Celiac disease (also known as coeliac disease) affects around one in 100 people worldwide. If untreated, it can lead to problems like osteoporosis, anaemia, various neurological conditions and even bowel cancer. Read on to find out more about celiac disease, or connect to other people who are living with the condition by joining Carecircle.

What is celiac disease?

Coeliac disease is an autoimmune condition – that is, a disorder in which the body’s immune system attacks healthy cells instead of foreign invaders. In this case, the immune system is triggered by gluten, which is found in a range of foods. If people with celiac disease eat something containing gluten, their immune cells go wild, damaging the lining of the small intestine.

What is gluten?

Gluten is a protein that is primarily found in three types of cereal: wheat, barley and rye. These three cereal grains are found in a huge range of foods, including bread, breakfast cereals, pasta, cakes, beer, gravy, and pretty much anything that involves wheat, barley or rye flour as an ingredient.

Gluten intolerance vs wheat allergy

Gluten intolerance can cause uncomfortable symptoms such as bloating and diarrhoea if an individual eats something containing gluten. But this is different from an allergy, which can potentially be life-threatening. People with a wheat allergy might develop symptoms such as hives and breathing difficulties, and in rare cases they could go into anaphylactic shock. In this case they may start to feel faint and clammy, with rapid, shallow breathing, and may even lose consciousness. Anaphylactic shock is a medical emergency that must be treated immediately.

Gluten intolerance is not the same as celiac disease, however. The medical name for gluten intolerance – non-celiac gluten sensitivity – hints at the difference. See ‘What are the symptoms of gluten intolerance?’ below for more details.

What are the symptoms of celiac disease?

The symptoms of celiac disease include:

• Bloating
• Stomach ache
• Diarrhoea
• Constipation
• Indigestion
• Fatigue
• Weight loss
• Itchy rash
• Infertility
• Anaemia
• Nerve damage

Some of these symptoms, such as fatigue, can be caused by malnutrition – as damage to the intestine can result in too few nutrients being absorbed by the body. Celiac disease can also result in stunted growth and delayed puberty in children, as well as deficiencies in vitamin D and B12.

What are the symptoms of gluten intolerance?

The symptoms of gluten intolerance (or non-celiac gluten sensitivity) are similar to the milder symptoms of celiac disease, including:

• Bloating
• Stomach ache
• Diarrhoea
• Constipation
• Indigestion

The difference is that gluten intolerance is not an autoimmune condition, and people with gluten intolerance can sometimes still eat small amounts of gluten without major effects. In people with celiac disease, on the other hand, just a crumb of gluten can trigger an immune response. Gluten intolerance is far more common than celiac disease, and affects roughly 6% of the US population, compared with roughly 1% for celiac disease.

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What causes celiac disease?

Coeliac disease is thought to be a genetic condition, and individuals with the disorder usually carry the gene variants DQ2 and DQ8. Around 30% of people have these gene variants, but only about 3% of those people develop celiac disease. The reason why some people develop the disease while others don’t is unclear.

If people with celiac disease eat gluten, it triggers immune cells to attack the lining of their small intestine, damaging the villi. Villi are tiny protrusions from the wall of the intestine, and in celiac disease they can become flattened, making it harder for the person to absorb nutrients.

How do you diagnose celiac disease?

If you suffer from any of the following symptoms and/or conditions, it would be advisable to ask your doctor to be tested for coeliac disease:

• Persistent fatigue
• Thyroid disease
• Irritable bowel syndrome
• Type 1 diabetes
• Persistent stomach or bowel problems
• Unexplained weight loss
• Tingling and numbness or problems with coordination
• Persistent ulcers
• Problems with growth

The test for celiac disease involves taking a blood sample, which is then checked for antibodies to see whether your immune system has been activated by gluten. To make the test accurate, you will have to eat gluten for a specified period before the blood sample is taken.

