Celiac Disease and Gluten Sensitivity

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Previously thought to be a relatively uncommon condition, celiac disease affects an estimated 1 out of every 100 people. And research suggests that it’s becoming more common, with some estimates stating that the incidence of celiac disease has quadrupled since 1950. In addition, experts believe that for every person diagnosed with celiac disease, there are another 30 people with the disease who are undiagnosed.

What is celiac disease?

Celiac disease (aka celiac sprue) is a chronic autoimmune condition that some people are genetically predisposed to. It involves an inability to digest gluten, a protein found in some grains, and foods containing wheat, barley, and rye. When a person has celiac disease, the immune system perceives gluten as a foreign invader and triggers an immune response that attacks the lining of the small intestine. As a result, the intestine is unable to properly absorb nutrients. Celiac disease affects both children and adults.

What are the symptoms of celiac disease?

Children with celiac disease often have short stature and experience delayed puberty. Classic symptoms, irrespective of age, include:

  • Diarrhea
  • Bloody stools
  • Constipation
  • Abdominal pain
  • Flatulence
  • Bloating
  • Weight loss
  • Anemia
  • Depression
  • Fatigue
  • Muscle cramps and spasms

All of these symptoms are similar to symptoms associated with irritable bowel syndrome (IBS) and other intestinal disorders, so celiac disease can easily be misdiagnosed.

What’s the treatment for celiac disease?

There is no known cure for celiac disease, but you can manage symptoms by adhering to a strict, lifelong, gluten-free diet.

How do I know if I have celiac disease?

Your health care provider will know if testing for celiac disease is warranted in your particular case. The most sensitive diagnostic blood tests (the IgA anti tissue transglutaminase and IgA endomysial antibody) are equally accurate. However, no single test can accurately establish the diagnosis of celiac disease in every individual. So if your blood test comes back positive, a small-bowel biopsy is typically required to confirm the diagnosis and to assess intestinal damage.

What is gluten sensitivity?

Even if you don’t have celiac disease, it’s still possible that you may experience symptoms after consuming gluten. This is sometimes referred to as non-celiac gluten sensitivity, gluten intolerance, or simply gluten sensitivity.

Gluten sensitivity manifests as a variety of symptoms that improve or disappear after gluten withdrawal, even if you’ve tested negative for celiac disease. Common symptoms of gluten sensitivity include the classic IBS-type symptoms (such as bloating, gas, diarrhea, and constipation). Gluten sensitivity can also trigger issues beyond the digestive tract, including joint pain, skin issues, fatigue, and even anxiety and/or depression.

Gluten sensitivity can appear at any time and is sometimes triggered by stressful situations such as pregnancy, childbirth, and surgery. Like celiac disease, gluten sensitivity seems to be on the rise, and the only form of treatment is avoiding gluten.

How do I know if I have non-celiac gluten sensitivity?

There are various food sensitivity labs that test for gluten sensitivity, but none are 100 percent accurate. Therefore, your best course of action is to follow The Institute of Functional Medicine’s gold standard for diagnosis: an elimination diet. You are the ultimate lab; if you feel better after at least 14 days without gluten, then you’re likely better off without it.

Why is celiac disease and gluten sensitivity becoming more common?

There’s no definitive answer as to why the prevalence of these two conditions is increasing, but there are several theories. Increased awareness among health care providers and patients is one factor that leads to more diagnoses. It’s also important to remember that grains were only introduced to our diets 10,000 years ago, when our ancestors learned about agriculture and started to plant seeds and domesticated crops for food; previously, our Paleolithic diet had been grain-free. Gluten has also become increasingly ubiquitous over the past 50 years. It’s found in all sorts of unexpected places, from soy sauce to potato chips and most processed foods–it can even be found in some medications. Finally, modern wheat isn’t grown and processed the same way it was decades ago, leading some to theorize that the hybridization and genetic engineering of wheat may result in substantial increases in the gluten content of modern-day wheat.

For further guidance and support with implementing a trial elimination diet, consult your health care provider.

Editor’s Note: Looking for gluten-free recipes? Check out these tips and tricks for inspiration:

5 Gluten-Free Breakfast Ideas

Tips for Making Gluten-Free Desserts

Healthy Gluten-Free Pumpkin Pie Recipe

Gluten-Free Plum Almond Crisp

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.