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Alternative Names: Also classified as a disease of nutrient malabsorption, celiac disease is also known as celiac sprue, nontropical sprue and gluten-sensitive enteropathy.
Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten (or a gluten fraction called gliadin), which is found in wheat, rye, barley, and possibly oats.
Gluten is a protein found in wheat, rye, barley, and oats that gives dough it's sticky quality. An inability to digest these grains is called celiac disease.
Incidence; Causes & Development; Risk Factors
Approximately 0.5% of Americans have symptoms brought on by this condition. About 10% of an affected person's first-degree relatives (parents, siblings or children) will also have the disease. It has also been estimated that up to 20% of Americans have the disease to some degree.
When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Specifically, tiny fingerlike protrusions, called villi, on the lining of the small intestine are lost. Nutrients from food are absorbed into the bloodstream through these villi. Without villi, a person becomes malnourished - regardless of the quantity of food eaten.
There is increasing evidence that most people with gluten sensitivity have latent celiac disease with such mild manifestations in the digestive tract that the diagnosis is never made. An allergy or intolerance to specific grains, such as wheat, may be due to a gluten sensitivity, but may occur for other reasons as well.
Celiac disease is considered an autoimmune disorder because the body's own immune system causes the damage.
Celiac disease runs in families. Sometimes the disease is triggered by surgery, pregnancy, childbirth, viral infection or severe emotional stress. Celiac disease affects people differently; some develop symptoms as children, others as adults. One factor thought to play a role in when and how celiac appears is whether and how long a person was breastfed - the longer one was breastfed, the later and more atypical the symptoms appear. Other factors include the age at which one began eating foods containing gluten and how much gluten has been eaten.
Signs & Symptoms
Symptoms may or may not occur in the digestive system. For example, one person might have diarrhea and abdominal pain, while another person has irritability or depression.
Symptoms include mood swings (down after eating and up after avoidance), severe depression, anxiety, irritability, compulsive behavior, "schizophrenia" symptoms, and other mental disorders.
Diagnosis & Tests
To diagnose celiac disease, physicians test blood to measure levels of antibodies to gluten. These antibodies are antigliadin, anti-endomysium and antireticulin. If the tests and symptoms suggest celiac disease, the physician may remove a tiny piece of tissue from the small intestine to check for damage to the villi. Gluten sensitivity should not be self-diagnosed, since other medical problems could be the cause of similar symptoms. A gluten-free diet should not be followed until you have been seen by your doctor. Tests for celiac disease cannot produce a proper diagnosis if a person is not currently reacting to gluten in their diet. Once a diagnosis is made and a person responds to the gluten-free diet, the physician will know for certain that the diagnosis of celiac disease is correct.
Screening for celiac disease involves testing asymptomatic people for the antibodies to gluten/gliadin. Because celiac disease is hereditary, family members - particularly first-degree relatives - of people who have been diagnosed may need to be tested for the disease.
Complications
While the gastrointestinal tract is the primary target organ, systemic disease is an important consequence of gluten ingestion in many patients. Latent disease may manifest itself as irritable bowel syndrome with iron deficiency anemia, but little or no diarrhea. There is increasing evidence that most people with gluten/gliadin sensitivity have latent celiac disease with such a mild manifestation that the diagnosis is never made. The undamaged part of their small intestine is able to absorb enough nutrients to prevent symptoms. However, people without symptoms are still at risk for the complications of celiac disease.
The longer a person goes undiagnosed and untreated, the greater the chance of developing malnutrition and other complications.
