Coeliac Disease: Causes, Symptoms, Treatment

Celiac disease, also called gluten enteropathy, is an autoimmune disease of the small intestine. A person suffering from this disease is unable to digest the so-called gluten, known mainly as gluten, which is a common component of food.

Since a celiac suffers a disease reaction when eating food containing gluten, a so-called gluten-free diet is essential.

You will learn all about celiac disease in the following lines, which focus on the characteristics, symptoms and diagnosis of the disease, including how to treat celiac disease and a list of foods that can be eaten as part of a gluten-free diet.

What is celiac disease?

It is a chronic disease of the small intestine in which the body becomes hypersensitive to a mixture of proteins called gluten. Gluten is a mixture of proteins contained in many types of cereals such as wheat, barley, rye, and the increasingly popular spelt.

The body of a person diagnosed with coeliac disease reacts very aggressively to even small amounts of these proteins - the immune system produces antibodies that disrupt the lining of the small intestine and cause inflammation.

Another dangerous phenomenon is the so-called smoothing of the villi that line the mucosa of the small intestine in a healthy person. The villi perform an important function in the human body, namely the absorption of nutrients obtained from food. They thus provide the necessary nutrition - the supply of vital vitamins, minerals and trace elements.

Therefore, untreated celiac disease can result in the so-called malabsorption syndrome, where the body is significantly depleted of important nutrients, which can lead to other serious diseases.

Deficiencies of the following elements in particular are observed in previously undiagnosed or untreated coeliacs: iron, calcium, vitamin D, folic acid, vitamin B12, zinc and selenium. As these are essential vitamins and minerals, it is necessary to monitor their levels in the body at the beginning and during treatment.

Unfortunately, celiac disease as an autoimmune disorder often takes a hand with other diseases. The most common associated diseases are lactose intolerance, histamine intolerance, various food allergies (e.g. to eggs, soy, nuts...), thyroid disease or diabetes.

Scientists have not yet found a unified answer to the question of why celiac disease actually occurs.

However, the disease is classified as genetic, suggesting that heredity plays a major role. When one family member is diagnosed with celiac disease, it is therefore recommended that other first-degree relatives are also tested.

Often, this will reveal hidden (latent) celiac disease in parents or, conversely, in children who have not shown any symptoms so far.

So is celiac disease hereditary? Despite the above, celiac disease is not necessarily hereditary. Unfortunately, it can also be acquired at any time during life. Neither age nor gender is relevant. Celiac disease can be triggered in particular by physical or psychological exertion, for example in women after childbirth.

How does celiac disease manifest?

The most common symptoms and manifestations of the disease are related to the problematic absorption of gluten in the intestine. The affected person suffers from various symptoms of digestive problems: perhaps the most typical are diarrhea, characterised by a yellowish colour and a distinctive smell.

Flatulence and bloating are also common, as is nausea associated with an urge to vomit.

The person is often tired, lethargic, and has pale, often irritable skin.

A thin, malnourished figure is also a typical sign - as a result of the non-absorption of vitamins and minerals, which the body is unable to absorb and therefore excretes together with diarrhoea. As the body is depleted of iron and calcium in particular, anaemia or brittle bones, which can lead to osteoporosis, are a common symptom. 

Are the individual symptoms of celiac disease dependent on a person's age? It can be concluded that symptoms in children and symptoms in adults do not differ significantly.

However, their number or intensity may differ. It is often the case that the person does not show any symptoms and lives with the disease for many years without knowing it.

The course of disease

Celiac disease is a disease that can occur at any time during life, either as a hereditary disposition or acquired as a result of weakening of the immune system due to excessive physical or mental stress.

The disease can have different manifestations and also a different course. However, they have one thing in common - each of the manifestations is the result of an autoimmune reaction to the presence of gluten.

The most typical is the classical form of celiac disease - characterised by the typical symptoms mentioned above (diarrhea, flatulence, nausea, vomiting...), but it manifests only in about one tenth of diagnosed celiacs. The remaining patients show the so-called oligosymptomatic or monosymptomatic form of celiac disease, where only some or one of the symptoms is manifested.

In such cases, the diagnosis of celiac disease is really challenging.

However, the most diagnostically challenging form is the so-called asymptomatic form.

The patient experiences none of the symptoms and the diagnosis of celiac disease is made accidentally, e.g. during an examination of family members. Many patients are also affected by the so-called atypical form of celiac disease, where problems with gluten absorption are manifested in parts of the body other than the digestive system.

The most common sites of such manifestations are the skin (so-called Duhring's dermatitis), the kidneys (IgA nephropathy), the reproductive organs (development of infertility), the nervous system (migraines, depression) and many others.

Thus, celiac disease can vary from the most noticeable manifestations to those less noticeable or typical of celiac disease. However, the sad news is that whatever the onset of celiac disease and whatever the symptoms, it is a chronic, i.e. a lifelong disease.

How is celiac disease detected?

Diagnosis is made only after a specialist examination by a gastroenterologist, because although it is an autoimmune disease, there are manifestations and damage to the small intestine.

