Within the past several years, gluten has become notorious. While this ingredient makes breads and baked goods fluffy and delicious, in some people it causes digestive issues. And it’s a problem that seems to be affecting more and more people as time goes on.
“Over the years, more patients have come to gastroenterologists complaining of gluten intolerance, and the medical literature is now starting to recognize it as a clinical issue called non-celiac gluten hypersensitivity,” says Yakir Muszkat, M.D., a gastroenterologist with Henry Ford Health.
But gluten sensitivity is very different from another issue you may have heard of called celiac disease, which is an autoimmune disease that is triggered by gluten. If you have celiac disease, ingesting gluten causes an uncontrolled inflammatory response in the small intestine. It destroys cells and damages the small intestine, along with other organs in the body.
People with celiac disease are at a higher risk for developing intestinal lymphoma and certain esophageal cancers — especially if they do not adhere to a gluten-free diet. They’re also at a higher risk of having other autoimmune conditions, such as type I diabetes and thyroid disorders.
Symptoms of Celiac Disease
Those with gluten sensitivity may complain of digestive symptoms and brain fog. Those with celiac disease can experience these symptoms and more, including:
- Abdominal pain
- Weight loss
- A skin rash called dermatitis herpetiformis
- Iron-deficiency anemia that doesn’t respond to therapy
- Tooth discoloration and problems with tooth growth, especially in young children
- Headaches and other neurological symptoms such as brain fog
- Liver problems
- Infertility. (Celiac disease blocks nutrient absorption, which can affect fertility. Inflammation from celiac disease can also damage organs outside of the small intestine, affecting fertility.)
Testing For Celiac Disease
So, how do you know whether you have a gluten sensitivity or celiac disease? The first step is to get a blood test called the tissue transglutaminase antibody test. Dr. Muszkat says it’s the most accurate test for diagnosing celiac disease.
“At Henry Ford, we also have a celiac disease panel that includes more than just the tissue transglutaminase antibody test," he says. "If you have been on a gluten-free diet prior to testing, the blood test will likely be falsely negative — in which case we can perform an endoscopy with small intestinal biopsy and do genetic testing.”
If the endoscopy reveals minor alterations in small intestinal biopsies, you’ll likely be diagnosed with non-celiac gluten hypersensitivity. If your endoscopy and biopsies are normal, however, your symptoms could be a result of irritable bowel syndrome, or IBS. IBS is associated with abdominal pain and bowel habit changes, but doesn’t lead to structural changes in the gastrointestinal tract. It is a diagnosis of exclusion, meaning you are diagnosed with IBS after all other gastrointestinal conditions are ruled out.
Treatment For Celiac Disease
The main method of treatment for celiac disease is eliminating gluten from your diet. Usually within a month of sticking to a gluten-free diet, people can expect to feel better. “If you don't feel better after going gluten free, make sure your diet is really strict,” says Dr. Muszkat. “A lot of times, food and medications are contaminated with gluten and you don’t even realize it, whether at restaurants or the grocery store. Ingesting less than 50 milligrams of gluten per day promotes healing of intestinal inflammation. Buying foods labeled as gluten-free is a sure way to know that you’ll be safe.”
As healthy carbohydrate alternatives, most patients with celiac disease can tolerate oats, says Dr. Muszkat, along with rice, quinoa, buckwheat, corn and millet, to name a few options. (You should avoid wheat, spelt, rye and barley.) It can be disorienting and stressful when first overhauling your diet, so Dr. Muszkat recommends using resources to guide you.
“It can be very helpful to join a celiac disease support group, some of which you can find on beyondceliac.org,” he says. “You’ll find people who know where to shop for gluten-free products in your area, and they’ll also share tricks to sticking to a gluten-free diet and other techniques to help cope with the stress of being diagnosed with celiac disease. There are also really helpful celiac disease websites, such as celiac.org, so I encourage patients to take advantage of those resources.”
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To schedule an appointment with a gastroenterologist at Henry Ford, visit henryford.com or call 1-800-436-7936.
Yakir Muszkat, M.D., is a gastroenterologist with Henry Ford Health. He specializes in intestinal rehabilitation and transplant, GI and nutrition, total parenteral nutrition, short bowel syndrome and malabsorption. He is the medical director of the intestine transplant program and sees patients at Henry Ford Hospital in Detroit and Henry Ford West Bloomfield Hospital.