May is Celiac disease awareness month. 

Celiac disease, an extreme manifestation of gluten sensitivity, occurs when an allergic reaction to gluten causes small intestinal damage. It is the most severe reaction anyone can have to gluten and is more prevalent than we may think, as most people who have this disease are never actually diagnosed.

For those of you who diagnosed with celiac disease, it’s likely that you already know what it is and how it impacts your life. For others, this is the opportunity to learn the truth about celiac disease, symptoms associated with it, and how it manifests itself - the impetus of the word “awareness.”

First, let’s start with the understanding that celiac disease is an autoimmune condition.

How any Autoimmune Disease Develops

The development of an autoimmune disease, celiac included, comes after a whole host of other conditions have been satisfied. 

To develop an autoimmune condition, you must first be genetically predisposed to it - although this is indeed not the primary driver. Second, you must be exposed to a trigger that turns on the genes for the condition. These may include your lifestyle, food choices, or an environmental factor such as previous or persistent infections, exposure to toxins, or a hormonal imbalance within the body. Any one of these can dictate whether your genes for autoimmunity get turned on to create disease or not. 

Finally, you must also have a leaky gut. This is a necessary component of autoimmunity and has often been found to precede the development of an autoimmune condition. 

What is a Leaky Gut? 

Yes, all celiac patients start out with a leaky gut, but you may or may not know that you have one. It usually presents with gastrointestinal symptoms, but it might not.

A leaky gut, or increased intestinal permeability, happens when cells lining your stomach are damaged, or the proteins that form tight bonds between these cells are damaged. When this occurs, tiny holes form in the gut wall that allow partially digested proteins, bacteria, waste products (meant for excretion), or a combination of these to enter the bloodstream or lymphatic system. Of course, they were never meant to escape the confines of your gut. So once floating around your blood, the immune system detects them as foreign entities and mounts an attack - just as it is designed to do. 

It’s important to note that the immune system has several jobs - one of which is to create inflammation at a spot in the body where damage has occurred. If you sprain your ankle, for example, your immune system springs into action to create swelling, redness and pain around the ankle to prevent you from walking on it and potentially creating more damage.

The problem with the immune system is that if inflammatory cytokines are released, general inflammation can result. These cytokines, or chemical messengers, do not have a specific target, so any cell in the body, even a healthy one, can become a victim of their attacks. A leaky gut also provides the trigger for the body to produce self-targeted antibodies. These are antibodies that recognize protein sequences within our body’s own cells and attack them if the protein sequence is close to something the antibody was designed to attack.

Once the immune system starts attacking one type of cell in the body, it becomes easier for it to learn to attack another kind of cell. In fact, it’s not uncommon for someone diagnosed with one autoimmune condition to be diagnosed with a second one, or even a third. Once the immune system can no longer differentiate between “self” (cells of the body) and an invader, any number of dietary, environmental, or infectious triggers can result in the formation of new self-targeted antibodies.

In the case of Celiac disease, dietary gluten, a protein found in wheat and other grains, is the trigger. Unfortunately, gluten also seems to play a role in other autoimmune conditions, as well - be sure to come back next week to learn more about the role gluten has on the brain.

If a leaky gut must exist before an autoimmune condition develops, what causes your stomach to become leaky in the first place?

A leaky gut can happen for a variety of reasons, including the use of certain medications (corticosteroids and NSAIDs) or the development of an infection like H. pylori, Norovirus, and streptococcus. If the drug or infection is short-lived, the gut might remain leaky due to poor diet and lifestyle choices, especially if the immune system is weak. 

Then comes gluten. Gluten itself can cause a leaky gut by opening up the tight junctions responsible for keeping certain particles from leaving the stomach and other particles from entering it. Gluten can also activate immune cells and directly trigger the release of inflammatory cytokines.

Autoimmune diseases are, after all, inflammatory disorders that result from - well, inflammation. More specifically, from chronic inflammation. 

The hallmark symptoms of Celiac disease include gastrointestinal issues like chronic diarrhea, abdominal pain, and weight loss; however, it can present with other symptoms that just may surprise you.

