Coeliac patients

What to know about celiac disease

Celiac disease is an autoimmune condition that involves the immune system reacting to gluten. Gluten is a general name for a group of proteins in cereals such as wheat, barley, and rye.

In a person with celiac disease, exposure to gluten causes inflammation in the gut. Repeated exposure gradually damages the small intestine, which can lead to problems absorbing minerals and nutrients from food.

Celiac disease affects around 1 in 100 people worldwide, and many have the condition without knowing it.

A gluten-free diet is the main treatment for people with celiac disease. Many people without this condition are also going gluten-free for its supposed health benefits. Many of adults are trying to reduce or eliminate gluten from their diet. Many of them do not have celiac disease.

The symptoms of celiac disease can range from mild to severe. They can change over time, and they vary from person to person.

Some people have no symptoms or only experience them later in life. A person may not know that they have celiac disease until they develop a nutrient deficiency or anemia.

Children are more likely to develop digestive symptoms than adults. These symptoms include:

• abdominal pain
• bloating
• gas
• chronic diarrhea or constipation
• nausea
• vomiting
• pale stool with a foul smell
• fatty stool that floats

Symptoms of celiac disease that are not digestive can include:

• weight loss
• fatigue
• depression or anxiety
• joint pain
• mouth sores
• a rash called dermatitis herpetiformis
• nerve damage in the extremities, called peripheral neuropathy, which can cause tingling in the legs and feet

People with celiac disease may develop nutrient deficiencies as damage to the gut gradually limits the absorption of nutrients such as vitamins B12, D, and K. For the same reason, a person may also develop iron deficiency anemia.

Beyond malnutrition, celiac disease can also cause damage to the large intestine and more subtle damage to other organs.

Variations in symptoms may depend on:

• age
• damage to the small intestine
• the amount of gluten consumed
• the age at which gluten consumption began
• how long the person was breastfed, as symptoms tend to appear later in those who were breastfed for longer

Health issues such as surgery, pregnancy, infections, or severe stress can sometimes trigger celiac disease symptoms.

Symptoms in children

When celiac disease limits or prevents a child’s body from absorbing nutrients, this can lead to developmental or growth problems, including:

• failure to thrive, in infants
• delayed growth and short height
• weight loss
• damaged tooth enamel
• mood changes, including impatience or annoyance
• late-onset puberty

Switching to a gluten-free diet early can prevent these issues. Intestinal damage can begin to heal within weeks of removing gluten from the diet.

As time goes by, children may experience spontaneous remission and remain free from symptoms of celiac disease until later in life.

Diagnosis

A doctor can often diagnose celiac disease by considering the medical histories of the person and their family and ordering tests such as blood tests, genetic tests, and biopsies.

Doctors check the blood for the presence of antibodies common in people with celiac disease, including antigliadin and endomysial antibodies.

If other tests indicate celiac disease, a doctor may perform an intestinal biopsy by using an endoscope to take samples of the intestinal lining. Usually, they take several to increase the accuracy of the findings.

Celiac disease can be difficult to diagnose because it shares symptoms with other conditions, including:

• irritable bowel syndrome
• Crohn’s disease of the small intestine
• lactose intolerance
• gluten intolerance
• small intestinal bacterial overgrowth
• pancreatic insufficiency

For more science-backed resources on nutrition, visit our dedicated hub.

Diet

For most people with celiac disease, switching to a gluten-free diet greatly improves the symptoms, and a person may notice improvement in days or weeks.

In children, the small intestine usually heals in 3–6 months. In adults, full healing can take several years. Once the intestine heals, the body is able to properly absorb nutrients from food again.

Having a gluten-free diet is easier than ever in some parts of the world, where gluten-free options are becoming more widely available.

The key is to understand which foods and products such as toothpaste tend to contain gluten. A qualified dietitian can help.

What to eat and avoid

Gluten occurs naturally in wheat, rye, and barley. Most cereals, grains, and pasta, as well as many processed foods, contain gluten. Beers and other grain-based alcoholic drinks can also contain it.

It is crucial to check labeling because gluten can be an ingredient in some unexpected products.

Foods that do not contain gluten include:

• meat and fish
• fruits and vegetables
• some grains, including rice, amaranth, quinoa, and buckwheat
• rice flour
• cereals such as corn, millet, sorghum, and teff
• pasta, bread, baked goods, and other products labeled “gluten-free”

A person can also eliminate gluten from recipes by substituting ingredients and sometimes by adjusting the time and temperature of baking.

In the past, experts recommended that people with celiac disease avoid oats. However, evidence now suggests that moderate amounts of oats are generally safe, provided that the oats have not touched gluten during processing.

It is worth keeping in mind while traveling that regulations about labeling vary from country to country.

Many processed foods can contain gluten, including:

• canned soups
• salad dressings
• ketchup
• mustard
• soy sauce
• seasonings
• ice cream
• candy bars
• processed and canned meats and sausages

Nonfood products can also contain gluten, including:

• some prescription and over-the-counter medications
• vitamin products
• toothpaste
• cosmetics, including lipstick, lip gloss, and lip balm
• postage stamps
• communion wafers

Read more about what a gluten-free diet contains here.

Should everyone follow a gluten-free diet?

Gluten-free diets have become more popular in recent years. However, research does not suggest that this diet benefits people who do not have celiac disease or gluten intolerance.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, “No current data suggests that the general public should maintain a gluten-free diet for weight loss or better health.”

Foods that contain gluten can be important sources of vitamins and minerals, including fiber, iron, and calcium. Speak with a healthcare provider before eliminating these foods, as doing so can lead to nutrient deficiencies.

Treatment

Most people find that eliminating gluten from their diets greatly improves their symptoms. It allows the intestine to heal.

If a person has dermatitis herpetiformis, medications such as diaminodiphenyl sulfone (Dapsone) can reduce the symptoms. This does not heal the intestine, however, so a gluten-free diet is still crucial.

People with celiac disease may also benefit from taking vitamin and mineral supplements to prevent or address deficiencies.

Researchers continue to work on drug therapies to reduce the burden of living with celiac disease and improve the long-term outlook.

The Celiac Disease Foundation offer more information about possible future treatments.

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Complications and outlook

In a person with celiac disease, repeated exposure to gluten damages the intestinal lining. This can result in nutrient deficiencies that can cause issues such as:

• anemia
• hair loss
• osteoporosis
• small bowel ulcers

Researchers have linked celiac disease with some types of cancer, including lymphoma, which develops in white blood cells. However, the association is rare, and most people with celiac disease never develop related cancer. A gluten-free diet can reduce the risk.

Some people develop refractory celiac disease, which involves the body not responding to a gluten-free diet for 12 months or more. This is rare, affecting 1–2% of people with celiac disease. People who have it are almost always over 50 years old.

Causes and risk factors

Celiac disease is an autoimmune disorder. When a person who has it eats gluten, their immune system attacks and damages their small intestine.

Over time, finger-like projections in the intestine that absorb nutrients, called villi, get damaged, limiting the overall absorption. This can lead to a number of health issues.

Celiac disease can develop in anyone. It is more common in white people and in females.

Also, it runs in families. A person with a parent or sibling who has celiac disease has a 1 in 10 chance of developing it, too.

Celiac disease is more common in people with other conditions, including:

• Down syndrome
• Turner syndrome
• type 1 diabetes

Summary

Celiac disease is an autoimmune condition. Exposure to gluten causes the body to attack cells in the small intestine.

There is no cure, but a person can ease or relieve the symptoms by switching to a gluten-free diet.