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Celiac Disease

What is gluten?

Gluten is a group of proteins found in cereal grains. It’s what gives bread and pasta their chewy texture.

Gluten is found in foods containing:

  • Wheat

  • Barley

  • Rye

  • Triticale

  • Spelt

  • Malt

  • Semolina

  • Graham flour

What is celiac disease?

For people who have celiac disease, the presence of gluten in their gut signals their immune system to attack their small intestine lining. Repeat consumption of gluten products will damage their small intestine lining and may result in malabsorption.

OK. I just had a whole wheat bagel. Now what?

If you have celiac disease, expect a bit of discomfort. Symptoms may include:

  • Abdominal pain

  • Gas and bloating

  • Diarrhea

  • Fatigue

  • Nausea and vomiting

  • Constipation

How can I know for sure if I have celiac disease?

Consider an evaluation before you go gluten-free. Going on a gluten-free diet before a workup can skew the results.

Diagnostic workup usually starts with blood work. The blood tests look for:

  • Antibodies that indicate an immune reaction to gluten (anti-tissue transglutaminase antibodies and anti-endomysial antibodies)

  • Specific human leukocyte antigen (HLA) genotypes strongly associated with celiac disease

The diagnosis of celiac disease is confirmed by an upper endoscopy with intestinal biopsy.

Symptoms be damned. I want my pasta. What’s the worst that can happen?

If the abdominal bloating and discomfort do not dissuade you from a bowl of whole wheat bread or pasta, consider the non-digestive system problems that may arise, including:

  • Anemia due to poor absorption of vitamin B12, folate, or iron

  • Clotting problems, due to poor absorption of vitamin K

  • Loss of bone density (osteoporosis) or softening of the bone (osteomalacia)

  • Itchy, blustery skin rash (dermatitis herpetiformis)

  • Unintentional weight loss

  • Recurrent aphthous ulcers in the mouth

  • Nervous system problems like muscle weakness, numbness, tingling, balance problems, and confusion

So how can I manage celiac disease?

Eliminating gluten from your diet can stop the immune-mediated destruction of your small intestine lining. In general, the symptoms should improve on the gluten-free diet within days to weeks as your small intestine heals.  If symptoms persist despite being on the gluten-free diet, you’ll need to be re-evaluated by a specialist.


Posner EB, Haseeb M. Celiac Disease. 2020 Aug 10. In: StatPearls

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