Celiac disease is a serious autoimmune disorder that affects around 3 million people in the US, or about 1 percent of the nation’s population. People with celiac disease become extremely sick when they consume gluten, a type of protein found in rye, barley, wheat and an array of other grains. Left untreated, celiac disease can cause insurmountable damage to the wall or lining of the small intestine, leading to malabsorption. The consequences are dire because prolonged malabsorption will likely result in anemia, osteoporosis, ulcers and other digestive complications.
A growing number of studies have shown that early diagnosis of the disease can make a huge difference. Thankfully, revolutionary testing platforms like the imaware™ at home testing kit have made celiac disease testing more accurate, more affordable and more accessible than ever before.
A brainchild of Microdrop, imaware™ is the world’s first blood-testing platform to offer at-home tests for several ailments. This means you can now screen test for the disease right from the comfort of your home. What’s more, early data has already demonstrated we can detect celiac disease with an accuracy of more than 95 percent!
There is much to know about celiac disease, an autoimmune condition that can lead to a battery of serious symptoms, including malnourishment, infertility, miscarriages and a host of digestive issues. This article covers everything you need to know about celiac disease, from what it is to screening and treatment options.
What is Celiac Disease?
Celiac disease is a digestive condition whereby consuming gluten leads to an immune autoresponse. This often induces widespread inflammation and severe damage to the lining of the small intestine. More specifically, the autoimmune attack affects tiny, finger-like projections lining the intestinal wall called villi. Villi help boost absorption of nutrients into the bloodstream. Extensive harm to villi has far-reaching health ramifications because the small intestine can’t do its job properly, which has a domino effect on the body. For instance, malnutrition as a result of malabsorption has been blamed for many health complications, from causing infertility to triggering certain cancers.
More and more people are voluntarily embracing a diet free of gluten. However, people with celiac disease have no choice but to stay away from the protein. The trouble is that gluten is almost ubiquitous in our daily diets and can be found in various foods from oats and rye to all forms of wheat and wheat blends.
It is estimated that celiac disease affects approximately 1 in every 100 healthy, average people globally. Unfortunately, about 2.5 million people with the condition in the United States are undiagnosed, putting them at the highest risk for celiac-related complications. This is an area where early screening solutions can be especially handy.
What Causes Celiac Disease?
Genes, along with consuming foods rich in gluten, and a host of other factors can lead to celiac disease. However, the exact cause of the disease is still unknown. Some recent studies seem to suggest that a combination of gut bacteria, infections in the small intestines and certain infant-feeding practices may contribute to incidence of the disease. Some people have developed celiac disease after undergoing traumatic stress, childbirth, pregnancy, surgery or viral infections.
Celiac disease is characterized by hypersensitivity to gluten. When you eat foods containing this type of protein, the automatic immune reaction attacks and damages the villi lining the small intestine impairing, and eventually preventing them from aiding the absorption of minerals, vitamins and other micronutrients from what you eat.
What are the Symptoms of Celiac Disease?
Celiac disease can become symptomatic at any age. Most people wrongly think that the disorder is a food allergy. It’s not. In fact, the symptoms for allergy and celiac disease are very different. If you are allergic to wheat, for instance; you may experience watery, blood-shot eyes, itchy skin, and breathing difficulties when you consume wheat products. However, when you eat something with gluten and you have celiac disease, you will most likely manifest the following common signs and symptoms:
Bloating is one of the most common symptoms associated with celiac disease. A rapid autoimmune response to the presence of gluten can cause massive inflammation in the gastrointestinal tract, most notably in the small intestine. Inflammation in the digestive system usually leads to bloating, accompanied by a series of other potentially serious gastrointestinal complications. Some people report bloating after consuming foods with gluten even if they don’t have celiac disease. So, bloating in and of itself isn’t a clear sign of the disorder. Still, bloating is one of the most prominent symptoms. In one study published in 2003 in the journal Digestive Diseases and Sciences (DDS), scientists found that 73 percent of the 1032 participants said to be bloated and were later diagnosed with celiac disease. This is corroborated by another 2004 study involving 215 patients with celiac disease. In this particular study, researchers discovered that removing gluten from the diet put an end to bloating.
In an interesting turn of events, a 2011 study of 34 individuals without celiac disease found that gluten actually causes digestive issues such as bloating. These symptoms, including bloating, resolved or improved after test subjects were put on a gluten-free diet.
As you may already know, bowel obstruction, gastrointestinal disorders, chronic gas, and constipation may also be responsible for bloating.