5 Surprising Symptoms of Celiac Disease

1. Anemia - If you have anemia, you have a low hemoglobin count in your red blood cells. Hemoglobin is responsible for carrying oxygen to body tissues, so it’s an essential component of the blood. Iron, folate and vitamin B12 help form hemoglobin and red blood cells, so a deficiency in any of these nutrients may lead to anemia and its symptoms of pale skin, shortness of breath, dizziness, headaches, and fatigue. 

How is anemia connected to celiac? A damaged intestinal lining leads to the poor absorption of all nutrients including vitamins and minerals. A deficiency of iron that causes anemia is the most common type seen in celiacs, as iron is absorbed through the small intestine. In fact, iron deficiency anemia is a ubiquitous presentation of celiac in adults. Anyone who has anemia due to iron deficiency which does not respond to iron supplementation should be looked at for celiac disease.

2. Bone issues - Healthy bones require enough calcium and vitamin D to remain healthy. When the small intestinal lining is damaged, as in celiac disease, neither calcium nor vitamin D can be adequately absorbed, which can lead to weak bones or osteoporosis and an increased risk of fractures.

How are bone issues connected to celiac? Celiac can cause osteoporosis, chronic bone pain, or recurrent fractures due to the malabsorption of calcium and vitamin D. Celiac should be considered in anyone affected by osteoporosis when there is no other apparent cause for it.

3. Liver disorders - Someone with celiac is at risk of developing autoimmune hepatitis or another autoimmune liver disease. As discussed earlier, a patient with one autoimmune disorder, like celiac, has a higher risk of developing another. The opposite also holds true. Someone with autoimmune hepatitis is at higher risk of becoming celiac.

How are liver disorders connected to celiac? When the liver is inflamed, as in hepatitis, liver enzymes that generally leak out in small amounts, leak out in more significant quantities. This influx of foreign enzymes can trigger an immune response. A timely diagnosis of celiac is vital to help resolve liver inflammation and prevent severe liver damage over time. 

4. Neurologic Problems - Gluten interferes with the body’s network of nerves, and can cause any number of nervous system symptoms or disorders. These can include ataxia (the inability to control muscle movements and balance), migraines, peripheral neuropathy (nerve inflammation which causes the sensation of pins and needles or numbness in the arms and legs), and even cognitive decline, confusion, amnesia, or personality changes.

How are neurologic problems connected to celiac? Once again, this has to do with damage to the intestinal wall and the malabsorption of nutrients like folate, vitamin B12 and vitamin E - all crucial for the proper functioning of nerves.

5. Reproductive problems - One cause of unexplained infertility or spontaneous miscarriages are undiagnosed celiac disease. A deficiency of nutrients necessary for reproductive health like folic acid, selenium, and zinc may be to blame. Another factor may be an imbalance of hormones that often occurs with celiac disease.

How are reproductive problems connected to celiac? Once again, celiac is responsible for the malabsorption of nutrients essential for reproductive health. Celiac should, therefore, be considered in women with unexplained infertility, even if they do not have other symptoms.

Common Myths about Celiac Disease Dispelled

MYTH: Celiac disease is rare in Canada.

FACT: Unfortunately, the number of people diagnosed with celiac disease is increasing annually. Currently, it affects 1 in 100 people.

MYTH: Celiac is a disease of childhood.

FACT: Anyone can be diagnosed with Celiac disease at any age, from youngsters to adults, to senior citizens.

MYTH: Celiac disease can be outgrown.

FACT: Celiac is a lifelong condition. Though it’s possible for someone in remission, after a dietary change, to ingest gluten without immediate or obvious harm, it’s been proven that intestinal mucosal damage can recur and clinical symptoms can reappear.

MYTH: Celiac disease is easy to diagnose.

FACT: Celiac disease often mimics other disorders, so its diagnosis is often missed, especially if symptoms like constipation, stomach pain, vomiting, or anemia present, as opposed to the classic symptoms of diarrhea, weight loss, failure to grow, and fatty stools.

MYTH: A blood test can diagnose celiac disease.

FACT: Currently, the only way to definitively test for celiac is to do an intestinal biopsy.  Blood tests can only screen for it, and can often be misleading.

