Gluten-Free Diet For Celiac Disease

Gluten| Celiac Disease | Autoimmune

Overview

Celiac disease erodes the lining of your small intestine.

What is celiac disease?

Celiac disease is an inherited autoimmune disorder that causes a reaction in your body to the protein, gluten. It is a disorder that damages your small intestine and keeps it from absorbing the nutrients in food. The damage to your intestinal tract is caused by your immune system’s reaction to gluten. Gluten is a protein found in wheat, barley, and rye. Some oats may be contaminated by gluten. When you have celiac disease, gluten causes your immune system to damage or destroy villi.

Villi are the tiny, fingerlike tubules that line your small intestine. The villi’s job is to get food nutrients to the blood through the walls of your small intestine. If villi are destroyed, you may become malnourished, no matter how much you eat. This is because you aren’t able to absorb nutrients. Complications of the disorder include anemia, seizures, joint pain, thinning bones, infertility, long-term (chronic) diarrhea, low vitamin levels, and cancer.

Gluten in your digestive system triggers your immune system to produce antibodies against it. These antibodies damage the lining of your small intestine (the mucosa). Damage to the mucosa in your small intestine impairs its ability to absorb nutrients from your food, causing nutritional deficiencies.

Gluten is a protein naturally present in grains like wheat, barley, and rye. Wheat, in particular, is a key ingredient in many staple foods commonly found in the Western diet, including bread, cereals, pasta, and baked goods. Additionally, gluten is often used as an additive in processed foods where it might not be expected, such as soups, sauces, and packaged products. Beer, which is typically brewed from barley or rye, also contains gluten.

How does celiac disease affect my body?

Celiac disease affects your small intestine. This is where most of the nutrients from your food are absorbed, including proteins like gluten. But when you have celiac disease, gluten in your small intestine triggers an immune response. Your immune system sends inflammatory cells and antibodies to destroy the gluten molecules. These cells damage the mucous membrane lining your small intestine.

The mucosa that lines your small intestine is vast but is scrunched up into many folds and fingerlike projections, called villi. If you stretched it all out, it would cover a tennis court. These folds and projections increase the surface area in order to absorb as many nutrients as possible during digestion. But immune cells triggered by celiac disease erode and flatten these projections, diminishing the surface area.

Is celiac disease serious?

Damage to your small intestine can have serious consequences. Your small intestine absorbs nutrients from your food through the mucosa. If the mucosa is damaged, it won’t be able to absorb nutrients as it should. This is called malabsorption. It can lead to malnutrition and to many other conditions that follow from the lack of different nutrients. In children, it can cause stunted growth and development.

Who gets celiac disease?

Celiac disease is more prevalent among individuals of Northern European ancestry, affecting approximately 1% of the populations in Europe and North America. If a first-degree relative, such as a parent or child, has the condition, the likelihood of developing it increases to 10%. Additionally, around 97% of those diagnosed with celiac disease possess a distinct gene variant linked to the disorder, specifically HLA-DQ2 or HLA-DQ8.

What other risk factors contribute?

Celiac disease is more common in people with certain inherited chromosomal disorders, such as Down syndrome. It’s also more common in people with certain other autoimmune diseases. These diseases often share common genes, and they also have a way of triggering each other. Like other autoimmune diseases, celiac disease is more common in females than males. The ratio is at least 2:1.

Certain factors can increase the likelihood of developing celiac disease. It is more commonly found in individuals of white ancestry and in those with a family history of the condition. People with chromosomal disorders like Turner syndrome, Williams syndrome, or Down syndrome may also be at higher risk. Additionally, those with other autoimmune diseases—such as Type 1 diabetes, rheumatoid arthritis, microscopic colitis, or Addison’s disease—are more prone to developing celiac disease. Studies also indicate that females may be more susceptible than males.  

Symptoms and Causes

What causes celiac disease?

Many autoimmune diseases, like celiac disease, are at least partly inherited (genetic disorders). That means a particular gene variant that’s passed down through family lines makes you more susceptible to developing it. But not everyone with the gene variant develops the disease, and not everyone who develops it has one of the known variants. Other factors appear to be involved in triggering it.

How does a person get celiac disease?

One theory is that it’s triggered by some type of significant physical stress that overextends your immune system. Healthcare providers have observed that the disease often shows up after a physical event such as surgery, illness or pregnancy, or a severe emotional event. Another theory is that microorganisms living in your gut are involved. More research is needed to explore these theories.

When does celiac disease develop?

Celiac disease can develop at any point after a person starts consuming gluten. Healthcare professionals frequently observe its onset during two key age ranges: early childhood, between 8 and 12 months, and mid-life, between 40 and 60 years old. In young children, this often coincides with the introduction of solid foods, such as biscuits or cereals that contain gluten.

Lifestyle changes to cope with celiac disease

A gluten-free diet is the only treatment for celiac disease. You’ll have to stay away from gluten for the rest of your life. Even the smallest amount will trigger a reaction that can damage your small intestine. Eating a gluten-free diet means a new approach to food. A gluten-free diet often means not eating most grains, pasta, cereals, and processed foods. This is because they often contain wheat, rye, and barley. You’ll need to become an expert at reading ingredient lists on packages. Choose foods that don’t have gluten. You can maintain a well-balanced diet by including a variety of foods, such as meat, fish, rice, fruits, and vegetables. Opt for prepared foods labeled gluten-free to ensure they align with your dietary needs. Be especially careful about condiments, dressings, and gravy, because these may contain gluten. Prescription and over-the-counter medicines may also contain gluten.

