You probably associate Celiac disease—the autoimmune disorder where gluten (the protein in wheat, rye, and barley) damages the villi (small finger-link projections that line the small intestine)—with gastrointestinal awfulness like diarrhea and stomach pain. But brace yourself—there are actually close to 300 symptoms that Celiac can set off, according to The University of Chicago Celiac Disease Center, and they can run the gamut from psychological to physical to neurological. "Some patients have strange symptoms, like early menopause or thinning hair, but don't associate them with celiac disease," says Sonia Kupfer, MD, assistant professor and member of the Celiac Disease Center.
24. Verily the likeness of
(this) worldly life is as the water (rain) which We send down from the sky, so
by it arises the intermingled produce of the earth of which men and cattle eat
until when the earth is clad with its adornments and is beautified, and its
people think that they have all the powers of disposal over it, Our Command
reaches it by night or by day and We make it like a clean-mown harvest, as if
it had not flourished yesterday! Thus do We explain the Ayat (proofs, evidences, verses,
lessons, signs, revelations, laws, etc.) in detail for the people who reflect.
25. Allah calls to the home
of peace (i.e. Paradise, by accepting Allah's religion of Islamic Monotheism
and by doing righteous good deeds and abstaining from polytheism and evil
deeds) and guides whom He wills to a Straight Path.
26. For those who have done
good is the best (reward, i.e. Paradise) and even more (i.e. having the honour
of glancing at the Countenance of Allah) Neither darkness nor dust nor any
humiliating disgrace shall cover their faces. They are the dwellers of
Paradise, they will abide therein forever. 10. Surah Yunus (Jonah)
According to the Celiac Disease Foundation, the condition may affect 1 in 100 people, so it's important to ID the hidden—and bizarre—signs that you may be suffering. Even if these symptoms sound familiar though, you shouldn't ditch gluten completely on your own and see if you feel better. Make an appointment with your doctor and ask about getting the simple blood test that detects the disease. (If you stop eating gluten before you take the test, the results won't be as accurate).
Here, five common—but strange—signs you might have Celiac:
1. You're anemic
If a blood test has revealed your body is running low on iron—the mineral that helps make hemoglobin, a protein in red blood cells that ferries oxygen around the body—Celiac may be the cause, since iron gets absorbed in the part of the small intestine damaged by the disease. "Women often think it's their period that's causing the iron deficiency, but that may not always be the case," says Kupfer. Doctors don't always make the connection between Celiac and more vague symptoms like anemia, but one study found that one-third of patients diagnosed were anemic. If you're experiencing symptoms of anemia, like fatigue and weakness, ask your doctor about running an iron level test, and if yours turn out to be abnormally low, consider being tested for Celiac.
If a blood test has revealed your body is running low on iron—the mineral that helps make hemoglobin, a protein in red blood cells that ferries oxygen around the body—Celiac may be the cause, since iron gets absorbed in the part of the small intestine damaged by the disease. "Women often think it's their period that's causing the iron deficiency, but that may not always be the case," says Kupfer. Doctors don't always make the connection between Celiac and more vague symptoms like anemia, but one study found that one-third of patients diagnosed were anemic. If you're experiencing symptoms of anemia, like fatigue and weakness, ask your doctor about running an iron level test, and if yours turn out to be abnormally low, consider being tested for Celiac.
2. You can't think straight
Why'd you walk into this room? What were you about to do? Sure, we all have those brain blip moments, but if brain fog happens often and you can't attribute it to other causes (like stress), it could be Celiac. "Antibodies produced by the body in response to gluten could be related to neurological symptoms, but exactly how this works isn't understood," says Kupfer. If you do have Celiac, a gluten-free diet may help you feel more on the ball.
Why'd you walk into this room? What were you about to do? Sure, we all have those brain blip moments, but if brain fog happens often and you can't attribute it to other causes (like stress), it could be Celiac. "Antibodies produced by the body in response to gluten could be related to neurological symptoms, but exactly how this works isn't understood," says Kupfer. If you do have Celiac, a gluten-free diet may help you feel more on the ball.
