Celiac disease is an autoimmune disease that causes an abnormal immune reaction to gluten, a protein found in wheat, rye, and barley.

An autoimmune disease is one in which the body’s immune system malfunctions and attacks its own tissues. In the case of Celiac disease, the immune reaction takes place in the small intestine, and leads to damage to the nutrient-absorbingvilli, which are part of the lining of the small intestine.When this damage occurs, nutrients are not absorbed normally, and both macro and micro nutrient deficiencies can occur.

Although damage by the immune response occurs in the intestines, it can affect the whole body and lead to a wide range of symptoms.

Celiac disease is not a food allergy with an immediate immune response. Instead, it’s a disease where a certain type of antibodies are created in response to gluten. Through a cascade of reactions, immune cells are activated and create chemicals called cytokines, a group of proteins involved in cell signaling. In Celiac disease, cytokinescause damage to the intestines and promote inflammation. That’s the basis of the damage caused by Celiac disease.

Who is at risk for Celiac disease?

Celiac disease is an inherited condition. People with a first degree relative who has Celiac disease are more likely to have it. They have about a one in 10 chance of developing Celiac disease versus the general population where the odds are one in 100.

When you have Celiac disease, you’re at increased risk for developing other autoimmune conditions, and vice versa. Someone with rheumatoid arthritis, or type I diabetes is more likely to have Celiac disease. Also, if someone is older, when they’re diagnosed with Celiac disease, they’re more likely to develop another autoimmune condition.

What is the difference between Celiac disease, being “gluten free,” and having gluten intolerance?

Celiac disease is the autoimmune condition with no cure. The only treatment is the gluten-free diet.

Gluten intolerance or gluten sensitivity is not an autoimmune disease. We’re still learning about what gluten sensitivity is, and what is going on when there is a reaction to gluten that’s not caused by Celiac disease. What we do know is that people who seem to have gluten sensitivity, have similar symptoms, but do not have that classic damage to the small intestine, or characteristic abnormalities in their lab values when they’re checked.

There are people who choose to follow a gluten free diet by choice. There’s a lot of information online and in the media about different reasons you might do that — for inflammation, or to control different conditions — but, there really isn’t a lot of solid evidence yet that any of those conditions improve by removing gluten from the diet. That being said, elimination diets with the guidance of a dietitian can be a great way to figure out how any food, including those with gluten, affects your body or specific symptoms.

What are the signs and symptoms of Celiac disease?

The signs range from mild to severe, and are different in children and adults. They vary wildly from person to person.

In adults, the most common symptoms are diarrhea, fatigue, and weight loss. Other GI symptoms include bloating and gas, abdominal pain, vomiting, constipation. In more than half of adults who are diagnosed with Celiac disease, they present with symptoms that are not digestive at all. These symptoms could include anemia caused by iron deficiency, osteoporosis, infertility, joint pain, mouth ulcers, damaged teeth, enamel, headaches, skin problems, and nervous system problems. That’s what makes Celiac disease hard to diagnosis. There are so many symptoms and they can present in a lot of different ways.

In children, malabsorption due to damage to the intestine can impact growth and development, which can lead to additional symptoms not seen in adults. Typical symptoms include vomiting, chronic diarrhea, abdominal distension, poor appetite and muscle wasting, and irritability, diarrhea, constipation, short stature, and neurological conditions.

Nutritionally, vitamin and mineral deficiencies can occur due to the reduced absorption in the gut, and the nutrients of primary concern are calcium, iron, zinc, B-12, vitamin D, and vitamin K. Chronic diarrhea, depending on how severe it is, may cause issues with electrolytes, and mineral deficiencies.

How do you get a diagnosis?

The first step is a blood test. A doctor will try to rule out other diagnoses and they might suggest a referral to a dietitian to see if there are other dietary things happening that might be the more likely cause for the symptoms.