Q. I have been hearing more about celiac disease, and wonder if I may have it. What exactly is celiac, and how is it diagnosed?
A. Celiac disease, also known as celiac sprue, is an inherited digestive disorder affecting between one in 100 and one in 200 people worldwide. With this disease, specific proteins in wheat, barley and rye (collectively known as “gluten”) damage a person’s small intestine, so nutrients are not well absorbed. Gluten can also affect other parts of the body.
The symptoms are many, and vary in different individuals. They range from abdominal pain and bloating, to nausea, diarrhea or constipation, migraines, difficulty digesting lactose, weight loss or easy bruising. Since these symptoms can be common to other conditions, people with CD are often misdiagnosed with irritable bowel syndrome, lactose intolerance, chronic fatigue syndrome, diverticulosis (a condition of weakness in the walls of the colon), ulcers or allergies. Those with CD often suffer for years before a correct diagnosis is made.
Celiac disease can develop at any age, even in the senior years. It may be triggered by a viral or gastrointestinal infection, pregnancy, severe stress or surgery. If CD is untreated, it can cause nutritional deficiencies and increase the risk of osteoporosis, intestinal cancers, neurological disorders, infertility, as well as possible development of other autoimmune disorders. Celiac disease can occur in combination with Type 1 diabetes, auto-immune thyroid disease, autoimmune hepatitis, Down syndrome and Turner syndrome. If a person has any of these disorders and celiac symptoms or a family history of CD, that person should be screened for the disease.
Once a family doctor suspects CD, you should be tested. The doctor can order specific blood screening called tissue transglutaminase (TTG) and endomysial antibody (EMA). However, these tests are not 100 per cent accurate, the only way to be certain that you have CD is to undergo an intestinal biopsy. This procedure should be done by a gastroenterologist in a hospital outpatient setting. It is essential to get the testing done before starting on the GF diet, as this can interfere with making an accurate diagnosis.
Once the diagnosis is confirmed, the person with CD must stop eating all foods and ingredients derived from wheat, rye and barley. This is challenging as gluten is found in a wide variety of foods. Fortunately, many foods are naturally gluten-free, including plain meat, fish, poultry, eggs, legumes, nuts, dairy products, fruits and vegetables, and as well there are gluten-free flours and starches that can be substituted for wheat, rye and barley. And if you do prove to have CD, you will also come to appreciate the numerous gluten-free specialty products now on the market.
- abdominal pain, bloating and gas
- indigestion/reflux (heartburn)
- nausea and vomiting
- diarrhea, constipation or both
- lactose intolerance
- weight loss (CD can occur in obese individuals)
- chronic fatigue and weakness
- iron, folate and/or vitamin B12 deficiency
- other vitamin and mineral deficiencies
- bone and/or joint pain
- easy bruising of the skin
- swelling of hands and feet
- migraine headaches
- canker sores
- menstrual irregularities
- infertility (in both women and men)
- recurrent miscarriages
- elevated liver enzymes
Additional Symptoms in Children
- irritability and behavioral changes
- concentration and learning difficulties
- failure to thrive (delayed growth and short stature)
- delayed puberty
- dental enamel abnormalities
Shelley Case, RD, is an international celiac nutrition expert, consulting dietitian and author of Gluten-Free: The Definitive Resource Guide. Learn more at ShelleyCase.com. Shelley Case is on the advisory boards of the Canadian Celiac Association, the Celiac Disease Foundation and the Gluten-Free Intolerance Group.