Celiac Disease: Causes, Symptoms and Treatments

Posted Feb 14, 2020

What is Celiac Disease?

Celiac disease is an immune disorder in which people cannot tolerate gluten. It will damage the inner lining of their small intestine and prevent it from absorbing nutrients. Moreover, when a person has celiac disease, gluten causes the immune system to react in a way that can cause intestinal inflammation—irritation or swelling—and long-lasting damage.

When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi—the tiny, finger-like projections on the inner lining of the small intestine. Villi normally absorb nutrients from food and passes it through the walls of the small intestine and into the bloodstream. Without healthy villi, people can become malnourished, no matter how much food they eat.

Celiac disease is a serious, genetic autoimmune disorder triggered by consuming a protein called gluten, which is found in wheat, barley and rye. When a person with celiac eats gluten, the protein interferes with the absorption of nutrients from food by damaging a part of the small intestine called villi. Damaged villi make it nearly impossible for the body to absorb nutrients into the bloodstream, leading to malnourishment and a host of other problems including some cancers, thyroid disease, osteoporosis, infertility and the onset of other autoimmune diseases.¹

What Causes Celiac Disease?

Researchers do not know the exact cause of celiac disease. Celiac disease sometimes runs in families. In 50 percent of people who have celiac disease, a family member, when screened, also has the disease.

A person’s chances of developing celiac disease increase when his or her genes have variants. In celiac disease, certain gene variants and other factors, such as a person’s exposure to things in his or her environment, can lead to celiac disease.

For most people, eating something with gluten is harmless. For others, an exposure to gluten can cause, or trigger, celiac disease to become active. Sometimes surgery, pregnancy, childbirth, a viral infection, or severe emotional stress can also trigger celiac disease symptoms.

What Are the Signs and Symptoms of Celiac Disease?

A person may experience digestive signs and symptoms, or symptoms in other parts of the body. Digestive signs and symptoms are more common in children and can include:

• abdominal bloating
• chronic diarrhea
• constipation
• gas
• pale, foul-smelling, or fatty stool
• stomach pain
• nausea
• vomiting

Being unable to absorb nutrients during the years when nutrition is critical to a child’s normal growth and development can lead to other health problems, such as:

• failure to thrive in infants
• slowed growth and short stature
• weight loss
• irritability or change in mood
• delayed puberty
• dental enamel defects of permanent teeth

Adults are less likely to have digestive signs and symptoms and may instead have one or more of the following:

• anemia
• bone or joint pain
• canker sores inside the mouth
• depression or anxiety
• dermatitis herpetiformis – an itchy, blistering skin rash
• fatigue, or feeling tired
• missed menstrual periods
• seizures
• tingling numbness in the hands and feet
• weak and brittle bones, or osteoporosis
• headaches

Intestinal inflammation can cause other symptoms, such as:

• feeling tired for long periods of time
• abdominal pain and bloating
• ulcers
• blockages in the intestine

Celiac disease can produce an autoimmune reaction, or a self-directed immune reaction. This reaction can spread outside of the gastrointestinal tract to affect other areas of the body, including the:

• spleen
• skin
• nervous system
• bones
• joints

Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases and conditions. Celiac disease can be confused with:

• irritable bowel syndrome (IBS)
• iron-deficiency anemia caused by menstrual blood loss
• lactose intolerance
• inflammatory bowel disease
• diverticulitis
• intestinal infections
• chronic fatigue syndrome

As a result, celiac disease has long been under-diagnosed or misdiagnosed. As healthcare providers become more aware of the many varied symptoms of the disease and reliable blood tests become more available, diagnosis rates are increasing, particularly for adults.

How is Celiac Disease Treated?

Most people with celiac disease have a significant improvement in symptoms when they follow a gluten-free diet. Healthcare providers typically refer people to a dietitian who specializes in treating people with the disease. The dietitian will teach the person to avoid gluten while following a healthy and nutritious diet. The dietitian will give the person instructions for how to:

• read food and product labels and identify ingredients that contain gluten
• make healthy choices about the types of foods to eat
• design everyday meal plans

For most people, following a gluten-free diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Symptoms may improve within days to weeks of starting the diet. The small intestine usually heals in 3 to 6 months in children. Complete healing can take several years in adults. Once the intestine heals, the villi will absorb nutrients from food into the bloodstream normally.

Some people with celiac disease show no improvement after starting a gluten-free diet. The most common reason for poor response to dietary changes is that people are still consuming small amounts of gluten, which can damage the small intestine—even in people without symptoms. Most people start responding to the gluten-free diet once they find and eliminate hidden sources of gluten from their diet. Hidden sources of gluten include additives made with wheat, such as:

• modified food starch
• preservatives like MSG, maltodextrin, and some natural and artificial colors and flavors
• stabilizers

Currently, the only treatment for celiac disease is a strict, lifelong gluten-free diet. Researchers are working hard to find alternative therapies and possibly a cure.¹ Visit the Beyond Celiac website to learn more about celiac disease drug development.

Some people who continue to have symptoms even after changing their diet may have other conditions or disorders that are more common in people with celiac disease. These conditions may include:

• small intestinal bacterial overgrowth
• pancreatic exocrine insufficiency, in which the pancreas does not produce enough digestive juice
• microscopic colitis, an inflammation of the colon that can only be seen with a microscope
• IBS
• lactose intolerance
• other food intolerances, which may occur because of continued damage to the intestine

In some cases, people continue to have difficulty absorbing nutrients despite following a strict gluten-free diet. People with this condition, known as refractory celiac disease, have severely damaged intestines that cannot heal. Their intestines are not absorbing enough nutrients, so they may need to receive nutrients intravenously. Researchers continue to evaluate medications to treat refractory celiac disease.

Depending on a person’s age at diagnosis, some complications of celiac disease will not improve, such as short stature and dental enamel defects.

Eating, Diet, and Nutrition

Eating, diet, and nutrition play a significant role in treating celiac disease. People with the disease should maintain a gluten-free diet by avoiding products that contain gluten. In other words, a person with celiac disease should not eat most grains, pasta, cereal, and many processed foods.

People with celiac disease can eat a well-balanced diet with a variety of foods. They can use potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour. They can buy gluten-free bread, pasta, and other products from stores, or order products from special food companies. Meanwhile, “plain”—meaning no additives or seasonings—meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat these foods.

In the past, healthcare providers and dietitians advised people with celiac disease to avoid eating oats. Evidence suggests that most people with the disease can safely eat small amounts of oats, as long as the oats are not contaminated with wheat gluten during processing. People with celiac disease should talk with their healthcare team when deciding whether to include oats in their diet.

Eating out and shopping can be a challenge. Newly diagnosed people and their families may find support groups helpful as they adjust to a new approach to eating. People with celiac disease should:

• read food labels—especially canned, frozen, and processed foods—for ingredients that contain gluten
• avoid ingredients such as hydrolyzed vegetable protein, also called lecithin or soy lecithin
• ask restaurant servers and chefs about ingredients and food preparation and request a gluten-free menu if available
• ask a dinner or party host about gluten-free options before attending a social gathering

Foods that are packaged as gluten-free tend to cost more than the same foods containing gluten. People following a gluten-free diet may find that naturally gluten-free foods are less expensive. With practice, looking for gluten can become second nature.

Content for this blog sourced from National Institute of Diabetes and Digestive and Kidney Diseases

References

1. Beyond Celiac. https://www.beyondceliac.org/