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What is Celiac Disease?


  •  Celiac Disease is an autoimmune disorder in which the ingestion of gluten leads to damage in the small intestine.

    In people with celiac disease, the body mounts an immune reaction to gluten. This reaction of the immune system attacks the villi present on the lining of the small intestine, which are responsible for absorption of nutrients from food. Due to the damaging of villi, the body is unable to fully absorb nutrients into the bloodstream.
    Celiac Disease occurs in genetically predisposed people, i.e. it is hereditary and could run in families. It is estimated to affect 1 in 100 people worldwide.


  •  Prevalence of CD in India

    Until recently, Celiac Disease was believed to be uncommon in India. However, recent studies show that the prevalence of celiac disease in the North Indian community is estimated to be 1 in 96, or 1.04% of the population.
    Additionally, the genetic risk for celiac disease was found to be 38.1% in Northern India, 31.4% in North Eastern India, and 36.4% in Southern India. It is also estimated that the number of patients with celiac disease in Asia (primarily India and China) may eventually surpass the rest of the world.


  •  Symptoms

    There are no hard and fast rules about the symptoms of Celiac Disease. There are close to 300 symptoms for this disease and they vary among different people. It is possible for some people to develop these symptoms in childhood, some to develop them in their adult life, and some to have no symptoms at all! Some of them are listed below.

    Infants and Children tend to have digestive problems which include:
    • Abdominal bloating and pain
    • Chronic diarrhea
    • Vomiting
    • Constipation
    • Pale, foul-smelling, or fatty stool

    They may also display other symptoms such as:
    • Dental enamel defects of the permanent teeth
    • Weight Loss
    • Fatigue
    • Irritability and behavioral issues
    • Delayed growth and puberty
    • Short Stature
    • Failure to thrive
    • Attention Deficit Hyperactivity Disorder (ADHD)

    Children often show malnourishment because the disease prevents their body from absorbing essential nutrients. A result of this malnourishment is Anemia, or other vitamin deficiencies, which are common symptoms.

    Adults: One-third of the adults show gastrointestinal problems such as diarrhea. Other symptoms mostly result from lack of absorption of nutrients. For example,

    • Calcium deficiency can cause problems like osteoporosis (thinning of bones that can result in painful fractures), and
    • Deficiency of iron can cause Anemia (lack of hemoglobin or healthy red blood cells)

    In addition to these, Celiacs have also reported symptoms like:
    • Bone or joint pain
    • Arthritis
    • Chronic Fatigue
    • Mood swings
    • Irritability
    • Anxiety
    • Tingling numbness in hand and feet
    • Erratic menstrual periods
    • Dermatitis herpetiformis(Chronic blistering condition)
    • Mouth sores

    This infographic by Gluten Dude lists down the symptoms reported by people with Celiac Disease categorically, the ones marked in red being the most commonly observed.


  •  Diagnosis

    Are you, or someone you know, experiencing the symptoms of Celiac Disease? The first step is to consult a physician experienced with CD to ensure proper diagnosis.

    It is very important to have a correct diagnosis of Celiac Disease. You might be experiencing some or all of the symptoms, but please do not self diagnose.
    The symptoms of celiac disease are similar to many other medical conditions, including irritable bowel syndrome and non celiac gluten sensitivity. Early diagnosis and treatment has additional benefits of reducing the risks of some associated health complications like osteoporosis, bowel cancer and other autoimmune disorders.

    There are two steps in the diagnosis of Celiac Disease:
    • Blood tests: There are a number of serologic (blood) tests available for screening. These tests are for gluten antibodies and give accurate results only while the individual is on a gluten-containing diet. The most commonly used test is called a tTG-IgA test.
      If test results suggest gluten intolerance/celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    • Endoscopic Biopsy: In the event that clinical signs and positive laboratory tests indicate gluten intolerance, an endoscopic biopsy of the small intestine is performed by a gastroenterologist. There is a remarkable difference between the tissue found in a normal small intestine and that found in an undiagnosed or untreated celiac patient. The normal finger-like projections (villi), which increase the absorptive surface area of the small intestine, are partially or totally flattened in a person with celiac disease.

      Depending upon the results of the Biopsy, your doctor will decide whether to put you on a gluten-free diet or not.
      The diagnosis may be confirmed when improvement is seen while on a gluten-free diet.

      There is a third type of a test, called a Gene Test which is only used to rule out the possibility of Celiac Disease. People with CD carry one or both of the HLA DQ2 and HLA DQ8 genes. If the test results indicate the absence of both the genes, one can be certain that they do not, and will not have Celiac Disease. At the same time, testing positive for the genes is not a diagnosis of CD. Only a blood test followed by an endoscopic biopsy can confirm Celiac Disease.

    PLEASE NOTE:

    • If you suspect that you might have Celiac Disease, please do NOT adopt a gluten-free diet on your own without proper diagnosis. Going gluten-free before getting tested can hamper correct diagnosis.

    • Since Celiac Disease is genetically linked, it is advisable for all first degree relatives of a Celiac patient (children, parents, siblings) to get themselves screened and tested as well.



  •  Treatment

    Once the diagnosis of Celiac Disease is confirmed, the treatment of a lifelong gluten-free diet is prescribed. This is the only known treatment of Celiac Disease to date. Overtime, the complete elimination of gluten from your diet will heal the villous atrophy in the small intestine, resolve the symptoms and prevent further damage.

    There is no surgery of medication required. However, due to the malabsorption caused by damage in the intestines, people with Celiac Disease often experience some deficiencies at the time of diagnosis. Common deficiencies include iron, calcium, vitamin D, vitamin B-12, which may require prescription of dietary supplements along with a gluten-free diet.

    No cheating!

    A gluten-free diet is a lifelong commitment. Please note that there are no “cheat days” when you’re on this diet. Ingestion of even a small amount (> 20 parts per million!) of gluten, at any point of time in life, can cause damage to the intestines. This is true for everyone with Celiac Disease, even those who do not have noticeable symptoms. Irrespective of whether or not you feel sick after consuming gluten, there is significant increase in the antibody levels resulting in damage on the intestines. Therefore, please ensure that everything you eat is prepared with 100% gluten-free ingredients and is also free from contamination with gluten.

    Following a strict gluten-free diet may seem difficult at first, However, with practice, identifying potential sources of gluten becomes second nature and you’ll learn to recognize which foods are safe and which are off limits.

    Check out our complete list of the Sources of Gluten.

    Having a Balanced Diet

    Since a gluten-free diet means complete elimination of wheat, rye, barley and all their products, one must include suitable substitutes in their diet to make up for the loss in nutrients. Therefore, it is critical to consult a dietician or a nutritionist experienced with a gluten-free diet and chalk out meal plans for a wholesome and balanced diet.

    Follow Up

    It is advisable to visit your physician 3-6 months after the diagnosis. He/She might recommend a follow-up blood test to observe the improvements in the antibody levels.

    Read our complete guide to getting started with a gluten-free diet.