Your Calgary Choice for Services related to Celiac Disease

If you have recently been diagnosed with celiac disease and require guidance or support with your gluten-free diet, Rory is here for you! Rory will walk you through the foods you should avoid, helping you create recipes and menus that fit into your life.

What is Celiac Disease?

Celiac Disease | Rory Hornstein | Registered Dietitian | Calgary and Surrounding Areas

Celiac disease is a medically diagnosed autoimmune condition where the body does not tolerate gluten in the diet. Gluten is the protein component of wheat, rye, barley and oats. After consuming gluten, the small intestinal lining (villi) in those with celiac disease becomes inflamed, and the normal appearance changes so that it has a flattened appearance. A strict gluten-free diet can reverse these abnormalities and is the only recognized treatment for celiac disease.

Celiac Disease | Rory Hornstein | Registered Dietitian | Calgary and Surrounding Areas
Celiac Disease | Rory Hornstein | Registered Dietitian | Calgary and Surrounding Areas

Presentation of Celiac Disease

Celiac Disease | Rory Hornstein | Registered Dietitian | Calgary and Surrounding Areas

When it comes to symptoms, it is becoming more and more evident that the presentation is incredibly broad. Increasing numbers of adults are being diagnosed, whereas years ago it was considered a disease that was only diagnosed in children. Celiac disease can present at any age, and the variability and often vagueness of symptoms can present a diagnostic challenge to many medical practitioners. Presentation of Celiac Disease can include the following things:

What are the Gastrointestinal symptoms of Celiac Disease?

  • Loose stools/diarrhea, or constipation (or a combination of both)
  • Flatulence
  • Bloating
  • Abdominal pain
  • Nausea
  • Symptoms of celiac disease can often be labeled as irritable bowel syndrome. It is strongly recommended that all people experiencing symptoms of irritable bowel syndrome be investigated for celiac disease.
  • Alternatively, symptoms of celiac disease may present with no gastrointestinal symptoms at all.
  • Lethargy and fatigue
  • Poor weight and growth gain in children
  • Iron, folate, zinc, Vitamin D deficiency
  • Osteopenia and osteoporosis. Approximately 5% of patients being investigated for reduced bone mineral density have undiagnosed celiac disease as a cause.
  • Delayed menarche or recurrent miscarriages in women
  • Infertility (in males and females)
  • Recurrent mouth ulceration
  • Dental enamel defects

Diagnosis of Celiac Disease

Celiac Disease | Rory Hornstein | Registered Dietitian | Calgary and Surrounding Areas

The gold standard for diagnosis of Celiac Disease is a small bowel biopsy (doctors will look for histological evidence of villous atrophy +/- infiltration of lymphocytes). This involves a special camera being passed down the esophagus, past the stomach, and into the first part of the small bowel. There, small samples of the lining of the small bowel are taken and investigated under the microscope. If the biopsy samples show flattening of the lining, then it confirms the existence of celiac disease.

There are some blood tests that can be performed to help screen for celiac disease in “at-risk” populations (e.g. family members of those with diagnosed celiac disease, people with diabetes, etc.). However, these are generally not ideal for a diagnosis, as there can be false positives and false negatives. Blood tests including IgA tissue transglutaminase antibody tests and IgG Deamidated Gliadin Peptide can be ordered (“celiac serology”). A total IgA antibody test should also be performed to help validate tissue transglutaminase results. The small bowel biopsy is still considered the best method for diagnosing celiac disease.

Celiac Disease | Rory Hornstein | Registered Dietitian | Calgary and Surrounding Areas

There is no role for a trial of a Gluten-Free diet without a preceding biopsy to confirm or rule it out. It is important that people being checked for celiac disease still include gluten in their diet. If they cut gluten out of their diet completely (e.g., if they experiment with a gluten-free diet) before being properly diagnosed, they can reduce their chances of being properly diagnosed, as the villi/lining can start to repair and therefore show as negative for the disease. If the camera is inserted to take the samples for biopsy, but the person being tested has already started the gluten-free diet, the biopsies might show things to be normal, since things may have begun repairing since the elimination of the gluten. As such, would not be an accurate result. Therefore, all people who have indicators of celiac disease (e.g. have symptoms) should still be eating gluten while being investigated by their doctor(s) and healthcare practitioners.

Celiac disease is a life-long condition, with no cure. The only treatment available is a diet free from all gluten. A gluten-free diet prevents further damage to the villi and allows patients to return to normal so that nutrients can be properly absorbed. People need to follow the diet even if they are not unwell with symptoms; it must be a strict and life-long commitment. People cannot take a break every now and then and have a bowl of regular pasta, or a slice of regular bread.

Celiac Disease | Rory Hornstein | Registered Dietitian | Calgary and Surrounding Areas

What are the Risks of Celiac Disease?

Celiac Disease | Rory Hornstein | Registered Dietitian | Calgary and Surrounding Areas

If left untreated, people with celiac disease can be at an increased risk of bowel cancer, osteoporosis, infertility, miscarriages, and chronic ill-health. These risks all return to normal when following a strict gluten-free diet.

Once the diagnosis has been made, the following tests are recommended if they have not already been completed: full blood examination, iron studies, folate, vitamin B12, zinc, vitamin D levels, and bone mineral density. Those with celiac disease can also have lactose intolerance, fructose malabsorption, problems with their thyroid gland (underactive, overactive), diabetes, etc. These should all be checked in people with celiac disease.

Celiac Disease | Gluten Free | Rory Hornstein | Registered Dietitian | Calgary and Surrounding Areas

Ongoing monitoring is important. People’s villi usually grow back and return to normal after some time following a gluten-free diet, but the time for this to occur can range from months to years. People need to remain on their gluten-free diet for life, even if the villi grow back. Strict dietary compliance is essential, even in the absence of symptoms. In this sense, people are only treated, they are not cured (until a cure is found – and the doctors are working on it!). A gluten-free diet is successful as a treatment because it prevents further damage to the intestinal lining, allowing villi to heal so that nutrients from food can be properly absorbed. A gluten-free diet involves a lot more than just avoiding regular bread and wheat-based pasta. While it is a very involved diet, there are plenty of foods you can still enjoy! Since the diet must be strict and life-long, and to help ensure that you are enjoying your diet safely and thoroughly, it is recommended that you see a dietitian with experience in celiac disease.

Celiac Disease | Gluten Free | Rory Hornstein | Registered Dietitian | Calgary and Surrounding Areas

All people diagnosed with celiac disease are encouraged to join the Celiac Society (www.celiac.ca).

The gluten-free diet can be challenging and difficult, especially for the first few months following diagnosis. However, it becomes progressively easier as familiarity with the diet and the available foods grows over time. There are many great gluten-free options, and the number of foods is increasing every day. Your Registered Dietitian can help support you on your new gluten-free path, and help you familiarize yourself with all the available food options. You do not need to embark on your gluten-free eating alone; let Rory help you live your best life!

Rory looks forward to helping you achieve your health and nutritional goals.
Contact her via phone at (403) 819-6919, or via email at rory@roryrd.com to learn how she can help with Celiac Disease.

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