Gluten, a protein found in grains like wheat and rye, is often essential in making bread and other baked goods. But it’s also the main cause behind a few medical conditions, including celiac disease.
Celiac disease is a chronic illness that, when triggered by eating gluten, can damage your small intestine. This results in symptoms like bloating, constipation, nausea, fatigue, weakness and more. If left untreated, celiac disease can eventually cause serious, long-term health problems, including bone diseases, anemia and infertility.
If you’re diagnosed with celiac disease, the good news is you can adjust your diet to treat symptoms and rebuild the lining in your small intestine. We’ll describe the symptoms of celiac disease, what it is, along with how it’s different from other related conditions like non-celiac gluten intolerance and wheat allergies.
We’ll also go into how genetics play a role in causing celiac disease, the tests your doctor can use for a diagnosis and how to treat celiac disease through a gluten-free approach to nutrition.
Symptoms of celiac disease vary from person to person
Some people with celiac disease may not have any symptoms. Some may have one or two telltale signs, while others may experience a variety of symptoms. They can be consistent, or they can come and go. Intensity can also range from slightly inconvenient to life-altering. But they all have one thing in common – a connection to your small intestine.
Pain, poop and other celiac digestive symptoms
Due to its focus on your digestive system, symptoms of celiac disease usually appear around your belly and gut, including:
- Belly pain
- Bloating
- Constipation
- Diarrhea
- Gas
- Nausea
- Poop that is loose, greasy or oily, and bad smelling
- Vomiting
You can also have a bout of lactose intolerance due to intestinal damage and irritation. All of these symptoms can also lead to decreased appetite and unexplained weight loss.
Rash, fatigue and celiac symptoms in other parts of the body
Symptoms of celiac disease can also develop beyond your stomach and show up elsewhere – mostly due to problems absorbing the nutrients your body needs. The most common include:
- An itchy, blistering skin rash called dermatitis herpetiformis
- Canker sores or dry mouth
- Depression or anxiety
- Fatigue
- Muscle cramps, joint pain or bone pain
- Nervous system issues like headaches, problems with balance, or tingling, numbness or pain in your hands and feet
- Weakness
Additionally, some people can have symptoms that affect the female reproductive system, including infertility and delayed or missed menstrual periods.
Symptoms of celiac disease in children
Because the effects of celiac disease make absorbing nutrients difficult, symptoms can show up early with children. By not having the essentials necessary for healthy growth, kids with celiac disease can have:
- Damage to permanent tooth enamel
- Slow weight and height gain – even weight loss
- Delayed puberty
- Mood changes and irritability
What celiac disease is and why gluten can make you sick
When flour made from grains like wheat, barley and rye is mixed with water, two proteins – glutenin and gliadin – form a thick, soft and elastic structure called gluten. This helps to create a tender dough that can also capture carbon dioxide from fermenting yeast. Many oven-baked creations depend on gluten’s thickening power, as do many noodles, processed foods, medicines and other foods we eat and products we use.
However, people diagnosed with celiac disease (also known as celiac sprue or just sprue) have an unhealthy reaction to gluten when it’s eaten or otherwise brought into their bodies. When the immune system of a person with celiac disease discovers the gliadin found in gluten, it sees it as a foreign intruder that needs to be destroyed.
The place where the immune system goes to work is the small intestine, which is lined with tiny little projections called villi. These little fingerlike nubs are essential to absorbing nutrients from food. But as your immune system fights the gluten that you’ve eaten, it also irritates and damages these important villi, causing symptoms in your gut and across your body.
The genetics behind what causes celiac disease
While doctors and scientists haven’t found a clear and single cause of celiac disease, there is plenty of evidence pointing to it being a genetic or hereditary condition. In particular, celiac disease is associated with variants of genes linked to the immune system. These genes provide the rules for the immune system to follow when it comes to proteins – namely, accept the ones the body makes and attack anything that seems made by a virus or bacteria.
The problem is that these variants think of gluten (gliadin, in particular) as an invader. When gluten appears in the small intestine, the immune system is told to go to work, irritating and damaging surrounding tissue in the process.
And while genetics seem to explain a lot of what’s happening, they don’t appear to tell the whole story. Approximately 30% of the world’s population carries these variants, but only 1.4% also have celiac disease.
So, it’s very likely that there are other factors at play. Since celiac disease can show up at any time during a person’s life, it could be triggered by something environmental or from another gene or set of genes – or something else entirely. But no matter how, when or why it’s caused, celiac disease is tied to our immune system thinking that gluten is a danger.
Exams, tests and diagnosing celiac disease
If you and gluten are having a hard time, schedule a visit with your primary care doctor. Come prepared with answers to questions about your symptoms, current diet and family medical history.
After a physical exam, your doctor will likely order blood tests to check for antibodies that are usually produced by immune systems affected by celiac disease. (For an accurate test result, you’ll want to provide blood samples while you’re still eating gluten regularly.) Your doctor might also recommend genetic testing for the associated gene variants.
If your blood test comes back positive, your doctor will likely set you up with an upper endoscopy. This is an outpatient procedure where a doctor inserts a scope inside your mouth to look at the inside of your small intestine using a thin, lighted tube. While your doctor is checking things out, they might also take a small tissue sample (a procedure called a biopsy) that will be sent to a lab for testing. If the doctor sees damaged villi and inflammation in your small intestine, it’s almost certain that the reason is celiac disease.
