Gluten intolerance: symptoms and diagnosis

Posted on Mon, 20 Jun 11

While cereal grains such as whole grain rye and wheat may appear healthy, for many people they can be the cause of a remarkably wide range of serious health problems. Going gluten free can help.

The many faces of gluten sensitivity  

A poorly digested protein in wheat, barley and rye called gluten can cause an autoimmune disease in genetically susceptible individuals known as celiac disease. Celiac disease damages the small intestine and hinders nutrient absorption. While Celiac disease was traditionally thought a rare disorder and to be limited to the digestive system it is now known to be remarkably common and linked to a wide range of symptoms (1).

The prevalence of celiac disease is approximately 1 in 100 people and is considerably higher in people whose relatives have been diagnosed with celiac disease. Most people with celiac disease are undiagnosed which may be in part due to a large percentage of cases being “silent” or unrelated to classic digestive symptoms (2).

 Symptoms of celiac disease vary significantly with age and range from digestive symptoms such as bloating, constipation and diarrhoea to disorders related to malnutrition including osteoporosis and anemia as well as autoimmune and nervous system disorders (3-5).

Celiac disease associated symptoms

Do you have gluten intolerance?

Considering the widespread symptoms it should be no surprise that celiac disease is commonly misdiagnosed or completely missed medically.

Celiac disease sufferers generally report symptoms for 11-12 years before diagnosis and although they may seek help, generally receive one or more different diagnosis before celiac disease is identified (5).

Furthermore no single test can definitively identify celiac disease; it is generally recommended that blood tests including home test kits are used as an initial screen with small intestinal biopsy providing the gold standard for identifying the disease (6).

Importantly, a recent study found that people can still suffer from sensitivity to gluten even in the absence of celiac disease, so even if tests say you are fine you may want to trial a gluten free diet anyway (7).

Going gluten free

Once diagnosed the only known treatment is a lifelong gluten-free diet. A trained health professional can help you implement a gluten-free diet and correct any nutritional deficiencies that may have developed.  Going gluten free usually results in improvements in symptoms within a matter of weeks although it may take years for the damaged small intestine to fully repair.

Sources:

1. Green PH, Cellier C. Celiac Disease. N Engl J Med 2007;357:1731-43.

2. Green PH. The many faces of celiac disease: clinical presentation of celiac disease in the adult population. Gastroenterology. 2005 Apr;128(4 Suppl 1):S74-8.

3. D’Amico MA, Holmes J, Stavropoulos SN, et al. Presentation of pediatric celiac disease in the United States: prominent effect of breastfeeding. Clin Pediatr (Phila) 2005;44:249-58.

4. Presutti RJ, Cangemi JR, Cassidy HD, Hill DA. Celiac disease. Am Fam Physician. 2007 Dec 15;76(12):1795-802

5. Niewinski MM. Advances in celiac disease and gluten-free diet.J Am Diet Assoc. 2008 Apr;108(4):661-72.

6. Rashid M, Butzner JD, Warren R, et al. Home blood testing for celiac disease: recommendations for management. Can Fam Physician. 2009 Feb;55(2):151-3.

7. Biesiekierski JR, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011 Mar;106(3):508-14