Celiac disease (or celiac sprue) is a chronic autoimmune disease that is related to a sensitivity to gliadin (gluten) which is found in some grains such as wheat, rye, and barley. Exposure to gliadin in someone with celiac disease leads to an inappropriate immune response that results in inflammation and damage to the inner lining of the intestines.
The estimated number of persons diagnosed with celiac disease in the U.S. is approximately 1% of the population1 and roughly 1-3% in the world. Celiac disease is often times challenging to diagnose since the symptoms in many cases are mild and non-specific. Investigators have identified that many other diseases, including irritable bowel syndrome, fibromyalgia, psoriasis, and many other autoimmune diseases, for example, have a high correlation with gliadin (gluten) sensitivity. A higher number of persons are now being recognized as having a gluten sensitivity, even though many may not fulfill the diagnostic criteria for celiac disease. It is for these reasons that these prevalence estimates are likely to be underestimated.
Symptoms of celiac disease (or gluten/gliadin sensitivity) may display as:
We don’t know exactly what causes celiac disease, however, the incidence has risen possibly due to the proliferation of modern diets using processed foods and commercial baked goods. Those with a first-degree relative with celiac disease seem to have a higher risk (10% chance) of developing it themselves, suggesting a hereditary link, but most investigators think that a number of environmental factors may need to be present in order for someone to develop the disease, such as intestinal bacterial imbalances, dietary factors, and/or toxic exposures.
1. Rubio-Tapia A, Ludvigsson JF, Brantner TL, et al. The prevalence of celiac disease in the United States. Am J Gastroenterol 2012, 107:1538-1544; quiz 1537, 1545.
Research has suggested that healthy bacteria in our intestines are protective, particularly in cases of celiac disease, and can help to reduce inflammation as well as help to keep a normal functioning immune system.2 Although eating a fiber-rich diet helps to build up healthy bacteria over time, many with celiac disease find it very helpful to take supplemental probiotics.3 Ask your doctor to discuss if taking probiotics is right for you.
Some with celiac disease may benefit from taking supplemental omega-3 oils for their anti-inflammatory action as part of their treatment plan.
The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)
I have celiac disease. I have been gluten free for over 4 years. However, in my earlier years I made a huge mistake and ate gluten. Now I am nutrient deficient due to damaged villi.
Do you know of any way to get the nutrients I need?
As you remain gluten free, the villi will heal and you will be able to have maximal absorption of nutrients. Eat very carefully and take the recommended supplements including vitamin D. Have a 25 hydroxy vitamin D level done to see if you are sufficient as you progress.
I was diagnosed with celiac disease shortly after I was born. My parents were never given much information about it, so I was fed foods with gluten as I grew older. How can I find out if the diagnosis was correct? Are there definitive tests that I can take?
One way to test for this is a blood test called “Celiac Disease Reflexive Panel” which will go through a series of tests, depending on the first one drawn, minimizing extra tests you don’t need. Another way to do it is to just do the following two tests which, if positive, will indicate high likelihood of the disease.
Tissue Transglutaminase Antibody, IgA
Deamidated Gliadin Peptide Antibodies, IgA
The blood tests are not the gold standard (biopsy of your intestines is) but will at least give you somewhat of a confirmation. If you notice sensitivity to gluten with your experience, then this is a test all by itself and should be recognized regardless of the blood test results because you could still have sensitivity to gluten and not technically have the diagnosis of Celiac.