Celiac Disease & Gluten-Free Diet

What is Celiac Disease?

Celiac disease is a serious autoimmune disorder of the small intestine triggered by the consumption of gluten. Specifically, when a person with celiac disease consumes gluten, their immune system attacks the small intestine, causing chronic local inflammation and gradually destroying the intestinal villi. This is crucial because the intestinal villi are located on the inner wall of the small intestine, appearing as finger-like projections into the intestinal lumen, and are responsible for absorbing many nutrients from food. Therefore, when gluten enters the body, these projections begin to atrophy, leading to a decrease in the absorptive surface area of the small intestine.

What is Gluten?

Gluten is the general term used to define the storage proteins found in the endosperm (i.e., the inner part) of many cereals, such as wheat and its various varieties (spelt, einkorn), rye, and barley. It is a complex protein with various subunits. The main groups of gluten are prolamins, which have a high content of the amino acids proline and glutamine (hence their name), and glutelins. The prolamins of wheat are called gliadins, of rye are secalins, and of barley are hordeins.

Gluten has the ability to give elasticity to dough, helping it rise and maintain its shape, giving the final product a sticky texture. However, in individuals with celiac disease, this very protein is responsible for the cascade of reactions described above.

Symptoms of Celiac Disease

Celiac disease can cause symptoms related to the gastrointestinal system and is quite common, but it can also cause symptoms outside the gastrointestinal tract. Specifically, individuals with celiac disease often experience diarrhea, abdominal pain, bloating, and flatulence (i.e., gas). This occurs because malabsorption of nutrients and their presence in the intestinal lumen increases osmotic pressure, leading to water entering the intestine, causing swelling and abdominal distention, possibly even pain in individuals with visceral hypersensitivity. Subsequently, the substances that have not been absorbed move to the large intestine, where some are fermented by local microorganisms, producing gas. This naturally exacerbates bloating, pain, and can lead to flatulence.

Nutrient malabsorption can also lead to low levels of certain markers in blood tests. Anemia (i.e., low hemoglobin levels) is quite common since iron is absorbed in the upper part of the intestine, the duodenum, which is the first to be affected, and low levels of vitamin B12 are also frequently observed.

Additionally, in children with celiac disease, low stature or growth stagnation is often observed due to reduced absorption of micronutrients (e.g., calcium) and due to improper absorption of all the calories from food and the loss of some through feces.

Finally, sometimes symptoms unrelated directly to the intestine are observed, such as dermatitis, depression, infertility, and others.

Diagnosis of Celiac Disease

Diagnosis of celiac disease is made through measuring specific antibodies in the blood, such as anti-endomysial antibodies (EMA) and anti-tissue transglutaminase antibodies (anti-tTG IgA), and can appear only in individuals with a genetic predisposition to this condition. Confirmation of the disease is made through gastroscopy and intestinal biopsy, where characteristic lesions are observed on the inner wall of the small intestine, including partial or total atrophy (flattening) of the villi. The more challenging cases are those where, despite histological lesions, individuals are clearly asymptomatic or exhibit non-specific symptoms outside the gastrointestinal system, e.g., anemia, chronic fatigue, infertility, etc. (asymptomatic or silent celiac disease).

Diagnosing celiac disease is particularly stressful for the entire family, both for the individual with the disease and for those in their close environment, as it truly affects the daily life of the entire family. Especially at young ages, the child is called to mature a bit faster and realize what is happening to them, while parents experience intense stress until they understand how to manage the situation and make the child's dietary environment safe.

Prevalence of Celiac Disease

Celiac disease appears in approximately 1% of the general population worldwide, although most cases remain undiagnosed for a long time, as the disease often does not present typical symptoms or there are other diagnoses that doctors often consider, with the most common being irritable bowel syndrome. Celiac disease is more common in women and in individuals with first-degree relatives diagnosed with the disease. In certain countries with more developed diagnostic protocols, the recognition frequency is higher, highlighting the importance of raising awareness among the public and healthcare professionals.

Management of Celiac Disease

The management of the disease is singular and involves lifelong exclusion of gluten from the diet of the individual with celiac disease. This means that all dietary sources of gluten, such as wheat, rye, barley, and all products made from them, must be removed from the individual's diet. However, it is also very important to remove all those products that may have been contaminated with gluten during their preparation (e.g., oatmeal) because even traces of gluten are capable of triggering the activation of the immune system and the destruction of the intestinal villi.

To be certain that a product does not contain gluten or traces of gluten, it must bear the label "gluten-free." This claim means that the product contains less than 20ppm of gluten and is suitable for those with celiac disease.

All products made from gluten-free cereals (e.g., bread, biscuits) must bear the "gluten-free" label, but also all foods that are naturally gluten-free, such as rice, buckwheat, millet, amaranth, quinoa—all of these must also bear the "gluten-free" label as contamination with gluten may have occurred during their preparation.

Individuals with celiac disease must also be cautious with the utensils they use in their daily life, e.g., toasters, baking trays, pots, etc., as contamination may occur if they are used simultaneously by individuals without celiac disease for preparing meals with gluten-containing cereals. For example, if a sandwich with wheat bread is toasted in a toaster and then a sandwich with gluten-free bread is toasted, the second sandwich will have been contaminated with traces of gluten left in the toaster from the first sandwich. Using parchment paper is the recommended solution in such cases, or the individual can have utensils they use exclusively for preparing their own gluten-free meals.

Biologiko Xorio and Gluten-Free Products

At Biologiko Xorio, there is a wide range of special dietary products, including quality and safe gluten-free products that bear the necessary "gluten-free" label, which is very important as mentioned for individuals with celiac disease, but also very important for parents of a child with celiac disease, so there is no anxiety regarding the safety of the products they procure for their child.

Because to take care of our health, someone must take care of what we eat!

Efi Koloverou
Clinical Dietitian
Specialization: Obesity - Diabetes
Doctor of Harokopio University