Am I gluten sensitive, gluten intolerant or have Celiac Disease?

If you have celiac disease you are by definition gluten intolerant and gluten sensitive.  If you are gluten intolerant and do not have celiac disease it means that when you avoid gluten your symptoms are relieved.  Food sensitivity means that when you eliminate the offending food your symptoms go away.  To be more specific you may notice that a predictable recurring set of symptoms is relieved when gluten is removed from your diet.  You may also find that you are able to eat gluten occasionally if you are gluten sensitive.

What is Celiac Disease?  It is a chronic autoimmune disease that affects the gastrointestinal system.  Celiac Disease is the body attacking itself and the target is the villi of the small intestines.  Villi are the little hair like structures that enable us to absorb the nutrients we need.  When a genetically susceptible individual consumes gluten the villi become inflamed and flattened which over time damages the absorptive surface of the small intestine.  Resulting nutrient deficiencies may include iron, calcium, folate and vitamin B12.  If the damage progresses then there is malabsorption of carbohydrates, fats, fat soluble vitamins (A, E, D, K) and protein.  Celiac disease can affect an individual at any age.  I have often seen it diagnosed as a causative factor in osteoporosis, pancreatitis, various neurological symptoms, and miscarriages.

What is the prevalence of Celiac Disease?  It affects approximately 1% of the US population.

What are the symptoms of Celiac Disease?  Are they different from gluten sensitivity or gluten intolerance?

Common symptoms of all gluten intolerance may include indigestion, bloating, gas, diarrhea, constipation or intermittent diarrhea and or constipation, chronic fatigue, easy bruising, migraine headaches, loss of bone density, depression.  There are many reasons to have some of these symptoms, so I first focus on the digestive system.  Additionally, some individuals have no symptoms at all.  This is called “silent celiac disease”.

How is celiac disease diagnosed?  Celiac disease can be diagnosed with blood tests and include IgA endomysial antibodies (EMA), the most highly specific.  IgA tissue transglutaminase antibodies (tTG), both IgA and IgG antibodies are seen as a reaction to gluten and are used to monitor how well someone is doing in staying off of gluten.  Deamidated gliadin peptides (DGP) looks for specific antibodies to deamidated gliadin.  If all of these tests come back negative you can still have celiac disease, meaning there may be less damage to the villi.  If you are not eating gluten, your tests will come back negative.  You can have a negative test and develop celiac later in life.  None of the blood tests are 100% specific or 100% sensitive.  The gold standard for diagnosing celiac is a biopsy of the small intestine, which is obtained through an endoscopy.  A biopsy is usually done when there is a high suspicion of celiac or a strong family history.  Many professionals think the EMA is specific enough.  If I suspect that an individual is gluten intolerant or has celiac, I also measure iron, B12, Folate, calcium and vitamin D.  Newer tests through Cyrex labs are now available and include a wider number of antibodies indicative of both celiac disease and gluten sensitivity.

What is gluten?  Gluten is a general name for storage proteins found in wheat, rye and barley.  These proteins damage the small intestine in people with celiac.  Other grains in the gluten family include bulgar, barley malt, couscous, spelt, kamut, triticale and semolina.  Grains that you can eat are rice, corn, millet, teff, sorghum, wild rice, buckwheat, quinoa, amaranth and pure, uncontaminated oats.

What is the most challenging aspect of becoming gluten free?  My experience is that the psychological attachment to gluten and a belief that “gluten free is being deprived” is the first hurdle.  I spend time with each person I see resolving these concerns and clearing beliefs in the way of health.  Then we begin the educational process of what it means to be gluten free.  The first step is learning about the grains that are gluten free.  The second step is becoming aware of hidden gluten in sauces, gravies, soups, prepared meats, flavored coffees, malted milk, meat substitutes and even nutritional supplements.  Shopping becomes a new adventure.  I recommend that you create a shopping list with general categories such as cereals and include a checklist underneath of the various cereals you can eat.  Do this for baking goods, legumes, grains, meat, fish, poultry, soups, sauces etc.  The question often arises early in this lifestyle change – How will I be able to go out to eat?  I recommend that in the beginning you go out during non peak hours so that you can ask specific questions about the ingredients in sauces, salad dressing, soups, whether or not meat/fish is dusted with flour or bread crumbs before grilling.  Ask about the ingredients in rice pilaf.  Check to see if there is gluten free pasta.  There are some enlightened restaurants that have special dishes, breads and menus that are gluten free.  Become aware of gluten free bakeries, grocery stores with gluten free products and manufacturers of gluten free products.

Glutenflam is one supplement that supports the digestion of gluten and casein by providing brush border enzymes in the intestinal tract.  It calms the inflammatory cascade promoted by gluten.

Open to the adventure of being gluten free and learn about foods, discover new tastes, take time to prepare food consciously and feed your body the fuel that it needs.

Resource for Gluten Free Diet:  Gluten-Free Diet: A comprehensive Resource Guide – Expanded and Revised Edition by Shelly Case

Moira Fitzpatrick is a Naturopathic Physician and Licensed Clinical Psychologist, who practices in the Northgate area of Seattle.  She practices functional medicine, is a primary care provider and specializes in the unique health concerns of women.  Support is available for lifestyle changes.  Dr. Fitzpatrick can be reached at 206.525.5576, www.theemeraldcenter.com.