Celiac disease is often associated with lactose intolerance. But are these two conditions only related by common symptoms, or is there a real connection?
Let’s start with the premise that both lactose intolerance and celiac disease belong to the so-called gastrointestinal disorders.
However, these disorders are often difficult to differentiate, because each condition shares common symptoms, which can contribute to delaying a diagnosis.
But while celiac disease is an autoimmune disease (and not a gluten intolerance) known as chronic enteropathy, caused by gluten, a protein present in wheat, barley, durum wheat, and many other cereals (you can consult the Italian Celiac Association website for more information); lactose intolerance is caused by a deficiency of the lactase enzyme, which is responsible for digesting milk sugar (lactose, to be precise).
Symptoms of celiac disease are very varied and, very often, involve the gastrointestinal tract, causing: diarrhea, weight loss, abdominal distension, bloating, dyspepsia, and flatulence.
Pain can be specifically localized in the lower right abdomen and even accompanied by a palpable mass, raising suspicions of appendicitis or Crohn's disease.
Systemic manifestations, on the other hand, include migraines, chronic fatigue, depression, irritability, dermatitis, oral aphthous ulcers, anorexia, joint pain, growth failure, delayed puberty, amenorrhea, premature menopause, and reduced fertility.
We have already discussed the symptoms of lactose intolerance extensively in this article, and as we can see, some related to the gastrointestinal system are overlapping.
It is interesting how celiac disease can be associated with lactase deficiency, which leads to subsequent lactose intolerance.
Lactase deficiency, or hypolactasia, can be divided into three types:
- Congenital, an extremely rare autosomal recessive condition.
- Primary, an autosomal recessive condition resulting from the physiological decline of lactase activity in intestinal cells, which does not occur before two years of age.
- Secondary, also known as temporary lactase deficiency, occurs when damage to the mucosa causes atrophy of the villi of the small intestine. This happens as a result of rotavirus infection, celiac disease, giardiasis, Crohn's disease, and more.
It is precisely this last form, therefore, that appears following untreated celiac disease.
Lactose intolerance is, therefore, increased in patients with celiac disease for two reasons:
- due to a reduced secretion of trypsin, a pancreatic enzyme that activates lactase,
- as a result of damage to the intestinal mucosa, where the lactase enzyme is normally present.
For the diagnosis of celiac disease, it is useful to perform blood tests and evaluate the presence of specific antibodies, which belong to the IgA class. Subsequently, in adults, an intestinal biopsy is performed.
In case of a positive result, it is necessary to follow a diet that is, first of all, gluten-free (the only possible therapy) and combine it with a lactose-free diet at least in the initial periods, until the intestinal mucosa is restored.
Bibliography
- Abenavoli et al. (2015). “Nutritional profile of adult patients with celiac disease”. European Review for Medical and Pharmacological Sciences.
- Hurduc et al. (2017). “Lactose intolerance: new aspects of an old problem”. BMJ journal Volume 102 - Suppl 2.
- Karlen E. Luthy et al. (2017). “Differentiating Between Lactose Intolerance, Celiac Disease, and Irritable Bowel Syndrome-Diarrhea” The Journal for Nurse Practitioners – JNP.