- Symptoms & Causes of Celiac Disease
- What are the symptoms of celiac disease?
- Why are celiac disease symptoms so varied?
- What causes celiac disease?
- So, what can I eat?
- Celiac Disease and IBS: Differences and Similarities
- How Are Celiac Disease and IBS Different?
- What is celiac disease?1,2
- What are the symptoms of celiac disease versus IBS?1
- What are some other differences between IBS and celiac disease?2,3
Symptoms & Causes of Celiac Disease
What are the symptoms of celiac disease?
Most people with celiac disease have one or more symptoms. However, some people with the disease may not have symptoms or feel sick. Sometimes health issues such as surgery, a pregnancy, childbirth, bacterial gastroenteritis, a viral infection, or severe mental stress can trigger celiac disease symptoms.
If you have celiac disease, you may have digestive problems or other symptoms. Digestive symptoms are more common in children and can include
- bloating, or a feeling of fullness or swelling in the abdomen
- chronic diarrhea
- pale, foul-smelling, or fatty stools that float
- stomach pain
For children with celiac disease, being unable to absorb nutrients when they are so important to normal growth and development can lead to
- damage to the permanent teeth’s enamel
- delayed puberty
- failure to thrive in infants
- mood changes or feeling annoyed or impatient
- slowed growth and short height
- weight loss
Celiac disease in children may lead to weight loss.
Adults are less likely to have digestive symptoms and, instead, may have one or more of the following:
- a red, smooth, shiny tongue
- bone or joint pain
- depression or anxiety
- dermatitis herpetiformis
- infertility or repeated miscarriage
- missed menstrual periods
- mouth problems such a canker sores or dry mouth
- tingling numbness in the hands and feet
- weak and brittle bones
Adults who have digestive symptoms with celiac disease may have
- abdominal pain and bloating
- intestinal blockages
- tiredness that lasts for long periods of time
- ulcers, or sores on the stomach or lining of the intestine
Celiac disease also can produce a reaction in which your immune system, or your body’s natural defense system, attacks healthy cells in your body. This reaction can spread outside your digestive tract to other areas of your body, including your
- nervous system
Depending on how old you are when a doctor diagnoses your celiac disease, some symptoms, such as short height and tooth defects, will not improve.
Dermatitis herpetiformis is an itchy, blistering skin rash that usually appears on the elbows, knees, buttocks, back, or scalp. The rash affects about 10 percent of people with celiac disease. The rash can affect people of all ages but is most likely to appear for the first time between the ages of 30 and 40. Men who have the rash also may have oral or, rarely, genital sores. Some people with celiac disease may have the rash and no other symptoms.
Why are celiac disease symptoms so varied?
Symptoms of celiac disease vary from person to person. Your symptoms may depend on
- how long you were breastfed as an infant; some studies have shown that the longer you were breastfed, the later celiac disease symptoms appear
- how much gluten you eat
- how old you were when you started eating gluten
- the amount of damage to your small intestine
- your age—symptoms can vary between young children and adults
People with celiac disease who have no symptoms can still develop complications from the disease over time if they do not get treatment.
What causes celiac disease?
Research suggests that celiac disease only happens to individuals who have particular genes. These genes are common and are carried by about one-third of the population. Individuals also have to be eating food that contains gluten to get celiac disease. Researchers do not know exactly what triggers celiac disease in people at risk who eat gluten over a long period of time. Sometimes the disease runs in families. About 10 to 20 percent of close relatives of people with celiac disease also are affected.3
Your chances of developing celiac disease increase when you have changes in your genes, or variants. Certain gene variants and other factors, such as things in your environment, can lead to celiac disease.
Conditions affecting the gastrointestinal tract are common in modern humans and many are on the rise. The gastrointestinal tract extends from the mouth to the anus, via the stomach and the bowels, which include the small intestine and the large intestine (colon).
Around one in five Australians suffers symptoms of irritable bowel syndrome (IBS) at some point in their life. Around one in 70 have coeliac disease (though many don’t know they have it). Inflammatory bowel disease (IBD), which usually manifests as Crohn’s disease or ulcerative colitis, is less common, affecting three in 10,000 Australians.
The gastrointestinal tract. Blamb/
Irritable bowel syndrome is also called irritable colon. People with IBS have sensitive large intestines that are easily aggravated.
