With the majority of menus and grocery shelves full of gluten-free options, most people are aware of celiac disease (CD). But many don’t understand what it is and how it impacts the roughly 2 million Americans with the disease.
To begin with, CD is an autoimmune disorder that can develop at any age after people start consuming gluten. It is slightly more common in women than men and frequently occurs in people of European descent, as well as those with other autoimmune or chromosomal disorders. People with a first-degree relative (e.g., parent, child, sibling) with celiac disease have a significantly increased risk of developing CD.
When people with CD consume gluten, their body misguidedly begins attacking the small intestine. Over time, these repeated attacks can lead to permanent damage to the intestinal lining. The damage can prevent nutrients from being absorbed into the body, which can cause abdominal pains, bloating, and bowel changes. Left untreated, celiac disease can lead to serious health problems.
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One of the biggest challenges of CD is getting a diagnosis. There are 250+ potential symptoms of CD, and they can vary greatly from person to person. Some may experience stomach pain or weight loss as children, while others can be well into adulthood before experiencing CD-related fatigue or anemia. It’s even possible for someone to have CD and experience no symptoms.
The most common symptoms of CD include:
- Stomach pain
- Chronic diarrhea or constipation
- Bloating and gas
- Fatigue
- Iron-deficiency anemia
Other common symptoms include:
- Weight loss
- Pale, foul-smelling stools
- Tingling or numbness in the legs
- Joint or bone pain
- An intensely itchy skin rash
CD in children is also associated with poor growth, delayed puberty, and behavioral issues.
If symptoms or personal and family history suggest CD, a diagnosis can be confirmed through a combination of three tests:
- Serology tests: a blood test to look for specific antibodies that indicate an immune response to gluten
- Genetic testing: a blood test for the presence or absence of genes necessary for CD to develop
- Endoscopy with biopsy: If the blood tests point to CD, an upper endoscopy is performed to obtain small intestine tissue samples that are then examined for CD-related damage
While there is no cure for CD, it can be managed through a strict, lifelong diet free of wheat, barley, and rye. Avoiding these foods allows the intestinal lining to heal, alleviates symptoms, and prevents long-term complications. In many cases, patients began to experience an absence of symptoms in a matter of weeks. Full healing of the intestinal lining typically takes months or years. Generally, the older the patient, the longer the time required for full healing.
As challenging as a gluten-free diet can be, it’s important for people with CD—even those with mild or no symptoms—to follow it. Unmanaged, CD can lead to a wide range of complications that go beyond the digestive system. These include increased risk of:
- Other autoimmune diseases
- Infertility and missed menstrual periods
- Lactose intolerance
- Osteoporosis
- Nervous system disorders, including neuropathy and ataxia
- Lymphoma
- Weakened tooth enamel
- Issue with the liver, gall bladder, and pancreas
- Heart disease
- Neurological issues, including seizures, dementia, attention-deficit/hyperactivity disorder (ADHD), and headaches
If you think you or a loved one might have CD, click here to take an online assessment from Beyond Celiac. Be sure to share the findings with your doctor. The sooner you get diagnosed, the sooner you can take steps to manage CD, reduce the risk of complications, and get back to leading an active and healthy life.
David Furman, MD, is a gastroenterologist at Southwestern Vermont Medical Center.