Suppose you or a friend has frequent abdominal distress, bloating, and other symptoms that seem to puzzle doctors.
Today, experts believe those doctors should consider celiac disease. Also known as celiac sprue, this illness can cause a range of symptoms and problems. Among them: diarrhea, constipation, bloating, abdominal pain, fatigue, irritability, infertility in women, depression, and anemia.
Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The culprit in celiac disease is gluten, a protein found in many grains, including wheat, rye, and barley. When a person with celiac disease eats gluten, the immune system responds by damaging the villi, the absorptive surface of the small intestine. This damage makes it difficult for the body to absorb nutrients the way it should.
In the past, U.S. doctors didn't often look for celiac disease — it was thought to be a rare childhood syndrome. Celiac disease is now known to be a common genetic disorder that tends to run in families. More than 2 million people in the U.S., or about 1 in 133, have the disease.
About 5% of the first-degree relatives of a person with celiac disease will also have the disease. A first-degree relative is a parent, sibling, or child.
Celiac disease can be triggered by surgery, pregnancy, childbirth, a viral infection, or severe emotional stress, the NIDDK says.
Symptoms occur at different times in different people. Sometimes they appear in childhood, but for other people, the symptoms appear when they are adults. Symptoms aren't always in the digestive system, the NIDDK says. Although chronic diarrhea and recurrent abdominal pain are symptoms, irritability and depression also can be symptoms.
Other symptoms, from the NIDDK:
Recurring abdominal bloating
Pale, foul-smelling stool
Failure to thrive (infants)
Pain in joints
Tingling numbness in legs
Pale sores inside the mouth
Painful skin rash
Missed menstrual periods
Doctors may have difficulty diagnosing celiac disease because its symptoms are similar to other diseases, the NIDDK says. Diseases that share symptoms with celiac disease include irritable bowel syndrome, Crohn's disease, ulcerative colitis, diverticulosis, chronic fatigue syndrome, and depression.
Recent research has found that people with celiac disease have higher than normal levels of antibodies to endomysium and tissue transglutaminase. Tests can be given to measure these antibody levels. If the tests and symptoms indicate celiac disease, your doctor may confirm the diagnosis with a biopsy of the small intestine, to check for villi damage.
Early diagnosis is important. The longer a person goes undiagnosed and untreated, the greater the chance of developing malnutrition and other complications, the NIDDK says.
Gluten does not harm the bowels of those who don't have celiac disease. But if you have the disease, there's only one treatment: Avoid gluten for life.
For most people, following this diet will halt the symptoms, heal existing villi damage, and prevent further damage, the NIDDK says. The improvement begins almost immediately — within days of starting the diet. The small intestine is usually completely healed, with the villi intact and working normally, in 3 to 6 months. (The healing process may take up to 2 years for older adults.)
A gluten-free diet bans all foods that contain wheat, rye, or barley. Most grains, pastas, cereals, and many processed foods fall into that category. You can eat breads and pastas made with potato, rice, soy, or bean flour, however, the NIDDK says. Gluten-free foods also are available from specialty food manufacturers. Other foods that are fine to include are meat, rice, fruits, and vegetables.
You must be cautious about what you buy for lunch at school or work, what you purchase at the grocery store, what you eat at restaurants or parties, and what you grab for a snack. According to the NIDDK, U.S. law requires food labels to clearly identify wheat and other common food allergens in the list of ingredients. For more information, talk with your health care provider or see a nutritionist who knows about celiac.