You can find gluten-free bread, pasta, and other products in just about every grocery store. Gluten-free dishes are on menus at all kinds of restaurants. But remember that gluten can be hidden in many foods. This includes foods served that a restaurant says are gluten-free. This is why preparing your own food is often the best way to go.

Why Go Gluten-Free?

A strict, lifelong gluten-free diet is the only treatment for celiac disease. It can alleviate the 250+ symptoms associated with celiac disease, including:

• Dermatitis herpetiformis, an itchy skin rash associated with celiac disease
• Fatigue
• Gastrointestinal distress, such as diarrhea, constipation, gas, bloating and abdominal pain
• Headaches, including migraines
• Iron deficiency anemia
• Joint and muscle pain
• Psychological issues, including depression, anxiety and “brain fog”
• Peripheral neuropathy, which causes tingling in hands and feet
• Osteopenia and osteoporosis
• Unexplained Infertility and other reproductive health problems
• Weight gain or weight loss

Left untreated, celiac disease can lead to further complications such as osteoporosis, other autoimmune conditions and even certain cancers. For a non-exhaustive list of potential complications and related conditions, check out our related conditions & diseases page.

Unfortunately, while the gluten-free diet can treat celiac disease, it is by no means a cure all. It is common for people with celiac disease to struggle with symptoms even after going on a gluten-free diet. Keep in mind, also, that it does take time for the body to heal—sometimes multiple years. A 2016 study found that in patients who received a follow-up biopsy one year after diagnosis, about half showed intestinal healing, and the other half still presented with villous atrophy. 

If you are still having symptoms even on a gluten-free diet, speak with your doctor and/or a registered dietitian knowledgeable of celiac disease. They can help you to determine if you are accidentally eating gluten or if something else may be causing your symptoms.

Tips for following a gluten-free diet

Here are steps to take when getting gluten out of your diet.

1. Know terms for hidden gluten. Stay away from einkorn, emmer, spelt, kamut, wheat starch, wheat bran, wheat germ, cracked wheat, and hydrolyzed wheat protein. Steer clear of emulsifiers, dextrin, mono- and di-glycerides, seasonings, and caramel colors. These all can contain gluten.
2. Check the labels of all foods. Gluten can be found in food items you’d never suspect. Here are some that are likely to have gluten:

•  Soy sauce  
•  Bouillon cubes  
•  Rice mixes  
•  Cold cuts, hot dogs, salami, and sausage  
•  French fries  
•  Candy  
•  Communion wafers  
•  Gravy  
•  Seasoned tortilla chips  
•  Beer, ale, and lagers  
•  Matzo  
•  Brown rice syrup  
•  Vegetables in sauce  
•  Sauces  
•  Imitation fish  
•  Self-basting turkey  
•  Soups  
•  Chips, potato chips  

New ways to approach your grain choices

• Stay away from all products with barley, rye, triticale (a cross between wheat and rye), farina, graham flour, semolina, and any other kind of flour. This includes self-rising and durum not labeled gluten-free.
• Be careful with corn and rice products. These don’t have gluten, but they can sometimes be contaminated with wheat gluten. This can happen if they’re processed in factories that also make wheat products. Look for such a warning on the package label.
• Go with oats. Recent studies suggest you can eat oats if they are not contaminated with wheat gluten during processing. Check with your healthcare provider first.
• Use potato, rice, soy, amaranth, quinoa, buckwheat, nut, or bean flour instead of wheat flour. You can also use sorghum, chickpea or Bengal gram, arrowroot, and corn flour. Tapioca starch extract is another choice. These act as thickeners and can be used for leavening.

More ideas for a gluten-free lifestyle

Here are ideas to help make the transition to a gluten-free diet:

Keep your kitchen organized by using separate utensils, cutting boards, dishes, forks, knives, and spoons for preparing gluten-free and gluten-containing foods.

When dining out, if you’re unsure about ingredients in a dish, ask the chef how it’s prepared and whether a gluten-free menu is available. Many restaurants provide menus online, allowing you to check options before you visit.

Consult your pharmacist about whether your medications contain wheat or gluten-based additives. Gluten can also be found in unexpected products like lipsticks, lip balms, supplements, and probiotics. If ingredients aren’t listed, manufacturers can provide details upon request.

Be mindful of portion sizes, as gluten-free foods might be safe for your diet but are not necessarily low in calories.

If you continue experiencing symptoms despite a gluten-free diet, carefully check for hidden gluten in sauces, salad dressings, canned soups, and food additives like modified starch, preservatives, and stabilizers containing wheat. Some medications, including tablets and capsules, may have trace amounts of gluten, though the risk is low. If concerned, seek advice from your healthcare provider.

As you and your family become skilled in reading food labels, identifying hidden gluten will become easier. Consider joining a support group to help navigate your dietary transition, share gluten-free recipes, and explore delicious alternatives, from cookies and banana bread to biscuits, trail mix, and grits. Would you like recommendations for gluten-free meal ideas?