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Celiac Disease: The Complexities Beyond Gluten Intolerance

Dr. Craig Smith, MD

4 Min read

Celiac disease, a gastrointestinal disorder triggered by an abnormal immune response to gluten, is more than just a condition associated with gluten sensitivity. Referred to by various names such as sprue, nontropical sprue, or gluten-sensitive enteropathy, this autoimmune disorder demands a deeper understanding of its symptoms, risk factors, diagnosis, treatment, and necessary food precautions.

Understanding Celiac Disease

Gluten, a protein present in wheat, barley, rye, and triticale, is the culprit behind celiac disease. It's even found in unsuspecting sources like oats processed alongside other grains or in certain medications and cosmetics. While gluten intolerance encompasses a range of disorders with symptoms after consuming gluten, celiac disease is a distinctive autoimmune disorder.

The immune response to gluten in celiac disease generates toxins that harm the tiny finger-like protrusions, called villi, inside the small intestines. Damaged villi impede nutrient absorption, leading to malnutrition and severe health complications, including permanent intestinal damage.

Statistics reveal that about 1 in 141 Americans suffer from celiac disease, necessitating the complete elimination of gluten from their diet. This includes steering clear of bread products, baked goods, beer, and any foods where gluten serves as a stabilizing ingredient.

Symptoms of Celiac Disease

Celiac disease manifests with symptoms primarily involving the intestines and digestive system, though it can affect other parts of the body. Symptoms differ between children and adults.

In children, signs may include fatigue, irritability, stunted growth, delayed puberty, weight loss, vomiting, abdominal bloating, abdominal pain, and irregular bowel movements with pale, fatty, foul-smelling stools.

Adults with celiac disease might experience digestive symptoms, but in many cases, other areas of the body are affected. These symptoms may include iron-deficiency anemia, joint pain, brittle bones, fatigue, seizures, skin disorders, numbness and tingling in extremities, tooth discoloration, pale sores in the mouth, and reproductive issues such as irregular menstrual periods and infertility.

Dermatitis herpetiformis (DH), an intensely itchy skin rash of bumps and blisters, is a common symptom affecting 15 to 25 percent of celiac patients. Notably, those with DH often do not experience digestive symptoms.

Symptom variation depends on factors like breastfeeding duration, age of gluten introduction, gluten consumption levels, and the severity of intestinal damage. Some celiac individuals may remain asymptomatic but are still at risk of long-term complications.

Risk Factors for Celiac Disease

Celiac disease tends to run in families, with a 1 in 22 likelihood of developing the condition if a parent or sibling is affected. Additionally, individuals with other autoimmune diseases and specific genetic disorders face an elevated risk. Conditions associated with celiac disease include lupus, rheumatoid arthritis, type 1 diabetes, thyroid disease, autoimmune liver disease, Addison’s disease, Sjogren’s syndrome, Down syndrome, Turner syndrome, lactose intolerance, intestinal cancer, and intestinal lymphoma.

Diagnosing Celiac Disease

Diagnosis initiates with a thorough physical examination and a review of the patient's medical history. Various tests contribute to confirming celiac disease, with blood tests detecting high levels of antiendomysium (EMA) and anti-tissue transglutaminase (tTGA) antibodies, especially reliable when gluten is present in the diet.

Common blood tests encompass complete blood count (CBC), liver function tests, cholesterol test, alkaline phosphatase level test, and serum albumin test. For those with DH, a skin biopsy aids in diagnosis. An inconclusive blood test or skin biopsy may prompt an upper endoscopy, involving an endoscope threaded through the mouth to examine the intestines, assess villi damage, and collect an intestinal biopsy for analysis.

Celiac Disease Treatment

The sole treatment for celiac disease is a lifelong commitment to a gluten-free diet. Eliminating gluten allows the damaged villi to heal, restoring proper nutrient absorption. Patients receive guidance from their healthcare provider on navigating a nutritious gluten-free diet, including deciphering food and product labels to identify hidden gluten.

While symptom improvement may occur within days of gluten removal, it's crucial not to cease gluten consumption before an official diagnosis, as it may interfere with accurate testing.

Food Precautions for Celiac Individuals

Maintaining a gluten-free diet poses challenges, but a growing availability of gluten-free products eases the transition. Identifying safe foods is crucial for those with celiac disease. Key guidelines include avoiding wheat, spelt, rye, barley, triticale, bulgur, durum, farina, graham flour, semolina, and oats unless labeled gluten-free.

Foods like beer, bread, cakes, pies, candy, cereals, cookies, crackers, croutons, gravies, imitation meats, processed lunch meats, sausages, hot dogs, salad dressings, sauces (including soy sauce), and self-basting poultry should be avoided unless labeled gluten-free.

Safe options encompass gluten-free grains and starches like buckwheat, corn, amaranth, arrowroot, cornmeal, rice, soy, potato, and bean flours, pure corn tortillas, quinoa, and tapioca. Additionally, fresh meats, fish, poultry, fruits, most dairy products, starchy vegetables, rice, beans, lentils, vegetables, wine, distilled liquors, ciders, and spirits are part of a healthy, gluten-free diet.

Adhering to these dietary adjustments should lead to symptom improvement within days to weeks for most individuals. Children may experience intestinal healing in three to six months, while adults may require several years for complete recovery.


Celiac disease transcends a mere intolerance to gluten, impacting various aspects of an individual's health. Recognizing the symptoms, understanding risk factors, pursuing an accurate diagnosis, committing to a gluten-free lifestyle, and navigating food choices are crucial steps in managing this complex autoimmune disorder. Timely intervention and adherence to treatment guidelines can significantly improve the quality of life for those with celiac disease. If there's suspicion of celiac disease, seeking medical attention promptly is essential to mitigate potential complications.

About the Author

In 1984, Dr. Craig Smith founded Lifesource. As a coach, he's worked with world-class athletes and guided thousands towards successful weight loss. Driven by a desire to elevate his understanding of the human body, he returned to the rigors of medical school in his 50s, achieving his goal of becoming a physician at 56. Now in his 60s, Dr. Smith leads by personal example, continuing to inspire, educate and empower individuals from all walks of life to achieve their health and fitness goals. If you wish to train and diet online with Dr. Smith, hear his message and schedule a 45-minute consultation on the New You page.