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Celiac Disease: Why Some People Really Have to Avoid Gluten

One percent of people go gluten-free, not for some diet fad, but because they have to for their health.


Woman saying no to breadWith the words "gluten-free" all over product packaging in the grocery aisles, you would think celiac disease is an epidemic on par with obesity. But brands aren't just marketing their foods to capitalize on the gluten-free diet fad, they're required by law to provide critical allergen information for the three million Americans whose health depends on avoiding gluten.

For people with celiac disease, being gluten-free isn't a trendy choice — it's medically necessary to prevent a number of unpleasant symptoms, malnutrition and other serious long-term health conditions.

What is celiac disease?

Celiac disease is an autoimmune disorder, meaning the immune system attacks and damages the body by mistake. Eating gluten causes the immune system to go into attack mode, targeting the small intestine where nutrients are absorbed. Those attacks can cause serious damage and make it more difficult to get the nutrients you need from food.

When the small intestine isn't digesting food properly, you can suffer from malnutrition — even if you're well-fed and eating a healthy diet. But weight loss is only one sign in a long list of celiac disease symptoms. There are more than 200 others! Some people show no sign of the disease at all; others experience a range of unpleasant issues.

Most common signs of celiac disease

The diversity of symptoms can make it difficult to diagnose celiac disease. Infants and children are more likely to have digestive issues, but they're also more likely to show no symptoms. Adults who develop celiac disease have problems all throughout the body. And many of them are serious, long-term health conditions.

Symptoms in Children Symptoms in Everybody Symptoms in Adults
Slow or delayed growth Weight loss Weakness
Vomiting Chronic diarrhea Muscle cramps
Behavioral changes Bloating, gas and abdominal pain Canker sores
ADHD Fatigue Osteoporosis
Irritability Celiac rash on the elbows, butt and knees Arthritis
Poor appetite Iron-deficiency anemia Depression
Damage to teeth enamel Bone and joint pain
Constipation – more common in kids but can be seen in adults

How do you get it?

That's still unclear. It's part hereditary. According to the Celiac Disease Foundation, if your parents, children or siblings have celiac disease, you are ten times as likely to get it too.

But having the genes that increase your risk of celiac disease doesn't mean you'll develop it. Environmental factors, infant feeding practices, gastrointestinal infections and gut bacteria also play a role. Sometimes a change in your health triggers celiac disease. Many people develop it after surgery, pregnancy, childbirth, serious infection or emotional stress.

How is celiac disease diagnosed?

Celiac disease is rare but the thought of it is still concerning. You may be living a happy, healthy life when, suddenly, something changes. For many of the people living with celiac disease, that's the case. It's estimated that 97 percent of people who have it don't know it.

When a disease has hundreds of possible symptoms, there can be an overlap with other health conditions. Celiac disease is often confused with irritable bowel syndrome, chronic fatigue syndrome or inflammatory bowel disease. You can also have a gluten intolerance, gluten allergy or non-celiac gluten sensitivity that shows similar symptoms but doesn't result in intestinal damage or the risk of other autoimmune disorders.

When symptoms point toward celiac disease, a gastroenterologist can make the diagnosis in one of many ways:

  • Blood test – Antibodies that react in autoimmune disorders appear in your blood, serving as markers for celiac disease. A blood test looks for these antibodies, as long as you eat gluten in your diet.
  • Upper endoscopy – Blood tests can be inconclusive or negative even if symptoms persist. Upper endoscopy uses a small tube inserted into your esophagus to go down into your intestinal link to confirm the presence of celiac disease.
  • Capsule endoscopy – A tiny, pill-sized camera can help diagnose celiac disease. After you swallow it, the camera takes thousands of pictures as it passes through your digestive tract. Capsule endoscopy is used for more information or when you're unable to undergo an upper endoscopy.

If you or someone in your family is diagnosed with celiac disease, it's recommended that the first-degree relatives — parents, siblings and children — of that person get screened.

How can you possibly avoid gluten in your diet?

It can be difficult but it's very important. A gluten-free diet is the only way to manage celiac disease. Following this diet strictly for the rest of your life can prevent further damage to your small intestines and associated health conditions. It also helps avoid uncomfortable digestive issues.

Gluten is a protein found in wheat, barley and rye — core grains present in most baked goods. Gluten can sneak its way into other foods too. It might be part of ingredients used in the processing of foods that you would never suspect contain gluten. Gluten-free foods can also be contaminated by foods containing gluten in the manufacturing process. You have to be knowledgeable of all the foods that naturally contain gluten and diligent about reading product packaging to ensure the foods you buy are gluten-free.

Within days of starting a gluten-free diet, your symptoms will fade and your small intestine will start healing itself. If you stray from the diet or accidentally eat even small amounts of gluten, you risk further intestinal damage — or other harmful effects if you continue eating gluten.

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