With all of the attention gluten sensitivities have gotten in the past few years, most of us have a friend or family member who has gone gluten-free, but for people living with celiac disease, eliminating gluten isn’t a choice—it’s a necessity. If you have celiac disease and consume gluten—a protein composite that allows dough to rise and gives it a chewy texture—it triggers an immune reaction that damages the small intestine, prohibiting you from absorbing nutrients from the food you eat. (While the gluten sensitivity may suggest celiac is a digestive disorder, it’s technically an autoimmune condition.) When damage occurs, your body can’t absorb and use proteins, carbs, fats, vitamins and sometimes even water. In addition to malnourishment and the discomfort associated with celiac disease, not absorbing basic nutrients can set you up for an array of dangerous health conditions.
Who Is at Risk For Celiac Disease?
Though celiac disease has affected people throughout history, scientists have only recently discovered how common the condition is. It is estimated that 1 percent of Americans suffer from celiac disease, which is hereditary and is especially prevalent in those with European heritage. Common triggers are stress, infection, surgery, pregnancy and childbirth.
Because celiac disease is an autoimmune condition, some people do not develop digestive symptoms, especially adults. “It may present as as unexplained osteopenia/osteoporosis, iron deficiency, miscarriages and peripheral neuropathy,” says Cynthia Geyer, M.D., medical director at Canyon Ranch in Lenox, Mass. "Because of this, celiac disease has been called the 'great chameleon.'"
There is a higher prevalence of the disease in people with another autoimmune condition, including thyroid disease, lupus, type 1 diabetes and certain types of arthritis. “In some instances the gluten may be the ‘trigger’ that contributes to the development of the other autoimmune disease,” Geyer says. She adds that uncovering celiac disease or gluten sensitivity in someone with an autoimmune disease often results in an improvement in their symptoms.
Celiac disease affects people in a variety of ways. Some develop symptoms when they are children, others as adults. Symptoms may be very pronounced or not present at all. People without symptoms are still at risk for the complications of celiac disease.
The root cause of the following symptoms is inflammation in the small intestine:
- Diarrhea and foul-smelling stool
- Stomach pain and bloating
- Bone or joint pain and muscle cramps
- Fatigue, irritability or depression
- Irregular menstrual periods and infertility
- Tingling or numbness in the hands and feet
- Canker sores and tooth discoloration
How Celiac Disease Is Diagnosed
Unfortunately, diagnosing celiac disease can be difficult because symptoms are similar to those of other conditions, like irritable bowel syndrome, Crohn's disease and chronic fatigue syndrome. If you experience any of the symptoms above, make an appointment to talk with your physician. If she suspects you have celiac disease, your doctor will take a blood test to measure your antibody levels and may also recommend a biopsy of the intestine.
A delayed celiac disease diagnosis can lead to some serious complications. Damage to the small intestine and difficulty absorbing nutrients put a person with celiac disease at risk for several health problems including anemia, osteoporosis, miscarriage, seizures and some cancers.
Treating Celiac Disease
If the disease has gone undiagnosed for a long period of time and symptoms are very severe, your doctor may recommend a prescription steroid. But for the majority of people with celiac disease, a gluten-free diet will alleviate symptoms, heal existing intestinal damage and prevent further damage. You can work with your nutritionist to create a healthy dietary plan.
Improvements in symptoms typically begin within days of starting a new diet, and the small intestine is usually completely healed in three to six months. There is no cure for celiac disease, so if you have the condition you will need to remain on a gluten-free diet indefinitely. Your physician may schedule periodic checkups to evaluate your progress.
How to Avoid Gluten
Learning to carefully read food labels is the first step to cutting gluten out of your diet. Eating any gluten, no matter how small an amount, can cause your symptoms to reappear and create new damage to the intestine, so it’s critical to steer completely clear of it. In addition to obvious culprits like pasta and pizza, you may need to forgo certain processed meats, jams, lipsticks and even medicines that may contain gluten. (Gluten is sometimes used as a thickening and flavoring agent in unlikely places. You can check the packaging to see if gluten is listed as an ingredient.)
Here are some of the most common places gluten is found:
- Bread, cereal, cookies, crackers and pasta
- Dairy products that contain fillers or additives
- Processed or low-fat and non-fat cheeses
- Canned soups and soup mixes
- Creamed vegetables
- Salad dressing and condiments
- Prepared or processed meats
- Beer, gin and whiskey
- Beverages flavored with malted barley like coffee, milk or tea
- Some medications and supplements
The following ingredients are wheat- or gluten-derived and are not safe for consumption if you have celiac disease:
- Fat replacers
- Graham flour
- Hydrolyzed vegetable protein or vegetable gum
More: Going Gluten-Free
Living Well With Celiac Disease
Rest assured that you will be able to enjoy a satisfying and flavorful array of foods without consuming gluten.
The very good news for those living with celiac disease is that the food industry has caught on to the prevalence of gluten sensitivities and it’s common to find restaurants with a gluten-free section of the menu. In addition, many grocery stores stock their shelves with gluten-free products—everything from gluten-free brownie mixes to gluten-free pizza crusts to gluten-free cereal. Just keep in mind that eating gluten-free foods from your supermarket shelves does not necessarily equate to healthy—there’s a big difference between eating a highly processed gluten-free diet versus one based around vegetables and lean proteins.
You can also cook delicious gluten-free recipes at home. Gluten-free cookbooks offer many tasty recipes that replace gluten with soy, tapioca, rice, corn potato and buckwheat. Dishes that include naturally gluten-free foods—like fish, unprocessed meats, vegetables, legumes and nuts—are all healthy choices.
When dining out, ask about food preparation before ordering and avoid buffets where it is more difficult to discern ingredients.