Do You Really Need to Go Gluten-free?

Know the signs of celiac disease

'not gluten-free' symbol

I’m sure you’ve seen the large selection of foods marked “gluten-free” in your supermarket. Or maybe you know people on a gluten-free diet.

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They may have celiac disease, a very common condition that is not diagnosed very often. Nearly 2 million people in the United States have the disease, and most do not know that they have it. There really is no typical set of symptoms for celiac disease, but diarrhea, unintentional weight loss, iron deficiency anemia, and osteoporosis can be presenting features.

Even if you have no symptoms, you are at risk if a member of your family has the disease since there are genetic mutations that cause the disease. You and your doctor need to think about it as a possible diagnosis since it is treatable.

People with celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, are not able to absorb nutrients properly since gluten destroys some absorptive surface of the small bowel.

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A very large part of our diet contains gluten, a protein which is found in:

  • Wheat
  • Rye
  • Barley
  • Oats

How do I know if I have celiac disease?

Since celiac disease may not be immediately evident, you will need to talk to your doctor about symptoms you are experiencing. These vary among people with celiac disease, but may include:

  • Anemia, fatigue and shortness of breath
  • Digestive problems that may include bloating, pain, gas, diarrhea, pale stools and weight loss
  • Low bone mineral density due to decreased calcium
  • Severe skin rash on buttocks, elbows and knees
  • Infertility and missed periods
  • Depression

Celiac disease is diagnosed with a blood test and then, to confirm the diagnosis, an extremely safe procedure called a small bowel biopsy. Taken together, the blood test and the biopsy should diagnose celiac disease in the vast majority of cases.

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Treating celiac disease

Of course, the treatment for celiac disease is a gluten-free diet — a highly restricted diet with no bread and pasta. Patients with celiac disease need to work with a nutritionist to get a palatable and safe diet. There are many gluten-free food products in the market and your dietician can work with you to provide menus and helpful hints. 

A strict gluten-free diet should reverse all of the changes seen in the small bowel.  Likewise, falling off the wagon will bring your problems right back. There are celiac support groups and advocate societies to help you and provide advice.

So, do you have celiac disease? If you have some of the above symptoms, it may be worth getting a blood test for celiac disease. It could lead you to a path of better nutrition and better health.

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Bret Lashner, MD

Bret Lashner, MD, is a gastroenterologist, Director of the Center for Inflammatory Bowel Disease and a Professor of Medicine at Cleveland Clinic.
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