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Eating Gluten-Free

The Truth About Celiac Disease

As you walk down the aisles in a grocery store (and Richmond has plenty of those!), gluten-free signs and labels are everywhere. Many restaurants are offering gluten-free dishes. Your friends tell you they feel great on a gluten-free diet. But will you? Should you be eating gluten-free, too? How about your family?

A gluten-free diet is a diet that does not contain any gluten, a protein found in wheat, rye, barley, and sometimes oats. People who have been diagnosed with celiac disease should be on a gluten-free diet. When someone with celiac disease eats even a small amount of gluten, the immune system attacks the lining of the small intestine. The small intestine is responsible for absorption of food and nutrients, so damaging its lining leads to decreased absorption of nutrients.

Classic symptoms of celiac disease are diarrhea, weight loss, anemia, osteoporosis, and vitamin B and D deficiencies. With milder celiac disease, people can have abdominal pain, bloating, iron deficiency, or osteopenia (decreased bone density). In children, it can cause slow growth and development. It is associated with other autoimmune disorders, including type I diabetes, autoimmune thyroid disease, and certain skin rashes.

Celiac disease affects about 1 percent of Americans. One in 133 people have celiac disease, and most are undiagnosed. It is primarily reported in people of European ancestry. However, celiac disease has also been found in people of North African, Middle Eastern, Indian, and Northern Chinese descent. There is a genetic component, so if you have celiac disease, members of your immediate family have a 10 to 15 percent risk of developing the disease. It affects both men and women of all ages.

Celiac disease is diagnosed with a blood test, as well as a small bowel biopsy done during an endoscopy. It is important to get evaluated before avoiding gluten in your diet because that will affect the test results.

The only treatment currently available for celiac disease is to abstain from eating foods with any amount of gluten. Strict adherence to a gluten-free diet is very important to avoid symptoms, as well as long-term complications including lymphoma and gastrointestinal cancers.

Non-celiac gluten sensitivity is when people develop symptoms after the ingestion of gluten-containing products, but there is no damage to the small intestine evident on blood tests or biopsies. Despite the discomfort that might result, small amounts of gluten can be ingested without the concern for long-term complications that are associated with celiac disease. The prevalence of non-celiac gluten sensitivity is not known, and there are no tests for it. It may be associated with sensitivity to other components in the grains, irritable bowel syndrome, or adverse reaction to fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (or FODMAPs). FODMAPs are non-absorbable or poorly absorbed sugars and carbohydrates that draw water into the intestines as well as cause fermentation with gas production leading to bloating, flatulence, and diarrhea.

If you are concerned about gluten sensitivity or celiac disease, please see a doctor to have testing done for celiac disease, as well as to evaluate for other causes. Starting a gluten-free diet before any testing can affect the test results and delay diagnosis. Furthermore, eliminating gluten from your diet can be an unnecessary and costly measure if you haven’t been diagnosed with a disorder that requires you to do so. Eating a gluten-free diet does not provide general benefits for people looking to eat in a more healthy and nutritious fashion.

Shweta Joshi, MD, grew up in the suburbs of Philadelphia and is now happy to make Richmond her home with her husband and two children. She is fluent in English and Kannada, and is also able to communicate in Hindi. Dr. Joshi sees patients at the West Creek location of Richmond Gastroenterology.
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