Years ago, celiac disease was viewed primarily as a medical curiosity as few physicians knew much about it or correctly identified the symptoms.  Fortunately, there has been an explosion of information obtained on celiac disease over recent years recognizing it as one of the more common autoimmune disorders as better diagnostic methods have been implemented.

 What is Celiac Disease and Non-Celiac Gluten Sensitivity?

 Celiac disease is an autoimmune disease, genetically inherited in which the immune system causes inflammation and damage to a part of the small intestine called villi.  Villi are fingerlike projections (think of shag carpeting) lining the walls of the small intestine that help in the digestion and absorption of food.  In celiac disease, the villi become flattened and thus are unable to break down or absorb nutrients from food.  This usually results in a variety of symptoms:

  ·         Vitamin and mineral deficiencies (exp. iron, folate, calcium or fat-soluble vitamins)

·         Weight loss

·         Fatigue

·         Osteopenia or Osteoporosis

·         Gastrointestinal symptoms – diarrhea, constipation, excess gas, nausea, bloating, abdominal pain

·         Headaches and migraines

·         Delayed growth in children

·         Dermatitis Herpetiformis – a painful skin rash

·         Joint pain

·         Infertility

·         Mood disorders such as depression, anxiety, and “brain fog”

How common is Celiac Disease?  

Only 1% of the U.S. population or one out of every 133 people has celiac disease.  Currently, it is estimated that 83% of Americans living with celiac disease remain undiagnosed or misdiagnosed.   

How is it diagnosed?

Celiac disease cannot be self-diagnosed.  A person will need to go to a physician to have an antibody blood test.   If celiac disease is suspected, then a small intestinal biopsy will need to be done to get a definitive diagnosis.  Unfortunately, due to the numerous symptoms celiac disease causes that could be related to other medical conditions, the average wait time to be correctly diagnosed is 6-10 years.  However, understanding what celiac disease is and going to an informed physician, can cut the diagnosis time significantly. 

Non-Celiac Gluten Sensitivity (NCGS) –

This is a condition that is estimated to affect 6% of the population or 18 million people, primarily adults.  It is not an allergy or an autoimmune disorder like celiac disease and is not genetically based.  The damage to the intestinal tract is more minimal than celiac disease but people with NCGS can have some of the same symptoms.  There are no laboratory or histological tests to diagnose it.  A diagnosis of NCGS may be given once celiac disease and wheat allergy have been ruled out, then followed by an elimination diet of gluten to see if the symptoms get better. 

What is the treatment for Celiac Disease and Non-Celiac Gluten Sensitivity?

Celiac Disease

The only treatment for celiac disease is simple: lifelong, strict adherence to a gluten-free diet.  Of course, that’s easier said than done.  But if a person with celiac disease wants to prevent symptoms and disease-related complications, they must follow a gluten-free diet.  No medications, surgeries or any other treatments will relieve this condition.

Non-Celiac Gluten Sensitivity

People with NCGS may benefit and often do when they also follow a gluten-free diet. 

What is gluten and a gluten-free diet?

Gluten is the name for the proteins (prolamins and glutelins) found in wheat, barley and rye and this is what needs to be avoided on a gluten-free diet.  The reason for this is that the immune system sees gluten as being harmful, triggering inflammation and damage to the small intestine.  By following a strict gluten-free diet, the small intestine will heal thus improving the gastrointestinal symptoms of diarrhea, constipation, excess gas and bloating. 

Foods not allowed on a gluten-free diet

Receiving a diagnosis of celiac disease or NCGS and learning to follow a gluten-free diet can be very overwhelming.  Consultation with a registered dietitian will be helpful in providing guidance and encouragement to adhere to this lifelong diet plan.  Foods to always avoid are:

·         Wheat – this includes all varieties, such as spelt, durum flour, farina, graham flour, kamut, semolina, wheat starches, wheat bran, wheat germ, cracked wheat and hydrolyzed wheat protein. 

·         Rye

·         Barley – includes malt, malt flavoring and malt extract

Be aware that non-food items that can contain gluten are dietary supplements, and both over-the-counter and prescription medications.   Check with your physician on such items. 

Fortunately many food companies have voluntarily produced many foods now as gluten-free, making it easier for those with celiac disease or NCGS to enjoy many of the same foods as others.  Always look for the words “gluten-free” as then it can be included in the diet.  If it is not labeled as gluten-free, look for the following six words in the ingredient list:

·         Wheat or says “contains wheat”

·         Rye

·         Barley

·         Malt

·         Brewer’s yeast

·         Oats

Notice that “Oats” are included on this list.  In their natural form, oats do not contain gluten.  The problem though is that oats are often harvested and processed with the same equipment used for wheat, barley or rye, making cross-contamination likely.  Before including oats in the diet, determine that they are labeled either “pure, uncontaminated,” “gluten-free” or “certified gluten-free” and ask the recommendation of a healthcare provider before making this dietary introduction. 

Foods allowed on a gluten-free diet

The good news on following a gluten-free diet is that many foods are allowed and here is a listing of them:

·         Fruits and vegetables

·         Most dairy products

·         Fresh meats, fish and poultry (not breaded, batter-coated or marinated)

·         Beans, seeds, and nuts in their natural, unprocessed form

·         Fresh eggs

·         Many grains can be part of a gluten-free diet such as amaranth, arrowroot, buckwheat, flax, quinoa, and teff.

Can a person without celiac disease or NCGS follow a gluten-free diet?

If someone without celiac disease or NCGS wants to follow a healthy gluten-free diet they can do so but it is not advised as it would be unnecessarily restricting food choices when they don’t have to.  Following a strict, gluten-free diet can also make it more difficult to obtain enough certain vitamins and minerals.  The following nutrients maybe insufficient if following this diet: iron, calcium, fiber, thiamin, riboflavin, niacin, and folate.  A registered dietitian can evaluate your food intake making suggestions on decreasing nutrient deficiencies, helping to avoid this situation.

Some people have used the gluten-free diet as a weight loss method but there are better ways to lose weight than to follow this method of eating. 

There has been some research and studies on the usefulness of following a gluten-free diet for other conditions such as autism, multiple sclerosis and ADHD but with mixed reviews.  However, some people with these conditions have experienced improvements by eliminating gluten. The gluten-free diet, though, is predominately used for people with celiac disease or NCGS.

 People with celiac disease or NCGS do not have to suffer from the various symptoms and conditions that can afflict them.  Becoming educated about these two conditions and learning how to follow a gluten-free diet, is the best way to remain symptom free and inflict as little damage to the intestinal tract as possible.