Gluten-free for celiac disease

It’s estimated that 1 in 100 Americans has celiac disease, though most do not know it. They suffer from diverse symptoms, ranging from diarrhea to depression. Although there is no known cure for celiac disease, it can be effectively treated.

At 7 p.m. Nov. 2, the Warren Celiac Center at UCSD will hold a free lecture titled “Celiac Disease and Gluten: Facts, Fiction & Controversies” in the Skaggs School of Pharmacy building at UCSD in La Jolla. To register or for more information, call (858) 822-1022 or visit

Speakers will include Dr. Martin Kagnoff, director of the celiac center; Dr. Kimberly Newton, pediatric gastroenterologist and Shawna McNally, M.P.H.M.P.H, R.D., the center’s dietitian. We asked Kagnoff, a national authority on celiac disease, to discuss some of the facts surrounding celiac disease.

Q: What is celiac disease?

A: It’s an autoimmune disorder with a strong genetic component that is triggered by gluten, a protein found in wheat, rye and barley. An immune reaction damages the lining of the small intestine, reducing the body’s ability to absorb nutrients. The disease is fairly common, but difficult to diagnose because its symptoms vary so much among individuals. We estimate 85 percent of Americans with celiac disease, or 2 million people, haven’t yet been diagnosed.

Q: Who gets celiac disease?

A: It’s hard to predict precisely. We know that it only occurs in people with certain genes, but those genes occur in about 40 percent of the U.S. population. Just having those genes does not mean a person will get celiac disease. On the other hand, if they do not have those genes they will not get celiac disease. If someone in your immediate family has celiac disease, chances are up to 5 to 15 percent that you’ll get it, too. The disease can appear at any time from infancy to adulthood.

Q: What are the symptoms?

A: Celiac disease results in destruction of tiny, fingerlike projections called villi that line the interior of the small intestine. Their job is to provide a large surface area, about the size of two regulation tennis courts, over which vitamins, minerals and other nutrients from passing food can be extracted. When the villi are severely damaged or totally disappear, expected symptoms like diarrhea, gas and bloating, belly pain, weight loss, anemia, vitamin deficiencies and fatigue can occur. However, quite a few people have milder damage.

Some people have mouth ulcers, an itchy skin rash, migraine, premature osteoporosis, unexplained iron deficiency, or even dental enamel defects. Celiac disease also occurs more often in people with Type I diabetes, and autoimmune thyroid or liver disease. It can be a cause of unexplained infertility or growth disturbances in children. There can even be severe psychological symptoms. The marked diversity of symptoms is what makes this disease so hard to identify. Physicians have to pull together a diagnosis from many different clues.

Q: How do you know then if you have celiac disease?

A: There are several blood tests. The major ones look for specific antibodies. These tests, however, are not perfect. A positive test result suggests the disease, but a definite diagnosis requires a tissue biopsy of the small intestine.

Q: What’s the treatment? Is there a cure?

A: No cure – at least not yet. Treatment means switching to a gluten-free diet, after which symptoms may decline quickly, often within a few weeks. Fully repairing damage to the gut lining requires more time. Barring a breakthrough, patients need to stay on a gluten-free diet for life. Gluten is found not only in grain products like bread, crackers and pasta, but also as a filler, thickener or binder in many other processed foods. Fortunately, the availability of good tasting gluten-free products has grown dramatically in recent years.