Celiac disease

Celiac disease is a medical condition in which the absorptive surface of the small intestine is damaged by a substance called gluten. This results in an inability of the body to absorb nutrients: protein, fat, carbohydrates, vitamins and minerals, which are necessary for good health.

It is estimated that 1 in 133 persons in Canada are affected by celiac disease.
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Gluten is a protein found in wheat, rye, triticale, barley.
There is a lot more that can be discussed about celiac disease that can be easily found on the attached links.
​I want to tell you what may harder to find or understand.

Let's focus on what you really need to know

  • I always ask patients to be on a gluten containing diet for at least 6 weeks before testing.
  • I use the blood test anti-transglutaminase antibody which has high sensitivity and is readily available. Anti-endomysial antibody can be ordered as well. I will always ask to check your immunoglobulin level since 2% of the population normally are IgA defcient. IgA is necessary for these blood tests to work.
  • If the blood test is positive, I recommend doing a gastroscopy to obtain a biopsy of the small intestine since there can be false positive results that need to be confirmed with a biopsy. The only time I may avoid it is if the anti-transglutaminase antibody level is over 100.
  • I always recommend seeing a dietician well versed in celiac disease. 
  • I always recommend contacting a support group such as the Canadian Celiac Association. Joining a group has been shown to improve compliance.
  • For patients newly diagnosed over the age of 40, I always order imaging tests to check the rest of their small intestine as there is a small risk of small bowel cancer. I also do a bone density test to rule out osteoporosis and prescribe vitamin D supplementation.
  • I follow patients yearly with basic blood work and anti-transglutaminase antibody test.

Remember
At the beginning, when your small intestine is still inflamed, your ability to digest other foods, especially foods containing lactose or fructose, will be diminished. 
Do not be discouraged. You will gradually be able to tolerate many foods again but it can take a few months until your bowels have healed completely.
It is very common for the ability to digest lactose and fructose NOT to return.
Be aware that before you think your celiac disease is not well treated that you completely eliminate these foods or at least be tested.

Family screening

Once I diagnose a patient with celiac disease, I recommend that all their first degree relatives, primarily their siblings and children, be screened even if they are not symptomatic. We usually wait till after the age of two to test. A blood test is sufficient but should be repeated 3 years later to be more sure.
We do not yet understand all the health issues that could be a result of celiac disease. It would make sense then to treat early to prevent any future health issues.
It is much easier to modify the diet of a child at an early age.
  • Gluten is ONLY found in wheat, rye, triticale, barley. All other foods are fine.
  • Most people with a "gluten sensitivity" have an intolerance to the sugars in grains and not the gluten protein.
  • Do not start a full gluten free diet before being tested or celiac disease.
  • Never cheat. Even a small piece of a slice of bread can trigger inflammation. 
  • Just because you feel fine does not mean you do not have active celiac disease.

Support groups are very important

Consider joining one