Celiac disease is an autoimmune illness, which causes deficiencies of vitamins A to Zinc!

1. Celiac disease is a common autoimmune disease. 1% of the general population has it. If you have Celiac disease, your son, daughter, brother or sister have an 8% risk of having it too!

2. Celiac disease is a great imitator because it can look like so many other diseases. The signs and symptoms can be anything from fatigue to diarrhea to osteoporosis. This makes the diagnosis easy to miss!

3. Pathophysiology of Celiac disease: If you are genetically susceptible (HLA DQ2 and DQ8), gluten peptides pass through the mucosa of the small intestine where they are modified by the enzyme tissue transglutaminase (TTG). They bind with high affinity to DQ2 and DQ8 on antigen presenting cells starting the autoimmune process.

4. Diagnosis of Celiac disease: The currently available blood tests for Celiac disease are 90% sensitive (few false negatives) and 95% specific (few false positives).  Ask your doctor to order “Tissue Transglutaminase IgA” (TTG IgA) from your local laboratory.

5. Who should be tested?  Any one with unexplained:

*  chronic diarrhea

*  weight loss

*  iron deficiency anemia

*  osteoporosis in non-menopausal individuals

*  fatigue

*  peripheral neuropathy or ataxia

*  recurrent canker sores (apthous ulcers)

*  dental enamel problems

*  infertility

*  herpes-like skin rash (dermatitis herpetiformis)

6. Test for “Total IgA” if TTG IgA is negative and your suspicion for Celiac disease is high.

7. Intestinal biopsy is the “gold standard” for diagnosing Celiac disease, but some suggest that biopsy should no longer be required. My take on this is that if a trial on a gluten-free diet resolves your health problems, you have made the diagnosis!

8. Treatment is a 100% gluten-free diet for the rest of your life. The amount of gluten found in a bread crumb (or crouton) is enough to cause intestinal damage! Work with an experienced nutritionist!!!

9. Celiac disease causes severe vitamin and mineral deficiencies. The basic blood tests to order are: ferritin, vitamin B12, folate and 25 – hydroxy vitamin D. Some physicians also test for zinc, copper, vitamin B1, vitamin B6, Vitamin A, Vitamin D, and Vitamin K deficiencies.

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10. Osteoporosis is common in Celiac disease. A bone density test (DEXA scan) should be done. With a gluten free diet, osteoporosis resolves in most cases, but it persists in about 20%.

11. TTG antibody should be monitored yearly and there should be decrease in the titer after one year of gluten avoidance. A persistently positive test probably means ongoing gluten exposure.

13. The LabCorp “Celiac disease panel” includes a newer variation of anti-gliadin IGA and IgG antibodies called "DGP" (which stands for deamidated gliadin peptide). Unlike TTG IgA, anti-gliadin antibodies are not specific for Celiac disease. They result from increased intestinal permeability (“leaky gut”) from any cause. In other words, Celiac disease is not the only cause of high levels of anti-gliadin antibodies.

14. You can recommend the following article for your doctor: 2011 Journal of the American Medical Association 306 (14): 1582-1592