Coeliac disease is an autoimmune condition in which the body reacts abnormally to gluten, which is found in wheat, oats, rye and barley. (An easy way to remember this is the acronym WORB.) This abnormal reaction to gluten causes damage and inflammation to the small intestine.
Coeliac disease is_ not _a food allergy or intolerance. Some people can be sensitive to gluten, but not have coeliac disease. This is called non-coeliac gluten sensitivity.
In inflammatory bowel disease, the gastrointestinal tract becomes swollen and red from inflammation. Abscesses and cracks can develop in any part of the tract in Crohn’s, while open sores called ulcers usually affect the large intestine in ulcerative colitis.
The causes of these gastrointestinal conditions are not well-understood, but may include a combination of genetic and environmental factors, such as infection, psychological stress and diet. Researchers have reported associations, for instance, between higher intakes of total fat and meat and an increased risk of developing Crohn’s disease and ulcerative colitis.
Symptoms of these gastrointestinal tract conditions include bloating, cramps, abdominal pain, excessive wind, diarrhoea, constipation, nausea, fatigue, mucus or blood in stools, body aches, weight loss and nutrient deficiencies.
Suffering from a gastrointestinal condition can be very stressful. Imagine being in constant abdominal pain and your toilet habits alternating between diarrhoea and constipation. Or your gut becoming so inflamed you have to go to hospital.
See your doctor if you suffer from these symptoms, particularly if you’ve had them for weeks or months; don’t wait years. Due to similarities in the symptoms of these gastrointestinal conditions, diagnosis often takes some time. It may also be necessary to investigate bowel cancer as a possibility.
It’s best not to self-diagnose or self-treat. If you remove gluten from your diet and feel better, for instance, that doesn’t automatically mean that you have coeliac disease and need to carefully avoid gluten for life.
Many gastrointestinal afflictions cannot be cured, but can be managed with combinations of medication, diet and psychological treatment.
Thankfully, irritable bowel syndrome can sometimes resolve over time and leave no long-term damage in the gastrointestinal tract. A 2015 review found that for the management of IBS symptoms, an individual’s diet, lifestyle and medical and behavioural factors must be taken into account. Because of a link between IBS and stress, psychological therapy has also been shown to reduce symptom severity and improve quality of life.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These nutrients are poorly digested and absorbed in the small intestine, and therefore reach the large intestine, where they are fermented by bacteria. A low FODMAP diet and certain probiotics may also help ease IBS symptoms, although the long-term benefits of a low FODMAP diet are unclear.
In comparison, coeliac disease cannot be cured and must be managed with a strict, lifelong gluten-free diet to prevent small intestinal damage. And I mean strict. Even the gluten in a wheat bread crumb can cause bowel injury.
Conversely, symptoms associated with non-coeliac gluten sensitivity may indeed be due to gluten, or may be associated with other dietary components. Recent research has implicated FODMAP in non-coeliac gluten sensitivity. Like with the dietary management of IBS, a diet low or free from gluten and/or FODMAP may improve non-coeliac gluten sensitivity.
Inflammatory bowel disease cannot be cured and is often managed with medications such as steroids and immunomodulators that control the high levels of gut inflammation. There is currently insufficient evidence to suggest dietary changes can treat inflammatory bowel disease, but future directions may involve manipulation of gut bacteria using combinations of antibiotics, prebiotics, probiotics and diet.
So, what can I eat?
The first step is to find out if you actually have a clinical gastrointestinal problem, which you can only do by consulting with a medical professional and having appropriate tests. Any dietary advice will depend on this diagnosis, as well as your individual situation.
Avoiding FODMAP-containing foods if you have non-coeliac gluten sensitivity or IBS may help ease symptoms and improve quality of life. This means cutting out otherwise healthy, fibre- and nutrient-rich foods, such as apples, onions and lentils.
The total removal of gluten from a coeliac’s diet means a rigid avoidance of not just bread and pasta but also many processed foods, including sauces, stocks, processed meats, ice cream, mayonnaise, vinegar and other products.
It also means shunning foods that are supposedly “gluten-free” but may have been contaminated with gluten by the use of shared apparatus, such as tongs to serve both gluten-free and other cookies in a cafe.
Avoiding gluten if you have non-coeliac gluten sensitivity may not need to be so strict.
For inflammatory bowel disease, the evidence may not yet clear enough to prescribe nutrition therapy, but eating a healthy and balanced diet can’t hurt.
