What to know about celiac disease

People with celiac disease experience inflammation and pain in the gut when they consume gluten. It is an autoimmune condition that involves the immune system reacting to gluten proteins.
In a person with celiac disease, exposure to gluten causes inflammation in the gut. Repeated exposure gradually damages the small intestine, which can lead to problems absorbing minerals and nutrients from food.
inflammation
Below, we explore the symptoms of celiac disease in detail, as well as the diagnostic process, the risk factors, and gluten-free diets.
What is celiac disease?
Celiac disease is an autoimmune disorder in which the immune system responds negatively to the gluten found in wheat and other grains.
Over time, celiac disease damages the finger-like projections in the intestine that absorb nutrients, called villi. This damage limits the overall nutrient absorption and can lead to a number of health issues.
It typically causes discomfort in the gastrointestinal tract after eating gluten-containing foods.
Celiac disease affects around 1 in 100 people worldwide, and many have the condition without knowing it. As many as 2.5 million people in the United States may have undiagnosed celiac disease.
Celiac disease
1 in 100 people
The only way for someone with celiac disease to avoid symptoms is to keep gluten out of their diet.
What are the symptoms of celiac disease?
The symptoms of celiac disease can range from mild to severe. They can change over time, and they vary from person to person.
Some people have no symptoms or only experience them later in life. A person may not know that they have celiac disease until they develop a nutrient deficiency or anemia.
anemia
Children are more likely to develop digestive symptoms than adults. These symptoms include:
abdominal pain
bloating
gas
chronic diarrhea or constipation
nausea
vomiting
pale, foul-smelling stool
fatty stool that floats
Symptoms of celiac disease that are not digestive can include:
can include
weight loss
fatigue
depression or anxiety
depression
joint pain
mouth sores
a rash called dermatitis herpetiformis
dermatitis herpetiformis
nerve damage in the extremities, called peripheral neuropathy, which can cause tingling in the legs and feet
peripheral neuropathy
People with celiac disease may develop nutrient deficiencies as damage to the gut gradually limits the absorption of nutrients such as vitamins B12, D, and K. For the same reason, a person may also develop iron deficiency anemia.
iron deficiency anemia
Beyond malnutrition, celiac disease can cause damage to the large intestine and more subtle damage to other organs.
malnutrition
Variations in symptoms may depend on:
depend on
age
damage to the small intestine
the amount of gluten a person consumes
the age at which a person started consuming gluten
how long the person was breastfed, as symptoms tend to appear later in those who were breastfed for longer
Health issues such as surgery, pregnancy, infections, or severe stress can sometimes trigger celiac disease symptoms.
stress
When celiac disease limits or prevents a child’s body from absorbing nutrients, this can lead to developmental or growth problems, including:
including
failure to thrive, in infants
delayed growth and short height
weight loss
damaged tooth enamel
mood changes, including impatience or annoyance
late-onset puberty
abdominal pain or diarrhea
Switching to a gluten-free diet early can help prevent these issues. Intestinal damage can begin to heal within weeks of removing gluten from the diet.
As time goes by, children may experience spontaneous remission and remain free from symptoms of celiac disease until later in life.
Celiac disease causes and risk factors
Celiac disease can develop in anyone. It is more common in white Americans and in females.
more common
It also runs in families. A person with a parent or sibling who has celiac disease has a 1 in 10 chance of developing it.
1 in 10 chance
Celiac disease is more common in people with certain other conditions, including:
more common
Down syndrome
Down syndrome
Turner syndrome
Turner syndrome
type 1 diabetes
type 1 diabetes
Hashimoto’s
autoimmune thyroid disease
autoimmune thyroid disease
Research has found a few other potential risk factors for developing celiac disease, though not all of these have sufficient research to back them up. They include:
include
having early exposure to gluten
experiencing many viral infections during infancy
having certain genes associated with celiac
Celiac disease tests and diagnosis
A doctor can often diagnose celiac disease by considering the medical histories of the person and their family and ordering tests such as blood tests, genetic tests, and biopsies.
Doctors check the blood for the presence of antibodies common in people with celiac disease: anti-tissue transglutaminase and anti-endomysial antibodies. They may also order a human leukocyte antigen (HLA) test. HLAs are proteins found on white blood cells, some types of which are associated with celiac disease.
check the blood
If tests indicate celiac disease, a doctor may perform an intestinal biopsy by using an endoscope to take samples of the intestinal lining. Usually, they take several to increase the accuracy of the findings.
endoscope
Celiac disease can be difficult to diagnose because it shares symptoms with other conditions, including:
including
irritable bowel syndrome
irritable bowel syndrome
Crohn’s disease of the small intestine
Crohn’s disease
Whipple’s disease
giardiasis
small intestinal bacterial overgrowth
small intestinal bacterial overgrowth
side effects of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs)
Celiac disease diet
For most people with celiac disease, switching to a gluten-free diet greatly improves the symptoms, and a person may notice improvement in days or weeks.
gluten-free diet
In children, the small intestine usually heals in 3–6 months. In adults, full healing can take several years. Once the intestine heals, the body is able to properly absorb nutrients from food again.
