Celiac Disease Basics

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Celiac disease is a surprisingly common autoimmune disorder — one that's treated entirely by making the right changes to your diet.

Celiac disease tends to take everyone by surprise — both those who receive the diagnosis and family doctors who are shocked when a physically robust patient's blood work comes back positive for the disease.

A couple of decades ago, the stereotypical celiac patient was a pale, malnourished child. However, as screening tests become more sophisticated, we’re learning that celiac disease is surprisingly common, affecting one in every 100 people in the United States. According to a 2009 study, celiac disease touches more than four times the number of people it had in the 1950s. Researchers can’t yet explain this dramatic rise in incidence.

Celiac disease can begin at any time in a person’s life, and there is no consistent set of symptoms. Some people lose a tremendous amount of weight; others experience fatigue, joint pain, or seizures; and sometimes there are no symptoms at all and the disease is discovered quite by accident. In fact, people often learn they have celiac disease when their doctors investigate possible causes for unexplained anemia or nutrient deficiencies. One minute you’re having blood drawn for tests during a routine physical examination and feeling just fine, and the next you’re facing nonnegotiable changes to your eating habits. If that scenario sounds familiar, you’re actually lucky to have caught the disease. If celiac remains undiagnosed or untreated, it can lead to osteoporosis, reproductive problems, skin rashes, epilepsy, and even some cancers. The good news is that celiac disease is currently treated entirely with dietary changes, so feeling better is as simple as knowing which foods are toxic to your gut.

What Affects Celiac Disease?

Celiac disease (also called celiac sprue, nontropical sprue, and gluten-sensitive enteropathy) is genetic. All individuals who develop celiac are born with a genetic predisposition for the disease, but the age of onset can vary from infancy to old age. (Some people are diagnosed at birth or during childhood, but in many people, the disease lies dormant until it is triggered later in life.) No one knows exactly what causes celiac disease to become active, but experts believe that times of extreme emotional or physical stress — including surgery, a viral infection, pregnancy, or childbirth — can set the stage. Researchers are also beginning to explore whether changes in the types of bacteria living in your gut may be the spark that ignites adult-onset celiac.

It’s important to remember that celiac disease is NOT a food allergy. Some practitioners call it an allergy as a shorthand way to explain why those with a diagnosis need to avoid certain foods, but that description is both misleading and dangerous. Celiac disease is an autoimmune disorder, a category of diseases in which the body’s immune system attacks itself. The immune system reacts to a protein called gluten, which is found in wheat, and related proteins found in rye and barley.

When even the smallest amount of gluten enters the digestive system, it sets in motion a cascade of inflammatory processes. The immune system begins to attack the body’s own tissue, resulting in damage to the small intestine. Counter to what you may think, the small intestine is not merely a smooth tube connecting the stomach to the colon; rather, its inner lining is jam-packed with protruding ridges called villi, which absorb nutrients as food passes through. Celiac disease causes inflammation that damages and sometimes destroys the villi, which means they can’t do their job; the result is that the nutrients your body needs end up passing through your digestive system unabsorbed and are eliminated in waste. The outcome of this damage varies depending on the extent of the disease. In mild cases, there are no overt symptoms, but blood tests might reveal a deficiency in certain nutrients, especially folate, vitamin B12, or iron (which can result in anemia). Over time, poor calcium and vitamin D absorption can lead to osteoporosis. In some people, celiac disease causes embarrassing and sometimes life-altering gastrointestinal symptoms, including gas, bloating, diarrhea or constipation, and weight loss. Other problems associated with celiac disease include nerve damage, migraines, seizures, infertility or miscarriages, joint pain, and even some cancers, including non-Hodgkin lymphoma and cancer of the esophagus or small intestine. The longer celiac goes untreated, the greater the risk of harm.

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