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Celiac disease

Related Terms
  • Antibodies, antibody, autoantibodies, autoantibody, autoimmune, autoimmune disease, autoimmune disorder, autoimmunity, biopsy, celiac, coeliac disease, cornmeal, digestive tract, endoscope, endoscopy, GFD, gluten, gluten-free, gluten-free diet, immune, immune defense system, immune reaction, immune response, immune system, intestinal lining, intestine, malabsorption, nutrient deficiency, potato flour, rice flour, vitamin deficiency, wheat.

  • Celiac disease, also called celiac sprue, is a digestive disorder that occurs when an individual's immune system overreacts to the protein gluten, or other proteins within gluten such as gliadin, found in grains including wheat, rye, barley, and to some degree, oats. When a patient with the disease eats food that contains gluten, the immune system's response damages the intestinal lining. This causes symptoms of abdominal pain and bloating after consuming gluten.
  • Additionally, complications, including poor absorption, may occur if the patient continues to eat gluten-containing foods. When the intestinal lining is damaged, patients have difficulty absorbing nutrients.
  • It has not been determined what exactly triggers this reaction in celiac patients. However, celiac disease is associated with autoimmune disorders, such as lupus. Autoimmune disorders occur when the patient's immune system mistakenly identifies body cells as harmful invaders, such as bacteria. As a result, the immune cells in celiac patients attack the patient's intestinal cells.
  • Researchers at the National Digestive Diseases Information Clearinghouse (NDDIC) estimate that one out of 133 people in the United States have celiac disease. Prevalence is even higher, one out of 22 people, among patients who have immediate family members (parent or sibling) who have the disease. This suggests that the disease may be inherited (passed down through families) in some cases.
  • Individuals can develop this disease at any age, but it is most commonly diagnosed in patients who are eight to 12 months old or in patients ages 30-40.
  • Although there is currently no known cure for celiac disease, the condition can be managed with a gluten-free diet. In general, patients who strictly follow a gluten-free diet can expect to live normal, healthy lives. Symptoms usually subside in several weeks and patients will be able to absorb food normally once they avoid eating gluten. A dietician or certified nutritionist may help a patient with celiac disease develop a healthy diet. Patients with celiac disease may also find gluten-free cookbooks to be a helpful resource. Many products, including rice flour and potato flour, can be used as substitutes for gluten.

  • Nutritional deficiencies: When a patient with celiac disease consumes gluten, the immune cells attack enzymes in the intestine that are needed for digestion and absorption of nutrients. Therefore, nutritional deficiencies are a complication of untreated celiac disease. Children may experience stunted growth if they are not receiving enough nourishment.
  • Patients who continue to eat gluten despite their condition may develop anemia (low levels of iron in the blood) because they are unable to absorb iron, folic acid, or vitamin B12.
  • Patients who continue to eat gluten often have low levels of vitamin K and D because they are normally absorbed in the intestine. Vitamin K is needed for the production of blood clotting factors. Patients with vitamin K deficiency have an increased risk of bleeding. Patients with vitamin D deficiency may have low levels of calcium in the blood, which may lead to bone disorders such as osteoporosis (hollow, brittle bones).
  • If left untreated, poor nutrition can potentially be fatal.
  • Other disorders: Celiac disease is associated with autoimmune disorders. The most common autoimmune disorders associated with the disease are lupus erythematosus, type I diabetes, rheumatoid arthritis, thyroid disease, and microscopic colitis (inflammation of the colon). The prognosis for patients with co-existing autoimmune disorders depends on the specific disorder. Most autoimmune disorders are chronic. However, many disorders can be managed with treatment such as immunosuppressants and anti-inflammatories.

