In the early 1930s, Dutch pediatrician K.W. Dicke was the first to link celiac disease to the consumption of wheat. However, it wasn’t until 20 years later that gluten was identified as the trigger to celiac disease and its manifestations. (10) Although the presence of celiac disease has been established for many years, recently, there’s been increased recognition of the disorder attributed to broader awareness, higher incidence, improvements in diagnostic testing methods, and a greater understanding of the signs and symptoms. (5)(8) Today, the prevalence of celiac disease globally is believed to be approximately 1%. (5)(8)(9)
What is celiac disease?
Celiac disease is a chronic, inflammatory condition, in which the body produces an autoimmune reaction in response to exposure to gluten, a protein found in grains like wheat, barley, rye, and spelt. (9) This immune response causes damage to villi, which are the finger-like projections in the intestine primarily responsible for increasing the surface area of the small intestine to improve nutrient absorption. (11)
It’s important to note that celiac disease differs from non-celiac gluten sensitivity (NCGS). While celiac disease and NCGS may present with similar symptoms, NCGS is not caused by an autoimmune reaction. NCGS is generally diagnosed by ruling out other possible causes of symptoms, including celiac disease and wheat allergy. (9)
Celiac disease is a chronic, inflammatory condition, in which the body produces an autoimmune reaction in response to exposure to gluten.
Celiac disease causes
Celiac disease, like many autoimmune conditions, is a multifactorial disease. While the exact cause of celiac disease is unknown (6), many factors may play a role in its development. Researchers have identified both genetic and potential environmental triggers. In order to develop celiac disease, individuals must possess a genetic predisposition to the disorder. (5) Specifically, they must carry the HLA DQ2 and/or DQ8 gene. (2) It was found that individuals with a parent, sibling, or child with celiac disease are ten times more likely to develop the condition. (11)
Although a genetic predisposition must be present, HLA DQ2 and DQ8 carriers will not necessarily develop celiac disease during their lives (2), indicating that other environmental factors are involved.
Did you know? Celiac disease appears to be twice as common in females than in males. (7)
Exposure to viral infections, such as rotavirus, and early feeding patterns may also play a role. There is some evidence demonstrating that breastfeeding may provide a protective effect (10) and that prolonging breastfeeding in infants with the gradual introduction of gluten may reduce the risk of developing celiac disease in children. Increased gram-negative bacteria and reduced bifidobacteria have also been noted in individuals with celiac disease, indicating a possible link between celiac disease and individual composition of intestinal microbiota. (9) Furthermore, individuals with other immune conditions, such as autoimmune thyroid disease, type 1 diabetes mellitus, and Down syndrome, have all demonstrated an increased risk of celiac disease. (11)
Recognizing celiac disease
The signs and symptoms of celiac disease vary widely, making the condition difficult to diagnose. Furthermore, several forms of celiac disease have been identified, including classic, atypical, and “silent” or asymptomatic. (9)
Celiac disease symptoms and complications
Classic symptoms are generally related to digestion and abnormal absorption of nutrients, while individuals with atypical celiac disease often display few or no gastrointestinal symptoms. Individuals with atypical celiac disease or those presenting with few symptoms account for more than half of all diagnosed cases. (9)
Common celiac disease symptoms include:
- Abdominal pain, gas, bloating
- Changes in mood
- Chronic constipation and/or diarrhea
- Chronic fatigue
- Delayed puberty
- Dermatitis herpetiformis, an inflammatory skin condition
- Failure to thrive, growth retardation in children
- Impaired absorption of nutrients
- Nausea, vomiting
- Persistent headaches
- Poor concentration (10)
- Weight loss (9)
Unidentified and untreated celiac disease may result in severe consequences. This disorder has been linked to an increased risk of several conditions, including:
- Certain cancers (e.g., Non-Hodgkin lymphoma, Small bowel adenocarcinoma, T-cell lymphoma)
- Increased mortality
- Neurological disorders (e.g., peripheral neuropathy)
- Nutrient deficiencies, including iron-deficiency anemia
- Osteoporosis, osteopenia
- Pulmonary hemosiderosis
- Renal disorders (i.e., IgA nephropathy)
- Ulcerative jejunoileitis (9)(10)
Research has identified a number of conditions associated with celiac disease. It appears that approximately 30% of people with celiac disease also suffer from other autoimmune conditions, such as Hashimoto’s or Graves’ disease, autoimmune hepatitis, and type 1 diabetes. (10) Other associated conditions include Down syndrome, Turner syndrome, and Williams syndrome. (9)
Celiac disease treatment
Integrative treatment of celiac disease can involve testing, diagnosis, dietary modifications, and supplementation based on the individual’s needs.
