What is celiac disease?

Celiac disease is a digestive system problem. It damages the lining of the small intestine and makes it hard for your intestines to absorb nutrients from food. If this disease is not diagnosed and treated, it can cause serious problems. Celiac disease increases your risk of:

• Not getting enough nutrients from food
• Anemia (not enough iron in your blood)
• Liver disease
• Osteoporosis (bone loss)
• Cancer

What is the cause?

Celiac disease is an autoimmune disease, which means that it’s a disease that causes your body to mistakenly attack your own tissue. When you have celiac disease, after you eat gluten your immune system attacks the part of your intestine that absorbs nutrients. The immune system is your body’s defense against infection. If you have an autoimmune disease, your body also makes antibodies that attack your normal, healthy tissues.

Gluten is a protein in wheat, barley, and rye grains. Gluten can also be found in oats if they are processed or packaged in factories that process wheat, barley, or rye. Also, some medicines and supplements contain gluten.

Celiac disease is inherited, which means that it’s passed from parents to children through their genes. Genes are inside each cell of your body. They contain the information that tells your body how to develop and work.

What are the symptoms?

Some people start having symptoms as children, others later in life. Sometimes the symptoms start after surgery, pregnancy, childbirth, a viral infection, or severe emotional stress. The symptoms vary a lot from one person to the next. When you start having symptoms, the kinds of symptoms you have, and how severe your symptoms are, is affected by:

• How long you were breast-fed as a child
• How old you were when you started eating foods with gluten
• How much gluten you eat

Digestive symptoms may include:

• Diarrhea
• Stomach pain and bloating

Not all adults with celiac disease have digestive symptoms. Other symptoms may include:

• Bone and joint pain
• Itchy rash
• Missed menstrual periods and trouble getting pregnant
• Numbness or tingling in the hands and feet
• Seizures
• Sores inside the mouth
• Feeling unusually tired

Some people don’t have any symptoms.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Blood tests, including a blood test for certain antibodies. Antibodies are the proteins your immune system makes to fight infections, such as the flu and measles. Celiac disease has many of the same symptoms as irritable bowel syndrome, chronic fatigue, or intestinal infection. However, people with celiac disease have a higher level of certain antibodies in their blood. Before having this test, you will be asked to eat your usual diet, including foods that contain gluten, such as bread. If you avoid foods that contain gluten before the test, the test may be negative even if you have the disease.
• Biopsy. If your blood test is positive for the antibodies, you may need a biopsy of your small intestine. A biopsy is the removal of a small sample of tissue for testing. It is done with a slim, flexible tube passed through your mouth and down into your small intestine.

How is it treated?

The only treatment for celiac disease is a gluten-free diet. For most people, this diet relieves symptoms in a few weeks. The gluten-free diet lets your intestine heal and prevents more damage. The longer you keep eating gluten, the more your intestine is damaged and the greater your risk for long-term problems. If you keep eating foods that have gluten, the disease can be life threatening. You must follow the gluten-free diet all your life.

In young adults, the bowel may be healed after 3 to 6 months on the gluten-free diet. In older adults, the healing may take longer. If your intestine was too damaged before you started the diet, you may keep having symptoms.

What is a gluten-free diet?

A gluten-free diet contains no wheat, barley, or rye. Because the American diet is based on grains, and many processed foods contain grain-based additives, this diet can be hard to follow. You may need to work with a dietitian to help you eat a healthy, gluten-free diet. Here are some suggestions:

• Grains are high in carbohydrates, also called carbs, which are a source of energy and nutrients. It is important to replace carbs from wheat, rye, and barley with carbs from foods such as wild rice, quinoa, millet, corn, and potatoes.
• Fresh fruits, vegetables, beans, milk, fresh beef, pork, poultry, fish, and eggs do not contain gluten. Nuts, seeds, and vegetable oils without additives are also safe.
• Any product with a “gluten-free” label is usually OK to eat. Some food products are certified by the Gluten Free Certification Organization (GFCO) and have a GFCO stamp on them. The GFCO tests for the amount of gluten in products and has strict standards.
• Always read labels to check for gluten, but remember that “wheat free” doesn’t always mean “gluten free.” Wheat-free products may contain barley or rye.
• Many companies will send you a list of their gluten-free products. If you have any question about whether a food contains gluten, avoid the product until you check with the manufacturer.
• When you eat at a restaurant or deli, ask if they have a gluten-free menu. Order foods without sauces since wheat flour is used as a thickener in many sauces.

Your healthcare provider may prescribe a daily gluten-free multivitamin and mineral supplement. Ask your pharmacist or call the manufacturer to find out about the ingredients in your medicine.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. Ask your provider:

• How and when you will hear your test results
• How long it will take to recover
• What activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

You can get more information from:

• Celiac Disease Awareness Campaign
  http://www.celiac.nih.gov
• The Celiac Sprue Association/USA, Inc.
  http://www.csaceliacs.org
• The Celiac Disease Foundation
  http://www.celiac.org
• Gluten-Free Diet: Comprehensive Resource Guide
  http://www.glutenfreediet.ca
• The Gluten Free Mall
  http://www.celiac.com/glutenfreemall/