What You Should Know About Celiac Disease

Abdominal pain and diarrhea are two well-known symptoms of celiac disease. But they are not the only ones. Celiac disease can cause many other less obvious symptoms such as poor weight gain, “foggy brain,” dental abnormalities, vomiting, infertility or miscarriage, joint pain, lactose intolerance, as well as vitamin and mineral deficiencies such as anemia.

Celiac disease is a serious inherited autoimmune disease that can lead to damage in the small intestine. In people with celiac disease, the body mounts an immune response to gluten, a protein found in wheat, rye and barley. This response presents as an attack on the villi, the small fingerlike projections that line the small intestine and that, when functioning properly, promote nutrient absorption. When the villi are damaged, the body cannot properly absorb necessary nutrients.

You can develop celiac disease any age. If you have a parent, child, or sibling with celiac disease, then you have a 1 in 10 risk of developing it.

Different types of celiac disease

There are two types of celiac disease: classical and non-classical. Patients with classical celiac disease typically suffer from diarrhea, steatorrhea (pale, foul-smelling, fatty stools), weight loss, or, in children, growth failure.

Patients with non-classical celiac disease may have a host of symptoms, including mild gastrointestinal upset, abdominal distension and pain, iron-deficiency anemia, chronic fatigue, chronic migraine, tingling, numbness, or pain in the hands or feet, elevated liver enzymes, reduced bone mass, bone fractures, deficiency in folic acid and Vitamin B12, among others.

Patients who have silent or asymptomatic celiac disease have no symptoms but will still sustain damage to their small intestine. Moreover, studies show that symptom-free patients who go on a strict gluten-free diet report better health and reduced acid reflux, abdominal bloating and distention, and flatulence.

Diagnosis is difficult

Diagnosing celiac disease can be difficult because it affects people differently. In fact, more than 200 known celiac disease symptoms may occur in the digestive system or other parts of the body. Some people with celiac disease have no symptoms but still produce a positive celiac disease blood test. Others may have a negative blood test but have a positive intestinal biopsy. Approximately 80% of people with celiac disease are undiagnosed.

Infants and children with celiac disease typically display digestive symptoms, such as:

• abdominal bloating and pain
• chronic diarrhea
• vomiting
• constipation
• pale, foul-smelling, or fatty stool
• iron-deficiency anemia
• weight loss
• fatigue
• irritability and behavioral issues
• dental enamel defects of the permanent teeth
• delayed growth and puberty
• short stature
• failure to thrive
• Attention Deficit Hyperactivity Disorder (ADHD)

Adults with celiac disease are more likely to experience:

• unexplained iron-deficiency anemia
• fatigue
• bone or joint pain
• arthritis
• osteoporosis or osteopenia (bone loss)
• liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, etc.)
• depression or anxiety
• peripheral neuropathy (tingling, numbness or pain in the hands and feet)
• seizures or migraines
• missed menstrual periods
• infertility or recurrent miscarriage
• canker sores inside the mouth
• dermatitis herpetiformis (itchy skin rash)

However, all people with celiac disease--whether or not they display any symptoms--are at risk for long-term complications.

Treatment is important

Left untreated, celiac disease can lead to additional serious health problems. The best treatment is a gluten-free diet, which heals damage in the small intestine and prevents more damage. Many people report feeling better within days to weeks of starting the diet.

Most people associate gluten with bread and pasta, but many products contain it, such as:

• Soups, sauces, salad dressings and beer
• Toothpaste and mouthwash
• Medications
• Vitamins
• Cosmetics, lipstick, lip gloss, and lip balm
• Skin and hair products
• Communion wafers
• Playdough

The problem with gluten-free diets, however, is that they aren’t always healthy. Gluten-free products often contain a lot of sugar to make them tastier, which can make you gain weight. Plus, many gluten free foods lack important vitamins and minerals, which can lead to nutritional deficiencies, including anemia. And some gluten-free products lack fiber which can contribute to constipation. Also, if you cook food that has gluten, it can linger on your utensils or appliances, which can cross-contaminate your gluten-free dishes.

If you think you have celiac disease and have first- or second-degree relatives with the disease, then see a gastroenterologist. Your gastroenterologist will not only to determine if you have the disease but also monitor your symptoms, regularly check for any vitamin and mineral deficiencies, and ensure that you remain in good health. You should also consult a dietician who has special training in working with celiac patients and gluten-free eating, so you can receive proper nutritional guidance.