When Robin finally decided to head to the doctor for a checkup it was after months of not feeling well. Her main complaint was bloating after eating foods like pasta and bread. Certain foods like ice cream, granola bars or beans also caused significant abdominal pain, gas and diarrhea. After asking a few questions, the doctor suggested a diet change, she was handed a paper on the gluten free diet and asked to return in a month. Within a week Robin began to feel significantly better. Problem solved, right?
You probably know someone with celiac disease. With the prevalence rising to 1 in 133 people, nearly 3 million individuals in the United States have this autoimmune disorder. Unfortunately, 80- 90% of people who have celiac disease don’t actually know it. Randomly starting a gluten free diet without understanding how celiac disease is identified can do more harm than good.
What is Gluten?
Gluten, a protein found in wheat, rye, and barley is a common food ingredient in the United States. Gliadin, a part of gluten, cannot be fully broken down by the intestine in those with celiac disease, and can pass through the barrier of the intestinal wall causing an inflammatory response. Over time, the ability of the small intestine to absorb nutrients is decreased due to damage by exposure to gluten.
Symptoms of Celiac Disease
Symptoms of celiac disease include abdominal pain, abdominal bloating, diarrhea, constipation, gastrointestinal reflux, or vomiting. People with undiagnosed celiac disease often become lactose intolerant due to the damage in the area of the small intestine that produces enzymes which help us break down and absorb our food. Although this sounds a lot like irritable bowel syndrome the cause and treatment is different.
When someone has celiac and doesn’t know it, over time the body destroys the area of the small intestine that absorbs all of our important nutrients. Exposure to gluten in a person with celiac disease can lead to nutrient deficiencies, specifically calcium, vitamins D and B-12, iron, folate, and zinc which can lead to anemia, fatigue, irregular periods and fertility issues, poor growth in children, and low bone density. Many people may not even have any GI symptoms.
Celiac disease is the only autoimmune disease where the trigger for the disease is known and can be avoided. Once a person has one autoimmune disease or certain medical conditions it is likely that another may occur. People with Type 1 diabetes, rheumatoid arthritis, Down syndrome, Turner syndrome and others should routinely be screened for celiac disease.
Testing for Celiac Disease
Testing for celiac disease focuses first on monitoring elevated levels of blood markers for an immune response while still on a diet that contains gluten. The gold standard of testing though is a tissue biopsy of the gastrointestinal tract done by a doctor specializing in gastroenterology. If someone starts a gluten-free diet prior to testing, the results of any blood or tissue tests are completely invalid. Knowing you have celiac disease versus just avoiding gluten by choice can significantly affect how careful you are with adhering to a gluten-free diet.
Increased awareness of gluten has led to an increase availability of gluten-free foods. But individuals with celiac disease must take avoidance to a higher level. They must be extremely careful to avoid allowing any gluten from coming in contact with their gluten free food. A salad that once had croutons on it or a cereal with malt flavoring is a no-go. For individuals with celiac disease, consuming even small amounts of gluten can have effects on the body without any physical symptoms. An immune response can’t be felt, so judging exposure by a gastrointestinal response doesn’t really indicate whether damage is occurring.
Test First, Avoid Later
If you have gastrointestinal problems such as bloating, diarrhea, or heartburn, don’t start a completely gluten free diet or a FODMAP diet prior to being tested for celiac disease and don’t encourage others to do so. Once gluten is removed, the body will stop producing antibodies against gluten and a test for celiac disease would come up negative. It’s important to know for sure if you have celiac disease. Celiac disease is a medical condition, and must be treated and monitored differently from those who simply choose to limit their gluten intake. Mineral supplementation is often needed, bone density can be affected, and the gluten free diet must be adhered to 100 percent of the time, 365 days a year for a lifetime.
To increase your knowledge of celiac disease and gluten free diets check out one of our excellent courses to bring you up to date.