Celiac Awareness Month – May 2024

Celiac disease or gluten-sensitive enteropathy is an inherited condition triggered by the consumption of cereal grains containing “gluten”. Simply put, the immune system of a celiac reacts negatively to the presence of gluten in the diet causing damage to the inner lining of the small bowel which reduces the person’s ablility to absorb nutrients including: iron, folate, calcium, Vitamin D, protein, fat and other food compounds. The grains considered to be capable of producing negative effects in individuals with celiac disease include the different species of wheat (e.g., durum, spelt, kamut), barley, rye, and their cross-bred hybrids (e.g., triticale, which is a cross between wheat and rye). Currently the only treatment for celiac disease is to continually maintain a strict gluten-free diet.

This disease affects nearly 1% of the population.

Closely related family members of celiacs have a greater risk of developing the disease. However, not all individuals carrying the genes identified with this disease will develop the disease. Therefore, other genetic and environmental factors have also been implicated in its development.

The symptoms of celiac disease vary greatly from one person to another both in extent and seriousness, making diagnosis difficult. Infants and children more often display symptoms of diarrhea and abnormal stretching of the abdomen. They could also show symptoms of malnutrition such as short stature, anemia (weakness or low stamina), defects in teething, failure to thrive, or in developmental delay. In adults, gastrointestinal complaints are common and include abdominal pain, flatulence, and diarrhea. Weight loss is most common, but symptoms of weight gain and constipation are not unheard of. Only some individuals with celiac disease suffer typical gastrointestinal symptoms, while others may display no visible symptoms.

Further symptoms vary and can include mouth ulcers, extreme fatigue, bone pain and others. A serious skin condition (called dermatitis herpetiformis) that results in an itchy rash with bumps and blisters is sometimes a result of this disease. This condition is linked to gluten sensitivity, and skin biopsy (sampling and testing) is usually performed to confirm diagnosis.

Other conditions associated with celiac disease include type 1 diabetes, down syndrome, thyroiditis, arthritis, ataxia, depression, and neuropathy.

If celiac disease is diagnosed early and treated with a gluten-free diet, the damaged tissues can heal and the risk of developing many of the long term complications of this disease, including osteoporosis (a weakening of the bones), lymphoma (tumors arising in the lymph nodes), and infertility can be reduced.

Diagnosis

In recent years, an improvement in the overall level of awareness about celiac disease and associated conditions has allowed individuals and health professionals to better suspect and screen for celiac disease. This is particularly true for those groups at high risk.

Celiac disease can be diagnosed through a combination of:

• Blood tests
• Small-bowel biopsy
• Recovery from the symptoms while following a gluten-free diet

Small-bowel biopsy remains the ‘gold standard’ test for celiac disease detection. 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 a practitioner’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 should become negative, and any small bowel injury should heal completely. It will be important for celiac patients to regularly follow up with their family doctor on their progress in treating the disease.

“As Minister of Health, I am pleased to recognize May as Celiac Awareness Month and to acknowledge the challenges faced by Canadians living with this chronic disease.

Celiac disease affects about 1 in every 133 people in Canada and more cases are diagnosed as awareness continues to grow. The symptoms of celiac disease can develop at any age and your risk of developing the condition is higher if you are related to someone with it. Not everyone who inherits the genes associated with celiac disease will develop it, but family members, especially if they are experiencing symptoms, should be tested.

Symptoms of celiac disease are triggered by gluten. For people with the disease, gluten causes a negative reaction in their immune system causing internal damage and making it hard to absorb nutrients. The good news is that, when properly diagnosed, celiac disease can be effectively managed by avoiding certain foods and following a careful diet.

I am proud to say that Canada’s food system is among the safest in the world and Health Canada is committed to making safe and healthy food more accessible to Canadians with food allergies and intolerances, including those who must follow a gluten-free diet. In addition to regulatory changes that were introduced in 2012 requiring manufacturers to ensure that sources of gluten are always identified on food labels, Health Canada is proposing changes to nutrition labelling that would make this information easier to find and read. These proposed measures further highlight our Government’s commitment to ensuring that Canadians have the information they need to make healthy and safe food choices for themselves and their families.

I would like to acknowledge the ongoing work of the Canadian Celiac Association and the Fondation québécoise de la maladie coeliaque for their ongoing efforts to raise awareness and support research about this condition.”

Sincerely,

Minister of Health