The Science of Celiac

By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

It seems like many people these days are being diagnosed with celiac disease. While this phenomenon may be the result of increased screening, celiac disease has been recognized in the medical community in both children and adults since the 19th century.

Celiac is an autoimmune illness sparked by a reaction to gluten, a protein found in wheat, affecting  approximately 1 in 105 people in the United States.  Because there is a genetic basis to celiac, it’s thought to have a possible association with other illnesses such as Type 1 Diabetes. In people with celiac disease, exposure to gluten triggers a reaction, causing their own immune system to target and attack an enzyme located in the lining of the intestine. Part and parcel of this attack is inflammation and damage to the intestinal lining.  Since this is where food is absorbed into the bloodstream, people with celiac disease are unable to effectively absorb digested food. Thus, they may develop deficiencies in minerals and nutrients such as calcium, iron and Vitamins A, D, E and K. Without a healthy lining, people with celiac are also unable to absorb carbohydrates and fats; in sum, these deficiencies can cause weight loss, fatigue and slowed growth (particularly in children).

In addition, unabsorbed food in the intestine stimulates diarrhea and gas, both of which may lead to abdominal bloating, cramping, and pain. In some people celiac disease may be a silent or subtle illness showing up only as a borderline anemia due to poor absorption of iron.  In others, celiac may present full force with the entire spectrum of symptoms.

Gastrointestinal symptoms such as recurrent diarrhea and bloating or weight loss should prompt a discussion with a healthcare provider. Because other conditions such as lactose intolerance and irritable bowel disease can present in a similar fashion, it is important to talk to a healthcare provider first rather than making diet modifications or other lifestyle changes based on ‘self diagnosis’. Healthcare providers may themselves suggest testing for celiac disease for someone with unexplained nutritional deficiencies or, given the genetic basis of celiac disease, with Type 1 Diabetes or other autoimmune illnesses. Testing for celiac disease is a multi-step process that often begins with a blood test and may include a biopsy of the small intestine.

Unlike many other diseases, we know the underlying cause of celiac disease: gluten. Treatment then rests in avoidance of this trigger – a task that may be easier said than done. Though ‘gluten-free’ is a quickly growing food category in restaurants and grocery stores alike, adherence to this diet requires care and attention.  If you have been diagnosed with celiac, a nutritionist can help develop an eating plan that works best for you.

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