Mayo Clinic Q&A
DEAR MAYO CLINIC: If someone has been diagnosed with celiac disease but has never had any symptoms, would eating a gluten-free diet still be necessary?
ANSWER: Following a strict gluten-free diet is important for anyone who has celiac disease, even if the disorder does not trigger any symptoms. Eating gluten when you have celiac disease injures the small intestine. Over time, that injury raises the risk for developing complications related to celiac disease.
In people who have celiac disease, eating gluten — a protein found in wheat, barley and rye — sparks an immune response in the small intestine that leads to inflammation. Over time, that inflammation damages the tiny, hair-like projections, called villi, which line the small intestine. Villi absorb vitamins, minerals and other nutrients from the food you eat. Normally, villi resemble the deep pile of a plush carpet, on a microscopic scale. The damage resulting from celiac disease makes the inner surface of the small intestine appear more like a tile floor. When that happens, the small intestine has difficulty absorbing some crucial nutrients the body needs to stay healthy and grow.
The symptoms and presentation of celiac disease can vary quite a bit from one person to another. In some cases, it may not cause noticeable symptoms right away. When symptoms do occur, they can include bloating and weight loss. Bowel changes due to celiac disease may trigger a range of gastrointestinal symptoms, from diarrhea to constipation.
Some people who have celiac disease don’t have any gastrointestinal problems. Instead, tests may reveal iron-deficiency anemia or premature bone disease. Less common symptoms of celiac disease can include an itchy, burning rash, called dermatitis herpetiformis, as well as heartburn, headaches, fatigue and joint pain, among others.
When celiac disease doesn’t cause symptoms, following a gluten-free diet may seem like an unnecessary challenge. But it is critical for everyone with celiac disease to eliminate gluten from the foods they eat. If that doesn’t happen, celiac disease can result in serious complications.
For example, when the small intestine cannot absorb enough calcium and vitamin D, it may lead to softening of the bone in children and a loss of bone density in adults. Over time, a range of other problems also may develop as a result of the body not getting the nutrients it needs — from skin rashes and difficulty absorbing lactose to infertility and nerve damage. People with celiac disease who don’t maintain a gluten-free diet also have a greater risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer.
Eating a diet without gluten may seem daunting at first, but you don’t have to manage it alone. For help planning a healthy gluten-free diet, consult with a registered dietitian who is familiar with celiac disease. He or she can give you an overview of gluten-free foods, show you which foods to avoid, and help you learn to recognize ingredients on nutrition labels that contain gluten. A dietitian also can offer gluten-free meal ideas and recipes.
Fortunately, gluten-free products are becoming more popular and easier to find, including gluten-free breads, pastas and baked goods. If you have trouble locating gluten-free items at your local bakery or grocery store, check online. Many companies now ship these products across the country.
Once gluten is removed from the diet, inflammation in the small intestine generally begins to lessen. Complete healing and regrowth of the villi may take several months to several years, so maintaining a gluten-free diet is vital for intestinal healing. — Amy Oxentenko, M.D., Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.