Apparently, in people with celiac disease, the body incorporates the wrong amino acid into a protein produced by the body that is used to recognize foreign invaders. As a result, gluten remains bound to these immune cells for longer and triggers a foreign-body reaction—which is actually unnecessary. Gluten is a protein found in grains.
However, the immune cells not only attack the gluten but also damage the intestinal lining: as a result of gluten intolerance, the villi in the small intestine atrophy.
This means that
- fats,
- sugars,
- proteins,
- vitamins,
- minerals, and
- water
are no longer properly absorbed by the body (malabsorption). The deficiency of these substances, in turn, leads to a wide range of symptoms and complaints.
The classic symptom of celiac disease is diarrhea. Since undigested fats are excreted in the stool, it is greasy, bulky, and foul-smelling.
In addition, there is
- flatulence,
- weight loss,
- possibly iron deficiency and anemia,
- muscle wasting,
- water retention,
- increased skin pigmentation, and
- hair loss.
Vitamin and calcium deficiencies can lead to coagulation disorders and osteoporosis. If the condition persists for a long time, it can also cause
may also develop.
The first symptoms in babies appear when they begin eating solid foods containing grain products (around 6 months of age). Babies with celiac disease then lose their appetite, experience abdominal pain, and have a bloated abdomen. This is often followed by large, greasy, and foul-smelling stools and growth failure.
Signs of anemia and dehydration may also appear.
However, nearly half of those affected do not experience gastrointestinal symptoms. The following symptoms may still indicate celiac disease:
- skin changes (dermatitis herpetiformis Duhring),
- iron deficiency,
- short stature,
- receding gums,
- joint pain,
- Hepatitis,
- Osteoporosis,
- depression,
- Irritability,
- fatigue,
- reduced physical fitness.
The only treatment option for celiac disease is a complete, lifelong avoidance of foods containing gluten. Only on a gluten-free diet can the small intestine lining heal and regain its function. Even the smallest amounts of gluten can cause damage and symptoms to recur.
In most cases, symptoms improve within a few weeks of changing the diet and then disappear completely. Until the diarrhea subsides, vitamins, minerals, and iron are supplemented.
The gluten that people with celiac disease must avoid is found primarily in the following grains:
- Wheat
- Spelt
- Rye
- Barley
- green spelt
- Oats
People with celiac disease must avoid all foods and medications that contain these grains in any form. This includes, above all, conventional baked goods and pasta, e.g.,
- bread,
- rolls,
- cakes,
- pasta, and
- pizza, as well as
- beer, malt beer, and grain schnapps.
Since November 2005, all products containing gluten must be labeled accordingly in food stores.
People with celiac disease must rely on gluten-free products for the rest of their lives © fotofabrika | AdobeStock
For people with celiac disease, the following grains remain off-limits:
- rice,
- corn,
- millet,
- buckwheat,
- amaranth, and
- quinoa
remain—these are also suitable for them to eat. Gluten-free products have been available for several years, even at most major supermarket chains. Gluten-free bread and baked goods are made, for example, from rice, corn, potato, or chestnut flour.
Many gluten-free foods can be identified by consumers through a special seal: a crossed-out ear of grain. To protect themselves legally, however, many manufacturers also note on the packaging that the product may contain traces of gluten, even though it actually contains no gluten or falls below the established limits.
A gluten-free diet is still expensive. Gluten-free ready-to-eat products cost about 30–50 percent more than comparable foods. For this reason, many European countries provide subsidies for gluten-free diets.
The exact causes of celiac disease are not yet fully understood, but a genetic predisposition appears to play a role. The only preventive measure currently recommended is to avoid offering gluten-containing foods to infants under six months of age.
Relatives of people with celiac disease are affected more frequently than the rest of the population. These individuals should get tested, especially if one or more of the typical symptoms appear.
People with celiac disease are more likely to develop type 1 diabetes. Both diseases are caused by defects in the immune system. It is believed that a genetic hypersensitivity to gluten triggers a chain reaction. As a result, cells of the immune system overreact and attack the body’s own tissues (autoimmune disease). If certain cells in the pancreas are destroyed, insulin deficiency develops, leading to diabetes.
What exactly is celiac disease?
Celiac disease is a chronic inflammatory autoimmune disorder of the small intestine in which gluten triggers an immune response. Celiac disease affects both children and adults, although it often presents with classic symptoms in children. The condition is also known as sprue and is not a simple intolerance, but a systemic disease.
What are the symptoms of celiac disease?
Typical symptoms of celiac disease include diarrhea, abdominal pain, bloating, and weight loss. Extraintestinal symptoms such as vitamin or iron deficiency may also occur. Some people with celiac disease experience only mild or atypical symptoms, which is why it is important to be screened for the condition.
How is celiac disease diagnosed?
Diagnosis of celiac disease begins with testing for antibodies in the blood, particularly specific antibodies against gluten. This is followed by a diagnosis of celiac disease via a biopsy of the small intestine mucosa. According to the guidelines and the S2k guidelines on celiac disease from the German Society for Gastroenterology, the full diagnostic workup should be completed before starting a gluten-free diet.
What is the treatment for celiac disease?
The treatment for celiac disease consists of a lifelong gluten-free diet. This means completely avoiding gluten-containing grains such as wheat, rye, and barley. Oats are only suitable in certified gluten-free form. With a consistent gluten-free diet, the intestinal mucosa usually regenerates completely.
Is celiac disease genetic?
Hereditary factors play an important role in celiac disease, as certain genetic traits increase the risk. People with other autoimmune diseases, such as type 1 diabetes mellitus, are at increased risk. Environmental factors may also contribute to its development, but celiac disease generally does not develop without a genetic predisposition.
