Hi. I'm Cathy with Level Up RN. In this episode of Ask a Nurse, I'll be answering your questions about celiac disease, such as what is celiac disease, what are the symptoms of celiac disease, how is celiac disease diagnosed and treated, and how does celiac disease differ from gluten intolerance or gluten sensitivity?
Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage to the small intestine. So normally, the immune system protects the body from foreign cells. With an autoimmune disorder, the immune system mistakenly attacks the healthy cells in the body instead. When a person with celiac disease consumes a food that contains gluten, which is a protein found in wheat, rye, and barley, their immune system attacks and damages the villi in the small intestine. So the villi are fingerlike projections that line the small intestine and allow for the absorption of nutrients. Over time, damage to the villi leads to malabsorption, which means the small intestine is unable to absorb certain nutrients, and it can cause permanent intestinal damage. In addition, impaired absorption of key nutrients can lead to a wide range of problems in the body, not just in the gastrointestinal system.
Symptoms of celiac disease include lethargy, diarrhea, abdominal pain and distension, constipation, and vomiting. In children, celiac disease can cause failure to thrive. And in adults, it can cause unexplained weight loss. Dermatitis herpetiformis is another common symptom associated with celiac disease. This is a very itchy skin rash that contains bumps and blisters. And because celiac disease impairs the absorption of key nutrients, it can cause anemia due to impaired absorption of iron, B12, and folate. It can also cause osteoporosis, mouth ulcers, joint pain, as well as nerve damage, which can cause numbness and tingling in the hands and feet as well as balance issues and cognitive impairment.
Celiac disease is hereditary, meaning it runs in families. People with celiac disease will almost always have certain gene variants present, which are DQ2 and DQ8. If you have a first-degree relative, such as a parent or sibling, with celiac disease, then your chance of developing this disorder is 1 in 10. In addition, people with other autoimmune disorders, such as type 1 diabetes, lupus, and rheumatoid arthritis, are more likely to develop celiac disease as well. If you think you may have celiac disease, it's important to talk to your provider and have diagnostic tests performed before trying a gluten-free diet. So avoiding gluten before testing can alter the results of the tests. So some of the tests that may be ordered by your provider to confirm the presence of celiac disease include serological tests, which look for the presence of specific antibodies in your blood. In addition, a biopsy, which is a tissue sample of your small intestine, may need to be obtained. So this sample is obtained through an upper GI endoscopy, which is a procedure where the patient is sedated, and a thin, flexible tube is inserted through the mouth, down through the stomach, into the small intestine, where a small piece of tissue is obtained and then sent to the lab for analysis. Other tests that may be performed include genetic tests to look for that genetic variant that we talked about earlier, which includes DQ2 and DQ8. So to be clear, most people with these variants do not have celiac disease. However, people with celiac disease almost always have these gene variants present.
Many people with gluten intolerance and gluten sensitivity may have similar symptoms to people with celiac disease, such as bloating, nausea, and diarrhea. But to be clear, these disorders are not the same as celiac disease. Gluten intolerance and gluten sensitivity are digestive disorders and not an autoimmune disorder like celiac disease, and they don't cause damage to the small intestine like celiac disease. So the bottom line is that if you have symptoms that are indicative of celiac disease, it's important to see your provider and get tested before eliminating foods from your diet so you can get an accurate diagnosis.
Treatment of celiac disease includes a strict gluten-free diet, which allows the small intestine to heal and helps to prevent new damage from occurring to the small intestine. So a gluten-free diet means that you need to avoid foods that contain wheat, barley, rye, and potentially oats. So to be clear, pure oats do not contain gluten, but oats are often processed in facilities that process grains that do contain gluten, so the potential for cross-contamination is very high. There are certified gluten-free oats that are available. But before incorporating oats into your diet, you should definitely check with your provider or your registered dietitian.
Common foods that will need to be avoided include bread, crackers, baked goods, pasta, as well as beer, and many processed foods such as soup, salad dressings, hot dogs, and many condiments. Foods that are safe to eat include vegetables and fruits as well as nuts and seeds, dairy products, meat, poultry, and fish, and gluten-free grains such as corn, rice, and millet. If you have celiac disease, it's going to be very important that you work with your provider or your registered dietitian to plan out a healthy and balanced meal that is both gluten-free and contains the important nutrients that your body needs.
All right. That is it for this episode of Ask a Nurse. I hope you have found it helpful. And if you have other health topics or questions you would like me to cover in a future episode, definitely leave those in the comments. Stay informed and stay well.