The doctor usually performs the following examinations:

• endoscopy of the small intestine, also called gastroscopy - a tube with a microcamera, called an endoscope, is inserted into the small intestine through the oral cavity to obtain an authentic image of the internal environment of the intestine. This is projected in real time onto a monitor, where it is then evaluated by the doctor.
• biopsy - at the same time, a sample is taken from the lining of the small intestine using an endoscope to determine the extent of damage to the intestine on the basis of the so-called Marsh scale (1/2/3a/3b/3c).  
• serological examination of blood - blood sampling to detect the presence of IgA antibodies 

In addition to the tests practised by a doctor, there are also various over-the-counter tests for celiac disease. These are used for so-called home self-examination. However, it should be remembered that they are not intended to replace a doctor!

On the contrary, their result should be an appeal to visit the doctor for a checkup.

If you suspect that celiac disease may be affecting you, do not start a gluten-free diet arbitrarily before the test. Since the diagnosis of the disease is based on observing the body's reactions to the gluten present, it will not be possible to make a correct diagnosis.

Switching to a gluten-free diet is really important

Unfortunately, there is no cure for celiac disease. Although there have been a few media reports about the search for, or even the invention of, a cure, the pharmaceutical industry has not yet launched any product that can cure the disease with any certainty. The only and most effective 'cure' is the so-called gluten-free diet.

Since celiac disease is a chronic disease, a gluten-free diet should be lifelong, without any compromises or occasional concessions. Even the slightest transgression can restart the process of autoimmune reactions and the subsequent destruction of the small intestine.

If you suspect celiac disease, don't wait too long to see your doctor, as early diagnosis and switching to a gluten-free diet is really important. 

What diet and meals to choose?

Many people panic after a diagnosis of celiac disease. "So what can I actually eat?" Foods on a gluten-free diet can be understood in 3 basic categories: permitted foods, prohibited foods and risky foods, whose safety is assessed individually according to their composition.

Food you can eat...

So what can I eat? All naturally gluten-free ingredients such as fruit, vegetables, rice, corn, potatoes, fish, fresh unseasoned meat, legumes, nuts, seeds, eggs, dairy products (unflavoured yoghurt, natural cheese, cottage cheese, cream), honey, sugar, soya, tofu... 

Food you can't eat...

What can't I eat? Practically all foods containing gluten, i.e. products made from wheat, barley, rye (e.g. bread, pastries, pasta, breadcrumbs...).

What to watch out for?

There are a number of foods that cannot be lumped together, so to speak.

Whether or not a celiac can eat something is always clear from the label, where the ingredients of the product are listed.

Please note that flour is not the only source of gluten!

Indeed, gluten can be hidden everywhere as part of many ingredients (e.g. in various flavourings, colourings, spice mixtures...).

For better orientation of the celiac consumer, the so-called crossed grain symbol is used, which is internationally considered a kind of trademark for a gluten-free product.

What celiacs can and can not eat

Manufacturers are responding to the growing number of celiacs. The current market is offering a wide range of tasty and affordable products. Foods are commonly available in supermarkets, specialist brick-and-mortar health food stores, and e-shops. A celiac can therefore indulge in anything from sweet gluten-free biscuits, crisps, pastries, pasta to different types of flours (corn, buckwheat, rice...).

There are also a growing number of restaurants, pizzerias and coffee shops where you can enjoy a tasty gluten-free lunch or dessert.

However, a gluten-free diet is undoubtedly a more expensive affair than the diet of ordinary people. The good news, therefore, is that there is a solution here, too. If a person has a diagnosis of celiac disease by a doctor, they are legally entitled to so-called prescription foods.

In practice, this means that his or her gastroenterologist can issue a prescription for a certain amount of food each month, which is partially reimbursed by health insurance. The patient chooses the type of food (flour, pastry, pasta...) and the quantity (subject to monthly limits) based on the current dietary food list.

Pregnancy and celiac disease

It is common knowledge that pregnancy is a challenging time for any woman. The body undergoes significant changes, is subjected to excessive physical (and other) stress and requires lots of care. Since not only the mother's organism is nourished during pregnancy, but also the fetus, it is essential to ensure a proper and balanced diet.

The problem may arise in women with celiac disease who do not know about their disease, or who have only recently been diagnosed with it. The organism is noticeably depleted of many important substances, vitamins and minerals as a result of the destruction of the small intestine. In women who want to have a child, this state of the organism can have really unfortunate consequences.

It is difficult for a woman to conceive and, unfortunately, in the case of an existing pregnancy, miscarriages are frequent, as the fetus is not sufficiently nourished.

Women with celiac disease are, therefore, advised to plan their pregnancy at least one year after starting a gluten-free diet. After this time, sufficient regeneration of the organism, restoration of the intestinal mucosa and the acquisition of the necessary levels of nutrients are assumed.

However, if a woman becomes pregnant earlier, it may not have immediately fatal consequences!

She should consult her gynaecologist and gastroenterologist as soon as possible about the next course of action, the possible risks and the determination of the necessary care.

Whatever the time of pregnancy, it is necessary to monitor the levels of iron, calcium, folic acid, fibre and other essential substances that are essential for the healthy development of the fetus and also for the nutrition of the mother. It is also advisable to consult your doctor about their increased supplementation.

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• https://celiac.org
• http://www.csaceliacs.org - The Celiac Support Association