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A gluten-free diet: Celiac disease and gluten hypersensitivity

Last Modified: September 18, 2019

Diseases & Disorders, Family Medicine

This post was written by Reshi Kanuru, MD, PPG – Gastroenterology.

It’s not uncommon for me to hear, “What do you mean gluten-free food isn’t healthier?” when discussing the facts about a gluten-free diet. Being gluten-free has become a significant trend over the last decade, with false claims about its benefits. Understanding if you have celiac disease or gluten hypersensitivity is very important, because, if these are not properly treated, they can lead to negative health consequences and to a poor quality of life.

What is gluten?

Gluten is a broad term used to describe proteins from wheat, rye, barley and derivatives of these products that are included in foods to help bind them together. Gluten is found in most products that we eat and is even in some medications we use.

Is a gluten-free diet healthier?

Roughly a decade ago, adopting a gluten-free diet started growing in popularity. There is a false belief that gluten-free foods are healthier than regular foods. It is true that people can lose weight on a gluten-free diet, if their new diet eliminates unhealthy foods. But gluten-free foods and their gluten-containing counterparts tend to contain the same amount of calories, so switching to gluten-free foods is not a strategy for cutting calories.

A recent study completed at Harvard showed that gluten-free foods might actually increase your risk of type 2 diabetes. If being gluten-free improves your symptoms, then a gluten-free diet might be right for you, but you should understand just because the label says “gluten-free”, that doesn’t necessarily mean it’s healthier.

What is celiac disease?

Celiac disease is when someone has a true allergy to gluten. If a person with celiac eats gluten, they develop inflammation in their small bowel. The inflammation prevents proper absorption of nutrients resulting in vitamin deficiencies and malnutrition. In addition, celiac patients exposed to gluten can develop a wide variety of abdominal symptoms including abdominal pain, bloating, reflux and diarrhea. In severe cases, a small portion of celiac patients can actually develop a type of small bowel lymphoma, which is a type of cancer. Uncontrolled celiac disease can lead to weak bones and even cause abnormal liver enzymes.

How do we diagnose celiac disease?

Celiac disease is diagnosed based on lab work and biopsies of the small bowel. The standard for diagnosis is blood work testing for an elevation in anti-tissue transglutaminase antibodies, otherwise known as an anti-TTG level.

If the anti-TTG antibody is elevated, the next step is to proceed to an upper endoscopy. An upper endoscopy is when someone is sedated with anesthetic and a flexible camera is maneuvered through their mouth into the esophagus, stomach, and finally reaching the small bowel. During the upper endoscopy or EGD, biopsies of the duodenum – the first portion of the small bowel – are completed to help identify celiac disease.

The biopsy findings of the small bowel that may indicate celiac disease are also used with many other diseases. Even medications like ibuprofen can cause findings similar to celiac disease in the small bowel. If both biopsies and blood work are consistent with celiac disease, then that person likely has celiac disease.  

Occasionally, people start a gluten-free diet before they are tested for celiac disease. If someone is already on a gluten-free diet, the standard celiac testing of blood work and biopsies will be normal. If someone is truly gluten-free, we can complete genetic testing for celiac disease.

It is important to understand that genetic testing for celiac disease can only tell us if someone does not have celiac disease. The genes for celiac disease are found in many people, most of whom do not have any evidence of celiac disease or gluten hypersensitivity. If the genetic test is negative for specific celiac genes, then it is highly unlikely that person has celiac. But if the test is positive, it does not tell us anything about whether they have celiac disease or not. More testing would be needed to confirm a diagnosis.

What is gluten hypersensitivity?

There are many people who don’t have celiac disease, but notice when they eat gluten they develop significant symptoms. The symptoms of gluten hypersensitivity can be very similar to celiac disease including bloating, nausea, abdominal pain and diarrhea. Unlike celiac disease, there are no specific tests for gluten hypersensitivity. If someone with gluten hypersensitivity undergoes testing for celiac disease via blood tests and small bowel biopsies, their tests will be negative for celiac disease. The only way to determine if you have gluten hypersensitivity is to go gluten-free and see if your symptoms improve. If you do have stomach symptoms, make sure to seek a gastroenterologist for a thorough evaluation.

What is the treatment of celiac disease?

A gluten-free diet is not the only important aspect in managing celiac disease. Since vitamin and mineral absorption can be difficult in patients with celiac disease, your care team will monitor you for iron deficiency anemia, as well as other deficiencies like B12, folate, vitamin D, vitamin A, vitamin K and vitamin E. It is also really important that we monitor bone density in celiac patients, as they are at a higher risk of developing osteoporosis, otherwise known as weakening of the bones. Small amounts of vitamin D and calcium daily, along with exercise can really help maintain bone strength and prevent critical fractures in the future. 

Who should I contact if I think I have celiac disease?

If you think you may have celiac disease or are dealing with abdominal symptoms, contact your primary care provider or PPG – Gastroenterology so we can help you better understand and find a solution to your symptoms.


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