People with gastrointestinal problems may benefit from personalised dietary advice from a health professional, such as a dietitian. There are also several national organisations that provide essential advice and support, such as Coeliac Australia.
Celiac Disease and IBS: Differences and Similarities
Diarrhea, constipation, and abdominal pain. These symptoms could indicate irritable bowel syndrome (IBS), but they could also be signs of celiac disease. And sometimes it can be hard to tell.
“There have been a few studies examining this, but between 5 and 15 percent of celiac cases were originally labeled as IBS,” says Alessio Fasano, MD, director of the University of Maryland Center for Celiac Research in Baltimore. “It’s not an insignificant number.”
Celiac Disease and Irritable Bowel Syndrome
Celiac disease and irritable bowel syndrome have a lot in common at first glance, but there are key differences.
- Disease vs. syndrome. “Real IBS has no organic cause,” says Dr. Fasano. “IBS is a syndromic description — you put all those symptoms together and it’s called IBS.” Celiac disease is more than the sum of its symptoms; celiac disease can be at work damaging your intestine even when you experience no symptoms at all.
- Symptoms. “In clinical presentation, we see gas, bloating, belly aches. These overlap,” says Fasano. Both conditions share other symptoms like diarrhea, constipation, and changes to the look and consistency of stools. But for celiac disease, there are additional possible symptoms, including signs and complications ranging from dental defects to joint pain and osteoporosis.
- Lack of symptoms. Not all people with celiac disease notice gastrointestinal (GI) symptoms. This is not the case for IBS. If you don’t have symptoms, you don’t have IBS.
- Movement. “Normal intestines move in a regular pattern. With IBS, the intestines are squeezing all the time, causing discomfort,” Fasano says. Celiac disease does not affect the way the bowels move. Instead, celiac disease is an autoimmune disorder that damages the lining of the intestine.
- Gluten sensitivity. “Besides celiac disease, there are two reactions to gluten, gluten sensitivity and gluten allergy. Sensitivity gives more IBS-like symptoms,” Fasano says. Allergies are less likely to cause GI symptoms as a reaction. Gluten sensitivity is doubly tricky because celiac disease is also responsive to gluten. For people who experience IBS symptoms after eating wheat, it can be hard to isolate the real culprit.
Celiac Disease: Getting the Right Diagnosis
Because of the overlap between these two conditions, celiac disease is often missed or misdiagnosed as irritable bowel syndrome. But getting the right diagnosis is important. “People need to know whether they have celiac disease,” Fasano says. “This is not trivial information to have.” The best way to ensure that you get the correct diagnosis is to not make any changes to your diet before you visit the gastroenterologist.
“This happens all too often, due to misconception about celiac disease, even among health care professionals. People eventually go online and read about a gluten-free diet. If the diet works, then the problems really begin, because you don’t know which of the three categories you fall into,” explains Fasano, adding that gluten sensitivity, gluten allergy, and celiac disease can cause reactions to gluten.
Knowing what you have makes a huge difference for your treatment. “Celiac treatment is for life,” Fasano says. “It requires 100 percent — not 90 or even 99 percent — commitment.”
How Are Celiac Disease and IBS Different?
Irritable bowel syndrome (IBS) and celiac disease are conditions that can cause similar symptoms, but the causes of those symptoms are very different. The similarities between the two conditions can make them difficult to tell apart. In fact, studies have reported that somewhere between 5% and 15% of people with celiac disease were initially diagnosed incorrectly with IBS.
What is celiac disease?1,2
Celiac disease is an autoimmune disorder that causes damage to a person’s small intestine and prevents the person’s body from absorbing enough nutrients from digested food. People with celiac disease are unable to process proteins called gluten, which are found in foods containing wheat, rye, and barley, for example.
When people with celiac disease eat gluten, their immune systems react by damaging the inner lining of the small intestine. This damage makes it difficult for their bodies to absorb the nutrients from any foods that they eat, which can lead to malnourishment regardless of how much food is being consumed.
What are the symptoms of celiac disease versus IBS?1
Celiac disease and IBS can cause a similar set of symptoms. These include:
- abdominal pain
- changes in stool appearance and consistency
However, an important difference between the two conditions is that celiac disease does not always cause a person to experience symptoms related to the digestive system, like those listed above. On the other hand, everyone who has IBS has at least one or more of those symptoms. IBS is a syndrome, not a disease. This means that IBS is diagnosed on the basis of the symptoms that a person is experiencing, whereas a person with celiac disease may not have any symptoms despite the ongoing damage to the small intestine.