Integrative therapies
  • Note: There is currently a lack of available scientific evidence on the use of integrative therapies for the treatment or prevention of celiac disease. The therapies listed below should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.
  • Unclear or conflicting scientific evidence:
  • Zinc: In limited early research, oral zinc supplements did not seem to improve the clinical condition of patients with unresponsive celiac syndrome. More research is needed in this area.
  • Zinc is generally considered safe when taken at the recommended dosages. Use amounts regularly exceeding the recommended upper tolerance levels (greater than 40 milligrams daily) under a physician's guidance only. Use cautiously in patients with bleeding disorders, diabetes, or low blood sugar levels, or in patients taking agents for these conditions. Use cautiously in patients with high cholesterol or blood fats, a high risk of developing heart disease, various skin disorders, gastrointestinal disorders, liver disease, genitourinary conditions, blood disorders, neurological disorders, pulmonary or respiratory disorders, immune disorders, or kidney disease, or in patients taking antidepressants, potassium-sparing diuretics, antibiotics (particularly tetracyclines and quinolones), iron, penicillamine, thyroid hormones, or copper. Avoid in patients who are homozygous for hemochromatosis (a metabolic disorder involving the deposition of iron-containing pigments in the tissues and characterized by bronzing of the skin, diabetes, and weakness) or with a known allergy or hypersensitivity to zinc compounds. Avoid use of intranasal Zicam®.
  • Traditional or theoretical uses that lack sufficient evidence:
  • Buckwheat: Buckwheat (Fagopyrum esculentum) has been suggested as acceptable for, or tolerated by, people with celiac disease. However, there is currently a lack of high-quality human studies in this area.
  • Use cautiously in patients with celiac disease, diabetes, or hypoglycemia. Use cautiously in those using agents that lower blood glucose, cholesterol, or blood pressure, or that increase sensitivity to light. Avoid nonfood parts of the buckwheat plant in pregnant women. Avoid with known allergy or hypersensitivity to buckwheat, its constituents, or members of the Polygonaceae family.
  • Carob: Germ proteins in carob (Ceratonia siliqua) have been found to have similar properties as wheat gluten and have been used in gluten-free baked foods. Carob germ flour has been used as an alternative to wheat flour in gluten-free bread. However, there is currently a lack of human studies on the safety and efficacy of carob for celiac disease.
  • Use cautiously in patients with anemia, known allergy to peanuts and other nuts, complications with powdered, bulk forming laxative drinks, diabetes, or high cholesterol. Use cautiously if taking oral herbs or drugs. Use cautiously in hypouricemic patients. Avoid if allergic/hypersensitive to carob (Ceratonia siliqua), its constituents, or any plants in the Fabaceae family, including tamarind. Avoid with metabolic disorders, with a chromium, cobalt, copper, iron, or zinc disorder or deficiency, renal disorders, or acute diarrhea. Avoid in underweight infants. Avoid if pregnant or breastfeeding.
  • Cassava: Cassava (Manihot esculenta), also known as manioc or yucca, is a starchy root vegetable that is widely grown and consumed as a staple food source in tropical countries. However, potentially toxic levels of cyanic glycosides are naturally present in cassava, and, if not removed during processing, they are converted to hydrogen cyanide, which may cause a number of diseases, and in some cases death, particularly in the presence of protein-deficient diets. The world market for cassava is limited, due to the abundance of substitutes; however, it may be increasing in popularity as a wheat-free alternative for individuals with celiac disease.
  • Cassava is thought to be safe when taken in small amounts for short periods of time by people who are not malnourished. Cassava is thought to be safe in pregnant and breastfeeding women who are not allergic and who take it in amounts that are generally found in foods. However, levels higher than those normally found in the diet are not suggested due to toxins that may cause thyroid and brain defects in babies. Use cautiously when the cassava contains 50-100 parts per million of cyanogenic content and is taken for extended periods of time by otherwise healthy adults. Use cautiously in people who are taking birth control or chondroitin. Avoid if allergic or sensitive to cassava, its parts, or members of the Euphorbiaceae family. Avoid if allergic or sensitive to latex or to yucca. Avoid using when the amount of toxins in the cassava product cannot be determined. High levels of toxins in cassava may cause disease and death. Avoid in people who have iodine deficiency, malnutrition, or thyroid deficiency, or those who are eating a low-protein diet.
  • Folic acid: The role of folic acid status in people with celiac disease has been investigated in preliminary research. High-quality human studies are needed in this area.
  • Use cautiously if receiving coronary stents and with anemia and seizure disorders. It is suggested that pregnant women consume 400 micrograms daily in order to reduce the risk of the fetus developing a defect. Folate is likely safe if breastfeeding. Avoid if allergic or hypersensitive to folate or any folate product ingredients.