MYTH: A person with celiac can tolerate small amounts of gluten once in a while.

FACT: It’s best to stay away from gluten completely. Severe damage to the intestinal wall can occur even if a small amount of gluten is consumed and the person appears well.

MYTH: The only foods a person with Celiac disease needs to avoid are wheat and wheat products.

FACT: Treatment of celiac disease requires the strict exclusion of gluten from the diet for life. Many foods contain gluten, not just wheat and wheat products. It's also found in rye, barley, triticale, oats, and many other foods. It’s important to know which foods and grains do contain gluten so that you can avoid it successfully.

Now What: What Happens After a Diagnosis of Celiac? 

It’s important to know that celiac disease doesn’t just harm the gut. Once the genes for celiac are triggered, gluten sensitivity is a lifelong condition that may affect other areas of the body. 

Though some people do experience the classic symptoms of diarrhea, stomach pain, nausea, and constipation, others may experience a silent attack somewhere else in their body, like their nervous system. Migraines, brain fog, and declining cognitive performance may result. 

Why? When antibodies contact a protein you are allergic to, the inflammatory pathway is initiated, and cytokines are released in large numbers. In the case of gluten sensitivity, you have high levels of antibodies against the gliadin component of gluten. When inflammatory cytokines are released, they attack the brain, damage brain tissue, and leave the brain more vulnerable to disease. In fact, elevated cytokines are often seen in Alzheimer’s, Parkinson’s, MS, and autistic patients.

People with celiac also produce more free radicals and have reduced levels of vitamins E, A and C, as well as glutathione - an important antioxidant in the brain. Besides, once a diagnosis of celiac has been made, some time will be needed to heal the damage already done to the small intestinal lining and gut. It will also take time to improve absorption and recover from any nutrient deficiencies. Only after this has happened will you start to see improvements in health and cognitive function.

The only way to do this and live successfully with celiac disease is to follow a stringent gluten-free diet for life. Learn to read labels and identify terms synonymous with gluten. In fact, many ingredients are often “code” for gluten, which is why celiac awareness and learning about safe and unsafe products is so critical. 

Other words for “gluten” include: amino-peptide complex, Avena sativa, brown rice syrup, caramel colour, cyclodextrin, dextrin, fermented grain extract, Hordeum distichon, Hordeum vulgare, hydrolysate, hydrolyzed malt extract, hydrolyzed vegetable protein, maltodextrin, modified food starch, natural flavouring, phytosphingosine extract, Secale cereale, soy protein, tocopherol/vitamin E, Triticum aestivum, Triticum Vulgare, vegetable protein (HVP), and yeast extract.

Grains and flours that contain gluten include barley, bran, bulgur, couscous, durum, farina, flour, graham flour, kamut, matzo, rye, semolina, spelt, triticale, wheat, and wheat germ.

Other commercially prepared products that usually contain gluten include: baked beans (canned), beer, blue cheese, bouillons/broths, breaded foods, cereals, chocolate milk, cold cuts, egg substitutes, energy bars, flavoured coffees, french fries, fried vegetables/tempura, fruit fillings/puddings, gravy, hot dogs, ice cream, imitation crab meat/bacon, ketchup, malt/malt flavouring, malt vinegar, marinades, mayonnaise, meatloaf/meatballs, non-dairy creamer, oat bran, oats, processed cheeses, roasted nuts, root beer, salad dressings, sausage, seitan, soups, scotch, soy sauce, syrups, tabbouleh, teriyaki sauce, trail mix, veggie burgers, vodka, wheatgrass, whisky, and wine coolers.  

With such a vast list of foods and ingredients (not to mention skin care products, supplements, and medications) that often contain gluten, being aware of what you consume becomes vital to the healing of your gut and your overall health. On top of it all, cross-contamination with gluten-containing products is also a concern.  

Learn the facts about celiac disease and know that there are places you can turn to for help. If you're struggling with how to keep gluten out of your life or need help with meal planning or creating a list of safe foods for you or a loved one, I’d like to help. Drop me a line or give me a call. 

As always, I look forward to hearing from you, and I’d love to know what you think!