For more than twenty years, October has been designated “Celiac Disease Awareness Month” in both the United States and Canada. But while there’s nothing new about this disease, there are still a lot of questions, and confusion, about what it is, and who is at the highest risk.
What is Celiac Disease?
Celiac disease is a hereditary autoimmune disorder in which the small intestines are damaged and the absorption of essential nutrients is disrupted. Those individuals who live with celiac disease experience a severe inability to tolerate gluten, which is a common protein found in wheat, rye and barley.
When an individual with celiac disease ingests foods containing gluten, a response is triggered wherein their immune system immediately begins to attack the internal lining of the small intestine. This lining is made up of fingerlike protrusions known as “villi”, protrusions that vastly increase the surface area of the small intestine and facilitate the absorption of nutrients from foods that have been eaten and processed by the stomach.
In celiac disease (also known as “celiac sprue”), not only does the immune system attack and damage the sensitive and important lining of the small intestine in the presence of gluten, but the disease itself also causes a general malabsorption of nutrients from all foods ingested, thus the individual with celiac disease runs a constant risk of malnourishment, nutritional deficiencies, and the effects of those deficiencies.
What Are The Symptoms of Celiac Disease?
The digestive symptoms of celiac disease usually occur more frequently in children, and may include chronic diarrhea, vomiting, constipation, abdominal pain and bloating, foul-smelling stool that is pale and frequently fatty, as well as weight loss. Irritability, delays in growth, defects of the tooth enamel, and delayed puberty are also common.
In adults, common symptoms include but are not limited to anemia, fatigue, joint pain, arthritis, osteoporosis, depression, miscarriage, infertility, seizures, mouth sores, and a itchy rash known as dermatitis herpetiformis. However, many adults with celiac disease can be asymptomatic for years prior to the acute manifestation of the disease.
Since celiac disease involves poor absorption of nutrients, deficiencies can lead to anemia, bone loss and other significant problems, and some evidence exists that a predisposition to cancer is also possible.
Who Has Celiac Disease?
It is estimated that approximately 2 million Americans have celiac disease. It is more common in individuals with Down Syndrome and Turner Syndrome (a genetic disease affecting females), and it is also common in those living with Type 1 diabetes and autoimmune disorders related to the thyroid and liver.
Most sources state that celiac disease is rare in African Americans and those of Asian and Caribbean background, however data also demonstrates that African Americans susceptible to the disease can frequently be misdiagnosed. Based on information from several reputable sources, some African Americans with Type 1 diabetes have more potential of developing the illness than others, but many African American Type 1 diabetics test negative for the gene predisposing them to celiac disease. These findings notwithstanding, a general under-diagnosis of celiac disease in African Americans is reported in the literature.
Testing and Diagnosis