Celiac disease

Celiac disease is a genetic, autoimmune disease. The immune system mistakenly recognizes gluten, a protein found in wheat, rye, and barley, as "foreign." When people with celiac disease eat foods containing gluten, the immune system attacks the gluten when it gets into the small intestine.

As the immune system wages war against gluten, it damages small, fingerlike projections in the small intestine called villi. Villi that make it easier for the body to absorb nutrients from food. As villi become eroded and flattened, they have trouble absorbing nutrients. The result is diarrhea and other gastrointestinal symptoms, as well as a host of health problems related to malnutrition, including weight loss, anemia, osteoporosis, infertility, nerve problems such as ataxia (loss of coordination), and even certain types of cancer.

Celiac disease, also known as non-tropical sprue, celiac sprue, gluten intolerance, and gluten-sensitive enteropathy, affects about one in 133 people, an estimated three million Americans. Approximately 85% of those with celiac disease are thought to be undiagnosed.

Symptoms and signs of celiac disease

Some people have no gastrointestinal complaints and no apparent symptoms, or their symptoms are so subtle that they never mention them to their doctor. Others have severe symptoms. These include:

  • abdominal bloating and pain
  • chronic diarrhea
  • constipation
  • pale, foul-smelling, or fatty stools
  • vomiting
  • weight loss
  • irritability

Nondigestive problems caused by poor absorption of nutrients include:

  • unexplained iron-deficiency anemia
  • fatigue
  • bone or joint pain
  • arthritis
  • bone loss (osteoporosis) or unexplained broken bones
  • depression or anxiety
  • tingling or numbness in the hands and feet
  • seizures
  • missed menstrual periods
  • infertility or recurrent miscarriage
  • canker sores inside the mouth

Diagnosing celiac disease

Celiac disease can be difficult to diagnose because it causes many common symptoms that resemble those of many other intestinal conditions, including irritable bowel syndrome and lactose intolerance.

Blood tests and biopsy of the small intestine are considered essential for making a definitive diagnosis of celiac disease. It's important not to start or be on a gluten-free diet before the blood test or biopsy, because doing so can skew the results and affect the diagnosis.

Blood tests are done to measure levels of certain antibodies produced by the immune system in response to gluten. These include anti-tissue transglutaminase antibodies, endomysial antibodies, and deamidated gliadin peptides.

People with positive antibody tests should have a biopsy of the small intestine to look for damage to the intestinal villi and for inflammatory cells that signal an autoimmune reaction.

Treating celiac disease

The treatment for celiac disease—stop eating gluten—sounds simple, but isn't easy. It means forgoing anything made from wheat, barley, and rye. Even a small amount of the protein can stir up trouble. A University of Maryland study showed that just 50 milligrams (mg) of gluten—a slice of wheat bread contains 2,000 mg—was enough to rev up inflammation and intestinal damage.

A gluten-free diet used to mean total abstention from foods like bread, cake, pizza, and even beer (see "Do's and don'ts of gluten-free eating"). But greater recognition of celiac disease has led to the development of hundreds of gluten-free foods, along with cookbooks that describe how to bake cookies, for example, using nut or rice flours. The Celiac Disease Foundation has detailed information at www.celiac.org.

Unfortunately, some foods that should be gluten free aren't. Take soy flour as an example. It shouldn't contain gluten. But if soybeans are transported in a truck or rail car that had previously held wheat, barley, or rye, or they are processed in a warehouse or plant that handles these grains, the soybeans and foods made from them can pick up enough gluten to fuel celiac disease.

Do's and don'ts of gluten-free eating

Type of food

Do not eat

Okay to eat

Grains, potatoes, flours, and cereals

wheat, rye, or barley breads, bread crumbs, pasta, or noodles; spelt, semolina, kamut, triticale, couscous, bulgur, farina; unidentified starches or fillers; most commercial cereals

gluten-free pastas and breads (made from soy, rice, corn, potato, or bean flours); plain rice, corn, popcorn, potatoes, sweet potatoes, soybeans and other beans, nuts, millet, amaranth, quinoa, oats (consult your doctor first), buckwheat, cornstarch, tapioca, and arrowroot starch; gluten-free cereals (such as corn and rice)

Fruits and vegetables

canned soups, soup mixes, bouillon cubes, creamed vegetables, most commercial salad dressings

fresh, frozen, or canned fruits or vegetables, unprocessed and without sauces; homemade soups with allowed ingredients

Meat, fish, poultry, main dishes

commercially prepared fresh or frozen meat and main dishes, lunch meats, and sausages

fresh meat, fish, poultry

Dairy products

processed cheese, cheese mixes, blue (veined) cheese; yogurt or ice cream that's unlabeled or that contains fillers or additives; low-fat or fat-free cottage cheese, sour cream, or cheese spreads

plain, natural cheese; gluten-free plain yogurt and ice cream; whole, low-fat, and fat-free milk; full-fat cottage cheese and sour cream


beer, ale, stout

gluten-free beer, wine, light rum, potato vodka


grain or malt vinegar, commercial pudding mixes, malt from barley, soy sauce made from wheat

distilled rice, wine, or apple cider vinegar; homemade puddings from tapioca, cornstarch, rice; sugar, honey, jam, jelly, plain syrup, plain hard candy, marshmallows; gluten-free soy sauce