• Jamie Sculley, ND

Understanding Celiac Disease

Updated: Jan 23


What is Celiac Disease?

Celiac disease, also called celiac sprue, is an autoimmune digestive disease that can affect many body systems. Gluten, a protein found in wheat, rye and barley, causes inflammation in the lining of the digestive tract. This damage reduces your ability to absorb nutrients, which can lead to symptoms like fatigue, diarrhea, constipation, abdominal pain, abdominal bloating, joint and nerve pain and irritability. In children it can lead to failure to thrive, stunted growth and delayed puberty. Vitamin and mineral deficiencies can occur leading to anemia or osteoporosis.


Symptoms of celiac disease

  • fatigue

  • diarrhea

  • constipation

  • abdominal pain

  • abdominal bloating

  • joint pain

  • nerve pain

  • mood changes - irritability

  • in children - additional symptoms may include failure to thrive, stunted growth and delayed puberty


How To Test For Celiac Disease

Blood tests can be done to diagnose celiac disease and sometimes your doctor may request that you have a biopsy of the small intestine. It's important that gluten is currently in the diet for these tests to be accurate.


Usually the first test to be done is IgA tissue transglutaminase (IgA anti-tTG). This is a sensitive test that looks for antibodies against an enzyme that's involved in repairing tissues called transglutaminase. Transglutaminase is attacked by the immune system in people with celiac disease, which is why this is considered an autoimmune disease. If IgA anti-tTG is elevated, there is a good chance that celiac disease is going on.


IgA may be tested alone as Total IgA to check that you have sufficient IgA to make other tests accurate. If total IgA is low there are other tests that can be done that don't involve IgA. These tests are called IgG deamidated gliadin peptides (IgG-DGP) and IgG tissue transglutaminase (IgG anti- tTG).


If blood testing is not clear but you have symptoms of celiac disease, your doctor may want you to do a small intestinal biopsy. A biopsy is done to look for changes in the intestinal lining and for the presence of a large number of immune cells or lymphocytes.


Tests to diagnose celiac disease

  • Total IgA - tested to check your overall levels of IgA to make sure other tests are accurate.

  • IgA anti- tTG - usually the initial test for celiac disease looking for antibodies against a repair enzyme called tissue transglutaminase.

  • Endomysial antibody (EMA) - a confirmation test if IgA anti- tTG is very high

  • IgG - DGP - this test may be done for diagnosis if total IgA is low because it involves a different immunoglobulin

  • IgG anti- tTG - this test may be done for diagnosis if total IgA is low because it involves a different immunoglobulin


Additional tests that your doctor might run include checking for anemia and vitamin and mineral deficiencies. For anemia a CBC, ferritin and iron panel may be ordered. Nutrient deficiencies that may be tested include vitamin B12, folate, vitamin D and calcium.


Tests to determine nutrient deficiencies

  • Anemia - CBC, ferritin, iron panel

  • B12, folate

  • Calcium

  • Vitamin D


What You Can Do About Celiac Disease


Avoid gluten

The treatment for celiac disease is to completely avoid gluten containing foods, medications and personal care products. The amount of gluten that causes symptoms can vary from person to person. Even a small amount of gluten may cause digestive inflammation with or without symptoms so it's important to avoid gluten everyday.


This can be a big change to the diet because it involves avoiding foods like bread, noodles, snacks like crackers or cookies or any other foods that contain wheat, barley or rye. Even beer and some liquors contain gluten. Nowadays there are more gluten free options made with other types of flour such as almond, coconut, cassava, buckwheat, oat, amaranth, and arrowroot. When you're shopping look for foods with the gluten free symbol.


Avoid these gluten-containing grains

  • wheat

  • barley

  • rye

  • spelt

  • kamut

  • farro

  • triticale

Check medications and personal care products

Also check non-food products for gluten such as soap, detergent, lotion, toothpaste and deodorant because these can also expose you to gluten and may cause symptoms.


If you're taking medications look them up at http://www.glutenfreedrugs.com/ .


Have dedicated gluten free cutting boards and appliances

Ideally, gluten should be removed from the home, but sometimes this can be difficult because other people in the home may not want to eat a gluten free diet. You could have dedicated areas in the kitchen such as cutting boards and toasters to prevent contamination from foods that contain gluten.


Oats in the diet

Oats can be a confusing part of a gluten free diet. People with celiac disease may not tolerate oats well and they may cause symptoms. Oats may be processed in facilities that also process wheat. I always advise that if you're going to eat oats to choose gluten free versions.


Consider going dairy free

Dairy intolerance or lactase deficiency can be common in those with celiac disease so consider going dairy free initially or until blood tests are normal to allow the digestive tract to heal.


Fix any nutrient deficiencies

Common deficiencies due to poor absorption can include iron, calcium, B12, folate, fat soluble vitamins such as vitamins A,D,E, and K. Make sure you're getting these in the diet or from supplementation. Blood tests can be done to see if you have adequate levels.


Find support and resources

Support groups can be helpful for sticking with the diet, recipe ideas and emotional support so check out The National Celiac Association or Celiac Disease Foundation for more resources.



Summary

Celiac disease, also called celiac sprue, is an autoimmune digestive disease that can affect many body systems. Gluten, a protein found in wheat, rye and barley, causes inflammation in the lining of the digestive tract. Symptoms include fatigue, diarrhea, constipation, abdominal pain, abdominal bloating, joint and nerve pain and irritability. In children it can lead to failure to thrive, stunted growth and delayed puberty. Vitamin and mineral deficiencies can occur leading to anemia or osteoporosis. Blood tests to diagnose celiac disease include IgA tissue transglutaminase, total IgA, IgG deamidated gliadin peptides (IgG-DGP) and IgG tissue transglutaminase (IgG anti- tTG), and endomysial antibody (EMA). Treatment includes avoiding gluten, going dairy free, fixing nutrient deficiencies, and finding support.



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In health,

Dr. Jamie




This website is not intended for the purpose of providing medical advice. All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.



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