MORE: The Herbal Remedy To Banish Brain Fog
3. You feel hopeless
"Depression and anxiety are common in Celiac," says Kupfer. "It may be related to inflammation caused by the disease, or simply the fact that you're not feeling physically well," she says. She has patients who report their mood gets better on a gluten-free diet. Still, because depression and anxiety are so common in the general population, Kupfer doesn't suggest getting screened for Celiac if this is your only symptom. However, if you notice this and others on the list, it might be time to have that talk with your doc.
"Depression and anxiety are common in Celiac," says Kupfer. "It may be related to inflammation caused by the disease, or simply the fact that you're not feeling physically well," she says. She has patients who report their mood gets better on a gluten-free diet. Still, because depression and anxiety are so common in the general population, Kupfer doesn't suggest getting screened for Celiac if this is your only symptom. However, if you notice this and others on the list, it might be time to have that talk with your doc.
4. You suffered a fracture
A 2014 review in the Journal of Clinical Endocrinology & Metabolism found that Celiac sufferers have a 30% increased risk of having any type of fracture compared to individuals without Celiac; more specifically, a 69% increase in risk of a hip fracture. That's possibly because nutrients like calcium are not as well absorbed in the damaged small intestine. Pay particular attention to this symptom if you're suffering from signs of osteoporosis at an early age, like bone fractures or posture problems.
A 2014 review in the Journal of Clinical Endocrinology & Metabolism found that Celiac sufferers have a 30% increased risk of having any type of fracture compared to individuals without Celiac; more specifically, a 69% increase in risk of a hip fracture. That's possibly because nutrients like calcium are not as well absorbed in the damaged small intestine. Pay particular attention to this symptom if you're suffering from signs of osteoporosis at an early age, like bone fractures or posture problems.
5. Your balance is iffy
Maybe you're a bit unsteady when you stand or you're stumbling often when you used to walk just fine. Balance issues and other symptoms like numbness and tingling in hands and feet are all neurological problems associated with Celiac. Though it's not entirely understood why, one 2012 UK study conducted MRIs on the brains of Celiac patients with these complaints and found brain changes—specifically less grey matter density—in areas that affect motor skills and cognition.
Maybe you're a bit unsteady when you stand or you're stumbling often when you used to walk just fine. Balance issues and other symptoms like numbness and tingling in hands and feet are all neurological problems associated with Celiac. Though it's not entirely understood why, one 2012 UK study conducted MRIs on the brains of Celiac patients with these complaints and found brain changes—specifically less grey matter density—in areas that affect motor skills and cognition.
Checking children for growth problems may help identify those with celiac disease, according to a new study.
Celiac disease is an autoimmune disorder in which the body has an immune reaction to a component of wheat called gluten, leading to damage to the small intestine. According to the Celiac Disease Foundation, the illness strikes about one in every 100 people worldwide.
Celiac disease is typically difficult to diagnose. It leads to "short stature, poor weight gain and poor growth, and has been underdiagnosed in children," said one expert, Dr. Gina Sam, director of the Gastrointestinal Motility Center at Mount Sinai in New York City.
The new study was led by Dr. Antti Saari of the University of Eastern Finland. His team tracked the growth of 177 children from the time they were born until they were diagnosed with celiac disease.
The researchers found that screening children for five height- and weight-related differences in growth could be an effective means of spotting those with celiac disease. Using all five measures together was more effective than using one alone, Saari's team noted.
Compared to children in the general population, girls with celiac disease were shorter two years before their diagnosis, while boys were shorter one year before diagnosis, according to the study published online March 2 in the journal JAMA Pediatrics.
"Growth failure remains an early and common feature in patients with celiac disease and an up-to-date growth reference and well-established growth-monitoring program could facilitate the early diagnosis of celiac disease," the research team wrote.
Sam called the research "important," agreeing that tracking growth may "help us diagnose young kids with celiac disease earlier."
Dr. Michael Joseph Pettei is chief of the division of gastroenterology at Cohen Children's Medical Center in New Hyde Park, N.Y. He said the new study "extends the well-known association of growth failure in children with celiac disease."
