When Gluten Attacks: The Reality of Celiac Disease

Celiac Disease vs Gluten Intolerance

Celiac disease and gluten intolerance can be confused because they share some symptoms, but they are different conditions.

With celiac disease, eating gluten triggers an immune response that physically damages the intestinal lining. That damage is measurable, cumulative and requires strict, lifelong dietary management along with regular medical monitoring.

Gluten intolerance, sometimes called non-celiac gluten sensitivity, can cause discomfort after eating gluten. But it does not involve an immune attack on the intestine and does not cause permanent damage.

If you are unsure which condition applies to you, an accurate diagnosis from your physician is the only way to know for certain.

What Causes Celiac Disease?

The exact cause of celiac disease is not fully understood. Most experts believe it develops through a combination of genetic risk, the introduction or reintroduction of gluten and how the immune system reacts to that. With celiac disease, the immune system attacks the lining of the small intestine, which leads to inflammation and damage over time.

Genetic Risk

Celiac disease tends to run in families. If a parent or sibling has celiac disease, your risk increases. Certain genes make individuals more likely to develop the condition, but carrying these genes does not mean you will have the disease.

Other Risk Factors

People with certain conditions, such as type 1 diabetes or thyroid disease, have a higher rate of celiac disease. Researchers believe these conditions share a common genetic marker.

What Are the Symptoms of Celiac Disease?

Celiac disease symptoms are different for every person. Some people experience digestive symptoms, while others notice changes that seem unrelated to food, such as low energy, weight changes and a decline in overall health and well-being.

Digestive Symptoms

The most common symptoms involve the gastrointestinal tract and may include:

• Abdominal pain or bloating
• Chronic diarrhea
• Constipation
• Nausea or vomiting

These symptoms can develop over time and appear hours after eating gluten, which makes the food connection easy to miss.

Non-Digestive Symptoms

Because malabsorption can affect the body’s overall nutrition, symptoms can affect the entire body, not just digestion. These may include:

• Bone or joint pain
• Fatigue
• Iron deficiency anemia
• Unintended weight loss

Silent Celiac Disease

Some people with celiac disease do not notice clear symptoms. This is called silent celiac disease. Without these physical warning signs, damage continues undetected.

Screening is recommended if you have a first-degree relative with celiac disease, if you are diagnosed with type 1 diabetes or thyroid disease, or have anemia or low bone density. A routine blood test can sometimes detect the disease before symptoms appear.

Symptoms in Children

In children, symptoms may differ from those in adults. Common signs include:

• Abdominal pain
• Delayed growth or short stature
• Fatigue or irritability
• Poor weight gain

The Risks of Untreated Celiac Disease

When gluten consumption continues without a diagnosis, damage to the lining of the intestine builds. That damage can affect digestion but also other body functions.

Complications of Ongoing Damage

Untreated celiac disease can lead to serious health problems, including:

• Bone weakening (osteoporosis) due to poor calcium and vitamin D absorption
• Infertility, which can occur when nutrient deficiencies and inflammation affect reproductive health
• Malnutrition since the body cannot absorb enough vitamins and minerals
• Neurologic symptoms, such as numbness or difficulty with coordination because of long-term nutrient loss

Secondary Conditions

Damage to the small intestine can lead to lactose intolerance, which is a difficulty digesting dairy. This can improve once the intestine heals on a gluten-free diet.

People with celiac disease also have higher rates of other autoimmune disorders, including thyroid disease and type 1 diabetes.

How Is Celiac Disease Diagnosed?

To diagnose celiac disease, physicians usually begin with blood tests that look for specific antibodies. These tests help identify an immune response to gluten.

If a blood test result suggests celiac disease, your physician may recommend an upper endoscopy with biopsy. This is a procedure where we gently guide a thin, flexible scope through your mouth into the small intestine. It allows your physician to take a small tissue sample and examine it for intestinal damage.

“These tests help us confirm the diagnosis and understand how much healing the intestine needs,” said Dr. Freeman. “Once we know what is happening, we can guide treatment and long-term care.”

Celiac Disease Treatment and Management

The only proven treatment for celiac disease is a strict gluten-free diet. It is not a lifestyle choice but rather a medical intervention that gives the intestines the chance to recover.

A gluten-free diet eliminates foods containing wheat, barley and rye. This includes many breads, pastas and processed foods. Even small amounts of gluten can trigger inflammation, so careful label reading and food preparation are important.

“Because celiac disease affects nutrient absorption, some people develop deficiencies in iron, calcium or vitamins. We work with patients to make sure they get proper nutrition and support,” said Dr. Freeman. “Supplements are often recommended during the early treatment phase. With time, the intestine can heal and symptoms often improve.”

Regular follow-up visits help track healing. Many people feel improvements within a few weeks of starting a gluten-free diet. Full intestinal healing can take longer, especially for adults.

Lifestyle and Long-Term Management

Day-to-day awareness and management of the disease involves building new habits. With the right plan, many people live healthy, active lives.

• A gluten-free diet can feel like a challenge at first. Work to adjust routines, social habits and meal planning and get support from your care team, family and friends.
• Prevent cross-contact in your kitchen and when eating out. Use separate utensils or prep areas when needed and ask questions at restaurants.
• The Celiac Disease Foundation offers educational resources and guidance for people living with celiac disease. These resources can help you navigate food choices, understand treatment and connect with others who share similar experiences.

Long-Term Outlook and Follow-Up

With proper treatment, many people with the disease experience improvement. The intestine can heal, symptoms can improve and complications can be prevented. Regular medical care helps monitor recovery and maintain long-term health.

With consistent care and a gluten-free diet, many people regain their energy and feel well again. The goal is to help you stay healthy for the long term.

If you have ongoing digestive symptoms, unexplained fatigue or a family history of celiac disease, it is worth talking to a physician. A gastroenterologist can review your symptoms, order the right test and help you understand your options.