Celiac disease is a lifelong autoimmune intestinal disorder, found in individuals who are genetically susceptible. Damage to the mucosal surface of the small intestine is caused by an immunologically toxic reaction to the ingestion of gluten and interferes with the absorption of nutrients. Celiac Disease (CD) is unique in that a specific food component, gluten, has been identified as the trigger. Specifically, it is a protein fraction in wheat gluten called gliadin that causes the abnormal immune response. Proteins in rye and barley trigger the same response.

What Happens With Celiac Disease

When individuals with CD ingest gluten, the villi, tiny hair-like projections in the small intestine that absorb nutrients from food, are damaged. This is due to an immunological reaction to gluten. Damaged villi do not effectively absorb basic nutrients -- proteins, carbohydrates, fats, vitamins, minerals, and, in some cases, water and bile salts. Specifically, malabsorption is most likely for macronutrients, fat-soluble vitamins, electrolytes, calcium, magnesium, zinc, folate, and vitamin B12. If CD is left untreated, damage to the small bowel can be chronic and life threatening, causing an increased risk of associated disorders -- both nutritional and immune related.
Symptoms of Celiac Disease May Include One or More of the Following:

• Recurring bloating, gas, or abdominal pain
• Chronic diarrhea or constipation or both
• Unexplained weight loss or weight gain
• Pale, foul-smelling stool
• Unexplained anemia
• Bone or joint pain
• Behavior changes/depression/irritability
• Vitamin K Deficiency
• Fatigue, weakness or lack of energy
• Delayed growth or onset of puberty
• Failure to thrive (in infants)
• Missed mentrual periods
• Infertility male & female
• Spontaneous miscarriages
• Canker sores inside the mouth
• Tooth discoloration or loss of enamel

An intestinal biopsy is necessary for confirmation of the diagnosis.

Cause of Celiac Disease

The cause of Celiac Disease, also known as celiac sprue, or gluten sensitive enteropathy (GSE), is unknown. Research indicates that Celiac Disease is strongly associated with a group of genes on Chromosome 6. These genes (HLA class II) are involved in the regulation of the body's immune response to the gluten protein fractions. One out of 133 people in the United States is affected with celiac disease. Celiac Disease occurs in 5-15% of the offspring and siblings of a person with celiac disease. In 70% of identical twin pairs, both twins have the disease. It is strongly suggested that family members be tested, even if asymptomatic. Family members who have an autoimmune disease are at a 25% increased risk of having celiac disease.
Below is a picture of healthy and damaged villi due to Celiac




The damage may be restricted to the duodenum or to the entire small intestine. The degree of malabsorption depends on the severity and extent of the damage.

Medical Nutrition Therapy for Celiac Disease
The recommended treatment is a lifelong gluten-free diet. In most cases, there is improvement within a few weeks. Dietary supplements can be used. A gluten-free diet eliminates all foods that have wheat, barley, and rye. Gluten-free products can replace common foods that usually contain gluten, such as bread, pasta, and cereal, but they are more expensive. Dietetic counseling may help celiac patients learn how to meet their nutritional needs and expand food options.