Celiac Disease

Celiac disease is also known as gluten-sensitive enteropathy and is an autoimmune disorder when a person consumes foods containing gluten.  Gluten is a specific protein fragment (peptides) found in wheat, barley, rye, and oats.  These peptides are more resistant to digestion and may reach the small intestine intact.  For normal, healthy individuals, these intact peptides are harmless.  However, for persons with celiac disease, these peptides can trigger inflammation that damages the lining of the small intestine, preventing the absorption of some nutrients.

The term gluten sensitivity is used to describe patients with nonspecific symptoms, without the immune response characteristic of celiac disease, or without intestinal damage as seen in patients with true celiac disease.  Gluten intolerance describes patients with symptoms and who may or may not have celiac disease.

Symptoms of Celiac Disease, Gluten Sensitivity, and Gluten Intolerance

Symptoms commonly seen in patients with celiac disease, gluten sensitivity, or gluten intolerance, and who have consumed a gluten-containing food include nausea, abdominal cramping, diarrhea, and weight loss.  Other than digestive problems, other symptoms of celiac disease may include itchy skin or rashes, headaches and fatigue, anemia, osteoporosis (loss of bone density) or osteomalacia (softening of the bones), joint paint, acid reflux, and numbness or tingling in the hands and feet.

It is not advised for patients who experience these symptoms to follow a gluten-free diet if they have not been accurately diagnosed with the disease because:

  1. there may be an underlying medical condition where a gluten-free diet is not the treatment
  2. after following a gluten-free diet for several months or years, it is difficult to truly diagnose celiac disease
  3. a gluten-free diet may be more expensive and restrictive

How is Celiac Disease Diagnosed?

There are several tests for celiac disease as outlined below.  If a patient is experiencing any symptoms similar to what is common with celiac disease, it is recommended they contact their doctor to be tested for this disorder before proactively starting a gluten-free diet, as this can alter the test results.

  • Blood test:  A blood test will test for elevated levels of antibodies, which can indicate an immune response to gluten.  These tests can detect celiac disease, even if the symptoms are mild or absent.
  • Endoscopy:  If the blood test detects the possibility of celiac disease, the physician may order an endoscopy to view the small intestine and take a tissue sample to check for damage to the villi.
  • Capsule endoscopy:  This may be a much less invasive method of viewing the patient’s small intestines.  The patient swallows a vitamin-sized capsule containing a tiny wireless camera, which takes pictures of the intestines as it passes through and transmits the images to a recorder.

Nutritional Management of Celiac Disease

Patients diagnoses with celiac disease are instructed to follow a gluten-free diet.  Dietitians play an important role in educating patients with celiac disease and the foods they can eat and what to avoid.  The following list of foods should be avoided on a gluten-free diet:

  • * Wheat
  • * Barley
  • * Rye
  • * Oats (some sources do not include oats as part of the list to avoid, however, oats may commonly contain wheat as part of cross-contamination during harvest, storage, or processing)
  • * Bulgur
  • * Durum
  • * Malt
  • * Graham flour
  • * Farina
  • * Semolina
  • * Spelt

Once gluten has been removed from the diet, the inflammation in the small intestines begins to improve.  Patients may begin to feel better within a few days or several weeks.  The villi in the small intestines can take several months or years to completely heal and regenerate.

Accidental ingestion of gluten may result in varying intestinal symptoms.  Even the smallest amount of gluten consumed can still damage the intestinal cells.

The dietitian or physician may assess the patient for a possible need for vitamin or mineral supplementation, depending on any nutritional deficiencies.  The patient may be instructed to supplement with iron, calcium, folate, vitamin B-12, vitamin D, vitamin K, or zinc as warranted.

So What Foods Are Allowed on a Gluten-Free Diet?

Although the list above of foods to avoid on a gluten-free diet is pretty extensive, there are alternative foods that can be milled into flour and should not pose harm to a celiac disease patient’s intestines, including rice, corn, tapioca, buckwheat, amaranth, chickpeas, lentils, millet, peas, quinoa, sorghum, and soy.

Knowing the rising need for gluten-free foods, food manufacturers have developed common gluten-containing foods, such as pastas, cereals, and breads into gluten-free alternatives so persons with celiac disease can still enjoy safely.  Many restaurants even include gluten-free options for these patrons.