Written by Qui Min, Pharmacist of AA Pharmacy Old Town.

What is Celiac Disease?

Celiac disease is an autoimmune and hereditary diseases where our own body’s immune system will attack or damage our small intestine (site of absorption) when we eat gluten. Gluten is a protein found in wheat, rye and barley and can be easily found in our daily foods. Celiac disease can develop at any age and if left untreated, it could lead to other serious health problems such as osteoporosis, vitamin D deficiency, iron deficiency, intestinal malignancy and etc.

Symptoms of Celiac Disease

This disease can be difficult to diagnose as it affects people differently. Some people might have no symptoms at all. However, digestive symptoms are the most presented symptoms.

Common symptoms
– abdominal bloating and pain
– chronic diarrhoea
– constipation
– pale, foul smelling and fatty stool
– weight loss


Other associated symptoms
– iron deficiency anaemia
– dermatitis herpetiformis (itchy skin rash)
– delayed growth and puberty
– dental enamel defects
– nerve damage
– fatigue


Who Should Get Screened?

  • Age more than 3 years and above presenting symptoms of celiac disease
  • First degree relatives diagnosed with celiac disease
  • Those associated with other autoimmune disease (e.g. type 1 diabetes, autoimmune thyroid disease, turner’s syndrome etc)

Test Available To Diagnose Celiac Disease

1) Tissue Transglutaminase IgA antibody ( tTG-IgA) test – this test requires the patient to be on a gluten-containing diet for accuracy. The tTG-IgA test will be positive in about 98% of patients with celiac disease who are on a gluten-containing diet.

2) Genetic Testing – 25%- 30% of the people diagnosed with celiac disease, carrying HLA DQ2 and DQ8 genes. However, this cannot confirm that the person is diagnosed with celiac disease.

3) Intestinal Biopsy – “gold standard” for diagnosis to check for damage and inflammation of the small intestine caused by gluten intake. In order to obtain a more accurate diagnosis, at least 4-6 duodenal samples from the second part of duodenum and the duodenal bulb should be taken.

Treatment for Celiac disease

  • Gluten Free Diet

The patient would be required to follow a strict gluten-free diet. Only food and beverage with a gluten content less than 20 parts per million (ppm) is allowed.



Gluten Free living

  • Label Reading And The FDA
    FDA only allows packaged foods with less than 20ppm of gluten to be labelled as “gluten-free
  • When eating out
    Always let the person serving you know your dietary requirements and how severe your food allergy or intolerance 
  • Vitamins And Dietary Supplements

Inflammation of the mucosa of the small intestine resulted from damaged epithelial lining of the intestine would lead to obstructed nutrient absorption. As a result, patients are associated with nutritional deficiencies (Malabsorption).

Vitamin B 12
Supplementation of vitamin B12 and folate may help individuals with celiac disease recover from anxiety and depression caused by vitamin deficiencies.


Calcium recommendations are higher for people with celiac disease (1,000mg per day )

– Vitamin D

In the general population aged 4 years and older should get 10 mcg of vitamin D per day.

– Folic acid
Folic acid recommendations (5mg per day) during pregnancy are higher for women with celiac disease


  • Gluten Free Foods Intake
    • Fruits
    • Vegetables
    • Meat and poultry
    • Fish and seafood
    • Dairy
    • Beans, legumes and nuts