Pettei believes the study "emphasizes the importance of regular well-child pediatric care with careful and sophisticated attention to subtle weight and height changes."
When people with celiac disease eat gluten (a protein found in wheat, rye and barley), their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body.
Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease.
Long Term Health Effects
Celiac disease can develop at any age after people start eating foods or medicines that contain gluten. Left untreated, celiac disease can lead to additional serious health problems. These include the development of other autoimmune disorders like Type I diabetes and multiple sclerosis (MS), dermatitis herpetiformis (an itchy skin rash), anemia, osteoporosis, infertility and miscarriage, neurological conditions like epilepsy and migraines, short stature, and intestinal cancers.
Treatment
Currently, the only treatment for celiac disease is lifelong adherence to a strict gluten-free diet. People living gluten-free must avoid foods with wheat, rye and barley, such as bread and beer. Ingesting small amounts of gluten, like crumbs from a cutting board or toaster, can trigger small intestine damage.
Read about the Gluten-Free Diet.
Celiac disease is also known as coeliac disease, celiac sprue, non-tropical sprue, and gluten sensitive enteropathy.
Undiagnosed or untreated celiac disease can lead to:
Long-Term Health Conditions
- Iron deficiency anemia
- Early onset osteoporosis or osteopenia
- Infertility and miscarriage
- Lactose intolerance
- Vitamin and mineral deficiencies
- Central and peripheral nervous system disorders
- Pancreatic insufficiency
- Intestinal lymphomas and other GI cancers (malignancies)
- Gall bladder malfunction
- Neurological manifestations, including ataxia, epileptic seizures, dementia, migraine, neuropathy, myopathy and multifocal leucoencephalopathy
Celiac disease may be at the root of some women’s problems with infertility, Indian researchers say. While there are many more common causes of infertility, the study suggests that women who don't have a ready explanation for their failure to conceive should be screened for celiac disease, said Dr. Govind Makharia, a professor at All India institute of Medical Sciences in New Delhi. "There isn't strong evidence to say that celiac disease causes infertility, but there are many anecdotal experiences where women with infertility have conceived after being diagnosed with celiac disease and put on a gluten free diet," Makharia told Reuters Health in an e-mail
About one in 100 people have celiac disease. If they consume wheat, barley or rye, or foods that contain those grains, their immune response leads to intestinal damage, malnutrition and other problems.
Generally, women are considered infertile after one year of unsuccessfully trying to conceive, or six months if they are older than 35. The most common causes are hormonal problems that stop the ovaries from producing or releasing mature eggs. Being extremely underweight or overweight can impact fertility, as can excessive exercise, smoking, and drinking.
To explore the link between celiac disease and infertility, Makharia's research team pooled results from previously published research studies.
Women with infertility were 3.5 times more likely to have celiac disease than women who didn't have difficulty conceiving, the analysis found, based on a review of three studies including 449 women with infertility.
For women with no known cause for their infertility, the connection was even stronger. These women were six times more likely to have celiac disease, based on data from five studies including 422 women with unexplained infertility.
"Celiac disease has been claimed to be the most common cause of unexplained infertility and these results support that conclusion," said Dr. Alessio Fasano, director of the Center for Celiac Research at Massachusetts General Hospital in Boston.
Celiac disease is not always recognized right away in women with fertility issues because ob-gyns will typically send them to see an endocrinologist, to explore hormonal causes, before they consider rarer conditions such as celiac disease, said Fasano, who wasn't involved in the study.
The study findings suggest that ob-gyns should consider a blood test to rule out celiac disease before sending a woman to other specialists, he said.
"If I was an ob-gyn, I would do the screening for celiac right there in my office before I sent the woman anywhere else," Fasano said.
Typically though, doctors start looking for the cause of infertility by asking women to record what's known as their basal body temperature, a reading taken immediately after waking up each morning, for two to three months to see which days the temperature spikes to indicate ovulation. This will show whether the woman has a normal menstrual cycle, and whether she's ovulating at the same time each month, potentially helping her to plan intercourse during the point in the cycle when she's most likely to conceive.