Celiac disease only affects the body when gluten is present. If there isn’t any gluten for your immune system to attack, your small intestine and villi have the environment they need to heal and thrive again. This means eating a diet that is completely free of gluten – one that, when followed, can effectively treat your symptoms. But beware, if even a small amount of gluten returns to your gluten-free system, it can cause a new bout of discomfort and irritation.
What to cut from your diet and daily routine
A gluten-free diet means cutting out any and all food made with wheat, barley or rye, or a cross of wheat and rye called triticale. This includes most bread and baked goods, like:
- Bagels
- Breakfast cereals
- Crackers
- Pasta
- Pizza
It also means keeping a close eye on other foods that either include grain as a basic ingredient or possibly use gluten as a thickener or filler, such as:
- Beer
- Candy
- Canned, frozen and other processed foods
- Processed dairy products
- Processed meats
- Salad dressings, sauces and mixes
You’ll also want to be aware of other products that might have hidden gluten, such as:
- Cosmetics (including lipsticks, glosses and balms), bath products and toothpaste
- Foods with hydrolyzed vegetable protein
- Play-Doh and other modeling doughs
- Prescription and nonprescription medicines
- Vitamins and nutritional supplements
What to eat as part of a celiac diet
The key is to look at a product’s list of ingredients, usually found underneath or near the nutrition facts label. You can also look for the words gluten-free on food labels, restaurant menus, boxes, bottles and anything else that you plan to eat or use on your body. Fortunately, this phrase is becoming easier to find, as more companies are either developing gluten-free options of popular foods or clearly labeling their current offerings to keep those with celiac disease safe.
And while many baked goods may be off your list, there are others that have gluten-free ingredients and are baked in gluten-free facilities. These can be safely eaten if made by flours of:
- Amaranth
- Arrowroot
- Beans
- Buckwheat
- Corn
- Cornmeal
- Flax
- Millet
- Potatoes
- Quinoa
- Rice
- Sorghum
- Soybeans
- Tapioca
- Teff
To be on the safe side, avoid foods made with oats or oat bran until your celiac disease symptoms have subsided and your body is well into recovering. Even then, make sure that any oat or oat product you eat is clearly labeled as gluten-free.
Plus, there’s a whole world of other foods you can choose from, like:
- Dairy products (after your small intestine recovers enough for you to tolerate lactose)
- Eggs and poultry
- Fresh, frozen and canned meats
- Fruits and vegetables – fresh, frozen, dried or canned
- Starches like beans and potatoes
- Wine and ciders
Just double check for the phrase gluten-free in the grocery store and at the restaurant. If you have any doubt, ask around. Your doctor can also give you some great suggestions on what you can add to your diet. You might also get a referral to a dietitian who can help you create a gluten-free meal plan that keeps some of your favorite foods while introducing some new and reimagined options.
Celiac disease vs. non-celiac gluten intolerance vs. wheat allergy
Celiac disease isn’t the only body condition that gluten can trigger. In fact, there are several that often get confused with each other. The key to understanding the differences between the conditions is to identify why you feel sick and where.
Celiac disease focuses on your small intestine
Celiac disease is both a digestive disorder and an immune disorder, with the problems happening mostly in your small intestine. So if gluten is causing your immune system to directly attack your small intestine, celiac disease is most likely behind it.
Unlike a wheat allergy, which also causes an autoimmune response, you shouldn’t have a near-instant, body-wide allergic reaction, including symptoms like trouble breathing or itchy eyes. But you will probably have the gas, bloating, constipation and other symptoms that those with gluten intolerance have.
Non-celiac gluten intolerance causes digestive discomfort but no damage
If you feel sick after eating gluten but your doctor isn’t finding signs of damage to your small intestine, you most likely have gluten intolerance or sensitivity, not celiac disease.
The good news is all of your body’s reactions of belly pain, tiredness, gas and more are not causing any long-term damage to your body. However, because your digestive system is having a hard time processing the gluten in the food you eat, it may be time to reduce or eliminate gluten from your diet so you can start feeling better.
Your whole body reacts to a wheat allergy
Celiac disease affects your small intestine and non-celiac gluten intolerance can make your body feel gassy, queasy and sluggish. But what if you have an immediate and urgent reaction in places on your body other than your stomach and gut after eating any kind of wheat product? That can be a sign of a wheat allergy.
While the autoimmune reaction from celiac disease is caused by gluten and focused on your small intestine, a wheat allergy can result from any food or product that contains wheat, rapidly causing bodily reactions in multiple places, including swelling in your mouth, dizziness, breathing problems and more. And unlike celiac disease or gluten intolerance, a wheat allergy can develop into a more acute and severe condition called anaphylaxis.
Don’t let celiac disease go untreated
If you have a feeling that you or your child might have celiac disease, it’s important to see a doctor as soon as possible. While some of the discomfort might come and go or is mostly bearable when it happens, letting symptoms of celiac disease continue has the potential to cause serious health conditions that could even become life-threatening, such as:
- Malnutrition
- Anemia
- Bone loss, fractures and disease, including osteoporosis
For developing children, these health problems can cause irreversible damage to growing bodies.
Fortunately, if diagnosed and treated through the right diet, most adults and children with celiac disease can recover significantly and heal the damage done to their villi, small intestine and body as a whole. To get started, make an appointment with your primary care doctor or set up a time to see one of our gastroenterologists. You don’t need a referral.