Celiac Disease 101

There is a lot of fuss about gluten these days – gluten is good for you, bad for you, the gluten-free craze is just a “fad”, gluten sensitivity is not a real condition, and so on.

It’s hard to keep it all straight. Well, it turns out, there is a lot of validity to the fuss surrounding gluten for patients who have a condition called celiac disease. Celiac disease is a genetic, autoimmune condition characterized by inflammation of the small intestines.

The genetic part means that this condition is passed down in families due to the fact that individuals with celiac disease have inherited genes that predispose them to this condition. The genes can be “activated” at any time or not at all due to certain environmental factors.

Celiac disease is an autoimmune condition since the immune system in patients with this condition attack a healthy part of the body by mistake.

Celiac disease affects at least 1% of the U.S. population, possibly higher in other parts of the world. This condition affects all races and ethnic groups and can occur at any age.

In celiac disease, exposure to dietary gluten (a protein found in wheat, rye and barley) leads to inflammation of the small intestine, as well as other parts of the body. Because the small intestine plays a key role in absorbing vitamins and minerals, inflammation can lead to poor absorption of these things, and can cause significant nutritional deficiencies. Patients with celiac disease often have unexplained weight loss and diarrhea. Other common symptoms include abdominal pain, gas, bloating, low energy/fatigue and unexplained anemia or low iron levels.

These are considered to be “classic” symptoms. There are also many “non-classic” symptoms that actually account for the majority of symptoms in patients with celiac disease. These include unexplained constipation, dental problems, weak bones (osteoporosis), heartburn, nausea/vomiting, skin rash, joint and muscle aches and pains, migraine headaches, fertility problems…just to name a few. It is important to emphasize that many patient with celiac disease have NO SYMPTOMS. These patients usually come to medical attention when a family member is diagnosed with celiac disease and, consequently, they are screened for this condition with blood testing.

The treatment of celiac disease is complete, 100% avoidance of gluten for life.

The symptoms discussed above are not unique to celiac disease and can occur with other conditions. However, if you think you might have celiac disease, recognize any of the symptoms described above or have any symptoms that concern you, please speak with your doctor and consider getting tested.

Testing is simple and involves a blood test to start. If you think you might have celiac disease, do not start a gluten free diet until you have consulted with your doctor. Going gluten free before testing usually makes it difficult to interpret the test results. Early diagnosis of this condition and effective treatment can get you back on the right track towards health and improved quality of life.

About the author

Rupa Mukherjee, MD

Rupa Mukherjee, MD attended Dartmouth College, and Johns Hopkins University School of Medicine. She completed her internal medicine residency and chief residency at Yale University, gastroenterology fellowship at Columbia University Medical Center, and an advanced fellowship in celiac disease at Harvard Medical School. Rupa is currently an attending physician in the department of gastroenterology at Beth Israel Deaconess Medical Center, as well as an instructor of medicine at Harvard Medical School. In addition to seeing patients with a wide variety of GI issues, she also has clinics devoted to patients with celiac disease and gluten sensitivity. She is actively involved in various research studies related to celiac disease and gluten sensitivity, and serves on the executive committee for the Harvard Medical School Celiac Research Program. In addition to practicing medicine, Rupa is senior medical advisor for a food-based company called Real Food Solutions. She believes strongly in the principle of food as medicine, and helped formulate the Anchor Nutrition Bar TM, an all-natural nutrition bar for the prevention and relief of nausea. She is also working with the team on formulating other all-natural, non-drug food products to manage common GI ailments and is looking into gluten-free formulations. See all of Rupa's articles.