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Signs, symptoms & indicators of Gluten Sensitivity / Celiac Disease:
Conditions that suggest Gluten Sensitivity / Celiac Disease: | | | | | Autoimmune |  Dermatitis Herpetiformis
 Diabetes Type I | Relatives of people with Type 1 Diabetes, as well as the sufferers themselves, run a 6% risk of developing celiac disease. |
Sjogren's Syndrome
Lupus, SLE (Systemic Lupus Erythromatosis)
Chronic Thyroiditis| | In one study, 83 patients with autoimmune thyroid disorder were screened for celiac disease. Three patients with asymptomatic celiac disease were found along with one who had previously been diagnosed, giving an overall frequency of 4.8%. By contrast, only one of 249 age- and sex-matched blood donors was found to have celiac disease. |
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Childhood |
Down's Syndrome| | Patients with Down syndrome have an incidence of celiac disease of at least 7 percent. [J Pediatr 1996;128: pp.555-7] |
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Circulation |
Anemia (Iron deficiency)| | Anemia is a frequent presentation of celiac disease. In one study, 200 consecutive patients of a hematology clinic were screened for antigliadin and antiendomysial antibodies. Patients with both positive titers underwent intestinal biopsy, and in 10 patients (5%), results were positive for celiac disease. The prevalence increased to 8.5% if the patients with macrocytic anemia and the patients with bleeding who responded to iron therapy were excluded. |
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Digestion |
Increased Intestinal Permeability / Leaky Gut |
Infections |
Canker Sores (Aphthous Ulcers)| | In a study of 15 patients, 7 patients responded completely and two partially to diets excluding gluten (3 patients), azo compounds (3), milk (2), azo and milk (1). Two failed to respond and three failed to complete the diet. Responses were confirmed by re-challenge. The patients in this study had relatively severe aphthous ulcers. The patients who responded to the gluten free diet had had gluten enteropathy excluded by biopsy. [B Med J 1986; 292: pp.1237-8] |
Yeast / Candida Infection |
Mental |
Depression |
Musculo-Skeletal |
Rheumatoid Arthritis
Osteoporosis - Osteopenia| | A study concluded that reduced mineralization occurs even in asymptomatic celiac patients, and that early diagnosis and treatment can prevent bone demineralization. [Am J Gastroenterol 1994;89: pp.2130-4] |
Muscle Cramps / Twitching |
Nervous System |
Seizure Disorder| | Blood tests for gluten sensitivity antibodies were performed on 783 patients referred for seizures. In 36 patients who also had clinically evident celiac disease, no further seizures were noted after treatment with a gluten-free diet. In a second group of 9 patients, celiac disease was not recognized because of mild or absent symptoms, but the diagnosis was confirmed by jejunal biopsy. [Lancet 1992;340: pp.439-43] |
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Nutrients |
Vitamin B12 Requirement |
Organ Health |
Hepatitis |
Symptoms - Allergy |
 Gluten sensitivity (confirmed)
Counter-indicators:
 Confirmed lack of gluten sensitivity |
Tumors, Malignant |
Small Intestine Cancer |
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Risk factors for Gluten Sensitivity / Celiac Disease: | | | | | Autoimmune | Autoimmune Tendency |
Family History |
Diabetes in family members| | Relatives of people with Type 1 Diabetes, as well as the sufferers themselves, run a 5% risk of developing celiac disease. When people affected by celiac disease eat wheat the immune system reacts by destroying the lining of the intestine. If these people avoid wheat the intestine heals; however, most people are asymptomatic and the untreated condition may bring about anemia, decreased growth and malignancy of the intestine if untreated. |
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Gluten Sensitivity / Celiac Disease suggests the following may be present: | | | | | Tumors, Malignant | Non-Hodgkin's Lymphoma| | Gluten sensitivity predisposes patients to the eventual development of lymphoma. If this relationship is re-stated as "cereal grains cause cancer" the implications are more easily understood. In addition, the incidence of undiagnosed celiac disease is higher among those with small-bowel lymphoma [Eur J Gastroenterol Hepatol 2000;12: pp.645-8]. There is evidence that strict adherence to a gluten-free diet will reduce the incidence of lymphoma. |
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Gluten Sensitivity / Celiac Disease can lead to:
Gluten Sensitivity / Celiac Disease could instead be: | | | | | Mental | Schizophrenia| | Studies have shown celiac disease to be inordinately high in "schizophrenic" populations. Research removing gluten and dairy products (which often seems to add to the problem) from the diet of a locked ward resulted in a significant improvement of patient behavior. |
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Recommendations and treatments for Gluten Sensitivity / Celiac Disease: | | | | | Amino Acid / Protein |  Glutamine| | Glutamine is the preferred fuel of small intestine cells. Supplemental glutamine may promote a faster recovery time once a gluten-free diet is begun. |
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Diet |
Gluten-free Diet| | The only treatment for celiac disease is to follow a gluten-free diet. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within days of starting the diet, and the small intestine is usually completely healed in 3 to 6 months. Healing may take up to 2 years for older adults. |
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Mineral |
 Zinc| | Tissue damaged by celiac disease has demonstrated an enhanced recovery rate with adequate zinc intake. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link | | | Strongly counter-indicative | | | Likely to help | | | Highly recommended |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Allergy (Allergies)
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Antibody (Antibodies)
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Asymptomatic
Not showing symptoms.
Autoimmune Disease (Autoimmune, Autoimmunity)
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Biopsy
Removal of a sample of tissue from a living being for diagnosis. A pathologist later uses a microscope to look for certain features, such as cancer cells, in the sample. A fine-needle aspiration biopsy involves inserting a thin needle to remove a small amount of tissue, sometimes using CT or ultrasound to guide the needle. A core biopsy involves obtaining a sample of tissue with a thick needle or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another biopsy method is to remove tissue during an operation.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Candidiasis (Candida)
Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge. Candidiasis is also known as: Candida; Candida albicans; Candida Related Complex; Chronic Candida Syndrome; (Chronic) Systemic Candidiasis; Monilia; Candidiasis Hypersensitivity Syndrome; Candidosis; (Chronic) Mucocutaneous Candidosis; Thrush (oral or vaginal); Moniliasis; Polysystematic Candidiasis.
