Celiac Disease and Gluten Free Diets

July 31st, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

You might have heard the terms “celiac” and “gluten free” before and vaguely understood that they have to do with digestion. Celiac disease is actually a problem with the immune system though. Gluten is a protein found in any wheat, barley or rye based food. These foods include breads, pasta and most baked pastry-like goods. When you have celiac disease, the gluten causes a reaction where your own immune system attacks the inner surface of the small intestine. This then limits your intestine’s ability to absorb nutrients, a problem called malabsorption.

Celiac disease can therefore not only cause gastrointestinal symptoms, but the lack of nutrients can lead to serious vitamin deficiencies as well.

What are the Symptoms of Celiac Disease?

The intestinal symptoms of celiac disease can be intermittent diarrhea, bloating and abdominal pain. However, you might not have any symptoms at all. Some other symptoms can be:

  • Irritable mood or depression
  • Anemia (from vitamin B12 deficiency)
  • Stomach gas, cramps, bloating
  • Achy joints
  • Muscle cramping
  • Rashes on the skin
  • Sores in the mouth and problems with teeth

Other more GI/malabsorption specific symptoms can include:

  • Loss of weight
  • Diarrhea
  • Foul smelling gray stools or oily stools
  • Neuropathy: tingling or numbness of the hands and feet (also from lack of B12)
  • Weakened bones, osteoporosis (from lack of calcium)
  • Poor growth in children

What Causes Celiac Disease?

The exact cause of celiac disease is not clear, but it is known that the disorder is your own body’s overreaction to gluten in the diet. There is some evidence that there can be a genetic component to the disease, that is, it can run in families.

How is Celiac Disease Diagnosed?

First of all, there are blood tests. Higher than normal levels of anti-endomysium and anti-tissue transglutaminase antibodies are found in your blood if you have celiac disease. This reflects your body’s over production of something normal to the point that it causes you harm.

Your doctor might also order a biopsy of your small intestine. This is easier than it sounds since you don’t have to have an operation. Your doctor simply slides a thin flexible endoscope down your throat and into the small intestine. A tissue sample is obtained and then examined by a pathologist under a microscope.

Finally, your doctor might even have you swallow a special tiny capsule with a remote controlled camera in it. This way the physician can visualize the entire small intestine.

One important thing to remember is not to change your diet until you are diagnosed. If you start a gluten free diet before any testing is done, you might get normal test results back making the disease more difficult to detect.

How is Celiac Disease Treated?

Unfortunately, a cure for celiac disease has not been found yet. The main basis of treatment is avoiding gluten containing foods. A dietician can help guide you in choosing the best gluten free diet. The following food ingredients should be avoided:

  • Barley
  • Bulgur
  • Durum
  • Farina
  • Graham flour
  • Rye
  • Semolina
  • Spelt wheat
  • Triticale
  • Wheat

One of the biggest challenges is for people that have no GI symptoms when they eat gluten. The damage can still occur to the intestines though and lead to malabsorption. So even if the food does not upset your stomach, it could still do you harm.

Vitamin supplements should also be taken for calcium, folate, iron, B12, D and K vitamins. Again, your doctor or nutritionist can help with types and dosages of vitamins.

Finally, in some severe cases, steroids must be used if there is a lot of intestinal inflammation associated with your celiac disease. However, once a gluten free diet is instituted the inflammation usually quiets down after a few weeks.


Celiac disease is an auto-immune response to the gluten protein found in many foods. The proper diagnosis is important to prevent malnutrition. By strictly following a gluten free diet, you can get rid of your symptoms and eventually return to normal health.

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