Sharp Weight Loss
Given that people with celiac disease are highly likely to suffer from malabsorption, it’s only a matter of time before they experience a drastic drop in weight. People with the condition find it hard to maintain their average weight right from the onset of the disease. The body’s inability to absorb important nutrients will eventually result in serious malnutrition and emaciation.
In a 2012 study that followed 112 patients for more than 24 months, 23 percent of the participants reported weight loss, the 4th most prominent symptom, right after stomach pain, fatigue, and diarrhea. This is in line with another study conducted in 2008 confirming that weight loss is a major symptom among elderly patients with celiac disease. Once they were treated, the patients emerged not only symptom-free but also gained an average of 17 lbs (around 7.75kg). A similar study that followed three groups of 42 children with celiac disease found that removing gluten from their diets led to an increase in body weight.
The bottom line is that individuals with celiac disease may experience sudden, unexplained weight loss. However, thyroid issues, depression, anemia, cancer, diabetes and a plethora of other conditions may also contribute to an unexplained drop in weight.
Fatigue is characterized by an excessive lack of energy and overall tiredness. This is quite prevalent in people with celiac disease, and with good reason. Without the ability to absorb energy-giving nutrients from food, your body will resort to reducing cell activity.
In a 2010 study, researchers saw that untreated celiac patients experienced more fatigue related issues than those who went on a gluten-free diet. Another study published in the same year showed that celiac patients are at higher risk of developing sleep disorders such as insomnia, which usually lead to fatigue. Several studies have also revealed that untreated celiac disease can lead to severe damage to the walls of the small intestine. This results in a deficiency of minerals, vitamins, and other nutrients, leading to feelings of tiredness and fatigue.
It’s worth keeping in mind that there are many other causes of fatigue, including: poor diet, lack of exercise, anemia, depression, viral infection, thyroid issues, and anxiety.
Most celiac sufferers endure diarrhea as one of the earliest signs of the disorder. They normally experience loose, liquid stool that may or may not be accompanied by stomach pains, dehydration, and fatigue.
In a 2004 study published in the American Journal of Clinical Nutrition, most untreated celiac patients reported diarrhea as one of the most common symptoms. After treatment began, most patients saw a decrease in the frequency of diarrhea after a few days. In an earlier study involving 78 people with celiac disease, scientists noted that around 80 percent of the patients experienced diarrhea before they were treated. After several weeks of treatment, only 17 percent of the participants still reported experiencing diarrhea.
While diarrhea usually disappears after a few days, the average time for complete recovery is about 4 weeks. Besides celiac sprue, other culprits behind diarrhea include food intolerances, gut infection and other digestive issues.
People with untreated celiac sprue frequently experience a gas buildup in the stomach. More often than not, gas, along with diarrhea, fatigue and bloating, are some of the first digestive problems to appear. In a 1999 study, researchers noted that most celiac patients developed gas after consuming gluten. In a similar research, scientists looked at 96 people with celiac disease. They found that bloating and excessive gas was most prevalent in close to 10 percent of cases. Excessive gas isn’t always an indication of celiac disease. In one study with 150 people complaining of gas issues, only 2 were diagnosed with celiac disease.
Other prominent causes of excessive gas include IBS (irritable bowel syndrome), lactose intolerance, indigestion, and constipation, just to name a few.
Any disease affecting the gastrointestinal tract usually results in constipation. Celiac disease is no different. Interestingly, celiac may cause constipation in some individuals, while others experience diarrhea instead. Because this condition damages the villi, more water is often absorbed from the food material, leaving a hardened stool. This is why some celiac patients complain of painful bowel movements and constipation.
Unlike other symptoms, however, it seems that constipation doesn’t go away easily, even after the patient adopts a strict gluten-free diet. The reason for this is because gluten-containing foods, such as wheat, are usually high dietary fiber.
A poor diet, excessive dehydration and lack of exercise may also lead to constipation.
Itchy Skin Rash
As mentioned earlier, people with dermatitis herpetiformis (DH), another autoimmune disorder, are more likely to develop celiac disease. As it turns out, the opposite is also true. Celiac patients may also develop DH, a condition that often causes blistering, bumpy and itchy skin rashes that can appear on the buttocks, knees, under armpits, scalp, back or elbows. About 17 percent of people with celiac disease exhibit these rashes, which is usually how doctors diagnose the disease. However, the itchy rashes may show up long after diagnosis if the condition is left untreated.
