Getting to Know Celiac Disease

It's easy to forget that dietary restrictions aren't always fads; not adhering to them can sometimes send a person to the hospital. Whether you're suspicious that you may be at risk for celiac disease or you feel you need a refresher on why kitchen precautions matter, it's time to brush up on celiac disease.

What is celiac disease?

Celiac disease is an autoimmune disorder, which, in this case, means the body attacks itself in the presence of what for so many people are comfort foods.

"Celiac disease is an abnormal reaction of your own immune system to the protein gluten," said Liia Ramachandra, Pharm.D., the founder of Epilynx, a manufacturer of gluten-free skincare products based in Los Angeles. "You can find gluten in beer—ale, porter, stout, usually containing barley—breads, bulgur wheat, cakes and pies, candies, cereals, etcetera.

"When the body's immune system overreacts to gluten in food, the reaction damages the tiny, hairlike projections, villi, that line the small intestine. Villi absorb vitamins, minerals and other nutrients from the food you eat. If your villi are damaged, you can't get enough nutrients, no matter how much you eat," she said.

A person with celiac disease can starve by eating the right amount of food if it's the wrong foods. This paradox is a vivid illustration of what makes celiac disease so dangerous.

Risks, causes and triggers of celiac disease

Ramachandra described how the causes behind celiac can be chalked up to both nature and nurture.

"This is not something that you get infected with," she said. "According to the National Institutes of Health, a genetic [link] is found in 5 percent to 15 percent of celiac disease patients."

She pointed to the following as environmental factors that are possibly involved:

• The amount and the quality of ingested gluten
• The type and duration of wheat dough fermentation
• Early infant feeding
• The spectrum of intestinal microorganisms and how they change over time
• Intestinal infections
• Stressors in general

"The later the age of celiac disease diagnosis, the greater the chance of developing another autoimmune disorder, such as eczema, psoriasis, etcetera," she added.

Even the most careful celiac sufferers can go awry, according to Blanca Garcia, a registered dietitian nutritionist in Los Angeles.

"The unexpected is what is hidden," she explained. "For example, imitation meat and seafood, processed luncheon meats, seasoned snacks like tortilla and potato chips, soups and communion wafers."

Garcia's point introduces yet another reason to opt for a whole-food diet. Reading ingredients is a basic protocol for most people with dietary restrictions, but some situations don't allow for that level of foresight. Even culturally significant foods, like Garcia's example of a communion wafer, should be considered and evaluated to keep others safe.

The three types of celiac disease

Celiac disease exists along a spectrum of intensity, but the illness has been broken down into three categories: classical, nonclassical and silent.

Classical celiac disease

Malnutrition is what sets classical celiac apart from nonclassical. While nonclassical celiac sufferers may experience some vitamin deficiencies, classical celiac is often identified with symptoms indicating a "failure to thrive." Specifically, feces may appear pale, fatty or particularly smelly, and the ensuing starvation leads to weight loss and stunted growth in youths.

Nonclassical celiac disease

Chronic abdominal pain is the hallmark of nonclassical celiac disease. A patient may have a gamut of symptoms observable to the untrained eye, including:

• Difficulty losing weight
• Late-onset menstruation (menarche)/early menopause
• Dispersion and anxiety
• A distended belly
• Chronic fatigue
• Migraines
• Rashes
• Tingling in their extremities

These are all symptoms that may be misinterpreted or deemed inexplicable, especially if a person has been living with this pain since an early age.

Nonclassical celiac sufferers also experience a slew of symptoms that require testing to detect: elevated liver enzymes, vitamin D deficiencies and skeleton-wide issues because of reduced bone mass. Even seemingly unrelated medical professionals like dentists should be alert to delayed tooth eruptions, enamel defects, and ulcers in the mouth or gums.

Silent celiac disease

The asymptomatic or "silent" version of celiac disease is no small matter, either. While a person may not be acutely aware of their symptoms, they are still damaging their small intestine when they ingest gluten. Even individuals who thought they had no symptoms see reductions in acid reflux, bloating and flatulence upon treatment.

It's worth noting that what sets celiac disease apart from even the most severe gluten allergy is that the lining of the intestine isn't compromised with allergies and there's no autoimmune response.

Fast facts

"About 1 in 100 people worldwide have celiac disease, but only about 30 percent of them are properly diagnosed," Ramachandra said. "It usually takes years to be properly diagnosed for celiac disease."

Celiac disease has been found to be present in otherwise healthy people at a rate of 1 in 133. This rate increases to 1 in 22 if a first-degree relative—parent, sibling, child—suffers from celiac disease, and 1 in 39 when a second-degree relative—cousin, uncle, aunt—is diagnosed.

The disease can manifest in many different ways. The Chicago Celiac Center came to the conclusion that celiac disease may account for up to 6 percent of unexplained infertility. Nor will the symptoms that directly manifest resemble what people might expect; for example, the center found only 35 percent of newly diagnosed celiac sufferers had diarrhea.

Another striking fact comes from a study published in the European Journal of Pediatrics. Researchers found an estimated 83 percent of celiac disease cases in children are undiagnosed.

The fact that only 17 percent of children are correctly diagnosed highlights the importance of celiac disease education.