People with celiac disease may also have symptoms that are not related to the digestive system, while IBS does not cause those types of symptoms. For example, celiac disease can cause symptoms such as joint pain, weakened bones (osteoporosis), or dental problems.
What are some other differences between IBS and celiac disease?2,3
IBS is a condition that mainly affects the large intestine (colon), while celiac disease mainly affects the small intestine. IBS is a “functional” disorder, which means that the digestive system is not working like it should, but not due to damage. In contrast, celiac disease has symptoms that are caused by damage to the small intestine. In people with IBS, symptoms are thought to be caused by changes in the patterns of movement inside the intestine as digested food moves through the digestive tract. People with celiac disease have symptoms that are caused by damage in the intestines due to their immune system’s response to gluten, not to changes in the way the intestines move.
Celiac disease not the only condition that can make person unable to digest gluten well–it may be caused by a gluten sensitivity or a gluten allergy. This can make figuring out the cause of symptoms more difficult, because some people with IBS have gluten sensitivity that causes IBS symptoms. These symptoms sometimes improve when they cut gluten out of their diet, making it harder to tell if the problem stems from gluten sensitivity, IBS, or both.
Currently there is no specific test that can be used to make a definite diagnosis of IBS, but there are tests that can be used to diagnose celiac disease. Healthcare providers can use these tests to help make a diagnosis if it is unclear what the cause of a person’s symptoms are.
This week on #AskADietitian live, I cover the differences about IBS, celiac, and non-celiac gluten sensitivity – there are IMPORTANT differences, and management varies!
Get the facts on the latest research!
The big takeaways:
What is celiac disease?
Celiac disease is an autoimmune condition, wherein your immune system responds to gluten exposure by destroying the lining of your small intestine. It is not curable, but rather can be managed by a life-long adherence to a gluten free diet. THIS is the disease where exposure matters. Even crumbs can make those with celiac disease unwell. Diagnosis typically in Canada requires a blood test and a biopsy.
IBS is a functional gut disorder. It is not harmful to your health in the way that celiac is (from a damaging perspective), however it can greatly impact quality of life! Read all about it here and here. The best evidence for management is the low FODMAP diet, but at Ignite, we do things a bit differently – encompassing our 4-pillar plan. Find out more about it here.
Non-celiac gluten sensitivity
We don’t know a lot about non-celiac gluten sensitivity yet. In fact, I think we can even say – we’re not sure it’s gluten that’s causing the symptoms. We know that those with non-celiac gluten sensitivity cannot tolerate gluten/wheat, but they do not experience intestinal damage, and do not develop antibodies. It is not considered an autoimmune condition.
We also know it’s not an IgE mediated allergy (think bee stings, peanuts etc.).
We think it may be a non-IgE mediated allergy, triggering other pathways of the immune system (maybe like my sulphite sensitivity!)
The fact is, there is still a lot we don’t know about how the immune system functions – however – a small scale study was recently done to begin to understand the mechanisms of this.
Non-Celiac Gluten Sensitivity in IBS
A recent SMALL scale study, with no control group took a look at how the GI tract/duodenum changes when exposed to a wheat suspension (read: not isolating various components, thereby not fully understanding the cause yet – but still an important first step). 13/36 IBS patients exposed to this wheat suspension had increased lymphocytes, epithelial shedding, and GI permeability. The remaining 23 did not.
This is the first studies directly looking at luminal changes in the gut when exposed to wheat in those who struggle with GI issues.
YES – it’s exciting. But the fact is – we need more information. We don’t know the mechanism yet. We don’t know rates of occurrence in a population without IBS. We don’t know what component of the wheat suspension may have triggered it, and if it occurs with other foods.
If you suspect you may have an intolerance to gluten – NEVER cut it out as your ‘first line defence’. Go to your doctor. Get the blood test. If you remove gluten from your diet, it will make proper diagnosis extremely difficult.
Your diagnosis then determines management.
Working with an RD to begin to tease out if your symptoms are solely IBS, or if you may have non-celiac gluten sensitivity is your next step. While we don’t have a test for this, with proper implementation of diets like the low FODMAP diet, we can help to guide you through managing your GI symptoms and living with a better quality of life!
At Ignite, we help people with coordination of care, and a holistic approach to health and wellness. Work with one of our dietitians today!