Celiac What is celiac disease?

Celiac disease is a chronic immune-mediated intestinal

disease
disease in genetically predisposed individuals induced by
exposure to dietary gluten proteins that come from wheat,
rye, barley and triticale (a cross between wheat and rye).
It is a different disease than a food allergy.

In celiac disease, the body's immune system responds

The gluten connection abnormally to gluten proteins, resulting in inflammation

and damage to the lining of the small intestine, and
reduced absorption of iron, calcium and vitamins.

The term gluten includes a broad group of related proteins

known as prolamins and glutenins. The prolamins found
in wheat (gliadins), rye (secalins) and barley (hordeins)
are considered to be of most concern to individuals with
celiac disease.

The only current treatment for celiac disease is

maintaining a lifelong strict gluten-free diet.

How common is
celiac disease?
Celiac disease is relatively common, in both adults
and children. It is estimated to affect 0.5–1% the
North American population (Kang et al, 2013), though
many remain undiagnosed. Celiac disease occurs with
increased frequency in relatives of individuals with
celiac disease and in individuals with type 1 diabetes,
autoimmune thyroid disease, Down syndrome and in
people with immunoglobulin A (IgA) deficiency.

2018
When do the symptoms appear? Is diagnosing celiac
The symptoms of celiac disease can develop at any age, once disease difficult?
gluten-containing foods are added to the diet. In the past, celiac
disease was thought to be a childhood disease, but it is now The symptoms of celiac disease are often similar to those of other
recognized that it occurs more frequently in adults, especially in diseases which can make diagnosis difficult. The Canadian Celiac
individuals between 30 and 60 years of age. A Canadian survey on Health Survey reported that it took approximately 12 years after
celiac health reported that the average age of diagnosis in adults the onset of symptoms for adults to be diagnosed with celiac
was 46 years of age (Cranney et al, 2007). disease (Cranney et al, 2007).

Celiac disease can be diagnosed in individuals (while on

a diet that contains gluten) through a combination of the
What are the symptoms? following methods:
a. Antibody blood tests:
The symptoms of celiac disease vary greatly in extent and
severity. Abdominal pain, diarrhea, bloating and constipation are • IgA-transglutaminase antibody (IgA-tTG)
common gastrointestinal symptoms. Some individuals have no • IgA-endomysial antibody (IgA-EMA)
gastrointestinal symptoms but present with fatigue, headaches,
difficulty concentration or depression. Others display no obvious • IgG-deamidated gliadin protein (IgG-DGP)
symptoms and present with anemia (a low red blood cell count Since people with celiac disease are more likely to be IgA
related to iron or folate deficiency) and osteoporosis (decreased deficient, it is also necessary to measure total IgA in order to
bone mass). Children may present with growth impairment or avoid false negatives.
delayed puberty. “Classical” celiac disease in children and adults
with the malabsorption syndrome of bloating, diarrhea, fatty b. Genetic markers (HLA-DQ2 and/or HLA-DQ8) allow exclusion
stools and weight loss or growth failure is now less frequently of a diagnosis of celiac disease when they are negative. For
encountered because of earlier diagnosis since screening with example, the markers HLA-DQ2 and HLA-DQ8 are positive in
serological antibodies has become more widely available. over 99% of individuals with celiac disease but only positive in
40% of the general population.
As the disease progresses with continuing exposure to gluten,
long-term complications can occur. Many organ systems of the c. Small intestine biopsy (tissue sample) is required to confirm
body can be involved, including the gastrointestinal, skeletal, the diagnosis of celiac disease.
reproductive (infertility) and nervous (ataxia (failure of muscular d. Recovery from the symptoms while following a gluten-free diet.
coordination) and neuropathy) systems. Individuals with untreated
celiac disease also have an increased risk of certain cancers.
Small intestine biopsy remains the 'gold standard' test for
confirmation of celiac disease. Testing for the disease
should take place before an individual starts a gluten-
free diet since removal of gluten from the diet would
interfere with the physician’s ability to detect the disease.
After 6 to 12 months of maintaining a strict gluten-free diet,
symptoms should disappear, blood tests for the disease
markedly improve and the small intestine begins to heal.
It is important for patients with celiac disease to regularly
follow up with their family doctor to monitor their progress.

