Estimated to affect about one percent of the population, celiac disease is an autoimmune condition where the ingestion of gluten — proteins found in wheat, rye, and barley — triggers an immune repose in the body that attacks the small intestine. It damages the villi — small hair-like projections that line the small intestine and allow the body to properly absorb vitamins, minerals and other nutrients. According to the Celiac Disease Foundation, two and one-half million Americans are undiagnosed and at risk for long-term health complications from celiac disease.
Many celiac patients are genetically predisposed to the disease. In fact, having a first-degree relative — a parent, child or sibling — with celiac is the number one risk factor. It can occur at any age, and the prevalence is believed to be increasing primarily due to the rise in screening. In fact, proper testing is critical to obtaining an accurate diagnosis.
Celiac Disease Symptoms
Not all celiac patients experience symptoms but those who do most often suffer from bloating and abdominal pain. More severe symptoms can include weight loss, anemia, fertility issues and abnormal liver enzymes. Left untreated, celiac can cause long-term damage to the body, including anemia, osteoporosis, malnutrition and in rare cases, it can even lead to intestinal cancers.
Proper Diagnosis of Celiac Disease
Because of the rise in awareness of gluten and the increase in the number of gluten-free products available, many people experiencing potential celiac symptoms will first try eliminating gluten from their diet before seeing a physician. While this may seem logical, it is actually detrimental to obtaining a proper diagnosis.
Gastroenterologists diagnose celiac disease through blood work and an upper endoscopy with biopsy. The purpose of these tests is to detect specific antibodies produced in an autoimmune response. The endoscopy also allows examination of the small intestine to identify any damage to the villi indicative of celiac disease. If someone has completely eliminated gluten before these tests are conducted, the result will appear normal even though that person may very well have celiac disease. That is why if celiac disease is suspected, it is critical to see a gastroenterologist for evaluation before completely eliminating gluten.
Understanding the Difference Between Celiac Disease and Gluten Sensitivity
Celiac disease is a serious autoimmune condition while gluten intolerance is defined as a sensitivity. Both are treated by eliminating gluten. However, someone with celiac disease must completely avoid gluten for the rest of their life while someone with a gluten sensitivity may be able to simply reduce gluten intake and achieve symptom improvement.
Gluten-free diets are not designed for everyone. Adopting a completely gluten-free diet should only be done if medically needed. Many grains that contain gluten are fortified with vitamins and minerals that are not present in gluten-free products. As a result, those with celiac must make a plan to incorporate adequate amounts of key vitamins and minerals like vitamin D, vitamin B12, iron and zinc into their diet through other foods or supplements. In addition, gluten-free products tend to be higher in refined sugars and can also alter the gut microbiome.
Treating Celiac Disease
The good news is that celiac disease is not only treatable but curable by adopting a completely gluten-free diet. Thanks to increased awareness of gluten and the abundant availability of gluten-free products, it is also easier than ever before. Patients who remove gluten exposure can eliminate symptoms, and follow-up endoscopies typically reveal no evidence of damage to the small intestine.
However, even the slightest amount of gluten can trigger a celiac attack. It has been estimated that 1/100th of a piece or white bread, the equivalent of a crumb, is all it takes. That is why thorough patient education and nutritional support of celiac patients is critical. This includes not only helping them to design a healthy, gluten-free diet that meets their nutritional needs, but also informing them about the dangers of cross-contamination that can occur from things as small as sharing a plate, silverware or straw with someone else. It also involves assisting with investigation of potential gluten culprits if attacks continue.
Celiac patients are monitored by periodically measuring the level of antibodies in their blood. If the antibodies are normal and the patient is still experiencing symptoms, a gastroenterologist can explore incidence of other gastrointestinal (GI) conditions and provide appropriate treatment. Celiac disease can overlap with other GI conditions such as irritable bowel syndrome (IBS), microscopic colitis and Crohn’s disease. Sometimes a patient’s IBS can worsen after treating the celiac disease, and the physician can work with the patient to develop a plan to address this.
The AdventHealth Digestive Health and Surgical Institute’s team of community gastroenterologists provide comprehensive care for celiac disease as well as a full range of GI conditions, including the most complex cases.
Once again, if you suspect celiac disease, it is critical to undergo testing before eliminating gluten. To schedule an appointment or refer a patient to the AdventHealth Digestive Health Institute.
About Andrew Elden, MD
Andrew Elden, MD, is a board-certified gastroenterologist, who specializes in a wide variety of digestive diseases and offers multiple treatment options, including colonoscopy, upper endoscopy and small bowel enteroscopy. After receiving his medical degree from Rutgers University, Dr. Elden completed his internal medicine residency at the University of Miami, where he was chosen as Chief Resident in Quality and Patient Safety. During his elite gastroenterology fellowship at Thomas Jefferson University, Dr. Elden received the Fellow Patient Satisfaction Award and earned research awards from the American College of Gastroenterology. He is fluent in English and Spanish.
