Gluten is a protein found in grains, like wheat, rye, barley, and triticale (a hybrid of wheat and rye). It helps foods keep their shape, which is why gluten is often added to other food products during manufacturing. (1) But when someone with celiac disease eats gluten, their immune system sees the protein as a threat and sends antibodies to attack. As a result, the lining of the small intestine gets damaged. If the lining experiences enough long-term damage, it’s unable to absorb nutrients the body needs to be healthy. This effect can cause a variety of health issues. (2,3)
Some Basic Background Info on Celiac Disease
Celiac disease affects about 1.8 million Americans, or 0.7 percent of the U.S. population, and symptoms include feeling unusually bloated after eating, constipation, and frequent diarrhea. The autoimmune disease can be found in people of all different cultural backgrounds, but it is most common in those of European or Indian descent. (4) Researchers don’t know exactly what causes the disease. It’s likely a combination of genetic and environmental factors, which can range from getting a disease or viral infection to the climate where you live. (5) If you have close family members with celiac, you’re more likely to also have it. (2) Doctors can find out if you have celiac by doing a blood test to look for the antibodies that are usually found when people with the disease are exposed to gluten. (6) A diagnosis is confirmed after a sample of the small intestine lining is collected through an upper endoscopy (a minor procedure) and examined. Being diagnosed with celiac is different from having a gluten allergy or intolerance. You may experience similar digestive symptoms, but the small intestines aren’t getting damaged. (3) Once you start a gluten-free diet, your small intestine will recover and absorb nutrients again, says Rudy Bedford, MD, a gastroenterologist at Saint John’s Physician Partners in Los Angeles and Providence Saint John’s Health Center in Santa Monica, California. (8) But getting exposed to gluten again will cause symptoms to return. (9) That’s why it’s important to stick to a strict gluten-free diet plan. You’ll need to be very vigilant about what you eat, especially when eating out or buying packaged goods. Restaurants can have cross contamination and so can packaged items, warns Sheila Reddy, MD, a gastroenterologist at Austin Gastroenterology in Austin, Texas. For example, soy sauce can have gluten. In addition to wheat, rye, barley, and triticale, gluten can be found in: (7,9)
Salad dressingSoupsBeerSaucesCondimentsCosmetics (lip balm, lipstick)ToothpasteHair productsMedicationVitamins and supplements
Possible Supplements for Celiac
Taking a multivitamin or specific supplements, like iron or vitamin D, can help provide the body with extra nutrients as the intestines heal. (11) Make sure to check the ingredients list on vitamins and supplements because some can include inactive ingredients that have gluten. Common vitamin and mineral deficiencies that happen with celiac disease include: (11)
IronCalciumZincCopperFolateVitamin B12Vitamin B6Vitamin DMagnesiumFiberNiacinRiboflavin
These are all essential nutrients the body needs. Not being able to absorb the necessary amounts over time causes complications. People who are newly diagnosed with celiac are likely to have some type of malnutrition. One study examined people recently diagnosed and found that almost 90 percent had one or more nutrient deficiency. (12)
Enzymes
There are enzyme supplements on the health-food market that claim to help people with celiac digest gluten by breaking down the protein. But studies show that these enzymes are unable to survive in the stomach’s acidic environment, making them ineffective. (13) Researchers did find that AN-PEP, a pure digestive enzyme that isn’t available in stores, can reduce gluten in the stomach. At this time, an AN-PEP is not recommended as a treatment outside of a clinical trial. For now, other than eliminating gluten, there really are no proven treatments for celiac disease, says Dr. Bedford. “Anything you eat you’re not able to absorb, so you’re essentially malnourished,” says Dr. Reddy. Children are especially at risk because their bodies are still growing. They may experience: (2)
Delayed pubertyTrouble gaining weightPoor muscle and bone growth due to lack of calcium and vitamin DProblems with tooth enamel from adult teeth not properly developingLearning disabilitiesSeizures
Often, a delay in treatment happens because a person doesn’t know they have celiac. They may struggle with lots of different unexplained health issues before getting the right diagnosis. Nutrient deficiencies from celiac can cause: (2,14,15)
Anemia Reddy says one of the first things medical professionals see in celiac patients is anemia, which happens when the body isn’t absorbing enough iron. Iron helps the body make the new red blood cells it needs to circulate oxygen.Osteoporosis When the body doesn’t have enough calcium and vitamin D to replenish bone mass, bones become very fragile. People with osteoporosis are at risk of breaking bones very easily.Lactose Intolerance The damage to your small intestine caused by celiac can also make you lactose intolerant. You might have stomach pain or diarrhea after eating dairy products, even if they don’t have gluten. Once the small intestine recovers, most people can tolerate dairy again.Missed Menstrual Periods and Fertility Problems, Including Miscarriages Researchers aren’t sure what the link is between fertility issues and celiac, but it likely has something to do with the body’s inability to absorb important nutrients needed for fetal development.Nervous System Issues These are also a likely result of malnutrition and include tingling in the hands and feet (neuropathy), seizures, and anxiety and depression.Pancreatic Insufficiency When the pancreas can’t make enough enzymes to digest food correctly, it’s called pancreatic insufficiency. About 5 percent of people with celiac also have this condition, although researchers aren’t sure exactly why they exist together.Gallbladder Issues The gallbladder helps during digestion by releasing bile to break down fats. When the small intestines are damaged, they can send incorrect signals to the gallbladder, making it release more bile than necessary. Signs of gallbladder issues include indigestion and abdominal pain.Liver Disease If the liver doesn’t get the correct balance of nutrients, it can become damaged over time. Nonalcoholic fatty liver disease is a condition where the liver is storing too much fat, which interferes with its ability to store nutrients. Research shows people with celiac disease are more likely to get nonalcoholic fatty liver disease than those without celiac. (16)
What to Know About Dermatitis Herpetiformis and Celiac Disease
About 10 percent of people who have celiac disease develop a rash called dermatitis herpetiformis. (14) The rash can look similar to herpes or shingles, forming itchy blisters on the knees, elbows, scalp, back, or butt. It usually appears for the first time between ages 30 and 40, but some people get it earlier. A dermatologist can diagnose the rash and prescribe a cream or ointment to soothe it, but you’ll need to go gluten-free to really get rid of it. If you have celiac and don’t remain gluten-free, you could also be at a higher risk for developing cancer. The most common cancers linked to celiac are bowel cancer and lymphoma. (2) In order to make sure you’re not getting accidentally exposed to gluten, Reddy recommends being really diligent and aware of your symptoms. She says loose stool combined with abdominal pain is a clue that you’re being exposed to gluten.
Comorbidities Common in People With Celiac Disease
If you have celiac disease, you have a higher likelihood of having certain conditions along with it. (2,6) Chronic or genetic conditions found to be connected to celiac disease include:
Type 1 diabetesThyroid diseaseAddison’s diseaseDown syndromeLupusCrohn’s diseaseRheumatoid arthritisSjögren’s syndrome
If you’ve been diagnosed with one of these and also have digestive system issues, experts recommend getting tested for celiac disease.