The rashes may be the only symptom of celiac disease in some people. Nine out of 10 celiac patients who suffer from DH may not develop any of the other typical digestive symptoms like diarrhea, constipation or gas.
As with the other symptoms, there are several other potential causes of an itchy, blistering rash, including hives, dermatitis, psoriasis, and eczema.
Depression is the leading psychological symptom and sign of celiac disease. A comprehensive review of scores of studies revealed that depression was more prevalent in adults diagnosed with celiac disease than healthy adults. This was supported by a 1996 study involving 48 adults.
Treating celiac disease seems to help reduce depression. In another study carried out in 2013, nearly 40 percent of people with celiac disease were said to have experienced depression. Thankfully, those who stuck to a diet free of gluten reported a reduction in depressive episodes over the long haul.
Of course, celiac disease is not the only cause of depression. Genetics, grief, trauma, stress, and changes in hormonal levels may also contribute.
Malnutrition due to celiac disease can lead to severe iron deficiency, resulting in anemia. This is a condition that is typified by a serious drop in the number of red blood cells in the body. Frequent bouts of dizziness, headaches, general weakness, chest pain, and fatigue are the most common symptoms of iron-deficiency anemia.
Anemia is often seen in celiac children. In a 2014 study involving more than 30 celiac children, scientists discovered that close to 15 percent of the participants had developed anemia.
Interestingly, another random study of 84 anemic patients revealed that 7 percent had celiac sprue. For the majority of these test subjects, a gluten-free diet helped increase iron levels.
What Happens if Celiac Disease is Left Untreated (Complications)?
Continuing to consume gluten-laden foods or medication can worsen symptoms. Getting tested for celiac disease sooner rather than later can help you get treatment early, manage the condition better, and helps keep most of these symptoms at bay. Left untreated, however, celiac disease can result in more serious health issues. These include:
Coronary Artery Disease – Celiac patients are twice as likely to suffer coronary artery disease than people who are not affected by it. Also called atherosclerotic heart disease, this condition is characterized by a narrowing of the coronary artery. Some of the most common symptoms include shortness of breath, sweating, nausea, fast heartbeat, and chest pain.
Small Intestine Cancers – Untreated celiac disease can increase fourfold the risk of developing small intestine cancers: lymphoma, gastrointestinal stromal tumor, carcinoid tumors, sarcoma, and adenocarcinoma.
Iron-Deficiency Anemia – In a 2013 study, 23 percent of celiac patients also had iron-deficiency anemia. When untreated, this number could jump by 63 percent.
Early Onset Osteopenia – The same 2013 study also showed that untreated celiac patients are two times more likely to have low bone density – the leading cause of early-onset osteoporosis.
Miscarriage and Infertility – Untreated or undiagnosed celiac disease can lead to unexplained infertility or miscarriage. This can be traced to ovulation issues related to malnutrition.
Gallbladder Problems – Untreated celiac disease is often linked to sclerosing cholangitis, a condition in which the duct that carries bile to the gallbladder from the liver is gradually damaged.
Lactose Intolerance – Autoimmune attacks destroy not only the villi but also the enzyme lactase that is produced by the small bowel cells. If untreated, celiac disease can make it harder for the person to digest dairy products, creating lactose intolerance.
Severe Mineral and Vitamin Deficiencies – This is due to malabsorption associated with celiac disease which can lead to a long list of health issues, including poor immunity, skin problems, heart degeneration, and so forth.
Pancreatic Malfunction – Pancreatic insufficiency is often linked to the damage of the bile ducts of the gallbladder. One study found that patients with untreated celiac disease are 20 times more likely to develop chronic pancreatitis.
Neurological Problems – Nutrients are essential for healthy brain, neurological and cognitive function. Celiac disease reduces the absorption of vitamins, minerals, and other nutrients, which means less food for the brain. That’s why untreated celiac disease has been found to cause an array of neurological manifestations, including: myopathy, neuropathy, migraines, dementia, epileptic seizures, and even ataxia.
Celiac Disease Diagnostic Options
A vast majority of patients suffering from celiac disease are not even aware they have it. In the US alone, it is estimated that 2.5 million people with the disorder are undiagnosed. This is because celiac damage to the small bowel occurs gradually, and that symptoms are varied and sometimes confusing.
Here are some of the top diagnostic options:
Serology Testing: from the comfort of your home
Serology tests help locate antibodies (and other biomarkers) in the patient’s blood. If the blood test shows higher-than-usual levels of certain antibody proteins, this is usually an indication of an autoimmune response to gluten.