What is the treatment

for celiac disease?
The only current treatment for celiac disease is maintaining a Are there any other
strict gluten-free diet for life. Complete avoidance of gluten
enables the intestine to heal, and the nutritional deficiencies and
gluten‑related disorders?
other symptoms to resolve. Children tend to recover more quickly Gluten-related disorders is a term used to describe all conditions
than adults. Following a strict gluten-free diet also reduces the related to gluten. These conditions include celiac disease, but also:
risk of developing many of the serious long-term complications
related to untreated celiac disease. As some of the foods missing • Wheat allergy, which occurs when a person’s immune system
in a gluten-free diet are important sources of nutrients like fibre, reacts abnormally to wheat proteins; it can be life-threatening.
iron and B vitamins, it is important to follow a dietary pattern The wheat proteins that can trigger an allergic reaction include
that avoids nutritional inadequacy. Therefore, consultation with a gluten proteins (see Health Canada’s pamphlet titled Wheat &
dietitian or nutrition specialist is recommended and invaluable. Triticale - Priority Food Allergens : www.canada.ca/en/health-
canada/services/food-nutrition/reports-publications/food-
Adjusting to a gluten-free diet involves a number of lifestyle safety/wheat-priority-food-allergen.html)
changes since many commonly eaten foods must be avoided, • Non-celiac gluten (wheat) sensitivity refers to a spectrum
including pasta, most breakfast cereals and certain snacks, of symptoms caused by the ingestion of gluten proteins or
most breads and other baked goods including cakes, cookies, other wheat-related components and occurs in individuals
doughnuts, bagels, etc. Wheat flour and wheat starch are also who are not affected with either celiac disease or wheat
frequently added as a thickener or stabilizer to soups, sauces, allergy. Symptoms, which are similar to those seen with celiac
and processed meats and fish, including wieners, sausages and disease, typically resolve with the elimination of wheat and
imitation seafood. Barley is used in the manufacture of beer and other gluten sources. Celiac antibody tests are negative and
of malt, a flavoring agent commonly used in food. To avoid hidden intestinal biopsies are not diagnostic of celiac disease.
sources of gluten in the diet, knowledge of potential sources of
gluten and careful reading of food ingredient lists are essential. In • Dermatitis herpetiformis or celiac disease of the skin is
addition to the gluten-free diet, patients with celiac disease require characterised by an intensely itchy blistering rash. This
multivitamin supplements for the first 1-2 years after diagnosis, disorder is triggered by dietary exposure to gluten and is
vitamin D supplementation and adequate calcium intake. strongly linked to celiac disease although small intestinal
injury is variable in severity.
• Gluten ataxia is unsteadiness or incoordination that is
associated with positive antibody blood tests with or without
small intestinal inflammation. Some of these individuals also
have celiac disease.
To avoid unnecessary dietary restrictions, it is important to avoid
self-diagnosis.
Celiac individuals can enjoy
a wide variety of foods
Adjusting to a gluten-free diet can be challenging, since it involves
knowing what foods contain gluten, and determining possible
hidden sources of gluten in food products. Nevertheless, with
a good knowledge of potential sources of gluten and carefully
reading food labels, celiac individuals can enjoy a wide variety
of foods.

Newly diagnosed patients should ask their physicians to refer

them to a registered dietitian with expertise in celiac disease and
the gluten-free diet for dietary counseling and recommended
follow-up.

Where can I get more information?

For more information on:
• food allergies / celiac disease
Visit Health Canada’s website at www.canada.ca/en/health-canada/services/food-nutrition/food-safety/
food-allergies-intolerances/celiac-disease.html

For information on:

• subscribing to the “Food Recalls and Allergy Alerts” e-mail notification service
Visit the CFIA Website at www.inspection.gc.ca or call 1-800-442-2342/TTY 1-800-465-7735
(8:00 a.m. to 8:00 p.m. Eastern time, Monday to Friday).

For information on this and other Government of Canada programs and services call
• 1 800 O-Canada (1-800-622-6232)
• TTY 1-800-465-7735

Below are some organizations that can provide additional celiac disease and NCGS information:
• Canadian Celiac Association (CCA) www.celiac.ca
• Fondation Québécoise de la Maladie Cœliaque (FQMC) www.fqmc.org

© Her Majesty the Queen in Right of Canada, represented by the Minister of Health, 2018 Cat.: H164-73/2018E-PDF | ISBN: 978-0-660-26703-6 | HC Pub.: 180101