There may also be urine and blood tests to screen for a variety of hormones involved in ovulation, as well as imaging tests to see if there are problems with the Fallopian tubes or the uterus.
While the new analysis, published in the Journal of Clinical Gastroenterology, establishes a link between celiac disease and infertility, it doesn't prove that celiac disease causes infertility, a task that has eluded scientists for decades. The researchers also said that the validity of their analysis is limited because it's based on just a handful of published studies with a small number of women.
"The issue of celiac disease as a cause of infertility has remained a debatable issue," Makharia said. "The pooling of data from all the eligible studies in this meta-analysis now brings forth reasonable evidence to support screening."
Gluten is the dietary boogeyman du jour.
And for people with celiac disease, a serious autoimmune disorder, gluten — a protein found in wheat, rye and barley — really is the boogeyman, triggering painful gastrointestinal inflammation and other symptoms. For these people, the phenomenal popularity of gluten-free diets has been both a blessing and a curse.
Kristen Deschamps, a university student in Calgary, Alberta, says that when she was diagnosed with celiac disease four years ago, "it was virtually impossible to find gluten-free products, and if you did, they tasted terrible."
But now she says she can easily find gluten-free doughnuts and pastries.
The profusion of gluten-free foods has made social events much less isolating, says Molly Lewis, a 28-year-old human resources professional in DeRidder, La., diagnosed with celiac disease in early 2014. "Having access to replacement foods helps you feel more included in events, parties and holidays," Lewis tells me.
But wider availability of gluten-free options has come at a price: Some people afflicted with celiac disease say their disorder isn't always taken seriously when they eat out.
"The biggest problem I experience is that restaurant servers don't understand the difference between being celiac and going gluten-free as a lifestyle choice," Deschamps says. "You can see the reaction where they think I'm just trying to lose weight or on a fad diet. I see eye-rolling."
Indeed, gluten-free has been one of the biggest diet trends of recent years. Although less than 1 percent of the population has celiac disease, a 2013 poll found that 30 percent of American adults say they are trying to avoid gluten. And it's not just the U.S.: Canadians and Europeans are increasingly going gluten-free, too.
There's a lot of confusion around gluten, even among people who eschew eating it, as late-night talk show host Jimmy Kimmel humorously demonstrated last year. The dramatic growth of the gluten-free movement has also spawned a vigorous backlash, with critics dismissing it as just the latest dietary fad.
"A lot of people who don't know much about [celiac disease] liken it to the Atkins diet," Lewis says. When she tells people that she avoids gluten for medical reasons, she says, "in many cases, I'm viewed as being difficult or seeking attention instead of just trying not to get sick."
Lewis says it has become worse in the past year. "Four out of five times, when I eat out, I find that my condition was not taken seriously. I can tell by the reaction from the server. They'll look at me like I'm crazy, and I know I'm going to get sick" because gluten will end up in the food, she says. For Lewis, getting sick involves gastrointestinal distress, followed by acne and negative mood changes lasting a week or more.
Deschamps, who also works as a restaurant server, experiences it from both sides: She sees customers order gluten-free meals washed down with a gluten-filled beer. On multiple occasions when dining out, she says, she has been emphatic to servers about her condition but was still served foods containing gluten. She has had major exposures resulting in "severe stomach pain, like a very sharp stabbing — sometimes to the point where I can't move for several hours."
Krista Moise, a 43-year-old chemist in Lively, Ontario, was diagnosed with celiac disease eight years ago. "Because so many are doing gluten-free as a lifestyle now," she says, "I'm embarrassed to ask for a gluten-free meal because of people judging me."
Moise says some gluten-free eaters who don't have her disorder can sound like ex-smokers talking about cigarettes when they say, "Gluten is just so bad for you." She says it's a "holier than thou" attitude that rubs her the wrong way.
"I don't want to be lumped in with these people," says Moise, who says she recently was sick for days after eating an allegedly gluten-free meal at her stepdaughter's wedding.
Many people who avoid gluten have diagnosed themselves with nonceliac gluten sensitivity, a condition that describes less severe reactions to eating the protein. These folks say that eliminating gluten from their diet makes them feel better.
