Celiac Disease

The immune disorder at the root of the gluten-free diet

The idea of eating gluten-free has been increasingly popular over the last decade, but what triggered this sudden disgust for a protein found in grains humans have been eating for thousands of years? The answer lies away from the hype that makes eating gluten-free a fad diet and in the reality of those who live with celiac disease, an immune disease that can severely affect the daily life of those who have it.

Gluten is a protein found in some of the more common grains in the western diet. Most people already know about wheat, but gluten also exists in rye, barley, and a grain called triticale, a mix between the last two—so no, celiac is not a wheat allergy. Gluten is the reason we use wheat and rye so commonly in baking. It acts as a sort of stretchy glue that allows baked goods to do things like stretch, roll, and rise without tearing, so it’s found in everything from sandwich bread to pizza while also popping up in unexpected places like soups or soy sauce.

Gluten is the root cause of all celiac disease. When someone has celiac, what it means is that for whatever reason, the immune system has decided that gluten is the enemy, causing the immune system to attack a person’s small intestine. In doing this, the immune system severely damages some minuscule structures known as villi.

While it would be nice to think that damage to a few handfuls of tiny structures wouldn’t mess a person up, the reality is the exact opposite. The small but mighty villi are a crucial part of the gut being able to absorb nutrients—meaning when they’re not functioning correctly, food can pass right through the system without nutrition making it into the body.

Long story short: in celiac patients, eating gluten makes it so their body can’t get the nutrition it needs.

What are the symptoms of celiac disease?
Let’s start with the general symptoms that tend to be what people think of when celiac is mentioned. The most classic is severe diarrhea, which is unpleasant enough. Other symptoms include weight loss, fatigue, bloating and gas, significant abdominal pain, nausea, and vomiting. No gastrointestinal list of symptoms would be complete without the possibility of painful constipation.

However, not all celiac sufferers will experience this exact suite of symptoms, so let’s take a closer look at what’s going on inside the body. We’ll start with what happens to the innocent villi that are being attacked. Healthy villi look like elongated, pinkish balloons; villi that have been attacked fall flat and generally take on the appearance of being furious with the world. Angry villi don’t work, and villi on strike are what causes those missing nutrients.

Where in the intestine these damaged villi exist primarily determines which nutrients may suddenly be missing from a person’s body, meaning that celiac symptoms can vary significantly from person to person. Someone may not experience the more apparent symptoms from above but instead suffer from years of unexplained anemia or go to the doctor and learn that their bone density is suddenly not what it should be. Headaches or even migraines can occur in celiac patients, or things like numbness and tingling, mouth ulcers, itchy rashes, joint pain, and even issues with spleen functionality, none of which seem related to the digestive tract.

The fact that someone with celiac can have such a wide-spread constellation of symptoms can be a significant part of the reason why celiac can take so long to diagnose. Many celiac sufferers will spend years or even a decade or more chasing down each symptom separately without being able to find relief before finally finding that one doctor who thinks to look for celiac.

Aside from the obvious concerns related to experiencing the celiac’s variable symptoms for years, yes, there are concerns that other complications can arise from untreated celiac disease. For one thing, people with celiac have a significantly elevated risk of developing other autoimmune conditions. On top of that, the risk of developing an arterial disease is two times greater than the norm, while the risk of developing cancer in the small intestine is four times greater.

Untreated celiac can also contribute to infertility and miscarriage, gall bladder issues, pancreatic issues, lactose intolerance, and even severe neurological symptoms like seizures or dementia. Again, these symptoms seem so far afield for an intestinal disorder—but then you remember that what celiac is at its root is a form of starvation for specific nutrients. Anything a nutrient deficiency can cause, celiac can bring on.

How is celiac diagnosed?
There are two blood tests a doctor can order to get started: serology testing and genetic testing. Serology testing looks for antibodies that indicate your body is attacking gluten, while genetic testing looks for some specific leukocyte antigens to rule out celiac.

If the blood work indicates a chance of celiac, you’ll likely have to undergo some form of endoscopy. The doctor will place a tiny camera into your small intestine to look at and take a villi sample. If your villi are look deflated and angry, celiac is your culprit.

How does gluten-free diet help?
At this point, the answer is probably evident. A gluten-free diet treats celiac by removing the thing your body is attacking: gluten. Once gluten exits your system, your immune system will quiet down, your villi can recover in peace, and your body can start receiving all the nutrients you’ve been missing.

Keep in mind, while gluten itself isn’t a nutritional necessity, many of the foods containing gluten are the main methods for getting things like fiber and B vitamins in many western diets. Be sure to get help and supervision from your doctor and preferably a dietician to make your switch as easy as possible, setting you on the path to a happier, healthier life.


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