How to test for celiac disease
Since the symptoms of the condition vary significantly, the first step of celiac disease diagnosis generally involves differentiating celiac disease from a number of other conditions, such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), food intolerances, congenital diarrheal diseases, and intestinal infections. (10) Clinical tests for celiac disease include intestinal biopsies to determine damage to the intestine and serum antibody testing, such as the tissue transglutaminase IgA antibody test. Remission of symptoms following a gluten-free diet also provides an indication of celiac disease (10)(11), however, this could also indicate other forms of gluten intolerance, like Non-Celiac Gluten Intolerance (NCGS).
Dietary modifications: follow a gluten-free diet
To date, strict adherence to a gluten-free diet is the only treatment for celiac disease. Following a gluten-free diet involves avoiding all gluten-containing grains, such as wheat, barley, rye, and spelt, as well as any foods or products manufactured from these grains. The gluten-free diet has been shown to eliminate symptoms and reverse the progression of celiac disease. Within a few weeks of beginning the celiac diet, individuals show improvements in clinical symptoms, while healing of intestinal damage and inflammation may take 1-2 years. (9)
Although wheat makes up a significant portion of a typical North American diet, the good news is there are several gluten-free grain alternatives, such as corn, millet, rice, sorghum, amaranth, buckwheat, quinoa, and teff. Oats are also naturally gluten-free, however, they are often manufactured in the same facility as wheat and are, therefore, susceptible to cross-contamination. Be sure to purchase gluten-free oats to minimize potential exposure to gluten.
To learn more about the gluten-free diet, visit the Fullscript blog.
With more people choosing to follow a gluten-free diet, gluten-free foods are also becoming increasingly available in restaurants and grocery stores. When purchasing prepared or packaged foods, be sure to read the ingredients label as many gluten-free alternatives contain unhealthy additives to improve texture, color, and flavor. Helping you make safe choices, gluten-free certifications indicate that a product has been extensively tested by a third party to ensure gluten content does not exceed a safe amount.
Dietary supplements for celiac disease
Supplementation for celiac disease is used most commonly to address micronutrient deficiencies resulting from malabsorption. Common nutrient deficiencies include vitamin B12, folate, vitamin D, iron, zinc, and magnesium. While adherence to a gluten-free diet can promote healing of the intestinal mucosa and improved absorption of nutrients, supplementation may be necessary in cases where deficiencies persist. In addition, vitamin D and calcium supplementation are often needed to normalize bone density. (1) Taking a daily multivitamin and mineral supplement can also help address general nutrient deficiencies following celiac disease diagnosis. (9)
Recently, studies have noted imbalances in the intestinal microbiota of individuals with celiac disease, indicating that the composition of bacteria in the small intestine may contribute to the pathogenesis of the disease. This has led to the promising hypothesis that probiotic supplementation may be a viable treatment option. However, more research is necessary as there are currently minimal studies examining the effects of probiotic supplementation for celiac disease. (3)(4)
The bottom line
If you suspect you or your child may have celiac disease, be sure to consult an integrative healthcare practitioner. Early diagnosis and treatment are imperative as it helps to prevent tissue damage and reduce the risk of celiac disease-associated complications. Health professionals can also provide dietary counseling and monitor your health for potential nutrient deficiencies or other complications.
- Caruso, R., Pallone, F., Stasi, E., Romeo, S., & Monteleone, G. (2013). Appropriate nutrient supplementation in celiac disease. Annals of Medicine, 45(8), 522-531.
- Celiac Disease Foundation. (n.d.). Screening. Retrieved from https://celiac.org/about-celiac-disease/screening-and-diagnosis/screening/
- Cristofori, F., Indrio, F., Miniello, V.L., De Angelis, M., & Francavilla, R. (2018). Probiotics in celiac disease. Nutrients. 10(12).
- de Sousa Moraes, L. F., Grzeskowiak, L. M., de Sales Teixeira, T. F., & Gouveia Peluzio, M. (2014). Intestinal microbiota and probiotics in celiac disease. Clinical Microbiology Reviews, 27(3), 482–489.
- Green, P.H.R., Lebwohl, B., & Greywoode, R. (2015). Celiac disease. The Journal of Allergy and Clinical Immunology, 135(5), 1099–1106.
- Holtmeier, W., & Caspary, W.F. (2006). Celiac disease. Orphanet Journal of Rare Diseases, 1, 3.
- Koning, F. (2014). Pathophysiology of deliac disease. Journal of Pediatric Gastroenterology and Nutrition, 59, S1–S4.
- Lebwohl, B., Sanders, D.S., & Green, P.H.R. (2018). Coeliac disease. The Lancet, 391(10115), P70-81.
- Parzanese, I., Qehajaj, D., Patrinicola, F., Aralica, M, Chiriva-Internati, M, Stifter, S., … Grizzi, F. (2017). World Journal of Gastrointestinal Pathophysiology, 8(2), 27–38.
- Schuppan, D., & Zimmer, K.P. (2013). The diagnosis and treatment of celiac disease. Deutsches Ärzteblatt International, 110(49), 835–846.
- Silvester, J., & Duerksen, D. (2013). Celiac disease. CMAJ, 185(1), 60.