News | Published July 28, 2014 | Written by Frank Guillard, MD, internal medicine, Mount Nittany Physician Group

Gluten sensitivity may indicate celiac disease

Celiac disease is an immune disorder triggered by gluten, a protein found in wheat, rye, and barley. The disease is considered common, affecting 2 to 3 million people in the United States.

A person with celiac disease has antibodies to gluten. When gluten is eaten, the antibodies react to gluten in the small intestine causing inflammation and damage. This leads to symptoms such as pain, bloating, diarrhea, and nausea. The damaged intestine also effects absorption of food and nutrients which can cause many other symptoms such as fatigue, anemia, nerve disorders, weight loss, thin bones, rashes, menstrual disorders, infertility, delayed growth, and possibly cancer.

There is a genetic predisposition to celiac disease. These genetic markers can be identified with specific blood tests. Therefore, if a family member has celiac disease, relatives are more likely to have this disorder. It is also associated with other immune disorders such as type 1 diabetes, autoimmune thyroid disease, and those with other genetic disorders. 

Diagnosis can be challenging and is often delayed because celiac disease can mimic many other disorders. Diagnosis is now made easier by testing specific antibodies in a blood test. If the antibodies are found, then most physicians recommend a small intestinal biopsy to confirm it since celiac disease involves life long dietary changes.

Before the blood test was available, diagnosis was much more difficult. Since two of my three children have had celiac disease for almost ten years, and I have treated many patients in my internal medicine practice, I understand that the process can be difficult. 

Treatment of celiac involves a strict gluten free diet. In recent years, the availability of gluten free food has become more widespread making this diet easier to follow. However, it is important to read all food labels since even the smallest amount and can cause symptoms and lead to long term damage. 

There are also many hidden sources of gluten. These may include such things as lipstick, play-dough, medication, vitamins, additives found in food such as modified food starch, and preservatives. “Natural flavor or spices” do not always mean gluten free. Consultation with a certified dietitian is often very helpful.

Gluten free diets are restrictive but include fresh meats, fish, fruits, vegetables and some dairy products. Also, common grains such as corn, quinoa, rice, tapioca, and buckwheat are permitted as well as gluten free pastas.

Gluten sensitivity is another area of concern. These people do not have celiac disease; they do not have antibodies to gluten. Nevertheless, they feel better by avoiding gluten. Strict avoidance of gluten is probably not nearly as important as in people with celiac disease. However, by avoiding gluten in their diet many problematic symptoms disappear.

If you believe you or a family member has celiac disease or gluten sensitivity, it is important to speak with your healthcare provider. Because of recent media attention to gluten free diets, many find they may feel better when they try it. However, if actual celiac disease is present and not diagnosed, it could cause long-term damage.

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