But, as The Salt has reported, gastroenterologists who are trying to untangle the issue are coming to believe that only a very small number of nonceliac people are genuinely experiencing gluten sensitivity.
As gastroenterologist Joseph Murray, a professor of medicine at the Mayo Clinic who studies celiac disease, told The New Yorker, "Everyone is trying to figure out what is going on, but nobody in medicine, at least not in my field, thinks this adds up to anything like the number of people who say they feel better when they take gluten out of their diet."
Some researchers suspect that people who attribute their gastric distress to gluten intolerance are more likely to be reacting to a type of carbohydrate found in wheat and other foods called FODMAPs. Some of these scientists have suggested a better term would be "wheat intolerance."
Aside from the perceptions some have that going gluten-free improves their health, the proliferation of gluten-free labels also sends the message that gluten must be bad. Dr.Ovidio Bermudez at Eating Recovery Center in Denver suggests that some people who are ditching gluten may simply see it as a quick shortcut to health.
"As we [deal] with more stress and greater complexity in how we live, work and play, we are looking for ways to be healthier, and it's taken a toll," Bermudez tells me. For some people, he says, avoiding gluten can be "a way to move towards health and reassure themselves that they're doing something 'right.' "
Unfortunately, such people who simply see a health halo around gluten-free may unwittingly be making life more challenging for those with celiac disease, by contributing to an environment where food servers have come to dismiss gluten avoidance as a silly fad that isn't worth taking seriously.
The Gluten-Free Diet
Currently the only way to treat celiac disease and gluten sensitivity is to avoid eating anything with even trace amounts of gluten. That’s hard. Gluten is in bread, pasta and baked goods. Often used in processed foods as an additive or preservative, it may lurk in salad dressing, soups and even candy.
Dr. Fasano suspects a fair number of the 100 million Americans currently consuming gluten-free products may in fact have gluten sensitivity or undiagnosed celiac disease. He strongly urges people who suspect they have a problem to be tested for celiac disease and other conditions that cause similar symptoms before going on the gluten-free diet, however.
“This is not the South Beach diet,” he says. “Treat this diet with respect as a medical treatment. For people with celiac disease, the gluten-free diet is like insulin for diabetics.”
The best way to stay healthy while eating gluten-free, Dr. Fasano believes, is to eat a variety of meats, seafood, fruits and vegetables that naturally don’t contain gluten. There are many commercially available gluten-free foods, but these products can be higher in fat and calories.
When he talks to patient groups about the gluten-free diet, he likes to demonstrate how easy it is to prepare healthy gluten-free meals liked the ones his mother cooked for him growing up. Like his mother—who still lives in Salerno on the southwest coast of Italy—he is a fantastic cook. In his book, Gluten Freedom, he includes adaptations of favorite recipes he learned from his mother.
“I can put together a great, healthy meal from scratch in a half hour,” Dr. Fasano says. In fact, he does just that at the end of long day, after he’s gone for a run or played tennis if there’s time.
There’s not much time in his day for hobbies, he admits. He owns a vintage Maserati car and a Harley Davidson motorcycle, both known for speed. But it is their beauty and engineering that he adores. It is similar to the awe he feels for the exquisite machinery of the human body.
More Clues to Find
Whether it’s his patients, Harvard Medical School students or doctoral candidates working in his lab, Dr. Fasano relishes teaching and mentoring others. At 58, he knows he’ll one day pass his quest for better therapies on to others, but for the foreseeable future, there is much more that he wants to do.
Dr. Fasano wants to know: Among people with a genetic predisposition for celiac disease, some develop the condition at age 2, others at age 72 and some never at all. What accounts for the difference and can we prevent the switch from happening?
He has commenced an ambitious long-term study, called CDGEMM, following infants from birth who are at risk for celiac disease. Preliminary research indicates that there are metabolic changes in the patterns of bacteria in the intestines, months before someone develops celiac disease.
Identifying these changes could present an opportunity to prevent the autoimmune disorder. As he has many other times in his career, Dr. Fasano is setting off to prove it. “To be able to intervene and re-establish the balance would be the Holy Grail,” he says.
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