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Understanding Celiac, Gluten Sensitivity, and Gluten-Free Diets

Aug 30, 2021 By Miranda Carpenello
Woman buying gluten free bread in grocery store

It wasn’t too long ago that gluten-free products were nearly impossible to find. For years, these items were scarce outside of health food stores, while restaurants with gluten-free options were considered a rarity.

Over the last decade, however, major food brands, stores, and restaurant chains dramatically increased their selection of gluten free products and the gluten-free diet has become one of the most popular and well-known food trends across the globe.

While this diet trend has gained momentum in recent years, avoiding gluten has always been crucial for people with celiac disease,

Research estimates that 1% of people in the United States have celiac disease, whereas 6% or more may be sensitive to gluten. Wondering if gluten is the source of your stomach troubles? Read on to learn more about celiac disease, gluten sensitivity, and gluten free diets.

What exactly is gluten?

Gluten is a protein naturally found in wheat, rye, barley, and triticale - a cross between wheat and rye. Think of gluten as the glue that holds some foods together to help maintain shape and provide satisfying textures. Gluten is commonly found in breads, pastas, cereals, beer, and baked goods. But, it can also be found in foods like salad dressings, food coloring, and soups, so it’s very important that those with a gluten intolerance or celiac disease read food labels.

What’s the difference between celiac disease and non-celiac gluten sensitivity (aka gluten intolerance)?

Celiac disease is an autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. When people with celiac disease eat gluten, their immune system is erroneously stimulated to attack their villi -- microscopic, fingerlike projections that line the small intestine and are essential for absorbing nutrients from food. Damaged villi cannot absorb many nutrients, so if left untreated, celiac disease can cause serious problems such as:

  • Anemia due to iron deficiency
  • Osteoporosis
  • Reproductive health issues, including infertility and changes in menstrual cycle
  • Nervous system disorders

Common symptoms of celiac disease include:

  • Diarrhea or constipation
  • Blood in stool
  • Abdominal pain, bloating and gas
  • Sudden weight loss

Celiac disease can also produce symptoms seemingly unrelated to digestive health, such as:

  • Fatigue
  • Skin rashes
  • Headaches
  • Mouth ulcers
  • Numbness and tingling in the feet and hands

Gluten sensitivity can cause some of the same symptoms as celiac disease, including diarrhea and/or constipation, crampy abdominal pain, gas and bloating, and fatigue, often within hours or days of eating gluten-containing foods.However, unlike celiac disease, there is no immune response damaging the villi of the small intestine and, as a result, nutritional deficiencies are rare in people who have a gluten sensitivity. So why are some people sensitive to gluten? In short, we don’t know, and there may be other reasons as to why some people find a gluten free diet helps reduce their symptoms. While some individuals may have a true gluten sensitivity, others may be sensitive to substances frequently found in foods that have gluten, such as wheat. Fermentable, poorly absorbed short-chain carbohydrates (FODMAPs or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), are sugars that are frequently reduced when following a gluten free diet and could be the true culprit for the digestion distress in individuals thinking they have a gluten sensitivity. One study in Italy sought to find out how prevalent non-celiac gluten sensitivity was among children who reported digestion issues when eating gluten. They conducted a randomized control study and exposed the children to gluten (without any FODMAP products inside) and found that over 60% of the children who were thought to be gluten sensitive had no reaction to gluten.

How do I know if I have celiac disease or if I am sensitive to gluten?

If you think you may be having trouble with gluten, the best next step is to schedule a visit with your primary care provider to go over your symptoms. Your provider may suggest a blood test to look for particular antibodies found in celiac disease antibodies or may connect you with a gastrointestinal specialist for more testing. If celiac disease is ruled out, your primary care provider may suggest an elimination diet to determine whether gluten or other elements of your diet are contributing to your digestive issues.

Is there any benefit to eliminating gluten if I don’t have an intolerance or celiac?

While a gluten-free diet is a must for people with celiac disease, it does not offer any particular health benefit for the average individual. Avoiding gluten does not help with weight loss and may even put you at risk for nutritional deficiencies as many of the foods that have gluten, such as bread and cereal, are fortified with vitamins that may be lacking in gluten free alternatives. If you choose to pursue a gluten free diet, it's important to take a holistic approach to your nutrition and ensure you are meeting all your basic nutritional needs.

If you have more questions about celiac, gluten sensitivity, and gluten-free diets, book a visit with your primary care provider.

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Miranda Carpenello

The One Medical blog is published by One Medical, a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.

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