Celiac disease: When the body goes against the grain
“Celiac” comes from the Latin word
for abdomen, but this digestive disease can cause symptoms
throughout the body. Celiac Disease:
Wheat-based foods — from a bagel for breakfast to pasta
for dinner — are a dietary staple for many people. But for a
person with celiac disease, nibbling even a crumb of toast
can spell trouble. Celiac disease (also known as celiac
sprue) is an inherited intolerance to gluten, the sticky
protein found in grains such as wheat, barley, and rye. For
people with this condition, eating gluten can trigger immune
system attacks that may ravage the lining of the small
intestine, causing symptoms that include abdominal pain
and bloating, diarrhea, and fatigue. Because the injured
intestine can’t adequately absorb vital nutrients (such as
iron, calcium, and vitamin D), untreated celiac disease can
lead to iron deficiency anemia, osteoporosis, lactose
intolerance (the inability to digest or absorb lactose, a
sugar found in milk and other dairy products), and other
problems.
Celiac disease was once thought to be rare, but experts
now estimate that in the United States, about 1 in 100
people — five million in all — have the disorder. It’s more
common among people of European ancestry (especially those
from Italy, Ireland, and the Scandinavian countries), and
it’s slightly more prevalent in women.
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Anatomy of celiac disease
The small intestine is lined with fingerlike
projections, called villi, that absorb nutrients. In
a healthy intestine, they resemble the rough surface
of a shag carpet. In celiac disease, the immune
system attacks the villi, causing them to flatten
and become inflamed. Sometimes only a small portion
of the intestine is affected. That’s why some people
with celiac disease have few or no symptoms and no
signs of nutrient deficiencies. |
Not always obvious
Celiac disease often goes undiagnosed because its classic
symptoms resemble those of other common ailments, such as
irritable bowel syndrome and lactose intolerance. Two other
bowel disorders, Crohn’s disease and ulcerative colitis, are
perhaps more familiar than celiac disease, but celiac
disease is more common than both of them combined.
Another reason for misdiagnosis is that one-half to
two-thirds of celiac patients don’t have gastrointestinal
complaints; instead, they show signs of anemia or fatigue.
Celiac disease is usually identified only after no other
causes, such as internal bleeding, are found for these
symptoms.
These difficulties help explain why it takes an average
of 11 years to be diagnosed with celiac disease after the
symptoms first appear. Many people assume that the disease
is diagnosed as soon as a child starts eating foods that
contain gluten, but that’s not the case. Celiac disease can
develop at any time in life, including old age. Also, people
with a genetic predisposition for gluten intolerance don’t
necessarily manifest symptoms of the disease. Researchers
describe this phenomenon as “the celiac iceberg” (see
illustration).
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