Celiac disease (CD) is an autoimmune disease affecting one out of every 100 people worldwide.
In those with CD, eating gluten causes the immune system to attack the cells in the small intestine. Damage to the finger-like microvilli in your intestines prevents the absorption of nutrients, which can lead to further conditions and illnesses (1).
This article is part one in a series of three, providing an overview of CD in addition to symptoms and diagnosis.
CD is an immune response triggered by gluten and it develops due to a combination of factors.
Gluten is a protein found in the grassy grains wheat, barley, and rye. Gluten provides structure and shape to bread, ferments to make beer and vinegar, and enhances flavors or thickens in a variety of products such as soy sauce, salad dressings, and ice cream.
Three factors influence the development of CD.
People with CD carry one or both of the human leukocyte antigen (HLA) markers, DQ2 and DQ8.
This doesn’t mean you automatically get CD if you have these genes. Approximately 30% of the population also carry these genes and do not have CD. It does mean that you carry the genetic coding necessary to develop it, and thus are more susceptible (2).
North Africa has the highest rate of CD reported worldwide, with higher-than-expected frequency also reported in the Middle East and Asia (3).
Gluten exposure must occur for CD to develop.
If you evade gluten your entire life, then you would not get CD. Unfortunately, this is nearly impossible, given that wheat-based cereals are among a baby’s first foods.
Once gluten is eaten, a person with CD will have an immune response. This generates antibodies against the protein gliadin found in gluten that damages the microvilli lining (shag carpeting) of the intestine.
For some, they may have the right genes and consume gluten, but they don’t develop CD until a triggering event occurs.
This event may take the form of a virus, infection, injury, stress, or surgery. It is unclear how or why this may cause the onset of the disease. However, it may explain why some people don’t’ develop the disease until later in life (4).
Summary: CD occurs with certain genes, gluten exposure, and a trigger.
Signs and Symptoms
Although not an exhaustive list, there are common signs and symptoms of CD.
Common Digestive Symptoms
- Diarrhea or constipation
- Cramping or stomach pain
- Fatty stool
Many believe digestive symptoms are the hallmark of CD. However, malabsorption of nutrients may cause further issues. Some don’t express any symptoms at all!
Less Obvious Signs
- Dairy intolerance
- Hair loss
- Skin conditions
- Canker sores
- Numbness and tingling
- Depression and anxiety
- Bone and joint pain
- Abnormal menstruation
- Other autoimmune disorders
The Celiac Disease Foundation has a checklist you can review and share with your physician.
Summary: CD can manifest as obvious digestive indicators or less obvious symptoms caused by malabsorption and deficiencies.
CD is not diagnosed based on symptoms alone.
You are at a higher risk of developing CD if you have an immediate family member who has been diagnosed. Get tested.
If you are eating a gluten-filled diet (wheat, rye, barley), then your doctor may start with a series of blood tests to see if your body is producing antibodies against gliadin:
- Tissue Transglutaminase Antibodies (TTG-IgA)
- Endomysial Antibodies (EMA-IgA)
- Total IgA
- Deamidated Gliadin Peptide (DGP)
- Anti-Gliadin Antibodies (AGA).
The most common antibody produced in the digestive tract is the immunoglobulin A (IgA). A small percentage of people are IgA deficient and their blood results do not show accurate IgA levels. Additionally, if you have been consuming a gluten-free diet then you will have very low (if any) levels of antibodies. For these reasons, your physician may run several tests before reaching a conclusion.
As mentioned previously, a blood test for HLA DQ2 and DQ8 can determine if you have the genetic coding for CD. A positive result doesn’t diagnose CD, but if you do not have the genes then most likely you won’t develop CD (5).
The endoscopic biopsy remains the gold standard for diagnosis. Your physician will insert a thin tube through the mouth into the intestine and take three to four samples of the upper small intestinal wall. Damaged microvilli are a definitive sign of CD (6).
Summary: There is not one best protocol to diagnose CD. The physician will consider symptoms and may order various blood tests in addition to the gold standard of a biopsy.
Once you have a diagnosis—whether positive or negative— you can take steps to restore your health.
Beyond Celiac estimates that 83% of Americans who have CD are undiagnosed or misdiagnosed. So, it is a positive step to have some resolution.
If confirmed with a CD diagnosis, then you can immediately begin a gluten-free life. While it may seem overwhelming, you should take heart that the solution to your un-wellness does not involve drugs, surgery, or other therapies. You have an answer and can take the steps necessary to feel better.
Summary: If you do not have CD, explore other conditions with your doctor. If you do have CD, remove gluten from your life.
CD is an autoimmune disease affected by the consumption of gluten.
Genes, gluten exposure, and stressors may all play a role in developing the disease. Digestive issues, less well-known symptoms of malabsorption, or possibly no symptoms at all, can indicate CD. Your physician will order blood tests and/or a biopsy to confirm the diagnosis.
If you have CD, stay tuned for part 2. We will explore how you go about starting and maintaining a gluten-free life.
By Lynnette L. Simpson @SimpsonNutrition