Celiac Disease, Gluten Sensitivity, & Food Allergies

by Kaetlin Zink & Rachel Mayan

May is Celiac Awareness Month, and in a climate where “gluten-free” is common nutritional jargon, it’s important to know the difference between celiac disease, gluten sensitivity, and food allergies.

Food Allergies

A food allergy is an overreaction – an immune response – to a particular food that causes potentially life-threatening symptoms. Symptoms occur shortly after ingestion and include hives, tingling or itching, swelling, shortness of breath, lightheadedness, vomiting, and possibly even death.

Food allergies can be severe and dangerous; HAC mom, Megan Vaughn, noted that having children with food allergies has compelled her to raise awareness everywhere she can because avoiding food triggers is a community effort. We don’t allow food in our childcare for this very reason. It’s not just the avoidance of the food, but even the risk of cross-contamination.

Any food, theoretically, can cause an allergy, but the most common food allergens are eggs, milk, peanuts, tree nuts, fish, shellfish, soy, and wheat. That last allergen – wheat – is a common one. The symptoms that arise from a wheat allergy are similar to those of a gluten sensitivity, like stomach cramps, diarrhea, and gastrointestinal problems, but a gluten sensitivity goes deeper than just wheat and can have more implications.

Gluten Sensitivity

Gluten-intolerant individuals react to the protein gluten, commonly found in wheat, rye, and barley. Symptoms mimic those of celiac disease, but these individuals do not test positive for celiac. This condition is also referred to as non-celiac gluten sensitivity (NCGS) because the symptoms are similar, yet the two are separate conditions. Symptoms resolve once gluten is removed from the diet for non-celiac gluten sensitivity (NCGS) individuals.

Celiac Disease

Celiac disease affects 1 in 100 people worldwide and is an autoimmune disorder where immune responses are directed toward the individuals’ own body rather than the foreign substance. When someone with celiac eats gluten, their body triggers an immune response to attack the small intestine. Over time, these attacks result in the destruction of villi — small, finger-like protrusions that make up the lining of the small intestine — responsible for absorbing key nutrients. Some people who are extremely sensitive also have to worry about cross-contamination.

Celiac disease is genetically inherited and can only develop in individuals carrying certain genes — HLA-DQ2 or DQ8. Interestingly enough, 30% of the population carries these genes, but only a small percentage of those individuals develop the disease. NCGS individuals, for example, may test positive for the gene and present symptoms but not have developed celiacs.

Difficulties in Diagnosis

Celiac is challenging to diagnose – sometimes even taking 6-10 years – because it affects people in different ways.  In fact, there are more than 200 currently known symptoms that can occur within the digestive system and other parts of the body.  What’s more, people can even fail to show any common symptoms, yet still test positive for the disease.

Diagnosing can be done via blood test and is usually verified or further examined by an endoscopy. The tough part? Certain screenings or tests can be inaccurate or contradictory. For example, one could test negative on a blood test, yet test positive when it comes time for the intestinal biopsy.  The age of onset is also variable — some develop the disorder as children and others as adults.  The reason for this is still unknown.

Symptoms

Children

Children with Celiac commonly experience more issues with digestion in comparison to adults. Celiac kiddos may experience

• Weight loss
• Vomiting
• Abdominal bloating/pain or discomfort
• Constipation
• Exhaustion or fatigue
• Chronic diarrhea
• Irritability/Behavioral issues
• Delayed growth and puberty
• Short stature
• Pale, foul-smelling fatty stool
• Dental enamel defects of the permanent teeth
• Failure to thrive
• ADHD (Attention Deficit Hyperactivity Disorder)

Adults

Adults with celiac are less likely to experience as many digestive or metabolic problems as children. Adults may experience

• Migraines or seizures
• Arthritis
• Depression or anxiety
• Missed or late menstrual periods
• Unexplainable iron-deficiency anemia
• Osteoporosis or osteopenia (bone loss)
• Infertility or recurrent miscarriage
• Bone or joint pain
• Dermatitis herpetiformis (itchy skin rash)
• Peripheral neuropathy (tingling, numbness, or pain primarily in the hands and feet)
• Liver and biliary tract disorders (fatty liver, transaminitis, primary sclerosing cholangitis, etc.)

Long-Term Health Complications

Getting diagnosed early can help prevent the threat of long-term health consequences.  According to the Celiac Disease Foundation, prolonging diagnosis can significantly increase your risk of developing other autoimmune disorders.  For example, if you are diagnosed anywhere between the ages of 12 and 20, the likelihood that you will develop another autoimmune disorder rises to 27%.  If you are 20 or older, your chance of developing another CD-related disease rises to 34%.

Some common long-term health problems that can arise include vitamin and mineral deficiencies, anemic iron deficiency, lactose intolerance, early onset osteoporosis or osteopenia, pancreatic insufficiency, gallbladder malfunction, central and peripheral nervous disorders, intestinal lymphomas and other GI cancers (malignancies), and neurological manifestations (including ataxia, epileptic seizures, migraines, neuropathy, dementia, and myopathy).

Types of Celiac

According to the World Gastroenterology Organization, celiac can be divided into three main categories:

• Classical Celiac Disease: patients experience typical symptoms of poor digestion including diarrhea, weight loss, fatty stools with an unpleasant odor, and failure to grow at a normal rate (in children).
• Non-Classical Celiac Disease: patients don’t show clear signs of malabsorption, or might exhibit other unrelated symptoms, yet experience mild symptoms of gastrointestinal discomfort or pain.  They can also struggle with some other common symptoms such as abdominal pain, iron-deficiency anemia, chronic migraine and fatigue, peripheral neuropathy, bone loss, and depression/ anxiety.
• Silent Celiac Disease: this is also referred to as asymptomatic celiac disease.  Patients do not suffer from any symptoms but fall victim to the deterioration of their small intestine.  Though patients do not experience any symptoms, studies have shown that those who go gluten-free report feeling better overall and see a reduction in bloating, acid reflux, and flatulence.

Next Steps

If you or your child are experiencing any odd symptoms as they relate to food or gluten specifically, consult your doctor on getting screened for food allergies or celiac disease. Knowing can provide all the difference and prevent long-term health struggles down the road. The only treatment for NCGS patients and celiac patients is a gluten-free diet, so making the switch to a gluten-less lifestyle may provide the relief you need.