3–6 months
Having a gluten-free diet is easier than ever in some parts of the world, where gluten-free options are becoming more widely available.
The key is to understand which foods and products, such as toothpaste, tend to contain gluten. A qualified dietitian can help.
For more science-backed resources on nutrition, visit our dedicated hub.
dedicated hub
Gluten occurs naturally in wheat, rye, and barley. Most cereals, grains, and pasta, as well as many processed foods, contain gluten. Beers and other grain-based alcoholic drinks can also contain it.
It is crucial to check labeling because gluten can be an ingredient in some unexpected products.
Foods that do not contain gluten include:
meat and fish
fruits and vegetables
some grains, including rice, amaranth, quinoa, and buckwheat
rice flour
cereals such as corn, millet, sorghum, and teff
pasta, bread, baked goods, and other products labeled “gluten free”
A person can also eliminate gluten from recipes by substituting ingredients and sometimes by adjusting the time and temperature of baking.
In the past, experts recommended that people with celiac disease avoid oats. However, evidence now suggests that moderate amounts of oats are generally safe, provided the oats have not touched gluten during processing.
evidence
According to the Food and Drug Administration (FDA), manufacturers must not label a food product as gluten-free unless it contains less than 20 parts per million of gluten — the lowest level that tests can reliably detect.
Food and Drug Administration (FDA)
It is worth keeping in mind while traveling that regulations about labeling vary from country to country.
Many processed foods can contain gluten, including:
canned soups
salad dressings
ketchup
mustard
soy sauce
seasonings
ice cream
candy bars
processed and canned meats and sausages
Nonfood products can also contain gluten, including:
some prescription and over-the-counter medications
vitamin products
vitamin
toothpaste
cosmetics, including lipstick, lip gloss, and lip balm
postage stamps
communion wafers
Read more about what a gluten-free diet contains.
what a gluten-free diet contains
Gluten-free diets have become more popular in recent years. However, research does not suggest that this diet benefits people who do not have celiac disease or nonceliac gluten sensitivity.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, “No current data suggests that the general public should maintain a gluten-free diet for weight loss or better health.”
National Institute of Diabetes and Digestive and Kidney Diseases
Foods that contain gluten can be important sources of vitamins and minerals, including fiber, iron, and calcium. It is best to speak with a healthcare professional before eliminating these foods, as doing so can lead to nutrient deficiencies.
What is the treatment for celiac disease?
Most people find that eliminating gluten from their diets greatly improves their symptoms. It allows the intestine to heal.
If a person has dermatitis herpetiformis, medications such as diamino diphenyl sulfone (Dapsone) can reduce the symptoms. However, this does not heal the intestine, so a gluten-free diet is still crucial.
dermatitis herpetiformis
People with celiac disease may also benefit from taking vitamin and mineral supplements to help prevent or address deficiencies.
Researchers continue to work on drug therapies to reduce the challenges of living with celiac disease and improve the long-term outlook. The Celiac Disease Foundation offers more information about possible future treatments.
Celiac Disease Foundation
What can celiac disease lead to?
In a person with celiac disease, repeated exposure to gluten damages the intestinal lining. This can result in nutrient deficiencies that can cause issues such as:
anemia
hair loss
osteoporosis
osteoporosis
small bowel ulcers
Researchers have linked celiac disease with some types of cancer, including lymphoma, which develops in white blood cells. However, the association is rare, and most people with celiac disease never develop related cancer. A gluten-free diet can reduce the risk.
linked
cancer
lymphoma
Some people develop refractory celiac disease, which involves the body not responding to a gluten-free diet for 12 months or more. This is rare, affecting 1–2% of people with celiac disease. People who have it are almost always over 50 years old.
1–2%
Frequently asked questions
Below are some frequently asked questions about celiac disease.
Five symptoms that could indicate celiac disease include:
abdominal pain
gas
bloating
nausea
chronic diarrhea or constipation
Digestive symptoms do not necessarily indicate celiac disease, and some people may have celiac disease and no symptoms. Talk to a healthcare professional to learn more.
Celiac disease is an autoimmune disease that occurs in people with certain genes. It can develop at any age after someone starts eating gluten.
certain genes
any age
When an affected person eats food containing gluten, the immune system responds negatively and damages villi in the intestine, affecting nutrient absorption.
People with undiagnosed celiac disease may experience digestive symptoms after eating gluten. They may also experience other health complications, such as anemia, unexplained weight loss, and nutrient deficiencies.
People are more likely to develop celiac disease if they have a first-degree relative with the condition. However, it can develop at any age after a person starts eating gluten.
more likely
Summary
Celiac disease is an autoimmune condition. Exposure to gluten causes the body to attack cells in the small intestine. There is no cure, but a person can ease or relieve the symptoms by switching to a gluten-free diet.