluten. In addition, people have become more aware of the disease and how to accommodate those with a gluten allergy. For more tips on managing a gluten free lifestyle and your autoimmune disease, be sure to follow me on Instagram, Facebook and YouTube. In addition, please contact me if you are looking for individualized help.