The good news is that you can use at-home blood-testing solutions such as imaware™. Like standard lab serology tests, imaware™ allows you to measure the levels of the same antibodies that indicate a gluten reaction, but from the comfort of your own home.
Early data has shown that imaware™ can help deliver a celiac disease diagnosis with +95% accuracy. Note, however, that the imaware™ test doesn’t actually diagnose you with celiac disease. Rather, imaware™ tests for specific biomarkers which tell you that you might have the disease. For a full diagnosis you will need an upper endoscopy while still consuming gluten.
Endoscopy is the gold standard path to diagnose celiac disease. Upper endoscopy involves inserting a long tube equipped with a small camera through your mouth and down your esophagus. Using this method, clinicians can check your small intestines for signs of celiac damage. As part of the endoscopy, they extract a tiny tissue samples. A biopsy on the sample helps check for villi damage, conclusively diagnosing celiac disease.
HLA genetic tests look for two particular genes, HLA-DQ8 and HLA-DQ2. The absence of the two leukocyte antigens shows that you are most likely celiac-free. This is often done via a swab test, saliva test or a blood test. Because of the nature of these genetic tests, they are usually not adequate to indicate whether you have the active disorder. If the results are positive, you will most likely have to take an imaware™ test or undergo an upper endoscopy.
Unlike upper endoscopy, that employs a wired camera, capsule endoscopy makes use of a small wireless camera. The camera is ferried via a multivitamin-size capsule. Once it’s inside your gastrointestinal tract, it will help capture images of your small intestines.
Doctors will study thousands of photos taken by the camera, checking for signs of celiac disease.
Celiac Disease Risk Factors
There is a myriad of risk factors you should be aware of. For example, celiac disease is more rampant in individuals who have other autoimmune diseases likeAddison’s disease, autoimmune thyroid disease, type 1 diabetes, and lymphocytic colitis.
If Duhring disease (dermatitis herpetiformis) or celiac disease runs in your family, you may also be at risk of developing the disorder.
Treatment Options for Celiac Disease
Unfortunately, the only way to genuinely treat and manage celiac disease is to stick to a strict, lifelong gluten-free diet. Your entire diet should be devoid of any foods that contain gluten. The means that you have to stay away from: beer, bread, cookies, cake, and other wheat products. You're wrong if thinking barley, rye and wheat are the only gluten-rich foods. Gluten is also found in: triticale, Spelt, semolina, malt, farina, durum, graham flour, bulgur, and much more. Gluten can be concealed in an array of nonfood items, medications, and other foods. These include:
OTC and prescription drugs – Always check the source of the starch in your medication. Certain manufacturing practices may also cross-contaminate some medications with gluten.
Toothpaste – Gluten is a chewy and somewhat sticky substance, which is why it is very popular in the manufacture of toothpaste. Celiac patients must look for gluten-free mouthwash and toothpaste products.
Lipstick, play dough, communion wafers, etc. – All of these products use gluten as a base because of its sticky nature.
Herbal/Nutritional Supplements – Some multivitamins and herbal supplements may contain gluten-rich starch.
A gluten-free diet often contains many vegetables and fruits, as well as nuts, potatoes, lentils, eggs and fresh fish, meat and poultry.
Using Mineral and Vitamin Supplements
This is an add-on to gluten-free diet treatment. If your physician or dietician finds that you have developed a serious case of malnutrition, they may recommend using supplements that contain Zinc, Vitamin K, Vitamin D, Vitamin B12, Iron, Folate or Copper. Often, you will have to take a multivitamin tablet. If your small intestine can’t properly absorb vitamins and minerals, these can be given by injection.
Dermatitis Herpetiformis Treatment
In addition to a gluten-free diet, your physician may recommend treatment options for itchy skin rashes associated with dermatitis herpetiformis. Some prescription medications such as dapsone might do the trick.
Steroids for Managing Intestinal Inflammation
Steroids may be prescribed for celiac patients with severe inflammation. This may be due to refractory celiac sprue or extensively damaged small bowel. Luckily, certain steroids can help manage several symptoms of inflammation as the small intestine continues to heal. Other medications such as budesonide and azathioprine can also help control intestinal inflammation.
Home Remedies and Lifestyle Programs
Several home remedies can be useful for managing celiac disease. This is particularly true if you accidentally ingest anything with gluten. Activated charcoal, ginger, omega-3, turmeric, and herbal infusions are some of the most recommended home remedies. As a general rule, however, it is important to consult with your doctor before you use any of these remedies.