Celiac Disease

Celiac disease is a genetically predisposed autoimmune disease where the ingestion of gluten leads to intestinal damage. This damage in turn causes both short and long term complications. The only treatment for celiac disease is a strict gluten-free diet. Celiac disease is a life-long condition. 

Celiac disease symptoms vary greatly amongst individuals. There are over 260 symptoms, non of which are unique to this disease, making it easily missed in a diagnostic process. Statistics tell us that celiac disease only has a 15% diagnosis rate in Canada. 

Symptoms come in three categories: classic, non-classic and neurological. 

Classic:

• Diarrhea.
• Fatigue.
• Weight loss.
• Bloating and gas.
• Abdominal pain.
• Nausea and vomiting.
• Constipation.

Non-classic: 

• Anemia, usually from iron deficiency due to decreased iron absorption.
• Osteoporosis or osteopenia
• Itchy, blistery skin rash, called dermatitis herpetiformis (DH)
• Mouth ulcers
• Fatigue
• Joint pain
• Hyposplenism.
• Elevated liver enzymes

Neurological:

• Nervous system injury, including numbness and tingling in the feet and hands, possible problems with balance, and cognitive impairment.
• Headaches
• Brain fog
• Depression/ anxiety 
• Dizziness 
• Ataxia 

Diagnosis typically involves a combination of:

1. Serological tests: Blood tests to look for specific antibodies (e.g., anti-tissue transglutaminase antibodies, anti-endomysial antibodies).
2. Endoscopy with biopsy: A biopsy of the small intestine taken during an endoscopy can confirm the diagnosis by showing damage to the villi.

Ask you physician about the ‘non biopsy approach to diagnosing celiac disease’ if you have a child under the age of 18. 

Gluten is a protein found in barley, rye and wheat. It is also found in regular oats, due to the high levels of cross contamination. We often use the acronym B.R.O.W. 

Here are some common sources of gluten:

Grains and Flours:

• Wheat (including varieties like spelt, farro, and durum)
• Barley
• Rye
• Triticale (a cross between wheat and rye)
• Regular oats (labelled gluten-free oats are safe)

Foods:

• Bread
• Pasta
• Cereals
• Baked goods (cakes, cookies, pastries)
• Crackers
• Beer
• Gravies, sauces, and soups (often used as a thickener)
• Processed foods (many contain wheat-based additives)

For all processed foods, remember to read all ingredient lists and look for BROW ingredients. If there are BROW ingredients in the ingredient list, a ‘contains’ statement or ‘precautionary’ statement then this product is NOT safe for someone with celiac disease. 

Precautionary statements may look like:  “may contain”, “made in a facility…”, “produced on equipment that..”. 

Recovery from newly diagnosed celiac disease varies for each individual and depends on several factors, including the severity of the disease at diagnosis, adherence to a strict gluten-free diet, and the body’s response to dietary changes. Here’s a general timeline and what you might expect:

Immediate Response (Days to Weeks):

• Symptom Improvement: Many people start to feel better within a few days to weeks of starting a gluten-free diet. Symptoms like diarrhea, bloating, and abdominal pain often improve quickly.
• Initial Healing: The small intestine begins to heal as soon as gluten is removed from the diet. Villous atrophy (damage to the intestinal lining) starts to reverse.

Short-Term (3-6 Months):

• Continued Symptom Relief: Most people experience significant symptom relief within a few months.
• Nutrient Absorption: As the intestine heals, nutrient absorption improves, which can alleviate deficiencies and associated symptoms.

Long-Term (6 Months to 2 Years):

• Complete Intestinal Healing: For many, complete healing of the small intestine can take up to 1-2 years, especially in adults. Children tend to heal faster.
• Symptom Resolution: Full symptom resolution, including non-digestive symptoms (such as anemia, fatigue, and skin issues), may take longer.
• Monitoring: Regular follow-up with a healthcare provider, including blood tests and possibly endoscopies, will monitor your recovery and adherence to the diet.

Factors Influencing Recovery:

• Strict Adherence to a Gluten-Free Diet: Strictly avoiding gluten is crucial for recovery.
• Age at Diagnosis: Children generally heal faster than adults.
• Extent of Damage: The degree of intestinal damage at the time of diagnosis affects recovery time.
• Overall Health: General health, including any additional health conditions, can impact the recovery process.

Tips for Managing Recovery:

• Education: Learn to identify and avoid gluten-containing foods.
• Cross-Contamination: Be vigilant about avoiding cross-contamination with gluten.
• Support Groups: Consider joining a celiac support group for additional resources and support.
• Nutrient-Rich Diet: Focus on a balanced diet rich in naturally gluten-free foods like fruits, vegetables, lean proteins, and gluten-free grains.
• Healthcare Provider: Regularly consult with your healthcare provider or a dietitian specializing in celiac disease.

If you experience persistent symptoms or complications despite following a gluten-free diet, it’s essential to consult your healthcare provider for further evaluation and management.

For more information on celiac disease check out the following websites: 

• Celiac Canada
• Beyond Celiac
• Celiac Disease Foundation