Celiac disease is an allergy to gluten, a substance found in wheat, rye, barley and sometimes oats that affects millions of Americans. Exposure to gluten in genetically susceptible individuals results in flattening of the villi in the small intestine, the fingerlike projections responsible for absorbing nutrients.
In its classic form, celiac disease causes weight loss and diarrhea, but patients often present with a variety of symptoms, including fatigue, dry skin, rashes, smooth tongue, abdominal discomfort, joint pain, headache, anemia, depression, anxiety, tingling in hands or feet, menstrual abnormalities, smelly stools, constipation, weight gain and the commonest complaint of all: bloating.
The fact that the symptoms are so varied and non-specific makes this a hard condition to self-diagnose. Many, many people are bloated and tired, and most of them don't have celiac disease.
Despite the variety in presentation, the treatment for celiac disease remains the same: strict avoidance of gluten, frequently referred to as a gluten-free diet (GFD). Most patients with celiac disease respond well to a GFD, and their symptoms gradually resolve.
Interestingly, the vast majority of people – including the 99% of Americans who don’t have celiac disease – also respond favorably to a GFD. Why? Because the small intestine is not designed to digest the large amounts of processed carbohydrates present in the Western diet.
Most of us don't have celiac disease, but many of us have gluten intolerance, which means your body feels better when you’re avoiding gluten-containing foods. Most people who are gluten intolerant can ingest small amounts of gluten without too much of a problem. But if you have celiac disease, you need to be super vigilant about completely eliminating gluten, so that your small intestine can heal, and also to avoid some of the conditions associated with untreated celiac disease, like esophageal cancer, lymphoma, arthritis, osteoporosis, anemia, and even infertility.
To meet the growing demand for gluten-free products, food manufacturers have come up with an infinite array of gluten-free foods made with processed corn, soy and other ingredients instead of wheat.
The goal for all of us should be to avoid packaged, processed foods and ingredients, not to swap one for another. If you have celiac disease, you should be avoiding cookies and bagels, not eating the gluten-free version. Just like if you have diabetes, I'd recommend avoiding candy instead of eating sugar-free sweets on a regular basis.
There's nothing wrong with trying a gluten-free diet, but if you think you may actually have celiac disease it's important to get evaluated by a gastroenterologist.
Celiac disease risk factors and testing:
- Family history; if you have a first-degree family member who is diagnosed with celiac disease, your chances of having the condition are between 10% and 20%.
- The simplest screening tool is a blood test that can check for antibodies associated with the disease. More sophisticated blood tests can also check to see if you belong to one of the genetic groups more likely to develop celiac disease.
- The most accurate test is a biopsy of the small intestine, which is obtained during a procedure called an upper endoscopy where you are given a sedative and a small tube is inserted through the mouth into the upper part of the small intestine. The test is safe and painless and is the "gold standard" for definitively diagnosing celiac disease. It's important to eat lots of gluten-containing foods for a few weeks prior to testing to increase the accuracy of the tests.
To learn more about celiac disease, click here.