If the test comes back positive, you might be referred to a specialist who can confirm the diagnosis by taking a small biopsy sample from your intestine. However, if the antibody levels in your blood sample are very high, this step might not be necessary.

What to do if you have celiac disease?

If you are diagnosed with celiac disease, it means making some big and permanent changes to your diet. You will have to cut out gluten entirely to avoid immune flare-ups that could damage your intestine and lead to further complications. Groups such as the Celiac Disease Foundation and Coeliac UK can provide help and advice, and you can find people who are going through the same experience by joining Carecircle.

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What’s the treatment for celiac disease?

The only treatment for celiac disease is switching to a gluten-free diet. Even a tiny amount of gluten can cause a dramatic immune response, so people with the condition must cut out gluten from their diet for the rest of their life.

Gluten-free diet

A gluten-free diet is one that is completely free of foods that contain wheat, barley or rye, as well as less common gluten-containing cereal grains such as semolina, couscous, spelt and durum.

You may want to speak with a nutritionist to work out how to maintain a balanced diet and replace common gluten-containing foods with alternatives. Many gluten-free options are now available for things like bread and pasta, where gluten-containing flours have been swapped for gluten-free alternatives, such as rice flour.

Gluten-free foods

Examples of gluten-free foods include:

• Meat
• Fish
• Dairy products
• Rice
• Potatoes
• Fruit
• Vegetables

There is also a variety of alternative flours that do not contain gluten, such as rice flour, corn flour and potato flour.

People with celiac disease should be careful to check the ingredients of the food they eat, since sometimes flour can be added in the cooking process, such as coating meat in flour or adding flour to sauces to thicken them.

Celiac disease FAQs

Below are a few answers to some commonly asked questions about celiac disease.

Are oats gluten free?

Yes! Oats contain avenin, which is similar to gluten, but can be eaten by most people with celiac disease. However, sometimes oats can be produced in the same factory as wheat or other gluten-containing cereals, such as wheat, leading to a risk of contamination.

What is gluten free?

A food is gluten free if it does not contain the protein gluten, which is most commonly found in the cereals wheat, barley and rye.

Is maize gluten free?

Yes! Maize, also known as corn, is free of gluten, so people with celiac disease can freely eat it. However, as with oats, there is a small risk of cross-contamination if maize/corn flour is produced in the same place as wheat flour or other gluten-containing flours.

Are potatoes gluten free?

Yes! Potatoes do not contain gluten, so they are safe to eat for people with celiac disease.

What foods contain gluten?

Gluten is contained in a range of cereal grains, including wheat, barley, rye, semolina, couscous, spelt, durum, pearl barley and bulgur wheat. These are typically used to make foods such as bread, pasta and pizza.

Is cheese gluten free?

Yes! Cheeses such as cheddar and brie do not usually contain gluten. However, some forms of cottage cheese could contain wheat starch, so it’s advisable to check the label. In addition, some reduced-fat or fat-free cheeses might be bulked out with other ingredients, so again it’s worth checking the label.

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Celiac disease resources

To find out more about celiac disease, or to search for advice and support, try these resources:

• NHS Coeliac disease overview
• National Institute of Diabetes and Digestive and Kidney Diseases
• Celiac Disease Foundation
• Coeliac UK
• Guts UK!

We hope that this guide has been useful if you or someone close to you has been recently diagnosed with celiac disease, or if you suspect you or someone close to you shows symptoms. If you’re concerned about any of the symptoms mentioned in this article, speak with your doctor. And remember that there’s a whole community out there on Carecircle who can provide support.

Guide sources

• NHS Coeliac disease overview
• Celiac Disease Foundation
• Coeliac UK
• Medical News Today: What is gluten intolerance?
• Medical News Today: Does cheese have gluten?
• Northwestern Medicine: Celiac Disease vs. Gluten Intolerance (Infographic)
• National Institute of Diabetes and Digestive and Kidney Diseases: Symptoms and Causes of Celiac Disease