Canker Sores (Aphthous Ulcers, Apthous Stomatitis)
Small, painful ulcers that occur on the inside of the cheek, lip or underside of the tongue. Caused by an assortment of viruses, doctors call this condition aphthous stomatitis. Canker sores usually clear up by themselves within a week or so, but they often recur, sometimes in the form of multiple sores.
Celiac
Pertaining to the abdomen.
Celiac Disease (Gluten Sensitivity)
A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Cobalamin (B12, B-12, Cobalamine, Vitamin B12)
Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Diarrhea
Excessive discharge of contents of bowel.
Gastrointestinal (GI, GI Tract)
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Glutamine
A "conditionally essential" amino acid, glutamine is considered to be a brain fuel. Glutamine has been used therapeutically for alcoholism, mild depression and to reduce the craving for sweets. Glutamine is very important in the functioning of the metabolism and muscle maintenance. Glutamine supplementation can help prevent muscle and other tissue breakdown by providing the body with nitrogen and fuel.
Hemochromatosis
A rare disease in which iron deposits build up throughout the body. Enlarged liver, skin discoloration, diabetes mellitus, and heart failure may occur.
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Irritable Bowel Syndrome (IBS)
A condition that causes upset intestines for a long period of time. It is very unpleasant to the sufferer but tends to be harmless and usually does not lead to more serious complaints. The symptoms vary from person to person and from day to day. In order to be diagnosed with IBS, a person must have at least three of the following symptoms: pain in the lower abdomen; bloating; constipation; diarrhea or alternating diarrhea and constipation; nausea; loss of appetite; tummy rumbling; flatulence; mucous in stools; indigestion; constant tiredness; frequent urination; low back pain; painful intercourse for women.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Lymphoma (Lymphomas)
Any tumor of the lymphatic tissues.
Malabsorption
Improper utilization of needed and available nutrients, either from impaired digestive function (such as B12 being unabsorbed because of gastritis), impaired absorption (poor Vitamin E absorption because of an inflamed ileum) or impaired transport (the diminished blood proteins of the advanced alcoholic). There are other causes as well.
Pathology (Pathologist)
Disease, particularly one with clear and obvious changes in structure or function; the study of same.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Schizophrenia
Any of a group of psychotic disorders usually characterized by withdrawal from reality, illogical patterns of thinking, delusions, and hallucinations, and accompanied in varying degrees by other emotional, behavioral, or intellectual disturbances. Schizophrenia is associated with dopamine imbalances in the brain and defects of the frontal lobe and is caused by genetic, other biological, and psychosocial factors.
Seizure (Seizures)
While there are over 40 types of seizure, most are classed as either partial seizures which occur when the excessive electrical activity in the brain is limited to one area or generalized seizures which occur when the excessive electrical activity in the brain encompasses the entire organ. Although there is a wide range of signs, they mainly include such things as falling to the ground; muscle stiffening; jerking and twitching; loss of consciousness; an empty stare; rapid chewing/blinking/breathing. Usually lasting from between a couple of seconds and several minutes, recovery may be immediate or take up to several days.
Small Intestine (Small Bowel)
The small intestine lies between the stomach and the large intestine. It is about 6 meters (20 feet) long and its primary function is to digest (break down) food and absorb nutrients (vitamins, minerals, proteins, carbohydrates, and fats). The small intestine makes up more than 70% of the length and 90% of the surface area of the gastrointestinal (GI) tract.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Thyroid (Thyroid Gland)
The thyroid gland is an organ with many veins, anchored around the front of the throat near the voice box. It is essential to normal body growth in infancy and childhood. It absorbs iodine from the diet and releases thyroid hormones - iodine-containing compounds that help govern the rate of the body's metabolism (its total life processes), affecting body temperature, and regulating protein, fat and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor. To a high degree, metabolism is regulated by the hormone thyroxine, which can be made by the thyroid if enough organic iodine is available. An enlarged thyroid gland that is not cancer is sometimes called goitre.
Villi (Microvilli)
The villi are small but significant structures of the mucosal layer of the small intestine. They are finger-like (or hair-like) projections, 0.5 to 1mm in length, that cover the mucosal surface and increase its absorptive area. Each villus contains a capillary network, a lymphatic vessel, and smooth muscle fibers. The villi are covered with absorptive cells that have cytoplasmic extensions known as microvilli; the microvilli serve to further increase the absorptive surface. The total increase in absorptive surface provided by the villi and microvilli is some 600-fold. The microvilli form what is known as the brush border; the cells that make up the brush border contain many enzymes and carrier substances that facilitate the digestion and absorption of nutrients.
Zinc
An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.
Last updated: May 11, 2008
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