What is Celiac Disease? (SQ-153)

Celiac disease is an autoimmune condition where eating gluten causes damage in the small intestine in people who are genetically predisposed. It is also called celiac sprue or gluten-sensitive enteropathy. Gluten is a protein that is found in foods such as wheat, barley and rye, and in foods made with these grains. It is also important to understand that celiac disease is not the same as gluten intolerance or gluten sensitivity. Experts believe that only 20% of the people with this condition receive the correct diagnosis. In this blog, we are going to explore all the usual and unusual symptoms of celiac disease.

This condition produces a wide range of symptoms that may or may not occur in the gastrointestinal tract. It can also be easily misdiagnosed as inflammatory bowel disease; due to the common digestive symptoms present in both the conditions.

What happens in celiac disease?

Celiac disease is an autoimmune disorder, where a person's immune system mistakenly attacks its own healthy tissues. If a person with celiac disease consumes gluten, their immune system views gluten as a foreign invader and starts producing antibodies to fight against it. This abnormal immune reaction causes inflammation in the gut and damages villi – small finger like projections that line the small intestine. Even a small amount of gluten can damage the small intestine, causing disagreeable symptoms.  

Villi helps in the absorption of nutrients from the food by increasing the available surface area. The inflammation in the gut is a source of the gastrointestinal symptoms such as abdominal pain, gas and bloating. And damage to the villi means your body is not able to absorb nutrients as efficiently as it should. This leads to malnutrition, weight loss and a myriad other health problems.

Celiac disease and your health

What does having celiac disease mean for your health? Celiac disease is a serious disorder. People with this condition are at a very high risk of developing long term health problems, including nutritional deficiencies and conditions such as coronary artery disease, small bowel cancer, poor bone density, anaemia, osteoporosis, infertility, pancreatic disease, miscarriage and more. For children, having celiac means poor growth and development and other psychological issues.

Common nutritional deficiencies associated with Celiac disease include vitamin B12, iron, magnesium, folate, zinc, vitamin D and fibre. These deficiencies further contribute to the burden of health problems faced by people with celiac. That is, people who have one kind of autoimmune disorder are more prone to developing other autoimmune problems.

According to the Celiac Disease Foundation, celiac disease is associated with other autoimmune conditions such as Hashimoto’s thyroiditis, Crohn’s disease, lupus, psoriasis, Type 1 diabetes mellitus, multiple sclerosis, arthritis, Sjogren’s syndrome, Addison disease and Berger’s disease.

What are the symptoms of Celiac Disease?

Diagnosing celiac disease can be difficult because it affects different people in different ways. This condition presents with an extensive range of mild to severe symptoms, some of them even occurring outside of the digestive tract. [1] While bloating and abdominal pain are common digestive symptoms, other non-classical celiac disease symptoms such as nutritional deficiencies, constipation, joint pain, anaemia and neurological issues such as brain fog and headaches can be vague and may cause the health care provider to suspect other medical conditions such as chronic fatigue syndrome, or fibromyalgia.

What also complicates the diagnosis is that its gastrointestinal symptoms may mislead doctors into diagnosing it as irritable bowel syndrome (IBS), Crohn's disease, infections of the intestine and ulcerative colitis. It is, therefore, important that you see a specialist to get a proper diagnosis, lack of which can cause significant exposure to several health problems. In most cases, following a gluten-free diet after a correct diagnosis would heal the damage and eliminate troubling symptoms.  
 
Some people develop this disease as a child while others may become celiac later in life. How do you know you have celiac disease? Adults and children may have different sets of symptoms. Let’s have a look.

Symptoms of Celiac Disease in Adults

Adults with this condition may not necessarily have digestive problems, but they may experience the following symptoms after eating foods that contain gluten:

1. Fatigue and lack of energy
2. Joint pain or bone pain
3. Abdominal pain
4. Nausea and vomiting
5. Gas
6. Fatigue
7. Iron deficiency anaemia
8. Arthritis
9. Osteoporosis
10. Lactose intolerance
11. Tingling sensation in the hands and feet
12. Itchy rash on the skin (a condition known as dermatitis herpetiformis)
13. Headaches
14. Mouth ulcers
15. Depression and anxiety

Again, it is very important to understand that people with celiac disease may not always have symptoms typically associated with their gastrointestinal tract. For example, one of the typical symptoms in adults and especially in women is an itchy rash on the skin. This celiac disease skin rash is commonly found on elbows, knees, buttocks and scalp. It is also called dermatitis herpetiformis, celiac rash or gluten rash. It's easy to confuse this rash with other skin problems with similar symptoms. And in an interesting connection, a gluten free diet is known to be helpful in improving symptoms in other autoimmune skin disorders such as psoriasis and alopecia.

Celiac disease and nutritional deficiencies

People with celiac disease, irrespective of their symptoms or lack thereof, struggle with poor absorption of nutrients.  Abnormal immune response to gluten causes inflammation and damage in the inner lining of the small intestine. This part of your small intestine contains villi (hair like structures responsible for healthy nutrient absorption) and micro-villi (extensions from the villi that is home to enzymes that improves absorption of nutrients). Damage to these structures in the small intestine and loss of enzymatic functions mean altered absorption of vitamins and minerals such as vitamin D, vitamin B12, calcium, zinc, magnesium and iron.