  • Iron: The role of iron deficiency in people with celiac disease has been investigated in preliminary research. High-quality human studies are needed in this area.
  • Use iron supplements cautiously in patients with gastrointestinal disorders, kidney disease, intestinal disease, peptic ulcer disease, enteritis, colitis, pancreatitis, hepatitis, or alcoholism; in those who plan to become pregnant; in uremic patients treated with dialysis; or in patients over age 55 with a family history of heart disease. Use cautiously during pregnancy for elevating iron stores in bone marrow. Pregnant or breastfeeding women should consult a healthcare professional before beginning iron supplementation. Avoid iron in patients with or at risk for iron overload, due to hematochromatosis (a disease in which too much iron is absorbed from the gastrointestinal tract, often genetic) or any other cause. Avoid in patients with hemolytic anemia. Avoid with known allergy/hypersensitivity to products containing iron. Contact hypersensitivity to iron has been reported.
  • Pancreatin: In early research, pancreatic enzymes, such as pancreatin, have been investigated as possible treatments for celiac disease. A conclusion on the safety or effectiveness of this use cannot be determined at this time.
  • Pancreatin supplements should be used only on the advice of a medical practitioner. Pancreatin is likely safe when taken by mouth in doses recommended by a healthcare practitioner for patients with exocrine pancreatic insufficiency, a condition in which food is not properly digested because the pancreas does not make an adequate amount of digestive enzymes. Use with caution in patients with diabetes or hypoglycemia, or in those taking drugs, herbs, or supplements that affect blood sugar. Use with caution in patients at risk for developing headaches or with a history of migraines, or in patients with gastrointestinal, lung, respiratory, or kidney disorders. Use with caution in patients using calcium carbonate- or magnesium hydroxide-containing antacids, folic acid, or iron. Avoid in patients with allergy or hypersensitivity to pancreatin, pork protein, or any other components of pancreatin. Avoid in pregnant or breastfeeding women.
  • Quinoa: Quinoa (Chenopodium quinoa) has been used as a substitute for wheat, especially by those on a gluten-free diet due to celiac disease or other conditions. However, high-quality human research is lacking.
  • Avoid if allergic or hypersensitive to quinoa, its constituents, or members of the Amaranthaceae family. Use unwashed quinoa cautiously because it is naturally coated with saponins. Avoid if pregnant or breastfeeding.
  • Selenium: The role of selenium deficiency in people with celiac disease has been investigated in preliminary research. High-quality human studies are needed in this area.
  • Use cautiously at doses from 27-2,310 milligrams daily, as well as in patients on hemodialysis, in patients with iodine deficiency, high cholesterol, or immune disorders, and in those using immunosuppressants, corticosteroids, antacids, erythropoietin (EPO), cholesterol-lowering medications, oral contraceptives, astragalus, or iron supplements. Avoid in patients at high risk of nonmelanoma skin cancers or at risk for developing diabetes. Avoid in patients with known allergy or hypersensitivity to products containing selenium; however, selenium is a trace element, and hypersensitivity is unlikely.
  • Vitamin E: The role of vitamin E deficiency in people with celiac disease has been investigated in preliminary research. High-quality human studies are needed in this area.
  • Use long-term vitamin E cautiously. Use cautiously in patients with heart conditions, skin conditions, kidney impairment, Alzheimer's disease, cognitive decline, retinitis pigmentosa (loss of peripheral vision), or in patients who smoke, or in preterm infants. Avoid high doses of vitamin E. Avoid above the recommended daily level in pregnant women and breastfeeding women. Avoid in patients with bleeding disorders or in those taking drugs that may increase the risk of bleeding. Avoid if allergic or hypersensitive to vitamin E.
  • Vitamin K: The role of vitamin K levels in people with celiac disease has been investigated. Although vitamin K deficiency is rare, patients who have celiac disease have an increased risk of developing this condition. High-quality human studies are needed in this area.
  • Conditions that interfere with absorption of vitamin K may lead to deficiency, including short bowel syndrome, cystic fibrosis, malabsorption (various causes), pancreas or gallbladder disease, persistent diarrhea, sprue, and ulcerative colitis. Use cautiously in patients with skin or gastrointestinal conditions, in pregnant women, and in those taking lipid-lowering drugs. Injection into the muscle or vein should only be done by a healthcare professional. Many serious side effects have occurred after injection. Avoid in patients with known allergy or hypersensitivity to vitamin K. Avoid supplemental vitamin K in patients using warfarin or other blood-thinning agents unless otherwise directed by a healthcare professional. Avoid use of vitamin K3 supplements or menadiol.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (

Copyright © 2011 Natural Standard (

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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