Iron deficiency anaemia is an important symptom in this disease. In fact, it may be one of the early signs that you are suffering from celiac [2]. Impaired absorption of iron results in fatigue, poor energy levels and headache. Studies show that people with celiac disease are much more likely to suffer from sleep issues, which can also lead to extreme tiredness. Celiac disease also causes a shortfall of B vitamins, which are known to play an important role in energy metabolism and nervous system health. Loss of bone mineral density and consequently poor bone health is often observed in people with celiac disease. This is due to poor absorption of calcium, magnesium and vitamin D.

Exposure to gluten causes inflammation in the whole body and this may result in pain in joints and muscles. Neuropathy (damage to the nerves) is another very surprising and seemingly unrelated symptom of celiac disease. Feelings of numbness and tingling in arms and legs are commonly seen in people with diabetes (as high blood sugar levels damage the nerves) and in those who are Vitamin B12 deficient. Most of these symptoms, especially bloating, fatigue and stomach pain, are usually resolved after going on a gluten-free diet.

 

Symptoms of Celiac Disease in Children

The signs of celiac disease in children are mostly related to their digestive health. Some infants and children may develop this autoimmune condition early in life, at around 6-10 months of age, while others may get it many years later. Even the symptoms vary from age to age. In children, this disease can impair normal growth and development as the body is not able to absorb nutrients effectively. Some common symptoms in children include:

1. Bloating and pain in abdomen
2. Chronic diarrhoea
3. Constipation
4. Fatigue and poor energy levels
5. Weight loss and poor growth
6. Delayed puberty
7. Short stature
8. Iron deficiency anaemia
9. Pale, foul-smelling stool (a condition known as steatorrhea)
10. Less weight-gain
11. Severe mood swings and irritability
12. Weight loss
13. Depression and anxiety

Inability to absorb the nutrients that their growing and developing body needs can lead to serious health problems in children, such as anaemia, damage to the teeth's enamel, crankiness and severe mood changes, delayed growth, delayed onset of puberty, problems with learning and even attention deficit hyperactivity disorder (ADHD).

Silent Celiac Disease

Some people with celiac disease may not experience any symptoms at all. This is called silent celiac disease. (If someone in your family has this condition, it is best to get yourself tested.) Being asymptomatic doesn't mean gluten is not causing any damage to the small intestine. The damage may still be happening, and you may still be at risk of developing other health problems, whether you are asymptomatic or not.  Following a gluten free may result in better overall health even if there were no previously reported symptoms.

The signs and symptoms of celiac disease might come and go. There are certain triggers that make the symptoms appear such as high levels of stress, some infections, surgery and pregnancy.

How can you make symptoms of celiac disease go away?

Can celiac disease go away? Removing gluten from your diet is the only way to get rid of the symptoms, heal the damage in the small intestine and reduce the risk of most health problems that are directly and indirectly linked to celiac disease. It is important to get a right diagnosis because a gluten free diet can also cause nutritional deficiencies, if not done under the guidance of an expert or a registered dietitian. Wheat and other gluten containing grains are a good source of B vitamins and fibre. If you are quitting gluten, it is important to compensate it with other grains, such as quinoa or amaranth, that are rich in vitamins and minerals. An experienced and trained dietitian can also make you aware of all the obvious and not so obvious sources of gluten in your diet. [3]

If you think you might have all or some of the above-mentioned symptoms, get in touch with a health care professional to find out whether these symptoms indicate the presence of celiac disease or some other health issue. Getting blood tests (to check for the antibodies) and biopsy are two of the important ways you can get a correct diagnosis. If you don't test positive for antibodies, this could mean you may have gluten sensitivity. People with gluten sensitivity may also have similar symptoms as that of celiac disease. But gluten sensitivity does not cause any damage to the small intestine. While it is not as damaging as celiac disease, you may still have to go off gluten to feel better and get rid of your disabling symptoms.

Quick facts on Celiac Disease

1. Celiac disease cannot be cured. It is a genetic condition. One must live with it, and only a gluten-free diet can help relieve symptoms and heal the intestine.
2. Research suggests that celiac disease is diagnosed more frequently in women
3. Majority of the people with celiac disease are not diagnosed.
4. If someone in your family has celiac disease, the odds that you will also have it are 1 in 10.
5. If you have celiac, you may also be at a high risk of inflammatory bowel disease such as Crohn's disease and ulcerative colitis.
6. Wheat, barley and rye are the most commonly known gluten-containing foods. Other varieties of wheat and their derivatives such as durum, semolina, graham, malt, spelt, farina, farro, wheat berries, bulgur, wheat bran, couscous and kamut also contain gluten and should be avoided by people with celiac disease. Triticale, which is a hybrid of wheat and rye, also contain gluten.
7. Some medicines, toothpaste, nutritional supplements and cosmetic products also contain gluten.
8. A product that can be safely called gluten-free should contain less than 20 parts per million (ppm) of gluten.
9. If you think you might have celiac disease, the best approach is to get tested for the antibodies before you actually go gluten free. Once you have quit gluten, your immune system gradually stops producing antibodies. Experts say that these antibodies last for about 3 to 6 months even after you go off gluten.
10. Gluten can also cause gastrointestinal symptoms like bloating, abdominal pain and fatigue in someone with irritable bowel syndrome, a fact that further complicates the diagnosis.  

References:

1. Tarar et al. The Progression of Celiac Disease, Diagnostic Modalities, and Treatment Options. Journal of Investigative Medicine High Impact Case Reports. 2021.
2. Martín-Masot et al. Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review. Nutrients. 2019.
3. Taoufik Ben Houmich and Brahim Admou. Celiac disease: Understandings in diagnostic, nutritional, and medicinal aspects. International Journal of Immunopathology and Pharmacology. 2021.

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